Vegan nutrition for a toddler

Hello Lisa

 

I hope that this message finds you well!  Last time we talked, I had just started a vegetarian diet.  I'm now eating nearly completely vegan and my wife is does the same with the exception of some cheese of dinners a few nights per week.  We have not given our daughter (16 months) any meat.  We HAVE, however, been giving her organic milk, yogurt and cottage cheese.  Her pediatrician says that she is healthy as can be and is growing as she should be.  She does have eczema, however.  It is not severe but she does have flare ups from time to time that look as though it would make her very uncomfortable.  We've been doing a lot of reading and it seems as though many parents of children with eczema have great success with relieving the symptoms by eliminating dairy from the diet.  We are strongly considering this and wondering if you could provide some insight or provide a reliable resource that would help us better understand how we could raise her healthfully on a vegan diet during this extremely formative time in her development. 

 

I believe that we have her covered on protein with beans, soy, and nuts.  Where I am worried is her fat intake!  I know that she needs a lot fat and saturated fat and that DHA and EPA are REALLY important.  Do you have any recommendations on how to get her all the fat she needs and specifically the DHA and EPA?  I found this supplement and thought that maybe something like this could be the key:  http://www.vitacost.com/barleans-total-omega-3-6-9-vegan

 

If saturated fats are important then can we simply supplement with coconut oil which is loaded with saturated fat?

 

Again, Lisa, I appreciate and respect your opinion.

 

Thank you so much for your help! 

Dear Friend,

thanks for the note.  I'm glad you and your wife are doing well with the vegetarian/vegan diet.

I must confess- pediatrics is not my forte.  But- I do know a few things!

My fear with a vegan diet in toddlers is lack of iron, vitamin D, calcium, zinc and B12 for growth.  Protein needs can be met with beans, lentils, soy milk and other soy products, but kids definitely need fat for brain development and as a calorie source for growth/energy.  It's not just the omega 3, 6 and 9 she needs.  

There are many other nutrients lacking in vegan diets, especially in toddlers because they are growing so rapidly.  If she's not already on a decent supplement containing all of the above nutrients, that would be my first advice.  You can season food with olive oil, light margarine, etc to get some fat in her diet as well.  I don't know much about coconut oil in kids- that would be a good question for your pediatrician.  I don't think it could 'hurt', but I don't know how palatable it is either by itself.  I suppose you could put it in iron-fortified cereal, rice and other foods.

Rather than eliminating food (or beverages in the case of milk/dairy from her diet), I'd consider going to a pediatric allergist and having her tested to see WHAT is causing the eczema.  It could be dairy, but it could be another food as well (bananas, tomatoes, wheat, etc).  Peanut allergy could also be the culprit, but I think the recommendation for nut exposure is 3.  

That's my 2 cents!  Let me know how it all turns out.

Lisa

What's a typical day like for a dietitian?

Thank you for taking the time to talk on Tuesday.  I am a recent graduate from Indiana University and has recently joined the IT consulting profession in Cincinnati. Due to my current work experience and a strong interest in dietetics I am considering going back to school to become a dietitian. Therefore, I wanted to reach out to you to ask about your experience in this profession and would appreciate your advice on the following questions:

 

What is an average day for you like?

At the hospital, it is very busy.  The first thing I do is go through admissions, discharges and transfers then make a list of patients I need to see.  I cover the MICU (medical intensive care unit) and SICU (surgical intensive care unit).  I see patients that have had major surgery or are on life support due to respiratory infections or disease.   I may also see patients with acute renal failure, liver disease, gastrointestinal bleeding or acute heart attacks.

With consulting, I could be at the doctor's office I rent space from seeing individual patients or at a company working a health fair or doing a lecture.  Or, I may be at home making invoices, handouts or lectures.  My days vary quite a bit with consulting.  I could also be at Kroger doing a grocery store tour.

What is your interaction like with patients/clients on a day-to-day basis?

