Photo Credit: Eric Striffler Photography

My 4½-year-old son Jack has been complaining about his tummy hurting for some time now—about six months. At first I didn’t think much of it. We have a pooping family, and as I’ve come to realize, “my tummy hurts” for a 4½-year-old can be mistaken for hunger, eating too much, or needing to pee. Instead of being overly cautious (I definitely have neurotic tendencies), I watched for about six months. I might add that we are talking about a kid who has an above average healthy diet so I felt fairly okay with my choice. But once I started noticing soft, red-gray circles under Jack’s eyes, I knew I had to put on my detective’s hat!

Clue One: gas, frequent bowel movements
Clue Two: soft, red-gray circles under eyes

In instances like this, conventional medicine typically prescribes unnecessary poking and pills as the first course of action. But for me, it was clear that dietary action was a must! It was the only thing I could control. I wanted to tap into my resources before taking him to the doctor. I must say that I had a brief moment of panic realizing that there was probably a problem, albeit a manageable one, with my kid’s diet (or possibly something else). He’s my baby, he’s got the tummy blues, and I want to make it better… NOW!

The first step to solving the tummy blues was identifying the symptoms. Once identified, I created an elimination game plan. If necessary, seek immediate assistance from an integrative doctor (who will typically look at dietary change as the first course of action) or qualified nutritionist (another very wise choice). If I were not a culinary nutritionist, I would have done just that!

My elimination game plan:
1. Identify the possible culprit(s).
2. Explain to my child what’s going on and what I plan to do.
3. Remove the culprit(s) from the diet for 2-3 weeks.
4. Rebuild the gut with Aloe vera juice and probiotics (both healing and restorative) making sure to confirm supplemental gut support with a healthcare provider (in my case, a close colleague—and registered dietitian—who specializes in supplementation).
5. Keep a diary noting symptoms or hopefully lack thereof.
6. At the end of the removal period, add the culprit back into the diet and watch for the return of symptoms. If present, avoid that food. If not (and no other culprits are suspected), seek further advice from a healthcare provider. If more than one culprit exists, add one at a time (over a three-day period) and watch for symptoms. If none exist, start with next item (noting that first item is safe to eat). If symptoms do exist, remove the item again from the diet, wait five days, then add the next culprit. Repeat as necessary.

I decided that wheat was my culprit (although I keep a fairly gluten-free home, Jack does eat wheat in some form or another daily). Even though he’s 4½, I feel very strongly about talking to him about matters related to his life. One morning I pulled my little dude aside and said, “We want your tummy to feel better, right?” He gave me a nod. “And you know that I want to do whatever I can to help you feel better, right?” Another nod. “I think that foods that contain wheat, like breads, pasta, pretzels, cookies, and cakes are making your tummy hurt.” He said, “I don’t want to eat those foods anymore, Mom.” Of course he didn’t want to eat those foods anymore, but he would still want them. I continued, “This is the deal, you can still have all of those foods but they will be special foods that I will give you. Mommy will do it with you.” With a slight smile, Jack added, “It’s like our special adventure, right Mom?”

And that it was. I took him to Whole Foods to pick out all the wheat-free products that he wanted to try. Although challenging at times (what do you expect?), we left without too many breakdowns. I must add that my extreme side wanted to start with the removal of gluten, but my practical side said, “Stef, you may not need to go there, so start simple and if you need to take it a step further you can.” I find that talking to myself often helps, even if out loud in public places!

We started the wheat-free challenge, and for the first few days there was no change. In fact I felt as though things worsened a bit (usually the body detoxing). Then, there seemed to be some improvement over the course of the next two weeks; however, not enough for my liking.

The next step was to try a gluten-free diet. I was ready to go there, but there was reason for me to believe that he could have celiac disease, the inability to digest the protein (gluten) present in many grains. I contacted his doctor and she suggested we screen him with a series of blood tests before he went off gluten. When screening a person for celiac, the most common tests taken are antibody tests (IgA and IgG). If a person is already on a gluten-free diet and has their blood taken, the test will be negative for the antibodies.

Jack was a champ during the test, and luckily the results were negative. No celiac! But the tummy blues kept on singing, and I was determined to turn that music off! So, back to my game plan. This is where I am now: I have identified additional culprits and continue to forge ahead to make my baby better! We have yet to see what this journey holds. It is a process, something that I do day in and day out with others, and at this moment it is hitting home.

