All posts in Children’s Health

Is Your Adolescent Getting Enough Nutrition?

I often get asked by parents of teenagers what kind of vitamins they need to be giving their child.  Adolescents need plenty of vitamins and minerals during their growth spurt.  For girls, this is usually around age 10 or 11; for boys this usually occurs around age 12 or 13.  Nutritional and energy needs during this time are greater than at any other time of life, except during pregnancy.  In addition to the increased nutritional needs, adolescence is usually a time when the diet is at its worse.  In order to combat these two things, we need to consider how to alter the diets of your teenagers and add nutritional supplementation to meet the needs that your child has at this time in their lives.  In this post we’re going to go over the diets of your teenager and the next post we’ll discuss nutritional supplementation.

Adolescent nutrition is incredibly important because teenagers require healthy foods in order to grow and develop normally.  In addition, at this time in their life the groundwork may be laid for future problems with obesity and other diseases.  The U.S. Department of Agriculture’s (USDA) Food Guide Pyramid recommends how many servings a day an adolescent should eat of each food group, such as milk, vegetables, fruits, fats, and meats. By sticking closely to these guidelines, parents can ensure their teens get a well-balanced diet that supplies the vitamins and calories they need.  In addition, eating a balanced diet through adolescence will give teenagers the energy they need to stay physically active and will encourage good eating habits into adulthood.

In spite of recommendations, the quality of most teens’ food intake is not what it should be. Today, about 9 million U.S. children ages 6 to 19 are overweight.  This number has tripled since the 1980s. To help guide teens, their families, schools, and others in making healthy nutritional choices, the USDA guidelines suggest the following daily food selections:

  • 6-11 servings of breads, cereals, rice, and pasta
  • 3-5 servings of vegetables
  • 2-4 servings of fruit
  • 2-3 servings of dairy products
  • 2-3 servings of meat, fish, poultry, and legumes

Fats, oils, and sweets should be used only sparingly.  The USDA says only about 30% of daily calories should come from fat.  You can switch to low-fat or nonfat milk and other dairy products.  Eat more chicken and fish than red meats, and remove skin from poultry or trim fat from red meat.  When cooking, use low-fat cooking methods such as steaming, baking (without adding fats or oils), and broiling.  Avoid buying high fat desserts or snacks, such as snack chips and ice cream.

Calcium requirements are particularly important for teens, yet studies show that about 60% of teenage boys and more than 85% of teenage girls fail to get the recommended daily allowance of calcium. Calcium not only helps strengthen bones and make for healthier teeth, it also is important in the teen years to prevent future osteoporosis, a condition that causes weakened, less dense bones in later adult years. Teens should consume 1,200–1,500 mg of calcium per day. Milk, cheeses, tofu, white beans, yogurt, oranges, and salmon are all good sources of calcium.

Iron requirements are also very important for adolescent health and growth. Teens need 12–15 mg of iron per day. A variety of iron sources come from each food group. Some include:  peanut butter, whole grain bread, spinach, green beans and lima beans, strawberries, and beef, poultry, or fish.

For both calcium and iron, female teens need the higher recommended amount per day in order to build strong bone and muscle that will prevent against osteoporosis and other conditions associated with post-menopausal women. Teen males need at least the minimum requirement.

Generally, an active male teen needs approximately 2,800 calories per day. They should eat the higher suggested number of servings in each food group. Active female teens require 2,200 calories per day. They should eat the average number of suggested servings per food group. Teens that are not as active and are overweight should eat the lower number of suggested servings per food group and cut back on their daily ingestion of fats, oils, and sugars.  There are easy ways they can cut calories from their diet, which I go over in my Ways to Cut Calories post.

Help Your Teen Make Good Food Choices

Adolescents are becoming more independent and making many food decisions on their own.  They tend to eat more meals away from home, and they are heavily influenced by their peers.  Meal convenience is important to many teens, so they end up eating too many wrong types of foods such as soft drinks, fast food, and processed foods.  So encourage your teenagers to find out about nutrition for themselves.  Take their suggestions whenever possible regarding foods prepared at home.  Experiment with foods from other cultures.  If there are foods that you don’t want your teen to eat, avoid bringing them home.