At the VA, I talk to patients about their diets and see how they are eating, order supplements and write progress notes.  If the patients cannot speak for themselves, I talk w/family members, nurses, MDs or other staff.  I spend a fair amount of time charting on the computer.

From your Linkedin profile, I understand you have experience in a hosptial setting, what was the drive for you to start your own practice?

I needed some variety in my career and was interested in wellness.  I like to teach and write, so the business is a good fit for me.

How do the two settings compare?

I have a set schedule with the hospital, I make my own hours (more or less) with consulting.

The hospital is hectic and I see sick people, the business is more laid back and I see healthy people.

I have more variety w/my business than the hospital, though the VA is a challenging and interesting place to work.

At the hospital, I have co-workers whereas my business, I am on my own.

What type of personality do you see in people who are successful in this field?

You need to be confident and like to work with people.  You have to enjoy reading and understand a lot of science and consumer interests.  In business, you need to network.  There is a lot of customer service in both positions.  Provide more than is expected of you!

And lastely, what do you most enjoy about your job, and what are some of the drawbacks of it?

I love teaching patients about healthy eating and seeing people get better, lose weight, etc.  The drawback of a hospital setting is that it never closes- so you have to work around holidays, etc.  I enjoy working with other medical personnel (speech therapists, RNs, doctors, etc).  I also get to teach interns at the VA.

Carbs on labels

I have a question…when I look at a label…it might say total carbs 5…then further down the label…it will say ….other carbs 1…what is that all about…?

Thanks for your question.  The nutrition facts section of the food label lists all carbohydrate sources including grains such as oats, wheat, bran, etc, fiber, sugar and any "fillers" that may contain carbohydrates.  These could be cellulose, methyl cellulose, corn or wheat starch, etc.  ALL carbohydrates can raise blood sugar and do contribute to the caloric value of a food.

I just found a great reference for food additives that may be helpful in understanding "what's in your food".
http://www.amazon.com/Consumers-Dictionary-Food-Additives-7th/dp/0307408922

ICU nutrition

Many of you may not know what a nutrition support dietitian does.  An RD in nutrition support works with patients that cannot eat on their own.  They may require feeding tubes and/or IVs to be fed.  Dietitians in nutrition support recommend and prescribe specialized nutrition for critically ill patients or patients that have undergone major surgery.   It takes knowledge in anatomy, physiology, digestion and confidence!  I refer to this type of work as my "meat and potatoes" because I work in a government hospital and am paid fairly well for my expertise.

This patient was a case study for UC College of Medicine students doing a rotation in surgery.  Below are my answers in italics.  While this work is stressful at times (who wants to see someone on a big blue breathing machine...?), I enjoy teaching doctors in training and taking care of patients in this high risk category:

75 year old patient s/p CABG day no 3, intubated, sedated in the CVIC. PMHx- DM, HTN, GERD. Labs today- alb 3.1, Glu-250-400 on insulin, Ca- 9.5, Na/K- 130/4.5. BUN/Cr- 35/1.5. The MD is unsure about extubating the patient. He is looking at your suggestions. Ht- 5’8”, wt- 220 lbs

1. Should the patient be considered for enteral  or parenteral nutrition?

Enteral nutrition.  If his gut works, use it unless contraindicated (patient is on pressors, suspected ileus or SBO post op, etc).  Feeding below his stomach (into small bowel) would be more appropriate given hx GERD, diabetes (risk for gastroparesis) and obesity.  This would reduce the patient's aspiration risk while intubated.

2. Determine energy and protein needs- show your calculations

Energy needs can be based on IBW of 154 lbs as pt is obese and on mechanical ventilation.   (22-25 kcal/kg and 1.2-1.5 gm pro/kg post op).  Calorie needs are lower to prevent overfeeding and increased CO2 production in the setting of mechanical ventilation.  Protein needs are higher to support wound healing and prevent muscle loss.

