A different perspective: nutrition from a 9 year old.

My guest blogger today is my daughter Michelle. As many other children, she has been on the receiving end of the well-meaning advice by her mother to eat her greens, then a conscientious change from white bread to wholegrain, cereal bars to school, “don’t eat that chicken skin” and many others in her 9 years. Over the last year we have managed to turn it 180 degrees and finally indulge her love of red meat, ribs, eggs and sausages. Along the way we have discovered that wheat, even in a tiny amount, triggers her eczema. This has been both a curse and a blessing. A curse because we realised that even a piece of battered salt and pepper squid can set off the dreaded red spots (funnily enough, even gluten-free products given to her by the well-meaning family members cause a breakout). A blessing because it gave Michelle extra motivation to avoid processed food.

I know I might have been a bit harsh on parents in one of my previous posts. Saying “no” to junk food has never come difficult to me. But I was little prepared for the onslaught of wheat-, sugar-, preservatives-, colours- and refined-carb industrial-strength garbage called “kids food” and the incredible temptations faced by Michelle every day. I know that she feels different. And sometimes being different is a lonely place to be, especially coming up to your teenage years. I did not want to medicalise this into a “condition”: you can’t eat wheat because you are allergic. I wanted to teach her that all these kids around might not have her skin but shouldn’t be eating what they are eating anyway. In an attempt to show her that there are other children out there who believe in eating real food that doesn’t come in a box I introduced her to Paleo Parents website. Reading the stories of Cole, Finian and Wesley was eye-opening for Michelle. I recommended that she should write down her experiences and her thoughts and maybe it will make it easier for another child (or adult) to say “No, thanks” to the sugar-in-the-box cereal in the morning or a sugar-in-a wrap snack bar.

So without further ado, here is Michelle:

Before I changed my diet I believed the government which was encouraging the point that wholegrain is best. Now I know otherwise and so does my family.

Nowadays when I go to school I notice a lot more about what my fellow students eat. Everywhere there are children stuffing themselves with chips, cookies, cake and donuts. The healthy options for lunch are a sandwich, a wrap, a bagel or some sort of batter. All my friends ask why I don’t eat like them and they offer some of their food to me because they think I’m missing out. Other children who follow the same diet as I do know how hard it is to skip the temptations, even my parents do.

After I changed my diet I noticed that an average child’s daily meals consist of:

Breakfast: Toast, pancakes or cereal, sometimes sprinkled with malt or sugar

Morning Tea: Packet of chips, brownie, donuts or any other sugar treat with one serving of fruit

Lunch: A sandwich, wrap or bagel/bun with sometimes a chicken schnitzel, low-fat yoghurt, serving of fruit or veg and some more chocolate and lollies

Afternoon tea: cake, biscuits and fruit

Dinner: Pasta, pizza, chicken nuggets, garlic bread with soup

Desserts: Waffles, ice-cream, chocolate and milk

As you can see every meal has at least one serving of wheat or sugar in it. Every day I go to school I yearn to say to my friends: “You shouldn’t eat that, it’s unhealthy”. But I know I can’t do that because nobody will believe me. It is difficult for a child like me to explain the matter that big.

I like the way I eat now because I don’t get “sugar crashes” anymore. I don’t get tired and have naps after school like I used to. I find that when I used to have wheat I was always hungry. Eating cereal for breakfast made me starving before recess, and then lunch. Now eggs and sausage make me full for hours. I also like that I get to try things I would never have tried before which I never thought I’d like.  I even tried chicken hearts once. The other day I tried baby octopus and it is now my #2 dish after osso bucco. I bring prosciutto to school and dare my friends to try it. If I had never changed my diet I would not be enjoying such great food.

We took some photos for you of my average day diet. Hope you like it.

Here is my breakfast.

And my lunch box.

And my dinner.

I also love to have a few squares of 85% cocoa chocolate for dessert.

I hope this helps some children and their parents to make better food choices.

Being active comes naturally if you are well nourished

I do too. Please feel free to share your journey across the muddy water of nutrition, conventional advice and real food in comments. Michelle and I would love to hear yours or your children’s story.

 

 

 

What the @#$! do I feed my child?

A blackboard used by Albert Einstein in a 1931 lecture in Oxford. Source: Creative Commons

I find maths and science quite soothing. There is something beautiful about straight numbers and clear cut conclusions. You must have already picked up on my love of graphs and diagrams. They got me through med school.

