Pica: A Flag For Mineral Imbalances, Especially In The Developmentally Disabled

Objects like nails are not an unusual choice for people with pica.

I know a woman who is a care provider for a disabled adult. She told me a little about this man, who is in his forties, and what kind of care he needs. He is infantile due to a head injury as a boy. She happened to mention, “he has pica” – so, all sorts of non-food things have to be kept out of his reach lest he eat them or chew them. Well, he can’t chew, she explained. He doesn’t have teeth, so all his food is pureed. No teeth at all. Why no teeth, I asked. Did they all rot? Did he lack access to dental care at some point? Does he have poor immune function? My friend wasn’t sure because the teeth were gone when she began working with this man, but she implied his teeth were removed because of his pica “behavior”.

Somewhere along the way, apparently, it was decided that the best solution to this behavior was to remove all this man’s teeth.

I hope this isn’t true. I’m hoping there is a reasonable explanation for why this individual no longer has any teeth other than ignorance on the part of a physician or dental surgeon somewhere – but my friend confirms that this disabled man’s primary care doctor has told them that pica is purely a behavior.

Not exactly. Pica is a well-known clinical sign of iron deficiency anemia. It can also indicate other mineral imbalances or deficiencies – like zinc or magnesium deficiency, or copper or lead toxicity. Mouthing or chewing objects is expected for teething babies, or during the developmental phase when oral exploration is key. Beyond that, persistently eating things that aren’t food – erasers, dirt, sand, rocks, clay, metal objects, plastic, wood, ice  - should be regarded as a flag for iron deficiency anemia, zinc deficiency, or mineral imbalances for magnesium, copper, lead, cadmium, or manganese. Could it be in this day and age that such a fundamental tenet of nutrition was overlooked? Or even more crazy, that it might have cost a developmentally disabled adult who can’t speak for himself every tooth in his head?

Was this man’s suffering avoidable? Well, it’s simple to screen for mineral imbalances by checking clinical signs and lab studies. My friend tells me she has no idea if anyone ever did this for this man.It can be relatively straightforward to correct them with the right nutrition measures. When this is done, pica “behavior” can resolve or improve – as can other behaviors that attend mineral deficits or toxicities, like aggressionattention deficitscriminality, or even schizophrenia.

Pica can mean that minerals necessary for learning, growth, behavior modulation, and development are not fully on board, or that they have been displaced by toxic minerals instead. It’s most common in people with developmental disabilities, including autism – not a coincidence, in my opinion. Neurotoxic effects of excessive lead, cadmium, copper, or mercury are well known; costs of deficiency for essential minerals in utero or early in life are old news too. Stunting, learning delays, behavior problems, attention deficits, and lower IQ have all been linked to pica and/or mineral imbalances. Pica can also predispose people to greater lead exposure, for two reasons: They may ingest objects containing lead; and, the lower one’s iron status is, the easier it is to absorb more lead, with any exposure.

Before it’s assumed that eating weird stuff is just a behavior – especially in a developmentally or learning disabled person – a doctor should do a full iron study. Blood work should assess ferritin, serum iron, total iron binding capacity (TIBC), hemoglobin, and hematocrit. Your doctor might look at red blood cell shape, size, and number to fully rule out anemia or pre-anemia. Reference ranges for iron parameters are wide. Children should fall solidly in the middle of the ranges for ferritin and serum iron. Teetering at either edge of the range, high or low – at least for me as a nutritionist – would prompt me to do more looking at the problem. Marginal iron markers often go hand in hand with inattention, insomnia, picky appetites, or behavior and learning deficits. It is also wise to check serum copper, serum zinc, and ceruloplasmin (a copper transport protein in the blood), to rule out toxic levels of copper. Copper circulating unbound in serum can become neurotoxic, while ceruloplasmin will safely transport this mineral for us. Adequate zinc status can keep copper levels in check.

Clinically, pica with iron deficiency can present as craving and eating pebbles, ice, sand, dirt, clay or metal objects, while pica with zinc deficiency might lean toward a child chewing fabric, clothing, erasers, wood, or pencils, and clenching and grinding teeth often, in sleep or when awake. This has been my own clinical observation in children, at least.

One caveat: If iron supplementation is warranted per your provider’s advice, make sure your child is not ill, febrile, or has active infections, including gut candida infections. Microbes love iron, and will thrive when it is supplemented – which can make your child feel some GI discomfort at the least, or worsen a fever, trigger pain, and worsen behavior outbursts. Iron is also poisonous at the wrong dose, so only use supplements with professional guidance.