Estimated needs:  1550-1750 kcal, 84-105 gm pro

A high protein formula (such as Vital 1.2) could be used and run at a lower rate.  The patient's BUN/creat need to be monitored for changes as well as his hyponatremia  Too much protein and/or fluid could worsen renal fxn.

3. What do you know about current evidence that is accumulating in treating hyperglycemia in critically ill patients in the ICU with reference to nutrition support?

Hyperglycemia is controversial in the ICU.  You want "good control" but you need to prevent hypoglycemia.  An acceptable range of blood sugar in the ICU is ~150-180 mg/dL.  In this patient, scheduled insulin or an insulin drip would be appropriate once tube feeding is initiated.  Hyperglycemia in the ICU leads to increased infection risk and increased mortality.

Atkin's diet

Why is it that everyone thinks Atkins is all about protein and fat? Your site
makes it sound like that is all that the diet allows yet it adds
carbohydrates back into the diet in a systematic manner using the glycemic
index and folks who follow it correctly generally end up eating many more
vegetables than before. I think too many people assume they know what Atkins
is without ever reading the book. I have been low carbing for years, lost 90
pounds and eat more veggies than 80% of the population on Atkins. Why do
sites like yours continue to spread misinformation?

Jill

Dear Jill,

Thanks for your note.  I assisted in a research study at the University of Cincinnati in early 2000 that compared the Atkin's diet to a traditional low calorie (AHA) diet for weight loss in women.  When the diets were analyzed for nutrient content, the majority of the nutrients from the Atkin's diet came from fat, then protein, with minimum from carbohydrate.

 

While the diet is safe and effective for weight loss in the short term (2 years or less), few if any researchers have studied it beyond that because most subjects could not maintain a low carbohydrate diet for much longer.  Compliance with this type of diet is difficult because it is so restrictive.  And no one knows if subjects regained their weight back over time.

 

In addition, most studies have only been done on healthy individuals (not persons with diabetes, risks for heart disease, kidney failure, etc).  So while it may be OK for you to follow it, as health care professionals, we can't advise it for everyone because we don't know the effects on people with chronic disease.

Finally, the diet is not balanced.  It does not put limits on types of fat (saturated, trans), cholesterol, sodium or protein and can be very limited in carbohydrate as well as fiber.  There is plenty of research to suggest a plant-based diet (including whole grain carbohydrate sources, fruits and vegetables) is the best diet to follow for long term good health, weight reduction and longevity.  See link below.

 

http://www.cnn.com/2011/HEALTH/02/14/fiber.lifespan/index.html

 

Lisa C. Andrews, MEd, RD, LD

fat and breast cancer

   Nutrition questions for you....Is palm oil bad for you?  I just realized my Maranatha Almond butter has palm oil in it!

                                              ....Is ground flax or flax in general safe for someone like me who has had breast cancer?  I have heard flax is similar to soy with estrogen properties?  I'm scared of the soy/estrogen link.

Thanks for your questions!  Palm oil is often added to food as a replacement for partially hydrogenated oils (trans fat) that was previously used in peanut butter, margarine and other foods..  You will see it lurking in "natural" peanut or almond butter, crackers, cookies and other commercially available foods.  Palm oil is saturated fat, the type that comes from coconut oil, which can raise blood cholesterol and has a possible link to breast cancer.  I would stick with nut butters that do NOT contain palm oil, such as Smucker's Natural Peanut butter or Krema where the oil is on the top.  If you hate stirring the oil, store the peanut butter upside down in your pantry before and after stirring.  It makes it less likely to separate.

As for flaxseed, there's been recent research to actually support its use in breast cancer survivors.  It has weak estrogen properties which may be beneficial in tumor prevention.  Try ground flaxseed in oatmeal, your salad or add to a smoothie. The oil goes rancid quickly, so use ground flax seed within a few weeks of grinding, or keep them whole and grind right before using.

liquid diets for diabetes

Q:  I am a 54 young female and also a type 2 diabetic. I am only on medication
right now. My AC1 is 6.4. I am 5'5, 203lbs. My question is,what are your
thoughts on liquid shakes? I am really interested in Visalus shakes and I
have enjoyed them. Are liquid diets safe for diabetics? I have consulted my
Internist, but I would like a second opinion, so to speak. Thank you for
your time and thoughts on this.