However, once you finish a beautifully straightforward equation or reach a perfectly logical conclusion using an algorithm you hit a little snag. How do you translate all these numbers to real life?

In the last few weeks I have read somewhere around 30+ journal articles on child metabolism alone. The numbers are simple, the graphs are straightforward but as we very well know the applications to child nutrition can be vastly different. For all the parents out there the only biochemical pathway they are likely to be interested in is the one between the fridge and the pantry.

Here is a short summary of my last few slightly dry posts on child metabolism (on conventional advice, BMRmalnutrition and catch up growth) and MY conclusions.

1. Children grow. Therefore children are not in “energy balance” in simple terms. The energy cost of growth is high including both the energy density plus quality nutrients to ensure lean body mass increase.

2. Energy quantity (calories) is important but ultimately you cannot build muscle and bone with broccoli or worse, orange cordial. The quality of nutrients needs to be concentrated to provide more bang for your buck: high nutrient density in a small volume fit for a small stomach.

3. Children regulate their energy needs with their appetite. No calorie calculators required. When the nutrient quality has been addressed the appetite will take care of the rest. If they are hungry they will eat.

4.  Babies, infants and children have less reserves to cope with malnutrition. Even a minor infection may potentially result in muscle loss.

5. Point 4 makes it obvious that it’s not a good idea to put children (=growing bodies) on calorie restricted diets for weight loss.

6. A decrease in activity is a pretty good marker for malnutrition especially for small children. This should give some worried-well parents some confidence, especially where breastfed babies are concerned. If you baby is happy and active it is likely that they are getting enough energy.

7. When children recover from even a minor infection their energy requirements are 4-5 times what they were before. They are going to be very hungry. Feed them. A lot.

8.The period of catch up growth during recovery puts children in a slightly vulnerable metabolic state. They seem more likely to develop insulin resistance (in skeletal muscle), sensitivity to glucose and store abdominal fat.

9. Point 8 makes you think that the post-recovery window is crucial for providing good nutrition for longer term gains. Maybe it is not a good time to provide sweet treats or let children laze around. My thoughts go towards fatty chewable chunks of meat and providing plenty of opportunities for spontaneous activity.

10. My personal way of identifying junk food: if a child is willing to have it after a steak dinner it’s junk. Nobody makes room for more meat or pumpkin when they are stuffed. But there is always stomach space to be found when lollies, cakes, milkshakes and ice-cream are on offer.

The diet recommended by our health authorities always confuses me. I assume (perhaps naively) that they read the same studies and they study the same physiology books. I’m stumped at how they arrive at their conclusions. Today Cancer Council NSW, backed by the Obesity Policy Coalition and the Parent’s Jury, announced the latest villains in the child obesity epidemic: Toucan Sam

and the Paddle Pop lion:

The research by Cancer Council NSW and the University of Sydney found  that 74% of supermarket products adorned with bright cartoon packaging are not up to our healthy nutritional standards. The specific complaints were high-sugar, high-salt and high fat. Apparently the adorable visages of cartoon characters and chiseled jaws of our sporting heroes are just too much for the little kiddies (and their parents) to resist.

“Although stopping short of calling for plain packaging (???) Cancer Council nutritionist Kathy Chapman said regulations around the marketing of foods to children were urgently needed.”

Deep breath. I am not defending sugary cereals. (Not entirely sure how the high-fat monster has slipped into the discussion since the foods in question are mostly low in fat to the point of deficiency. But that’s another matter). In fact, I’m happy to wear a t-shirt: “Friends don’t let friends eat cereal”.  I am more concerned about the whiff of a new scare campaign and propaganda. Plus, when it comes to my own child, I’m the one with a wallet, sorry kiddo.

The second issue is that we rely on these guys for their interpretation of science to tell us which foods are healthy and which are not. I hope we all agree that Froot-Loops are not exactly health food. Nobody buys those because they think that the multiple colours are indicative of the high antioxidant and phytonutrient content. On the other hand Kathy Chapman “welcomes cricketers fronting Weet-Bix” presumably because she thinks that this brand of bland cardboard-like blocks of processed wheat is a healthy alternative. Never mind that most children cover it with malt, sugar, fruit and honey just to make it palatable.