For more signs of how mineral deficiencies present clinically, see Special Needs Kids Eat Right. This is a potentially easy nutrition fix that is worth the effort. Check status of all essential minerals and rule toxic mineral exposures, to really know if pica has a physiological underpinning. Toxic minerals don’t remain in whole blood for long, so a knowledgeable practitioner may want to check hair or packed red blood cell elements to more accurately assess presence of toxic metals. Optimal mineral balance means optimizing many metabolic and neurotransmitter pathways in the brain for learning, processing, and emotional regulation – something will benefit any person with a developmental disability.

Getting through the holidays with kids on special diets

Kids avoiding dairy, gluten, soy, and nuts can eat these.

Special needs families face additional stresses at holiday times. Everything is harder when a child’s diagnosis or circumstance means s/he isn’t able to manage changes in routines – travel, packing, preparing meals, mingling with family and guests. This may be one of the biggest reasons why parents defer restricted diets and nutrition measures entirely, as part of a special needs child’s total plan for well-being. They fear these will set the family even further apart at times when they already suffer some isolation, bringing up children with autism or other differences. When you can’t participate in holiday or celebratory food traditions – at a time when some respite and joviality is most needed – it is more isolating.

The good news: Not as isolating as it used to be, just a few years ago. In fact, it need not feel isolating at all, once you get the game down. It’s easier than ever to navigate this time of year when you have little ones using special diets or supplements. There are more allergen-free foods available than ever before. Support on the web is just about infinite for recipes and resources that support allergy-free cooking and baking. There are even gluten free holiday cookie exchanges popping up. Your family can relax about the food part, and focus on the joy.

After fifteen years of doing this for my own family, and twelve years doing this for others in my nutrition practice, I’ve come up with “best practices” for this time of year on special diets. Here’s my short list – there’s loads more to try, once you dive in – but these are my recommended starting points:

-       This may be the most important thing you do for reducing stress: Forgive your in-laws. Or siblings, parents, grandparents, cousins – whoever is passing judgment on you for working with a special diet for your child, or blaming you for “ruining” the holiday gathering with special diet needs. Let it go. Don’t need your relatives to understand; in fact, expect them not to. Don’t try to enlighten them. If you have supportive and understanding family, lucky you! If you don’t, simply releasing this argument will lift a big burden.

-       Nothing eases tensions more than kindness. Bake or buy extra gluten free pies; bring a gluten free pie crust (available ready made at Whole Foods and other resources) so it can be filled grandma’s with signature filling and enjoyed by all. Offer to bring alternate main dishes that meet the special diet needs of your family members. Or bring an extra special gift for the host family, with a note acknowledging their efforts.

-       Whatever your child can eat, bring enough for many to enjoy. No need to explain that these are allergen-free versions of holiday favorites. Just bring and share.

-       Often people simply don’t know how to help, what to say, or what to do. If you’re hosting, give instructions so guests can make it easier for you. They may be relieved!

-       Ship key items ahead to your destination. Gluten free bread can be shipped direct by Udi’s Gluten FreeCanyon Bakehouse (my favorite), or Rudi’s Bakery. Each of these bakeries offers an assortment of gluten free baked goods too, from muffins and pizza rounds to hamburger buns. I sometimes ship ahead a box filled with gluten free pasta, cookies, baking or pancake mixes, and even the raw goat milk cheddar we use instead of cow’s milk cheeses.

-       What about supplements – should you carry them with you? Is it okay to miss them for a few days? Supplements are as important as prescription medications in a biomedical treatment model. But too many can be so unwieldy that compliance fails. I often work with families to trim supplement protocols down. For travel, ask your provider which items you can skip for a brief time. You may be able to get by with just protective supplements like your child’s probiotic (these mitigate inflammation from foods) and digestive enzymes (these can help manage foods your child is avoiding if he eats them by mistake).

-       For food allergy, in addition to bringing your usual medications (Benadryl, EpiPen), consider naturopathic helps too, like activated charcoal, nettles herb, or homeopathic Apis, Urtica urens, or Rhus tox. Ask a naturopathic doctor how these help stop dangerous exposures to allergens in their tracks, and how to administer them.