It is important that teens eat three meals a day with healthy snacks.  Studies have shown that children and teens that skip breakfast have more trouble concentrating and do not perform as well in school.  Skipping breakfast in childhood and adolescence is related to later health problems such as obesity and heart disease.  Also, have several nutritious snack foods readily available since teens will often eat whatever is convenient.  Avoid stocking high sugar and refined carbohydrate foods in your cupboard.  Have more fresh fruits and vegetables available for snacks.  You can visit my 2 posts on healthy snack recipes for more ideas:  Healthy Snack Recipes, More Healthy Snack Recipes.

While the obesity problem in today’s youth can be blamed on a number of factors, including larger food portions, convenient salty snack foods, cheap and convenient fast food, and increased time spent sitting in front of the television instead of out being physically active. Teens are receiving and growing accustomed to less nutritional food choices.  Many experts say that getting teens up off the couch and stocking healthy snack choices helps.  Also, many sources can help parents find healthier alternatives to fast food meals for their families. Suggestions include cooking meals on weekends and freezing them for busy weekdays, and looking for cookbooks or online sources of quick and healthy recipes.

A Word of Caution

If your adolescent is overweight, you should be cautioned not to turn to fad diets. Many of the diets and diet products on the market have not been proven by clinical studies as effective in the long term for adults; they certainly have not been proven safe or effective as a solution to weight problems in children and teens. The best solution for obesity is a combination of activity, a balanced diet, and involvement of a trained professional as needed. Further, adolescents who worry too much about weight and appearance can develop social anxieties and eating disorders such as anorexia and bulimia. Girls may feel pressure from peers to be thin and to limit what they eat.  Both boys and girls may diet to “make weight” or “look good” for a particular sporting or social event.  Over one third of American teenaged females have used such un-healthy methods as self-induced vomiting, laxative abuse, diet pills, and water pills to control their weight.  So we need to try to encourage our youth to have a healthy weight, making food choices that are healthy and becoming involved in some type of physical activity.


Childhood Calcium Intake May Prevent Obesity and Osteoporosis

I live and practice in Apex, NC which is in the middle of what’s called the Triangle.  For those of you now familiar with North Carolina, it’s basically the area that encompasses Raleigh, Durham, and Chapel Hill.  It is also known for its prominent universities, namely Duke, UNC, and NC State.  The reason I’m explaining this to you, is my post today comes from research just published by a researcher, Dr. Chad Stahl, from NC State University.  Dr. Stahl’s research shows us the importance of calcium in our diets as children.

Granted, we all know that we need calcium for healthy bones.  I advise most of my patients, the females especially, over the age of 35 to make sure they are taking a good calcium supplement.  However, this new NC State study suggests that not getting enough calcium in the early days of life could have a lifelong impact on both bone health and even obesity.  During this trial involving newborn pigs, it was found that the stem cells in the bone marrow of calcium-deprived piglets appeared to be programmed to become fat cells instead of bone-forming cells.  Because these stem cells provide all the bone-forming cells for an animal’s entire life, early calcium deficiency may have predisposed the piglets to have bones that contain more fat and less mineral.

The researchers in this study used pigs as a model for human health because pigs and humans are similar in terms of bone growth and nutrition.  Pigs are one of the few animals to experience fractures due to osteoporosis.  Dr. Stahl thinks this research is relevant to the infant food industry as well as the nutritional status of breastfeeding mothers.  It also points to a need for greater emphasis in early life on bone health.  This may even change the way health professionals look at osteoporosis – not as a disease of the elderly but a late onset pediatric disease.  It also points to the importance of childhood nutrition and the role it plays in the child’s health for the rest off their lives.