And because the University of Sydney (the home of GI) is involved in this story I’ll throw in a GI reference:

Froot-Loops 69
Weet-Bix 69

Ha.

P.S. I have a very special guest post coming up for you next time. The guest is currently in the middle of the creative process and I am not sure how long before we see the final result. But I know it is going to be something.

Catch me if you can

Before my foray into the world of celebrities I was talking about babies, children and the effect that illness can have on their metabolism. I have also alluded to something called catch up growth and the fact that it might be important for the overall risk of obesity and chronic disease.

What is catch up growth? The medical dictionary defines it as:

“…an acceleration of the growth rate following a period of growth retardation caused by a secondary deficiency, such as acute malnutrition or severe illness…”

The easiest way to track catch up growth in visual form (and you know that I like my visuals) is on growth charts. Children tend to follow an individual growth curve, predetermined largely by genetics, and this phenomenon is called “the canalisation of growth”. As we have established in the previous post, an illness or or a period of malnutrition may result in falling off the curve. Catch up growth is the body’s attempt to get back onto the original curve.

Growth curve flattening and fall (example only)

Accelerated growth during recovery phase

It has been known for quite a long time from observational studies that babies and children who undergo a period of catch up growth seem to be at higher risk for obesity and diabetes later in life. This was also observed in children born small for gestational age (SGA),  which is an indirect indicator of fetal malnutrition. Similar phenomenon was noted in children growing up in famines (the Dutch famine study) and the survivors of the Leningrad blockade in the WW2.

Studies conducted in the 60′s and 70′s looked further into the energy metabolism of catch up growth. They showed that the rate of growth in these children is astonishingly up to 15-20 times the rate of normal pattern. Moreover, this period was accompanied by both increase in appetite and increase in BMR in the order of 4-5 times the controls. It seems that when children were fed ad libitum they spontaneously increased their food intake to ensure their bodies get back on the curve. As their weight approached the expected measure for height their appetite would decrease back to normal levels.

Another interesting observation made around 1980 was that children do not regain lean body mass at the same rate as they lose it. Muscle recovery lags behind the recovery of fat tissue even when children regain their weight and get back on their growth curve. As one of the studies frames it:

“The impressive gains in weight made by recovering malnourished infants are largely fat; reconstitution of lean tissue does not occur equally well at all rates of weight gain.”

Let’s go back to some visuals or rather my illustration of the above.

Body composition changes during illness and recovery

The greater degree of the initial weight loss, the more unbalanced the pattern of catch up growth.

Later research started to elucidate the mechanism by how this imbalance occurs. Several studies have identified that the phenomenon of catch up fat is accompanied by hyperinsulinaemia, relative insulin resistance in skeletal muscles and hyperresponsiveness to insulin in adipose tissue.

Basically, when the child is recovering from a period of malnutrition their bodies produce more insulin for the same amount of glucose. Their muscles “shut down” the insulin gates and their fat tissue opens the gates wide so that glucose is shuttled away from the muscles and into fat.

Some of the more recent studies have tried to explain this phenomenon using terms like “thrifty gene”. Since no such gene has yet been identified to my knowledge I’m a little unconvinced. What interests me however is whether this slightly worrying pattern is diet-dependent. In other words, what do you feed a sick malnourished child to prevent this from happening? Is there a single dietary cause? What did all these children in observational studies eat?

Looking for causes in cohort data is always a fruitless exercise and a reminder that we should use it to generate hypotheses only. Randomised controlled studies on actual babies are obviously out of the question, I doubt there is an ethics committee on earth which would agree to withholding food from children and then watch them lose and then regain weight on various dietary regimens. There are always rats but they have an obvious disadvantage of being…well, rats.

One zealous study examined the rats undergoing catch up growth after semi-starvation. Those re-fed a high-fat diet were found to have more hypinsulinaemia, higher fat deposition and lower metabolic rate than the rats fed a low-fat diet. Both re-fed groups had worse metabolic derangement compared to controls. A closer attention to the high-fat diet tells you that the rats were fed 1:1 corn oil:lard mixture as 50% of their diet. What does it tell you? That it’s not a good idea to feed rats 25% of their diet as corn oil. Not much else really. It also makes it clear that both re-feeding diets resulted in higher insulin response to the same glucose load, higher adiposity, lower thermogenesis and other markers of disordered metabolism.