-       If your child is not anaphylactic, but avoids foods due to intolerance, don’t sweat the small slips. Have chewable enzymes, chewable probiotics, homeopathics or medications on hand to help your child safely digest and excrete foods they should avoid.

-       Plan ahead for rare treats that give your child full inclusion. If your sister’s homemade egg nog is to die for – but full of forbidden ice cream, milk and eggs  – let your child enjoy a cup with cousins, if you know this can be safe, with planned use of appropriate enzymes and probiotics.This won’t work for anaphylactic children, but for those with intolerances, a single transgression may be manageable. Check with your health care provider working with you on nutrition.

For recipes, check out Gluten Free BakingWhole Life Nutrition Cookbook, or Gluten Free Italian Cooking – a few of my go-to books for baking and cooking at holiday time. My own book Special Needs Kids Eat Right includes an egg nog recipe for those avoiding dairy and soy. Here’s to a happy and minimal stress holiday season to all families with special needs!

Simple Nutrition Steps To Help Your Child Sleep

In my pediatric nutrition practice, problems with sleep are more common than many parents would like to admit. It can keep whole families awake and exhausted year after year, if a young household member has trouble sleeping. If your child has sleep problems as well as aversions to light, noise, touch, clothing on skin, or varied food textures, sensory integration techniques can calm and organize their nervous systems to promote sleep at the right times. The other part of this equation is supplying the brain and nervous system with the right nutrients for calming chemistry, with helpful foods and nutrients.

Babies and kids normally drop off within 15-30 minutes on their own, once settled into a sleep pattern, and can usually stay asleep. When insomnia regularly disrupts this, the health costs start to mount: Immune function suffers, as can learning and developmental tasking during the day. Cortisol, a stress hormone, will rise and remain elevated at the wrong times, which has many negative effects on metabolism. Try this nutrition checklist for better sleep:

1 – Omit reactive foods. There are three types of reactions to foods: Allergy, sensitivity, and intolerance. Any of these problems can be active at once, and to more than one food. These can impede children for everything from growth and appetite to sleep and mood. It is harder to make calming brain chemistry when the food proteins we use to make it are triggering inflammation on a daily basis, or are poorly absorbed. The good news is, this is very responsive to nutrition care. In my practice, I use pediatric nutrition assessment tools to sort these out; lab testing may be needed, depending on the case. Ask your pediatrician or local naturopathic doctor where to start. If you have a hunch about a triggering food, trial a withdrawal period of at least one month; longer is better. If nothing improves, this may mean other foods were also problematic during the trial. This is when lab tests can help.

2 – Should you worry about gluten? Only if it bothers your child! If gluten sensitivity is active, it can disrupt sleep as well as absorption of many other nutrients. Migraines, poor focus/attention, weaker than expected growth, mood swings, or skin and stool changes can accompany gluten sensitivity. Click here for more on how to tell if gluten free diets and sensitivity screening are for you.

3 – Mineralize! The nervous system depends on a good supply of minerals to run neurotransmitter chemistry. Magnesium is especially useful here. Foods with magnesium include flax seeds, sesame tahini, pumpkin seeds, sunflower seeds, almonds, cashews, and edamame (boiled soy beans). It’s common for kids’ diets to be low in magnesium, or for kids to have allergies to those foods. In that case, give your child a luxurious bedtime bath with Epsom salts (magnesium sulfate) dissolved in the water. Use about a cup in a regular size tub, and less for smaller children bathing in less water. Both the magnesium and the sulfur will be absorbed through skin to enrich liver and digestive enzyme pathways, and calm nerve cell transmission. Add a drop or two of lavender essential oil to heighten the calming effect.

Iron is another key nutrient for sleep; insomnia is a symptom of poor iron status. Iron rich foods should be eaten often: Lentils, chick peas, kidney beans, pumpkin seeds, beef (organic and grass fed if possible), baked potato skins, and spinach. Herbs like nettles or chamomile contain iron and can be sipped as teas too. If these foods aren’t part of your child’s day, add a multivitamin with iron or an herbal supplement like Floradix Iron Plus Herbs. Don’t exceed 10 mg/day without medical supervision, since iron is toxic at the wrong dose. If you think your child may be low in iron, have your doctor screen ferritin and serum iron level in blood.

If you notice your child grinding his teeth at night, zinc may be part of the puzzle. It’s easy to supplement with zinc lozenges or enjoy nuts, seeds, organic pork or lamb, or shellfish, if you eat fish. Children can add 10-30 mg zinc/day if they are low in this nutrient.