Obstacles are put in our way for a reason (although sometimes I am not totally convinced of that). The tummy blues are solvable and manageable. Just take a step back, create an elimination game plan with the help of a healthcare provider, and follow the plan. I would love to tell you it is easy, but it is not. Clear goals, objectives, communication, and support will help you get from A to Z as smoothly as possible.

I will leave you with this, I recently had a discussion with a pediatrician colleague of mine and he reminded me to look at the mind and gut as one, a very important component to solving and managing the tummy blues.

I love gummy bears! And, quite honestly, over the years, I have become a self-proclaimed gummy bear connoisseur. A family friend introduced my brother and me to Haribo gummy bears when we were kids. And ever since, I have had a love affair with those colorful, chewy (but not stick to your teeth chewy), sweet yet tangy little loveable bears.

What’s wrong with this picture? Right, a culinary nutritionist who has devoted her life’s work to teaching people about health supportive food lifestyle is talking about her love of candy. Well, maybe that’s not such a bad thing?

I just wrote an article for my holiday newsletter entitled You and Your Kids: How Much Health Food is Too Much? An excerpt:

I picked my older son Jack up from school the other day to find him wearing a necklace made of Frootloops (artificially colored “cereal” that is literally the bane of my existence). OK, I will openly admit that I took a slightly not-so-silent gasp as he ran over to me filled with pride over his creation. I pulled it together just in time to meet his enthusiasm with a smile at the same time thinking, “OMG, my kid is wearing a necklace made of “food” with carcinogenic dyes.”

So, that evening Jack’s  culinary nutritionist-mom (me, that is) decided to email his teacher to “just throw out there” that in the event that she has food related activities in the class, I am happy to make suggestions for the healthiest products on the market to use (ie. New Morning Fruit-e-O’s versus Frootloops). I received a very nice e mail back from her stating in not so many words that to teach kids about what is healthy, they also need to experience what is not healthy. Point taken.

This whole experience triggered a very important thought process for me: How much “health food” is too much? A weird question posed by a person who devotes her life to teaching people about eating healthfully. But, at the same time a very important question to ask and address. And one I deal with every day in my work and personal life.

First, back to the gummy bears. Yes, Haribo does have those carcinogenic dyes* in them, the same ones that Frootloops have, but I have come to the conclusion, after wearing many different food lifestyle hats, that a little junk can’t hurt. In fact, it is actually healthy. OMG! What a weird thought! Even so, I must add that I do have a little Jewish guilt when I eat those dyes (which comprise less than .1% of my diet).

Second, I will have you all know that I love kale! It is an acquired taste for some but raw and if cooked just right, it’s delicious (and filled with all that good stuff our bodies need). I love it raw in salads (finely chopped); sautéed in olive oil and garlic with a little lemon; and roughly chopped with onions and cooked in a little olive oil, broth and white vinegar with a touch of salt.

So, I guess the big question is (and appropriately so post-Holidays): How do you balance junk food with healthy food?

Firstly and most importantly, I want to point out that it differs for everyone. To some, junk foods are chips, candy, cookie, cakes, beverages and more that are made with “fake” ingredients (dyes, flavors, sweeteners, preservatives) and to others junk foods are the same foods with natural ingredients. To me, the first is SUPER JUNK and the latter is JUST JUNK. My choice: SUPER JUNK is for once in a while and JUST JUNK is OK in small doses everyday.

I am big on Conscious Eating. And the way I encourage my clients to become conscious eaters is to keep a food diary. They eat, write down what they are eating then look at what they have eaten. After about two days, they don’t like what they see. Thus, they start thinking about what they are putting in those precious bodies of theirs. So, just a little suggestion for all of you who want to assess the “candy” (junk food) and “kale” (healthy food) in your food lifestyle:

• Keep a food diary for one week

• When complete, highlight “candy” in one color and “kale” in another

• Assess the results, determine what you want to change and write it down

• Then ask yourself, can I replace any of the “candy” with the “kale” or can I replace the SUPER JUNK with JUST JUNK (the healthier JUNK choice)

Life is about balance. Moderation is my mantra!

I can’t end this article without adding that I have finally found the perfect natural and organic gummy bear thanks to Yummy Earth! It is even better than Haribo. My SUPER JUNK is now JUST JUNK. I can have my candy and eat it too, all guilt-free!!!

Finally, for those of you who love “candy” (literally), check out www.naturalcandystore.com. An amazing resource!

*The FDA will argue that food dyes are GRAS—Generally Recognized as Safe. Don’t know about you, but I want to eat (99.9% of the time) things that are safe versus generally recognized as safe?