So we are back to generating hypotheses.

Recent developments implicate a group of messengers called IGFs, insulin-like growth factors. A series of experiments on none other than zebrafish showed that low cell oxygen level as would occur in malnutrition or disease can disrupt IGF signalling which activated the MAP kinase pathway, necessary for growth. Restoring oxygen to the tissues did not always result in full system reboot. Pathways other than MAP kinase may be activated which could explain the different growth pattern. Sigh… let’s wait for the zebrafish to give us the answer.

While you are digesting all of this info I will put together my take on some of these fascinating issues. Of course, I could be the only one who actually finds this stuff so intriguing and you might be going about your day without giving the concept of catch up growth a second thought. But I reckon some of this might still apply to you whether you are a determined bachelor or a mother of four. What if you were the one who had a prolonged illness at some point in your childhood? What if this pattern of metabolic disregulation also applies to the yo-yo dieters amongst us? Aha, now you are thinking about this.

Look out for my summary post on child metabolism in the next couple of days.

More reading:

Ashworth A, Milward DJ, Catch up growth in children (1986) Nutrition Reviews 44(5):157-163

Jackson AA, Wootton SA, The energy requirement of growth and catch up growth, Proceedings of an I/D/E/C/G Workshop held in Cambridge, USA 1989

Dulloo AG et al, Pathways from weight fluctuations to metabolic diseases: focus on maladaptive thermogenesis during catch-up fat (2002) International Journal of Obesity 26(S2): S46-S57

Ong KKL et al, Association between postnatal catch-up growth and obesity in childhood: prospective cohort study (2000) BMJ 320:7240

 

 

Playing hostage to your child

I was trying to find a picture of a child gnawing on a bone. But apparently it doesn't send the right message

We have all seen TV footage which normally accompanies the “childhood obesity epidemic” stories. Strangely headless muffin-topped children’s bodies in oversized t-shirts, digging into a packet of chips or clutching an ice-cream, filmed walking out of a fast-food joint with their obese parents. You’ve all seen it, right? This picture is remarkably divisive: some of us come pouring out with indignant accusations (“child abuse”, etc), some shrug off the criticism recognising themselves or friends. Dismissing the unlikely scenario that the parents of the 25% of overweight and obese children in Australia really don’t give a toss about their offspring (let’s work on the assumption that most people love their kids) what do we do?

Whether you are a parent or plan to become one some day you might feel legitimately concerned about how to keep your child out of similar news footage.

You might want to do what any responsible parent would do to find information: google it. A cursory search for “healthy eating for children” has yielded a staggering 19 500 000 results. So far so good: almost 20 million ways to avoid being a weight statistic. Encouraging to see so many experts.

But you don’t have to be a doctor, a nutritionist, an organic biochemist or a passionate Paleo convert to know a thing or two about kids. First, they are small. They have small stomachs, small mouths, small hands and small appetites compared to an adult. Second, they are not just “little grown ups”. They have unique needs for growth and development.

Put these two assertions together: high needs/small appetite. That makes me think that we need something nutritionally dense in a small package. Let’s see what the Healthy Kids Association (a very official looking site) says on the subject.

The Dietary Guidelines for Children and Adolescents in Australia (DGCA) recommends that for best health children should “enjoy a wide variety of nutritious foods”.

Why such concern about variety? Sounds like we are calculating that if we cast the net wide enough, sufficient nutrients will hopefully get inside those little bodies.  Every parent knows that extra food volume equals extra drama at the dinner table. If you put 5 different types of veggies on little Johnny’s plate hoping that one of them fulfills the vitamin C quota you might be setting yourself up for failure. It doesn’t look like we are aiming for the bull’s eye: that small package of condensed nutrition. “Eat a balanced diet” is a nutritional equivalent of sitting on the fence. Let’s find something more specific.

According to the official HealthyKids website (I’m sensing a certain lack of originality here) courtesy NSW Government there are 5 ways for your children to be healthy.

1. Get active each day

Sounds great, albeit oddly contrasted with the mantra of the 19th century: “children should be seen and not heard”.  All those quiet well behaved children back then clearly had a weight problem.

2. Choose water as a drink

In the world where soft drinks (sodas) are the daily norm this statement does not sound bizarre anymore.