4 – Eat more! It may surprise you to hear that not eating enough, rather than eating too much, is something I encounter very often in practice, when I evaluate children’s diets. Kids need a lot more food per pound than adults – they’re growing, and working hard to learn and neurologically integrate all the events of the day. A very general rule of thumb: Your child’s age in years + 1000 = a ball park figure for total calories per day. So, a 7 year old child should have about 1700 calories/day. If that child is very active, this will bump it up even higher. If that child is already underweight, the calorie needs go higher still. Waking at night after falling asleep readily is a sign that bigger meals or more snacks during the day may help your child sleep more soundly. Allow ample healthy fats and oils (coconut, avocado, nuts, seeds, nut butters, olive oil, organic dairy if tolerated, organic meats, and a supplemental fish oil are good sources), plus fresh fruits, whole grains, or calorie dense vegetables like beans, squashes, pumpkin, yams, or potato.

These are just a few steps for deeper, easier sleep. Supplements can help too, but it’s always best to start with food. For more information on using tools like melatonin, tryptophan, 5-htp, or other herbs and supplements for insomnia in children, see the chapter on sleep in Special Needs Kids Go Pharm-Free: Nutrition-Focused Tools To Help Kids Minimize Meds and Maximize Health and Well Being.

Judy Converse, MPH, RD, LD has worked as a research technician, nutrition educator, grant writer, and outpatient dietitian. She has had her own practice in pediatric nutrition since 1999. Her professional path was informed by her son’s many challenges with feeding, growth, and development.  Author of three books, she has created an accredited learning module on nutrition and autism for dietitians and nurses, testified before state and federal lawmakers for safer vaccines, consulted with industry partners on specialized formulas for infants and children with inflammatory conditions, and has also assisted non-profits and hospitals serving children with special needs.

Top Three Nutrition Fixes For School

Those annoying back-to-school ads have already begun, with school looming as close as three weeks from now for many kids, including mine. It’s also the time of year that I get frantic phone calls, like these:

“My son is losing weight each week, is very picky, has Asperger’s syndrome, and the doctor says he’ll need a stomach tube if this doesn’t turn around. We need to do something before school starts” So, the doctor had no particular plan other than to let this child go completely off the rails, and into the GI surgical suite on the first day of school?

“I need testing, we think my son has food sensitivities. No appointment, just a test. I want to bring it to his first IEP meeting.” That’s another blog: Why they may not work very well, and what to do instead.

“If we start now, will a special diet mean she doesn’t need an IEP?” Hmmm.

“They said psych meds for school. But we want to try nutrition first. It has to work before school starts.” Another hmmm.

Nutrition is a process, not a pill; it takes weeks or months to repair the nutrition possibilities that land kids in the realm of needing psychiatric medications, IEPs, or stomach tubes. So the last moments of summer are not the best time to pitch desperate, incomplete, ill-fated measures at a child who faces a big transition just around the corner. But, if you want to try one or two simple measures to settle your student for the changes ahead, these tricks below usually show a benefit within three to four weeks. Don’t expect planets to move: You may see just a glimmer or partial shift in the right direction. But pick one you can consistently stick with from now until the end of summer, and see what happens.

1 – Pump up micronutrients – that is, vitamins and minerals. These have multiple roles in nerve processing and the chemistry of mood, focus, and attention. Most store bought multivitamins for children are just that – vitamins, with few minerals, or only some minerals at doses too low to make up for poor eating patterns. If your child is a picky eater who prefers processed snacks and has a limited intake of fruits, vegetables, whole foods, or good proteins like organic eggs, beans, grass-feed meats, or chicken, switch to a high quality, high potency multivitamin and mineral supplement daily. Look for full potency or even higher for all B group vitamins and zinc; 5-10mg iron per dose; and selenium, chromium, molybedenum, iodine and magnesium to at least a third to one half the daily value. Try VitaTab Chewables from Klaire Labs, or Kirkman Labs Chewable Multi-Vitamin-Mineral wafers. Both are available on line. By contrast, Nordic Berries multivitamin is widely available and popular, but has a mineral content that most likely won’t meet the nutrient needs of a long-time picky eater.

