Ditching Dairy? CAUTION!!

Use caution when avoiding entire food groups,
including dairy.  You may be setting yourself up
for nutrition deficiencies that may manifest
in health problems.

I recently attended a Diary Forum in Alexandria, Virginia that was all about lactose intolerance. It amazed me to learn how many people avoid dairy products because they think they are lactose intolerant! Before ditching the dairy, consider my caution for you and/or your family as it can have major nutritional consequences.

When people think of milk and other dairy foods, they think of calcium. But the truth is that milk contains 9 essential nutrients that our bodies need in order to function normally. Of those nine essential nutrients, milk meets at least 20% of your daily value for not only calcium, but vitamin D, riboflavin and phosphorus. That is why the Dairy Guidelines of Americans strongly recommends three servings of low-fat dairy per day in order to meet your minimum nutrition needs. Did you know that dairy foods are most Americans primary food source of vitamin D? Much in thanks to the great work by Dr. Michael Holick, we have been learning more and more about the epidemic of vitamin D insufficiency and deficiency that is having serious health concerns.

The lack of nutrient information regarding dairy really hit home with me the other day. An amazing, well-respected doctor I work closely with in my practice shared with me that when a patient comes to him with lactose intolerance, he simply tells them to avoid milk and start a calcium supplement. I had to remind him that dairy not only provides so many more nutrients than just calcium as mentioned above, it also contains naturally occurring ACE inhibitors similar to the same components given in prescriptive form that help regulate blood pressure. That is why the government-backed blood pressure diet, called the DASH diet (Dietary Approaches to Stop Hypertension), encourages 3 servings of dairy because it has all 3 of the nutrients of the DASH diet that help regulate blood pressure – calcium, potassium and magnesium. Milk also contains melatonin that helps decrease stress and promotes sleep. (Ever drink a warm glass of milk before bedtime? There’s a reason behind that!) And as if that was not enough, over the last several years there has been a slew of research coming out on the impact of dairy foods in weight management.  Hmm...a link between a decrease in dairy foods and obesity?  Many say, yes.

Growing up, our favorite mealtime beverage was milk. I grew up in a combined family of 6 children (think Brady Bunch, and I was "Cindy" -- the youngest) and my mother reports that we went through 5-7 gallons of milk every week! I drank milk with every meal and so did all my siblings. But I remember very well that when I was around 17 or 18 years of age, milk and I started having problems. Within 2-3 hours of drinking milk, I would have bad stomach pain, bloating and eventually gas that was very characteristic of lactose intolerance. Oh, the shame as a teenage female! The very easy thing to do is just eliminate dairy to avoid the very embarrassing consequences. But as I fell in love with nutrition in the 90’s, I learned that this was a move was costing me dearly and as a result, negatively impacted my nutrition status.  Now, I am enjoying dairy again and that has helped me be a positive role model for my young children.  (Check out my son's Yogurt Emergency, which was a previous blog post.  I know many moms can relate!)

So, the question is for you – have you or a loved one ditched dairy for the same reason as I did as a teenager? If so:

1. Get Diagnosed. Don’t self-diagnose like I did because it could be something else other than lactose intolerance. All that rumbles in not lactose intolerance! A proper diagnosis is done via a hydrogen breath test and it is covered under most insurance plans. Keep in mind that lactose intolerance is very different than a milk allergy. Lactose intolerance involves the lack of an enzyme that helps digest the milk carbohydrate, lactose. Milk allergy or milk-protein intolerance, is mostly found in young children, and involves an immune reaction to the milk protein. If you or your child has milk allergy, it is highly recommended that you see a Registered Dietitian for nutrition guidance. In this case, complete elimination of dairy components is necessary due to possible dangerous allergic reactions. The good news is that most children outgrow milk allergy by the time they are 3 years of age. It is rare to that a person continues the allergy into adulthood. If they do, there are actually immunologists that can do milk challenges that will decrease or even eliminate the milk allergy altogether.

2. Work it in. Most people with lactose intolerance can tolerate small amounts of milk at a time and most can eat yogurt and cheese without the negative side effects. At your local grocery store, there are lactose-free milk products of varying brands – Lactaid®, Dairy Ease® and even store brands now. Lactaid® is even coming out with an organic version of lactose-free milk for those that prefer organic varieties. There are even over the counter oral lactase enzyme pills that a person can take that be taken prior to the ingestion of dairy. The National Dairy Council has a great educational resource to help you find ways to get dairy in even when you have lactose intolerance.

3. Seek a Registered Dietitian (RD). Anytime you are thinking of eliminating an entire food group, it is highly recommended that you meet with a Registered Dietitian (RD) in your area to develop a plan for you. You may not realize what key nutrients you are eliminating from your diet that may be compromising your health. As an RD myself, I am very sensitive to the food desires of my patients. If eliminating dairy or other foods are simply a personal preference, we will honor that and can ultimately work within your desires to put an alternate nutrition plan that will meet all your needs.