Natural Treatment of ADHD, Part 4

ADHD can often be successfully treated naturally to the point where the need for medication may be significantly decreased or even eliminated.  Research has shown that improvements can be made with ADHD through diet, nutrition and chiropractic care.  The Center for Science in the Public Interest (a division of the U.S. Dept. of Health and Human Services) has published a report, “Diet, ADHD, and Behavior”, that reviews studies on the effect of diet on behavior (including ADHD) and touches on side effects of the stimulant drugs that have been used to treat behavior disorders in millions of children.  CSPI’s report reviews more than 20 controlled studies of diet and behavior. Most of the studies found that food dyes and, in some cases, other additives and foods provoked symptoms of ADHD or other behavior problems in some children.  They recommend the first avenue of treatment should be the elimination of foods with dyes and additives from a child with ADHD’s diet.  They recommend this be done before any medication is prescribed due to the side effects of the medications as well as Ritalin being a “possible human carcinogen”.  Therefore, if your child is properly diagnosed with ADHD, your first step in treatment should be to change their diet to organic foods with as few food dyes, additives, and preservatives as possible.

Food sensitivities and allergies are starting to be more widely looked at in terms of the treatment of ADHD patients.  In the research of diet and its connection to ADHD, nutritionists commonly find the elimination of foods such as oranges, chocolate, corn, wheat, eggs and milk, may work to improve a child’s mental functioning and, thereby, alleviate, to some degree, the symptoms associated with ADHD.  During an allergic reaction, or food sensitivity reaction, the body releases a chemical known as histamine. Histamine, in physiological terms, works to increase the removal of blood serum from around the brain tissue, thereby reducing adequate blood flow to the tiny capillaries which nourish the brain. When this reaction of histamine occurs within the body, the brain becomes unbalanced and the first indications of complication, from a psychological aspect, involve loss of memory, attention and cognitive function.  Using a diary or journal to log the activities and foods of your child, over a 30 day period, will often provide insight into the natural culprits which may be creating more complex ADHD symptoms; being mindful that food sensitivities, generally, take several hours to appear following consumption. Once the foods are identified, steps can be taken to remove those exposures from the child’s diet and, thereby, remedy the symptoms of ADHD.

Another area that’s getting a lot of research lately is Omega-3 fatty acid supplementation. Dr Basant Puri, a consultant and senior lecturer at Hammersmith Hospital has been using sophisticated imaging techniques to study the role of fatty acids in brain function. He says he has unearthed a wealth of evidence about how supplementation with specific fatty acids can not only help those with ADD/ADHD (attention deficit/ hyperactivity disorder), but also dyslexia and dyspraxia.  “In clinical trials we have seen significant improvements in ADHD symptoms in children administered with fatty acid supplements,” he said.   Typically those who get a benefit enjoy improved attention and concentration, a reduction in anxiety and impulsivity and generally an improvement in self esteem.   Fatty acids are important for the brain growth of all children and particularly so for those with learning conditions.   Dr. Puri recommends that the best results have come from supplementation with a combination of marine and botanical oils rich in a specific fatty acid called Eicosapentaenoic Acid or EPA.   Similarly, a Purdue University study showed that kids low in Omega-3 essential fatty acids are significantly more likely to be hyperactive, have learning disorders, and to display behavioral problems.  Your brain is more than 60% structural fat, just as your muscles are made of protein and your bones are made of calcium. But it’s not just any fat that our brains are made of – it has to be Omega-3 fats, and the typical American diet is low in these types of fats.  We eat man-made trans-fats and excessive amounts of saturated fats and vegetable oils high in Omega-6 fatty acids, all of which interfere which our body’s attempt to utilize the tiny amount of Omega-3 fats that it gets.

Because ADHD can be caused by both biochemical imbalances and brain under-stimulation, chiropractic care is often needed to help stimulate the nervous system and restore normal brain stimulation.  Research has shown not only that the developing brain relies on normal structural integrity and joint movement, but that complex neurochemical communication and pathways involved in helping us to “feel good” are tied into spinal biomechanics.  Children’s nervous systems need the constant stimulation of movement in order to develop and function properly. Abnormal position or movement of the spinal vertebra can develop and this can lead to nerve interference. It is this interference that chiropractors correct.  In the October 2004 issue of the peer-reviewed research publication, the Journal of Manipulative and Physiological Therapeutics (JMPT), a case study shows a child with ADHD who was helped with chiropractic care.  The case study was of a 5 year old boy who had been diagnosed with ADHD at the age of 2.  The child’s pediatrician prescribed Ritalin, Adderall, and Haldol for 3 years.  After 27 visits to a chiropractor, “The patient experienced significant reduction in symptoms. Additionally, the medical doctor concluded that the reduction in symptoms was significant enough to discontinue the medication.”  This case study can be found at the following link:

So, if you do have a child with ADHD, there are a number of alternatives that you can try before using medications that have numerous side effects and may possibly be carcinogenic.  I hope this series was helpful for you, and if you have any questions or comments, please post them or contact me directly.