Why I Dread my Kid’s Mealtime

I remember thinking every day (if not almost every moment) when I was pregnant that I hope that I have healthy kids with no major medical concerns. I think all parents do that. However, do we ever think about the smaller things that could perhaps go wrong, the very basic things?

On October 7 2008, my second son, Hunter James Dec (my married name) was born with a heart-shaped tongue (how cute!?). My husband was the first to notice it. We quickly learned that our sweet little boy was tongue-tied. Our pediatrician assured us that there were very few instances where there is a functional problem. Translated: we didn’t have to worry. Phew!

Hunter seemed fine when breast-fed but when bottle-fed (I had to stop breast feeding after four days due to personal medical issues), the formula poured out of either side of his mouth. And it took him over an hour to drink 2-3 ounces.  At his one-week check up his weight was down and upon observing Hunter feed, our pediatrician told us that his frenulum (that small band of tissue that connects the underside of the tongue to the floor of the mouth) needed to be clipped. Ok, so my kid had no major diseases, but he COULDN’T EAT!

So, at one week old, Hunter was clipped! Yes, feeding improved but not by much. Formula still poured out of his mouth and he took forever to drink the smallest amounts. As we soon found out, he had problems coordinating sucking and swallowing (apparently not connected to being tongue-tied?). Although he would eventually grow out of (as per our doctor), I couldn’t sit by and watch my kid struggle eating if there was something I could do to help. At my persistence, we were referred to a myofacial pathologist who taught my husband and I how to help Hunter eat. And, after almost four months Hunter was able coordinate his sucking and swallowing on his own. Yippee!!!

Onto solids. Whereby my older son started eating solids at four-months (and eating everything under the sun), Hunter wouldn’t even entertain the idea until 7 months. For the first month or so he would gag and throw up most of what he ate. I am the culinary nutritionist here, so I am supposed to know what to do, right? Well, all I felt like doing was crying and throwing in the towel (you can’t do that when you have kids!). Were there more problems or did he just hate my cooking? On top of everything, I also discovered that Hunter had geographic tongue, a benign oral condition that gives your tongue a map-like, or geographic, appearance. It can sometimes cause tongue discomfort and increased sensitivity to certain substances. Another complication (albeit small) to add to the mix.

I found myself beginning to dread mealtimes. In fact, sweating them. I put my ego aside and tried jarred food and he seemed to enjoy. Hmm? Jack loved everything I cooked! I kept telling myself, “All kids are different and Hunter has a history of oral issues.” Let go, and take a deep breath! Hunter was going to be my food challenge. Now it was about trying to better understand what Hunter could tolerate and actually enjoy. But, then there were blatant food sensitivities to complicate things even further—citrus and eggs made evident by the onset of eczema after both were introduced into his diet.

So, I may be better equipped than most to deal with a child with food challenges BUT none of that matters when it’s your own kid! I am like many out there—a mom of two who is trying to meet the demands of family (including a dog who is literally my shadow) and part-time work (as well as trying to take care of me). So any complication makes things a little more difficult. But hey, that is life! And I gotta deal with the cards I am dealt!!!

I am in the process of accepting that Hunter is different from Jack (it is hard not to compare the second to the first). And that perhaps the feeding difficulties Hunter had upon birth, the geographic tongue and food sensitivities all contribute to the challenges I meet on a daily basis when trying to figure out what to feed him. I have to keep telling myself, “It is OK!” My kid is surely not starving at almost one year old and 25 pounds. In the scheme of things, this is no big deal for sure!

Although I dread (and sweat) Hunter’s mealtimes, I will still offer some advice (that perhaps I too can take): It is OK to dread your kids’ mealtimes. Just make sure that you are doing all you can to give them the healthiest choices you can within the given restrictions. It is our job as parents to offer our kids a variety of healthy foods to choose from. If they don’t eat, they won’t starve!

I am now the proud mother of two young boys. Jack is almost four years old and Hunter is 9 months. After Jack was born I went through a major adjustment period, as do all new moms. However, after Hunter’s birth (that being NOW), I am finding this need to redefine myself both personally and professionally.

Many many years ago (like 25), I wondered why the doctors I visited (all too frequently) for my asthma and allergies never questioned if my food intake was affecting my health. Around that same time I started cooking in a local health food joint and happened upon a book, Food and Healing by Annemarie Colbin, PhD. I must say my world was rocked. I became convinced that what I ate had EVERYTHING to do with my health (Duh!). Thus, I said no more to these doctors and sought out someone who could not only medicate me if needed, but also look at my diet and other lifestyle factors to determine what was really making me sick.