3. Eat more fruit and veggies

I’m all for fruit and veggies. But what does “more” mean? More than what? Is the total amount of fruit and veggies per day uncapped? And if I could make an objective assessment that my child does not have “enough” you’d think that I would also work out that she needs “more”.

4. Turn off the TV or computer and get active

I thought we have already covered that one. What if you have a Wii-Fit? Does it count as active? Because I think it requires having the TV on? (we don’t own a Wii-Fit, or Nintendo or X-box  so I’m not sure how it all works). Is doing wii-boxing better than doing none? What about those schools that use Wii instead of sport?

5.  Eat fewer snacks and select healthier alternatives

Spot on. What are the healthier alternatives?

Here is a list from the snack page:

Fruit muffins or slices, baked using monounsaturated or polyunsaturated oils and margarine instead of butter
Fresh, frozen, canned (in natural or unsweetened juice) or dried fruit
Raisin or fruit toast
Toasted English muffins, preferably wholemeal or wholegrain
Reduced fat custard with fruit
Rice crackers or corn cakes
Plain popcorn (unbuttered and without sugar coating)
Muesli and fruit bars – look for the healthier choices or those with the Heart Foundation Tick.
Scones or pikelets (plain, fruit or savoury)
Plain breakfast cereals, such as wheat breakfast biscuits, topped with sliced banana with a drizzle of honey
Snack-sized tub of reduced fat yoghurt (plain or fruit flavoured)
Cubes, slices, shapes or wedges of reduced fat cheese with wholegrain crackers or  crispbread
Potatoes, topped with reduced fat cheese and baked in the microwave or oven.
Corn on the cob
A boiled egg (wow, and I almost lost hope at this point)

Question: since when have desserts become acceptable snack items?

So how much have we learned so far about child nutrition from popular media and health policy providers? Not much. Still clear as mud. More googling unearths the mention of the Food Pyramid, or MyPlate for my American friends. The development of this extremely intricate logo and the accompanying website has so far cost the American Government over $2 million. According to my calculations a nasty fake-meat patty on a “plastic bread” bun topped with flavor-free lettuce and tomato and served with banana milkshake is totally MyPlate-compliant. I can’t wait for an Aussie version. MyPie, anyone?

If you are still unclear on what to pack in school lunch boxes there are also the recommendations on the number of servings. Some recommend 1/2 serve of meat or fish a day, some go for 2-3. I’ve now spent a few hours browsing popular healthy kids sites and I’m still not closer to an answer.

Out of the confusion rises one common pattern. Every child-related website/book/magazine is full of it. It’s that child nutrition is soooooo difficult. Anybody under 18 is represented as a hardcore junk food addict and they will hold your household hostage until you give them that pizza. Here is a few titles and phrases.

Feeding your children is a challenging experience

Tips for fussy eaters

Persevere, keep trying

Ingredients in disguise

Do not ban foods – they will only want them more (Is that how we feel about giving children alcohol as well?)

Constant struggle

How to hide more vegetables in a pie

Snacking challenges in the shops (C’mon, is it really that hard to survive a 2 hr shopping trip without a top-up?)

On the other hand the advice of introducing solids to babies generally includes phrases like “delicate palate”, “bland foods preferred”, “many flavors are too strong”.

How does a baby with a pure clean delicate palate turn into a toddler incapable of staying sane in a confectionary aisle? Shouldn’t a 50 year old have more addiction issues with 50 years worth of bad habits? Let’s not even mention the fact that most toddlers do not own a wallet let alone the ability to navigate a self-serve checkout. Oops, I just mentioned it.

It shouldn’t be this hard. What nutrients are essential for growth? I’m sorry but bagels and peanut butter are not essential.  However after hours of perusing popular health websites a normal and slightly befuddled parent would come to believe that perhaps they are.

They are low-carb, I swear!

Maybe we should stop assuming that our kids cannot survive without muffins, waffles and milkshakes. Stop making “acceptable” healthy substitutes whether it is low-fat/low-carb/Paleo/vegan/gluten free just to avoid a tantrum. Remember Shakespeare? A pancake under any other name…

I know we are parents but do we have to be so damn patronising? Give your children some credit. They might surprise you.

This rant was inspired by my recent research into child nutrition. Next post I promise to bring you some science on this fascinating topic. Trivia question of the day: what is the average percentage of body fat in a newborn?