Sincerely,
Judy 

A:  Hi Judy,
Thanks for your question about liquid diets for weight loss in persons with diabetes.  It is likely safe to use a meal replacement shake for weight reduction, as long as you are monitoring your blood sugar closely so you don't become hypoglycemic.  Most shakes designed for diabetics should have a balanced blend of slowly digested carbohydrates (such as corn starch or resistant starch), low saturated fat and protein to mimick a meal.  Meal replacement shakes have been found to be convenient and beneficial in reducing weight compared to other methods of weight loss, but like many diets, have not been researched long term.
My only concern would be transitioning to solid food after you've used these shakes for a while.  If may be unrealistic to use them forever to control weight and keep blood sugars in check long term.  I'd suggest you work with a Registered Dietitian to develop a meal plan that is reasonable for weight loss and sustainable long term for blood sugar control.  You can locate one through the ADA web site at http://www.eatright.org
Best of luck!

dairy gives me gas!

Nutrigirl-
 
Q:  Hope you are doing well.  Quick question:  I have been drinking one glass of chocolate milk per day since we met in the fall.  I love the taste of it and don't want to give it up.  But, quite frankly, it give me a lot of gas.  I'm already having 2 yogurts/day, taking calcium pills, and having a cheese stick.  Is there something else I can do to make up for the calcium loss if I stop drinking chocolate milk?  Or, is there a way to keep drinking it?  
 
Your help would be greatly appreciated.  Thanks very much




A:  Thanks for your question.  You can probably cancel the calcium pills if you are having 3 dairy servings/day.
The gassiness you are experiencing may be from yogurt due to the bacteria.  Try cutting down to 1/day to see if that helps.
Keep the chocolate milk- it is a great way to "replenish" glycogen stores after workouts.

Nutrigirl

Should I go "G-free"?

Q:  A lot of my friends have decided to try a gluten-free diet.  What's your take on this?

A:  Thanks for your question about gluten.  It seems to be a very popular diet among celebrities, but truthfully should only be followed if you have a sensitivity to gluten.

Gluten is a protein found in grains, specifically wheat, barley and rye.  People with celiac disease (also known as "celiac sprue") have an autoimmune disease where they cannot digest and use gluten appropriately.  Gluten is not absorbed, and damages the lining of the small intestine, causing malabsorption and malnutrition over time.  Oats and oat products are often avoided because they are procuced in facilities along with wheat.

Symptoms of gluten intolerance include abdominal pain and bloating after consumption of wheat or the above grains, diarrhea (and sometimes constipation), skin rash, weight loss, joint pain, iron deficiency and even depression.  Some individuals diagnosed with celiac disease may not have any symptoms, but may be tested if they have an immediate family member with the condition.  It can be genetic in nature.

Now- why would someone follow this type of diet?  One benefit of taking gluten out would be you'd drastically cut your consumption of carbohydrates- including bread, pasta, baked goods and desserts and some cereals.  This would reduce overall calorie intake, which may lead to weight loss.  But keep in mind, there are plenty of gluten free brownies, cookies, cakes and other junk food to replace what you've taken out.

Gluten is found in other foods as well including ketchup, soy sauce, processed meats and frozen entrees to name a few.  Following a gluten-free diet  is expensive and the market for these foods is growing.

If you suspect you have celiac disease, keep a food diary to monitor symptoms after eating foods containing gluten.  Do NOT take gluten out of your diet until you have a blood test to see if you are gluten-sensitive as you may end up with a false negative test if you've removed the trigger from your diet.

Finally- the gold standard for diagnosis of celiac sprue is a small bowel biopsy.  Not exactly a walk in the park, but money well spent if your doctor believes you suffer this condition.