Medical Treatment of ADHD, Part 3

pillsOut of the three most commonly used medications for ADHD, Ritalin, or methylphenidate (MPH), is prescribed for more than 70 percent of patients according to one public health conference:  Although in many patients the disorder may result from the lack of brain stimulation, the medical profession leans toward treating the biochemical theory of ADHD – hence, the use of medications that affect the level of dopamine in the brain.

Dopamine is the main neurotransmitter in the “pleasure center” of the brain – a network of nerve cells or neurons that motivates much of human behavior. The “pleasure center” reinforces people’s drives to eat, drink, and procreate and is responsible for addiction.  For example, when a person tastes ice cream, the sensors of the tongue signal the brain that it feels something, and a neuron fires in the taste center of the brain.  Dopamine from one neuron is released into the space between it and another neuron.  The second neuron, in turn, sends the signal to third neuron by the same process.  Through this complicated network of signaling, the brain lets the person know that an experience is pleasurable and is worth paying attention to.

Dopamine is recycled by dopamine transporters—proteins that are embedded in the membrane of the initial neuron.  When molecules of dopamine are floating around in the synapse (or gap between neurons), any that come in contact with the transporters are sucked back into the initial neuron.  A recent study (Lancet, 1999; 354:2132-2133) showed that ADHD patients have more dopamine transporters than people without the disorder.  This means that dopamine is not given enough time to reach the second neuron and instead is taken back into the first neuron’s membrane. As a result, an inadequate number of dopamine molecules reach the second neuron so it won’t send a signal.  MPH (Ritalin) is called a reuptake inhibitor.  It blocks dopamine transporters and allows dopamine to reach the second neuron and create a signal, improving children’s ability to focus.

But Ritalin is not a cure for ADHD. The medication neither corrects the disorder nor addresses the patient’s individual problems. Eighty percent of hyperactive children have ADHD features in adolescence, and up to 65 percent maintain them in adulthood.(  Medications merely control the symptoms of hyperactivity/ impulsivity and even aggression.

Side Effects

Effects associated with moderate doses of stimulants are decreased appetite and insomnia.  Negative effects on growth rate are possible, but ultimate height appears not to be affected.  Very high doses of psychostimulants, such as Ritalin, may cause central nervous system damage, cardiovascular damage, hypertension, compulsive behaviors, and, in certain vulnerable individuals, movement disorders.  A rare percentage of children and adults treated at high doses have hallucinogenic responses.  An animal study of Ritalin has produced a “weak signal” that the drug may potentially cause cancer.  Other drugs used for ADHD have their own adverse reactions: tricyclic antidepressants may induce cardiac arrhythmias, bupropion can cause seizures, and pemoline (Cylert) is associated with liver damage.

Stimulant therapy is not recommended in patients with a history of tics or Tourette’s disorder, the presence of a thought disorder, significant resistance to such medications in the patient or family, or insufficient severity of the symptoms or dysfunction.

Ritalin’s chemical properties cause the most serious concerns about its use. MPH is a schedule II narcotic that belongs in the amphetamine family of stimulants and is regulated by the Drug Enforcement Agency (DEA) as a controlled substance.  Chronic exposure to stimulants during development may change the way the brain reacts to environmental challenges, including stressful events and pharmacological agents.  Another concern is that long-term stimulant administration in children may alter the way the brain reacts to further exposure to stimulants or other drugs with potential for abuse.

A recent study showed that MPH is not a weak stimulant, as had been thought, but is a more potent transporter inhibitor than cocaine. A typical dose given to children (0.5mg/kg) blocked 70 percent of dopamine transporters, while cocaine blocks only 50 percent. People who took MPH displayed high levels of extracellular dopamine—just as people using cocaine did.  The only difference between the MPH and the cocaine effect on the brain is in the way it is administered: MPH taken orally raises dopamine in about an hour, whereas inhaled or injected cocaine hits the brain in seconds.