Get the facts when it comes to nutrition. Even if it's written, it doesn't always make it factual.  And we all come with our own nutrition biases, but ask questions about those biases that may have been handed down from generation to generation. Are they really true? As in lactose intolerance for instance, many African American families avoid milk altogether because they already assume it will be a problem. Lactose intolerance in African Americans is grossly overstated, and teaching your children to avoid dairy can have lasting consequences for yourself and for them. Proper diagnosis and learning ways to get dairy foods in can be the best move for you. What is your nutrition bias? Dairy or otherwise, ask the questions and get accurate answers. You owe it to yourself and you also owe it to your family.

The "Must Knows" of Outdoor Hydration in Children

Children enjoying fresh, ripe fruit is one of the great ways to
help keep them hydrated this summer while outdoors.

It is true.  Our children overheat much easier than adults while outdoors in the summer heat.  I notice this easily with  my 3 year-old son.  His little face gets red quickly when running around in the heat!  The more humid the weather, the more my little guy and your children are at risk for heat-related illnesses such as heat exhaustion and fatal heat stroke.  While we are encouraged to head outdoors throughout the summer, let's do some proper planning so we can avoid any emergency room visits due to overeating bodies.  Some of the non-nutritive things we can do to prevent overheating include wearing light-colored and lightweight clothing (or even wicking-type material that allows more air through the clothing), using water to cool the body via swimming, sprinklers or spray bottles, or periodically going into shaded areas.  Outdoor explorations at the very beginning of the day or even toward the evening times are also a good consideration.  That way, we avoid the heat of the day.

But proper hydration is a vital key in maintaining normal body temperatures while outdoors.  The American Academy of Pediatrics recommends that a child be well-hydrated prior to any prolonged physical activity.  During the activity, the following amounts of water should be consumed every 20 minutes even if the child does not feel thirsty (cold water is generally more palatable):

--> 5 ounces for children > 3 years of age weighing up to 88 pounds
--> 9 ounces for children and adolescents >88 pounds

The most accurate way to rehydrate is to weigh the child before and after physical activity - then replenish accordingly by loss.  For excessive sweating and/or high intensity physical activity greater than >1 hour, the American Academy of Sports Medicine (ACSM) recommends an electrolyte replacement drink such as Gatorade®, POWERADE® or CeraSport® (I happen to like the quality of CeraSport® the best).  These beverages are good for prolonged outdoor activities that do not allow for snack stops using food (see below).  These beverages replenish water, but also essential minerals that are lost through sweat.

Food Sources for Hydration
If your outdoor activity allows for snacking, take advantage of the food sources that can assist with hydration alongside the cold water supply.  Since it is vital for our children to stay hydrated, we want to choose some snacks that they are sure to consume.  Again, for the high sweat factor and prolonged outdoor activities, we need water plus sugar, potassium, magnesium which are the essential nutrients lost in perspiration.  Choose a combination of healthy sweetness and healthy saltiness.  My choices are:

1. Fresh fruit.  Fruit is actually 80-90% made of water and it contains most of the electrolytes needing replishment.  Keep cut-up pieces of ripe fruit ready for your children to grab and enjoy.  Fruit such as watermelon, cantaloupe, oranges, mango and pineapple are great choices that can be eaten separately or even put on skewers to make a nice, tasty kabob.  Or, you can make some frozen yogurt fruit smoothies for them to enjoy.  See my easy peasy recipe that was featured in the Dallas Moms Blog earlier this month.  The yogurt provides more mineral replacement and quality protein.  My daughter loves them!

2. Salted nuts.  Salted nuts of any variety are great snacks to keep outdoors for your children to grab and refuel during and after physical activities.  The sodium on the salted nuts fill the mineral gap that the fruit does not supply.  However, be careful of any children that might be playing outside that might have a nut allergy.  If you have anyone present with a nut allergy, consider using other salty foods such as popcorn or whole grain crackers.

Keep children that have had an illness involving diarrhea or vomiting indoors for at least 24 hours following their illness.  And make a call to your doctor to discuss special hydration considerations for children with medical conditions before heading into the heat - especially for lengths greater than one hour.  All parents would benefit from reviewing the signs and symptoms of all heat-related illnesses before heading outdoors.  The more your family is prepared, the more time you can spend enjoying your time together outside!  Our family is headed out geocaching in the morning with our fresh reminder on proper outdoor hydration to avoid heat-related illnesses.  How about yours?