I hope this information was helpful!

Nutrigirl

Nutrition for kids

Q:  Hey Lisa,

 

I'm going over the food pyramid and healthy eating with my cub scout den tomorrow.  I've done a little research on-line and see that we use the MyPlate diagram instead of he pyramid.  Is that pretty much the standard now?  Also, any ideas for presenting this stuff in a meaningful way to 8 year olds?  I'm making cut outs of various foods and I'm going to make up a game to play.  I just don't want it to be BORING!

 

Any advice would be appreciated.  Thanks!

A:  Thanks for your question.  The government switched from the Pyramid to the plate method some time last year (maybe March)?  The web site choosemyplate.gov web site is pretty useful for explaining serving sizes, nutrients, etc.  It is the same information, just presented in a different style.  We eat from plates, not pyramids!

 

For 8 yr old boys, you might want to focus on the need to eat right to have energy to learn, get good grades, play sports, grow strong. 

 

You can break it down to food groups (carbs such as bread, cereal, fruit, pasta, rice) give your brain and body energy while protein (meat, fish, eggs, beans, peanut butter) help keep your muscles strong.  Milk needed for strong bones & teeth and to become taller!  Fruits & vegetables needed for a healthy heart and to prevent them from getting sick (good for immunity, etc).

 

Tell them sugar/soda and junk food/chips wear their bodies down, ruin their teeth and should only be eaten now and then.  Soda = obesity!  Advise them to choose healthy snacks- nuts/seeds, fruit, veggies + hummus, cheese/crackers, etc.

 

I would also encourage them to drink enough water- needed to cool their bodies off after sports, keep their heart/blood pressure in good shape, prevent them from fatigue/feeling tired, etc.

 

If I were there, I'd let you borrow my food models!  I've done games w/younger kids where I put them on a big table and then shout out "choose a fruit high in vitamin C" and the kids have to run up to the table and grab something (whoever gets it first wins a point for their team).

Best of luck with your program!

Nutrigirl

Q  I am trying to find some quick, low carb snacks to help maintain my blood sugar.  Any ideas?


A  Here's what I suggest:  light (low fat) cheese sticks, 2 Tbsp. nuts (any kind), pepper strips with hummus, a hard-boiled egg, grape tomatoes, baby carrots or celery sticks, or beef jerky.  All are low in carbohydrate.  Sunflower seeds, edamame or soy nuts are also healthy, low carb snacks.

numbness with diabetes

Q My husband was diagnosed with Type 2 Diabetes and has been put on one medication Metformin HCL 500 mg.  He has lost 12 lbs. in exactly 1 week of changing what he eats (counting his carbs – no more then 30 carbs per meal) & he is walking about 1 hour each day.  He feels ok, but he is having some tingling in his toes and fingers plus he is always cold now.  My question is should this tingling and coldness be happening? 

Any suggestions for him?  He is a vegetarian does not eat anything that could have a face so no eggs, chicken, pork, fish or beef in his diet.  What is the best protein shake for a diabetic that is also a vegetarian.  He does eat milk products like cheese, milk & is loving cottage cheese with avocado & salsa.  It is weird that things I have suggested he eat in the past he is now eating and loving it.

Thanks so much for taking the time to read this & thanking you in advance for any insight you can give us.

A  Thanks for your question.  It is possible that his numbness and tingling could be from diabetes (neuropathy from nerve damage). I am not a doctor, so I recommend he see his MD to diagnose what is wrong.

If he has been primarily vegetarian for a while, he could have a low vitamin B 12 level, which can cause the symptoms he has. B12 is only in animal foods, so his intake may be lower than most if he does not eat meat, etc. Ask his doc to check a level with his next blood work.

As for shakes for diabetics, Glucerna is one he can try that is designed for diabetics. Is he trying to put the weight back on? 

Shakes are used as meal replacements or snacks or as a supplement for weight gain.