2 – Get the right fish oil at the right dose, and use it daily. Many parents try fish oils, but don’t realize that they are using a dose too low to trigger a benefit for dyslexia, attention, focus, or mood. Clinically relevant doses begin at 400 mg daily for DHA, and 800-1000mg daily for EPA for children. I frequently use more in my practice, preferring a 2 gram (2000 mg) dose daily for mixed omega 3 fatty acids made up of EPA and DHA. Read the label carefully on your fish oil product to see what you are really giving you child – does it measure up? Buy a brand carefully screened for mercury and other toxins, and with a potency guarantee, such as Nordic Naturals or Pharmax. Don’t buy large gel caps for children. Liquid fish oils like Pharmax Finest Pure Fish Oil are easy to give, taste fine if they are refrigerated, and can be taken off the spoon or blended into tart drinks like lemonade or even sorbet-based smoothies with orange juice added. Another option: Gels or pudding-like products like Barlean’s Omega Swirl or Coromega are tasty and easy to use – just get up to the right dose daily. Don’t use cod liver oil at doses over 2 teaspoons, since this can give a child too much vitamin A.

3 – Go for it: No added sugars. Summer may be a hard time to do it, with ice cream, cook outs, popsicles and more, but if you really want to get serious, you might be surprised by what a different child you have on the first day of school, after four weeks of seeing no added sugar. This means not eating foods that have sugar added to them, including soda, fruit juice blends (some are pure juice, many are not), ice cream, frozen treats, baked goods, breakfast cereals, candy, chocolate, granola bars, “energy” bars, muffins, pancakes, waffles, ketchup, chocolate milk, vanilla milk, strawberry milk, purple yogurt - anything that has sugar as an ingredient. And, to make this even harder for you, sugar comes in many forms: corn syrup, maple syrup, maltose, dextrose, high fructose corn syrup, fructose, cane sugar…

Can you do it? At the very least, you will be amazed to see how much refined sugar your child actually eats, once you start looking for it. Most processed foods have added sugars in some form or another, and most kids I meet tote processed snack foods around a lot, for lunches, camps, beach picnics and so on. Replace these with watermelon chunks, blueberries, oranges, clementines, fruit salads with coconut, juices without added sugars, nuts, raisins, or dried pineapple or mango; try avocado chunks with lemon juice, olive oil, and garlic; pita breads with hummus; or naturally sweet drinks like carrot juice or “naked” brand unsweetened smoothies.

Pick one of these to suit your family’s plans for the final weeks of summer, and see what happens by that first day of school. Whatever you pick, commit to it and do it consistently for a solid three weeks, four if you can. Good luck!


Fear-Less Parenting

Can kids survive when vaccines are deferred? Ian and David, now grown, are healthy living proof.

We have lift off. My second book with Penguin/Perigee is out of the barn now, giving me pause for reflection. I never planned to be an author, and don’t remember to refer to myself as one. I also never planned to work with pediatrics as a nutritionist, much less special needs babies and kids. My rotation at a children’s rehab hospital in graduate school was one of the dreariest moments in my training. I thought myself utterly incapable of working with such a needy population.

But here I am. The kids I meet are mostly not living normal lives. They are fraught with seemingly insoluble problems. Most of these are problems that didn’t hit the CDC’s radar at all when I was trained. The document that we worked for then, as public health graduate students in the late 1980s, was Healthy People 2000. Pulling that up now is almost tragi-comic. It certainly validates that Special Needs Kids Go Pharm-Free is needed, that we have to steer a new course for our children. As a cohort, they are the sickest the US has ever seen. They are also the most medicated, and the most vaccinated.

It’s not working. Our health care system truly is failing our children. They have more diabetes, obesity, epilepsy, autism, asthma, rheumatoid arthritis, severe food allergy, Crohn’s disease, developmental disability, and learning disability than ever before.  Some ten million US children have one or more of these problems. Most tellingly, our nation failed miserably at the top two goals from Healthy People 2000: (1) Increase span of healthy life, and (2) Increase Life Expectancy at Birth.  Both have dropped in the last ten years, for the very first time.

There are answers in Special Needs Kids Go Pharm-Free.  These conditions often have treatable nutrition components that our health care system overlooks. We give children drugs when what they may actually need is different food, more food, toxin-free food, some targeted supplementation, or some natural tools to improve digestion and absorption. I have seen miraculous turnarounds in children’s lives with nutrition strategies. It’s not that medications have no place in our children’s lives. It’s that they shouldn’t be every place. Is this all our health care system can deliver?