So, at the ripe age of 17 I had my first appointment with Dr. Sherry Rogers, a pioneer in environmental medicine (what we now call integrative medicine). To make a long story short, she put me on a special diet (to address my asthma and allergies), gave me vitamin and mineral supplements (after checking for deficiencies), allergy shots (after testing for allergies) and one or two medications (rather than the 5 I was on).

Let’s talk about the diet. Thank goodness I worked at a health food store, was passionate about food and food products and loved to cook. Compliance was easy. And what was a necessity (food lifestyle change to support my health) soon became a bleeding passion (bordering on obsession at times) and the center stone of my personal journey.

But, what if I didn’t have that knowledge and interest? How could I have changed the course of my health? This question sat with me for many years. Fast forward to 1997 when I entered culinary school. Soon after I graduated a dear friend’s father became ill with lung cancer and asked me to cook for him. This led to others. But because I wasn’t a huge fan of private cooking (too isolating for me), I figured that there had to be another way to help those in need of food lifestyle change.

New business idea! Bridge the gap between a practitioners’ dietary recommendations and what the client can and will do to implement the suggested changes—bring the nutrition prescription to the living kitchen. I traveledv this road personally, so why not turn it into my profession? By 2003 I felt comfortable calling myself a culinary nutritionist. I was a professionally trained chef and had a Masters degree from Columbia University. So, this brings me to my question: What is a nutritionist and who is qualified to call themselves this?

In the process of redefining myself professionally, I have been asking myself this question daily. I am a chef with a Masters in nutrition. Does that qualify me? Would I have been qualified if I did a 6-month program in NYC? As far as many registered dietitians (those who study nutrition—Bachelors, Masters or both—then go through an internship with clinical, food service and community rotations) are concerned, neither is enough to wear the “nutritionist badge”. I beg to differ. I believe the answer truly lies with the consumer (yes, that is YOU!). But, you must be an educated consumer!!!

I always like to use this example: When buying a car, a person takes the time to research the make, model, take it for a test drive, look into financing options, etc. So, why don’t we take the same measures when seeking a nutritionist (or other healthcare provider for that matter)? Research a potential healthcare provider as you would a car. They work for you thus it is your job to seek out your best match and “hire” them to support you in the best way possible.

As a patient, I always follow these guidelines:

-Identify my healthcare need

-Go to the people I know and trust (especially my current healthcare posse) and ask for suggestions

-Research suggested provider on web (formal education—and you need to decide what is formal enough for you to make him/her credible; philosophy; scope of services)

-Make sure that the provider is doing what he/she is qualified to do (I once worked with a woman with cancer whose yoga instructor prescribed herbs for her that were contraindicated to the medication she was on for cancer—bad news!!!). You can find this out by speaking to potential provider, other patients on the web (if he/she has a website).

-Make sure provider is not claiming to be everything under the sun (which can be the case and is just not possible). Again, you can find this out by speaking to potential provider, other patients on the web (if he/she has a website).

-If possible, speak directly to provider prior to arranging appointment

In the end, it is up to you to decide whom you want to partner with on your road to wellness. An educated consumer is the best consumer. And, asking the right questions will ensure that you are working with the right person for you.

As for me, although I am always and will always be redefining myself both personally and professionally, I am comfortable calling myself a culinary nutritionist given my formal training. In the end, I know what I know and I know what I don’t know! (And when I don’t know, I refer out to tried and true colleagues).

It is not often that I find time to read. Typically I put books, magazines and newsletters in a pile and throw a few in my bag wherever I go thinking that I may catch a moment to read while waiting for one son while at a swim lesson, while the little one naps or perhaps at a red light!

So, excuse me if you have all heard about this before me, but I recently found out that our trusty supermarkets have now decided to implement their own nutrition profiling system—in the form of shelf-tag programs—to help shoppers identify healthy foods. What a great idea! NOT!!! There are several (five so far) different profiling systems and each is using different criteria to determine how healthy a food is (there are no regulations for these systems as of yet). Like we weren’t confused enough! And according to one system, Frosted Flakes is considered a smart choice. What?!

Is this going to make shopping easier for Americans (no need to read ingredient lists or nutrition facts labels anymore) or more confusing? Because each system has different criteria, I believe it will be far more confusing for a person to navigate the grocery store. My advice: stick to the ingredient lists and nutrition facts labels.

To make myself totally clear, we are talking specifically about packaged foods from bags to cans and everything in between.