New Activity + Outside = Family Fun & Energy Balance

Some of my best childhood memories were of my brother and I going on day long outdoor explorations.  We'd pack ourselves sack lunches and just head out with no real plans other than to play and discover.  Many times we'd head to a nearby lake and watch fish, catch garter snakes or even go visit our pet rock.  What is your favorite outdoor memory as a child?

Let's Move, the child obesity initiative started by First Lady Michelle Obama, is promoting Let's Move Outside!.  Let's Move Outside! encourages parents to move outside with their children in order for them to achieve the recommended 60 minutes of active and vigorous activity each day.  Many children are not meeting this minimum recommendation, which is one of the many contributors of the child obesity epidemic.  The Let's Move website provides tons of ideas for families, including links to local activities depending on where the family lives.

One outdoor activity that I learned from a patient of mine last year is geocaching.  It's basically a high-tech treasure hunt that families anywhere in the world can enjoy.  Started by a man named Dave Ulmer in May of 2000, it was originally geared toward only the GPS user community that utilized that very new technology at the time.  Today, there are over 1 million "caches" all over the world that that can be found.  One may be just yards away from where you are sitting at this very moment!  Now mobile devices come with GPS technology, and there are applications that can pull up all the geocaches in your area on one screen.

Remember, simply stated, ENERGY IN (food) - ENERGY OUT (activity) = Weight Maintenance OR Weight Loss OR Weight Gain. It's all about energy balance, which is what dietitians specialize in. Although we talk much about the energy in part, we also need to discuss energy out. How are you balancing your energy?  How are you promoting energy balance in the life of your children?

Summertime is the perfect time of year to try a new family activity to promote good energy balance.  And at the same time, you are helping your build memories that they will eventually look back and remember with great happiness.  Learn about all the great outdoor activities in your area by going to the Let's Move website or, even try some geocaching!  What a way to spend quality time together, improve your health and be a great role model for your children.  For everything you need to know about geocaching including how to get started go to http://www.geocaching.com/.  In our next post, we will discuss proper hydration for children and adults while enjoying those great outdoor activities.  Stay tuned!

"Do This, Not That" When Raising Healthy Families

My mother is a huge fan of the Eat This, Not That book written by David Zinczenko with Matt Goulding. I have not read nor reviewed the book, so please do not misunderstand by mentioning it as a recommendation. [For the record, I don't believe any one food is strictly forbidden, although I certainly think there are foods we should concentrate on eating more than others.] What I like about the title is that there is an alternative provided instead of just stating the problem! Such is true with child feeding and healthy family lifestyles. I came up with my own "Do This, Not That" when raising healthy families. Let's start with the don'ts:

DON'T:
• Put your child on a restricted diet. Special diet prescriptions must be done under the care of a Registered Dietitian only and even then, we try to keep things as liberal as possible to avoid nutrition deficiencies.
• Deny your children food when they request to eat. This leads to food insecurity and can exacerbate a weight problem.
• Try to control your children’s eating habits like you wish you could control your own.
• Nag your children about food they did or did not eat.
• Force your child to eat vegetables or any other kind of healthy foods. It will backfire in the long run!
• Provide separate meals for your children, i.e., no short order cooking.
• Skip meals. Skipping meals often leads to overeating later.
• Force children to take part in exercises they do not enjoy.

OK, good. We got the don'ts out of the way. There are many more do's than don'ts and I believe in positive, empowering guidance:

DO:
• Focus on a family-wide healthy lifestyle that includes low-fat high nutritional foods along with regular exercise.

• Provide plenty of healthy food options in your home such as whole grains, fruits and vegetables reduced fat and sugar foods. Exclude any foods that may be overeaten.
• Be patient when your child denies certain foods. Research shows that it sometimes takes 15-20 exposures before they will accept. Continue to put those foods on their plate instead of deleting it from their menu.
• Plan meals at least one week in advance. Grocery shop at off hour times on the weekends so you have all the food you need during the week when schedules are busiest.
• Have regular family meals. Regular family meals are an essential part of a healthy family lifestyle. This is not only where families can have quality time together to talk about their days, but it is also a time where parents can model good eating behaviors.
• Limit calorie-containing beverages except skim milk, especially at meal times. Even 100% natural juices have a lot of calories.
• Limit “screen time” (television and computer/computer games) to a maximum of 2 hours/day.
• Exercise/Be active as a family. What a great way to do 2 things at once - spend time together and also getting healthy as a unit.
• Listen to what your children say they are interested in and help them get involved. If they enjoy an activity, they are likely to do it more consistently.
• Consider joining a team or a group for whatever activity you choose to take part in. The teams and groups help with consistency and accountability.
• Make changes slowly. Slow changes have a tendency to be more permanent.
• Involve your children in all aspects of food and eating: growing or shopping, planning and preparing.
• Make food experiences fun and creative. Fun and creativity is your child's world, so go there and experience things together.
• Model, model, model the behaviors you want to see in your children. Remember parents, you are your child’s biggest role models! How humbling, but oh so true.