I don’t think so. It’s time for parents to reach past the prescription pad for their babies and kids. I might call this Fear-Less Parenting – because in order for this colossally profitable machine called Pharma to survive, it needs to keep parents afraid – afraid of disease, afraid of mild signs and symptoms, afraid of routine childhood illnesses.  Don’t be afraid. Follow your instincts as a parent. Read this book. You will be pleasantly surprised at how well your children can be.

Nutrition Solutions You Didn’t Know: Being A Pharm-Free Kid

I'm not sure how to eat these. Anybody? Beuller?

We’d all nod in agreement if asked, “…does nutrition matter for babies and kids? Is it important that they have enough to eat?  Does it make any difference what they eat?” I bet any pediatrician would too. So why don’t we tap that when it comes to helping special needs kids thrive to their potential? After all, these kids are at higher risk for nutrition problems than typical peers – problems that often go unnoticed, and have the power to impede progress.

We can, and this is what I have done in my pediatric nutrition practice for over ten years, working with kids who have asthma, severe food allergy, autism, Down’s syndrome, arthritis, growth failure, feeding problems, ADD or ADHD, clinical depression, and more. On top of that work, I’ve written Special Needs Kids Go Pharm-Free – because even after a decade working with kids, I am surprised that parents still have so little reliable information on how to leverage nutrition-focused tools for a child with a chronic condition or disability. Just as they can for any child, nutrition tweaks can make or break the difference between staying well or getting sick a lot, succeeding versus struggling at school, growing as expected or being stunted, and relying on symptoms-only drug treatments versus ditching the drugs altogether to feel and function even better.

Pharmaceuticals are not a bad thing. But our health care system may be stacked to make these too much of a good thing for our children.  For example, prescriptions to young children for stimulants (like Ritalin) and proton pump inhibitors (reflux medications) – just two types of drugs – have skyrocketed in recent years.  Children are now more medicated and more immunized than ever before – but are more chronically sick and disabled too.  Between 1980 and 2000, a 57% increase occurred in the rate of children with disabilities served by government programs.  In our public education system nationwide, about one fourth of learners are served under the Individuals with Disabilities Education Act (IDEA) – and the increase in number of children served under IDEA has grown at twice the rate of the general pediatric population.  In the same time frame that Americans have used more medications than ever, our overall health related quality of life has declined.

What this means is that our children have become more sick and disabled in the last thirty years, not healthier, and that prescribing more medications may not be helping. Physicians aren’t trained in non-pharmaceutical strategies for disease management in the US, as they are in several other developed countries.  Controversy continues regarding the influence the pharmaceutical industry may wield here on medical training, clinical trials, even medical journal publications – making good information on strategies like nutrition almost invisible.

Gluten free noodle bowl and gluten free pot stickers. No sweat.

Special Needs Kids Go Pharm-Free to the rescue. Affected children are often assumed to be presenting in a certain way because of the condition or disability itself, rather than because of a fixable, nutrition-related impairment.  Here are just a few examples of how nutrition can impact a child with a learning difference, developmental disability, or chronic condition. More examples with strategies to address them are found in Special Needs Kids Go Pharm-Free. These spotlight nutrition problems that have been linked in myriad clinical trials and public health data to learning deficits, growth or developmental impairments, insomnia, psychiatric disorders, or behavior problems in children; others abound in my case files:

-        Children with Down’s syndrome may have gluten sensitivity or celiac disease more often than typical peers. Even in the absence of celiac disease, untreated gluten sensitivity in itself may impede growth, stooling, and functional abilities for a child with Down’s syndrome.  A gluten free diet may help a Down’s child make unexpected leaps.

-        Over a third of boys with Asperger’s syndrome tend to be clinically underweight – that is, their body mass index (BMI) is <10th percentile.  This is a growth pattern deficit that may impair infection fighting, sleep, continence, and cognition.   The only correction: More food!  Healthy fats, easy to absorb proteins that are not inflammatory, good carbs – and plenty of them all.  In some cases, specialized formulas or custom made smoothies can help too.

-        In puberty, low BMI in boys is linked to low total cholesterol.  This is inversely related to testosterone level, meaning that testosterone will rise when cholesterol is too low. Low total cholesterol has been linked to psychiatric disorders, suicidality, and aggression.  Excess testosterone has been noted in about a third of boys and girls with autism; aggressive or obsessive compulsive behaviors showed improvement, in early work treating high testosterone with medication in these children.  Keeping a child’s BMI above 20th percentile, plus allowing ample daily healthy organic fats and oils, are nutrition measures that may help.