In 1999, approximately 9 million Americans used prescription drugs for non-medical purposes—to get high, to have fun, to get a lift, or to calm down.  Ritalin abuse has been reported among middle and high school students. Some used it to suppress appetite or to stay awake while studying. The DEA lists Ritalin as a “drug of concern” and reports that some abusers have dissolved the tablets in water and injected the mixture, which can block small blood vessels and damage the lungs and retina of the eye.


Diagnosis of ADHD, Part 2

medical-doctorWhen a child’s behavior or academic performance starts troubling teachers, they usually make the preliminary ADHD diagnosis and report it to the parents.  The parents then take the child to a general practitioner or a pediatrician who makes the final diagnosis and prescribes a stimulant medication, typically Ritalin.  The problem with this scenario is that the people involved aren’t the right ones to be making the diagnosis.  Before placing a child on medications and pinning him or her with a diagnosis of ADHD, first get a second opinion from a healthcare professional that specializes in this disorder, such as a psychiatrist, psychologist, or doctor specializing in neurology and/or in ADHD specifically

But even for a qualified specialist, ADHD is not always easy to diagnose. ADHD belongs to a spectrum of neurological disorders.  The spectrum goes from attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) through learning disabilities, obsessive-compulsive disorder (OCD), and Tourette’s syndrome, to pervasive developmental disorders and autism. The neurological mechanisms involved in all the disorders are very similar.  Besides, there is increased co-morbidity among these syndromes, meaning that a child can have multiple disorders.  For example, 50 percent of the ADHD patients will have OCD, and 50 percent of patients with Tourette’s syndrome will have ADHD.  Early-onset mania or bipolar mixed state may be particularly difficult to distinguish from ADHD, or may also be co-morbid.

On the other hand, some children may be at the high end of the normal range of activity, or have difficult temperaments. Poor attention may also be caused by impaired vision or hearing, seizures, head trauma, acute or chronic medical illness, poor nutrition, insufficient sleep, anxiety disorders or realistic fears, depression, or the sequelae of abuse or neglect. Various drugs (including phenobarbitol) may interfere with attention.

Similar symptomatology and co-morbidity of conditions increase the possibility of misdiagnosis.  ADHD is not a learning disability, but it can affect the ability to progress in society and the ability to learn. Many children are misdiagnosed with ADHD because they have learning disabilities or language problems.  Some children may simply have difficulty learning certain subjects, but schools often push to diagnose the child with ADHD.  There have always been children who learn at different speeds, but it almost seems easier to put a diagnosis of ADHD on the child and deal with the learning difficulties in that way.

Communication with the child and his/her parents is the key to a correct diagnosis.  We need to understand the frustrations the child has.  Is he/she too active?  Bored?  Do they have dyslexia or a different learning pattern?  It can be a behavior problem, problems at home, or frustrations with the teacher’s style. If the child is a visual learner, and the teacher is not teaching towards that learning style, the problem may be the child is not being taught in a way he can learn.  As adults, if we went to a conference where the speakers taught in a way we can’t learn, we would be frustrated and would start to misbehave—we’d leave or chat to the person sitting next to us.  The same thing applies to children.

The traditional way of diagnosing ADHD seems to follow a cookie-cutter principle. The very diagnosis of ADHD is based on the questionnaire laid out in the DSM-IV5 or other diagnostic manuals.  If the child’s parents or teachers identify as positive six out of nine criteria for inattention, or six out of nine criteria for hyperactivity and impulsivity, the child leaves the doctor’s office with a drug prescription and a new personality label.  The patient is basically at the mercy of the medical doctor’s clinical experience—and 60 percent of doctors agree that there aren’t enough properly qualified ADHD diagnosticians, according to a Canadian survey performed in 1999.

Therefore, if your child has been diagnoses with ADHD, please make a point of seeing a specialist to confirm the diagnosis and other possible contributing syndromes the child may have.