Ingredient Lists

Let’s first talk about ingredient lists. The longer the list, the more processed the food is (less whole). So go for the shorter list. And, keep in mind that the first ingredient is of the highest quantity in the food product and the last ingredient is of the least. So if sugar (or some form of like corn syrup) is number one or two, the food has tons of sugar! Make sense? When it comes down to the actual ingredients, I tell my clients to lookout for the following:

Artificial Colors

FD&C Colors (Food Drug and Cosmetic Colors) are a wide variety of artificial colors used to color food (as well as drugs and cosmetics). Colors are typically a derivative of coal tar, a thick liquid or semi-solid tar obtained from coal. Main concern about coal tar derivatives is that they cause cancer in animals as well as allergic reactions. Found primarily in processed foods (candy, confections, cereals, puddings, jelly, hot dogs, imitation foods, condiments, soft drinks, etc.).

-FD&C blue no. 1/FD&C blue no. 2
-FD&C citrus red no. 2
-FD&C green no. 3
-FD&C red no. 2 (in Canada and Europe ONLY)/FD&C red no. 3/FD&C red no. 40
-FD&C violet no. 1
-FD&C yellow no. 5/FD&C yellow no. 6

Although all colors are permanently listed for use in foods and drugs with the FDA, their safety is not fully proven (inconclusive data).

Artificial Flavors/Flavor Enhancers

There are approximately 1500 synthetic flavorings added to foods. Most often food labels say “artificial flavors” rather than listing the individual synthetic flavorings (because they are typically flavoring compounds that are proprietary “recipes”). Flavor enhancers, such as Monosodium Glutamate (MSG), common in Chinese food and many processed soups and sauces, can cause headaches, chest pain and numbness. Although MSG is on the list of additives needing further study it is still considered Generally Recognized as Safe (GRAS) by the FDA. Just as MSG is GRAS so are all of the 1500 synthetic flavorings.

Artificial (and not so artificial) Sweeteners

Artificial sweeteners refer to a group of non-nutritive, low-calorie sweeteners all with individual properties and concerns (see article in Articles of Interest on subject). Included are:

-Aspartame
-Acesulfame K
-Neotame
-Sucralose (Splenda)
-Saccharin
-Sugar alcohols (sorbitol, xylitol, mannitol…)
-Tagatose

High Fructose Corn Syrup

Also called dextrose, this sugar is a sweet syrup derived from corn and highly processed. Most commonly comes from genetically modified corn. It is cheaper than natural sugar. Contained in large amounts in processed food and thought to contribute to the obesity epidemic in our country.

Preservatives

Preservatives, unless natural (such as vinegar, citrus and salt), are synthetic chemicals used to preserve food and beverages. Generally Recognized as Safe (GRAS) by the FDA, these substances do not need pre-market approval:

-Calcium Propionate
-Disodium EDTA
-Nitrates/Nitrites
-Potassium Benzoate
-Potassium Sorbate
-Sulfur Dioxide
-Sodium Propionate

Trans-Fat

Also called hydrogenated oil, trans fat is liquid oil made partially solid by adding hydrogen gas under high pressure to liquid oils. Trans fat is cheap and increases the shelf life of food (that is why the processed food industry loves it) yet, it has been found to greatly contribute to raising the levels of fat in the blood thus raising cholesterol.

*Information taken from A Consumer’s Dictionary of Food Additives by Ruth Winter, M.S.

A pretty long list, I know. But, put your antenna up and leave it up. Soon the label looker outer in you will be second nature!

Nutrition Facts Labels

This is that chart-like thing on the back of all packaged foods. What is critically important to know is that to make any sense of the label you must first look at:

-Serving size (like how many cookies are considered ONE serving!)
-How many servings in package

If you don’t get that down first, nothing else will make any sense. So, once you know the serving size then you can better understand the calorie, fat, carbohydrate, sodium and fiber distribution. And, why is all of this important? Well, some information may be important to one person but not to another. You can visit http://www.cfsan.fda.gov/~dms/foodlab.html#twoparts to get finer details on the nutrition facts labels.

What do I concern myself with? Mostly the ingredient list—I don’t want to put junk in my body; and from the nutrition facts label I always lookout for the salt content (I have to manage a kidney disease) and whether or not a food has trans fat (see above). Sometimes when I am feeling a little “over my normal weight” (as in trying to lose my baby weight) I keep the calories and fat in mind.

That being said, I like to think of myself as a “food product watchdog”. There are over 15,000 new food products introduced yearly. It is utterly exhausting to keep the pace as a consumer. So, keep this information in mind as you try to navigate your way through the maze we call a grocery store.

If you have specific questions, feel free to e mail me at sbs@stefaniesacks.com.