-        Any child with a self-limited diet (eats just a few foods) or mechanical problems with feeding (tube feeding, swallowing disorders, oral tactile defensiveness) can quickly become depleted for minerals like zinc, which allows normal appetite, growth, and immune function; magnesium, which helps nerve cell function; chromium, which helps control blood sugar; and selenium, a key antioxidant.  Children with Down’s syndrome in particular should be screened for zinc status.  While a high potency supplement can help, so can slow cooked stews and broths, chock full of vegetables and gluten free carbohydrates like quinoa (a grain that is also high in protein), black rice (higher in iron than regular rice), lima or kidney beans (to add zinc, protein, fiber) or breadfruit and potato (great for potassium).  Adding grass fed beef or free range poultry – organic if you can afford it – will further up the mineral, protein, fat, and calorie content of a crock pot meal.

-        Any child with a self limited diet or chronic inflammatory condition like cystic fibrosis, rheumatoid arthritis, Crohn’s disease, food allergies, or asthma may have sub-optimal iron status – which will make them more susceptible to infections, more cranky, hyper or irritable, less able to focus at school, and less likely to sleep well.  Entrenched iron deficiency (anemia) can leave your child tired, averse to exertion or typical play activities, showing shiners at eyes, and prone to eating non-food items.  Have your pediatrician screen serum iron, ferritin, transferrin, hemoglobin, and hematocrit.  If a supplement is needed, use one that is gentle and well absorbed, like ferrous bis glycinate instead of ferrous sulfate – but only with supervision, as iron quickly becomes toxic to children.

-        Copper is a metal we need in extremely small amounts, and a potent neurotoxin, if too much circulates in a free, unbound form.  High serum copper level has been linked to several psychiatric diagnoses.  Some children with autism may need treatment to reverse copper toxicity and should avoid copper in daily multivitamins; special formulations are available for this purpose.

-        Several studies have documented the presence of opiate-like polypeptides from poorly digested food proteins in autism; these have neurotransmitter effects that can impede language, pain tolerance, stooling, cognition, sleep, and behavior.  Special diets or digestive enzymes that target these proteins have shown promise.

-        Children with autism were found to have four or more GI issues, including histological changes, diarrhea, reflux, constipation, and abnormal endoscopies, about 40% of the time, compared to 5% of the time for their neurotypical siblings, in a study published in Pediatric Gastroenterology.  While some studies countered this finding, debate centers on methodology weaknesses in those studies that “bury” evidence of gastrointestinal problems in these children. In clinically standard nutrition screening in my own practice, I routinely find these problems in children with autism. If your child has a picky, weak, or rigid appetite, vomits undigested food, is dependent on medications for constipation or reflux, has undigested food in stool, can’t move bowels at least three times a week, has more than three loose or foul stools/day, or often presses his stomach on pillows, knees, or furniture for comfort – these signal atypical digestion and absorption that may mean lessened health or functional ability for your child. Several nutrition interventions may eradicate these uncomfortable symptoms and improve the flow of crucial nutrients to your child’s brain, muscles, bone, and organs.

-        Food allergies and sensitivities may go undetected in kids with Crohn’s disease, rheumatoid arthritis, autism, asthma, or other conditions.  Help can be had with correct screening for these, plus plug-ins of hypoallergenic formulas, special diets, or supplements to diminish inflammation.

-        Children with seizure disorders may improve with dietary measures beyond the traditional ketogenic diet.  Lessening inflammatory foods, avoiding neurotoxic trigger ingredients like glutamate, glutamine, phenols, or colorings, or treating undectected bowel infections for Candida or Clostridia are measures that have helped children in my practice with seizures.

Changing how your child eats, using a special diet, or adding targeted nutraceuticals may be a long term commitment for a person with a chronic condition or disability.  But it is a critically worthy one, if it means a child can improve beyond expectations, attend a regular school with no aide, avoid residential care or placement as an adult, have independence or have a job, and contribute to society in what ever way their unique talents and gifts allow.   I have witnessed all of these outcomes in persons with disabilities because of nutrition interventions.  This is not new, not novel, not even alternative – it’s simply engaging what we already know to be evidence-based in child nutrition. Any parent can start tapping these tools anytime, with Special Needs Kids Go Pharm-Free.

Judy’s Clinical Practice