Take advantage of the summer months. This is such a great time of year to make positive family changes that can become more habitual when school starts back up in the fall. My challenge to you is to decide to make just one change - big or small - this week that will make your family healthier. What will that be? I'd love to hear from you!

Getting Kids To Know Food: Reminders From AIWF's Days of Taste

With any relationship, you must work to grow and deepen the connection. So is the same for food! Sweet. Salt. Bitter. Sour. Umami. Metallic. Astringent. Taste sensations along with other senses – smell and vision – heavily influence our experiences with food. And with children, you are also dealing with motor coordination, cognition, social development and emotional aspects. As you can see, so many things come into play in child feeding. But one thing is sure. Exposing children to different food experiences can yield very positive results. Allow me to share a recent experience with you, as I promise that it does involve lessons to be learned for your child and mine.

The American Institute of Wine and Food's Days of Taste was
held at the Dallas Farmers Market in May 2010.  AIWF's Days of
Taste occurs throughout the country.  Contact your AIWF local
chapter to find out how you can be involved in your area.

In May, I was a volunteer at The American Institute of Wine and Food (AIWF) Days of Taste in Dallas. One of my friends and colleagues, Robin Plotkin, RD, LD, was the event’s Program Manager and she asked me to be a part of the event. Days of Taste is a  national discovery-based program that exposes local fourth and fifth grade students to learn all aspect of food. Students were brought to the Dallas Farmers Market where they learned and experienced taste sensations, experienced different flavors and heard real-life stories from local culinary professionals. As a volunteer, I was in charge of a small group of students. We were given a task to make our own, customized pasta salad. The pasta and sauce ingredients were provided, but we were charged to get some fresh ingredients at the market. Each student was given $1 (our group had a total of $5) to purchase whatever we wanted to make our pasta salad unique. These students absolutely blew me over at how interested and excited they were to take part in this project! Armed with our limited budget, we headed to the local producer shed and off we went looking for our fresh items. The kids agreed on celery, carrots, onion and tomatoes after working deals with the farmers. While we were at the market, we were able to meet several farmers and find out where many of their farms were located. After we got back to the classroom, I gave each of the students individual responsibilities in preparing the salad. Several of the students said they had never had a salad that looked like ours and even thought the sauce looked strange to them. I encouraged them all to keep an open mind and that this was something we were gong to experience together. As a group, they ate their production with great pride. I am thrilled to report that all of my students loved their recipe! One little girl even said that she was going to have a talk with her mother when she got home to request more fruits and vegetables at their house. Another student said she might want to be a chef when she grows up. This experience for me was so nourishing in more ways than the food I ingested! It renewed my passion about educating, exposing and empowering children when it comes to food. But more specifically, I was reminded of many things that day:

1. We must do more food education programs for children. Kudos to the AIWF! The more we educate, expose and empower our children with all things related to food, the more they will appreciate food variety, differing flavors and learn to be more open minded when it comes to food. Just like anything else in life, the more we experience something that is positive, the more we want to re-experience and examine further. What I would absolutely love to see is the school cafeteria to be part of the school curriculum. Jamie Oliver, best known for his Food Revolution, has done a great job exposing communities to companies that can assist in food education. Companies, associations, organizations, schools and communities take note.

Me and my students posing with our customized pasta salad
recipe. (One student's face covered due to request of
protected identity.)

2. Food experiences in groups yield higher acceptance. This is not the first time I have seen children be more open-minded than expected when experiencing food in a group educational format. These environments make children feel less pressure to eat for nutritional reasons and more for the overall experience and learning aspects.

3. Families need to spend more time experiencing food with their families. This speaks to me as a mother. I enjoy cooking with my children, although I am encouraged to involve them in more aspects of feeding our family even if it might take a little more time. If you have a challenged eater in your home, make a special point to have “no pressure” experiences with food, i.e., experience food in a non-meal situation. Make it a classroom affair. Consider growing a produce item and make plans to eat your crop with a recipe of your child’s choice. Visit a local farm. Search out new farmers markets in your area. Do a taste sensation lesson together.  

Bottom line lesson here: Let’s get back to experiencing food the way they did before all the mass production of food of the modern age. We have all lost essential experiences with food that allow us to truly appreciate different flavors. Seek out farm to table education for your children. (The Local Harvest website is a great start!) Children in the 1800’s had no choice, although I would venture to say that the children back then appreciated food more for many reasons.  Make steps to make an enhancement when it comes to your family's relationship with food, and that will ultimately equate to improved nutrition for your children. I needed this lesson for my children’s sake and the summer has come at a perfect time to do this as a family!