nutrition solutions — beyond diets: march 2014 kids...

Where We Eat — How We Eat

1900 — 2% of Meals Eaten Away from Home

2010 — 50% of Meals Eaten Away from Home

2013 — 20% of Meals Eaten in Our Car

Family Meals 3 times per week

Meals Eaten in 20 Minutes or Less

Family Members Watching TV or Texting While Eating

Nutrition Solutions — Beyond Diets: March 2014

Kids, Tweens & Teens WA-NAPNP Conference

BeNt KINDBLADI:

NUTPITiONIST

Nutrition Solutions — Beyond Diets():

Kids, Tweens & Teens

Beverly Kindblade MS, RD, CD www.SeattleNutrition.com

206-920-7676

Disclaimer & Copyright Notices

Disclaimer: Information presented at this conference is not intended to diagnose, treat or cure any disease or condition. Please consult your physician before changing your diet, supplement and/or medication regimen. The author does not accept any responsibility for injury sustained as a results of following the advice or suggestions contained within this presentation. Information presented is for educational purposes only.

C)Copyright Notice: It has been an honor creating this presentation for your conference. Please do not copy, distribute, or reproduce the content of this presentation in any manner without the written permission and consent of the author, Beverly (Beve) Kindblade, Owner, Seattle Nutrition, 2014.

Br•ertn eindhl..th• MS. RD, CD SEATTLENUTRITION,COM 50,4

1940-2014: Changes in Our Food

Food Safety & Sanitation Food "Processing" & "Refinement" Additives, Preservatives & Flavorings "Enrichment"— Replacing Lost Nutrients "Fortification"— Adding Vitamins & Minerals Hydrogenated Fats - "Trans" Fats High Fructose Corn Syrup (HCFS) Genetically Engineered/Modified (GMO) Foods Modified Food "Starches" Maltodextrins

Poor Nutrition in Kids (Ages 2-12) & Teens (Ages 13-19):

▪ Food Avoidances . Limited Access to Food

Poor Diets . Poor Eating Habits

Lack of Physical Activity ▪ Lack of Appetite ▪Varying Growth Rates for Age


Additional Risk Factors in Child & Adolescent Nutrition

• Nutrient-Nutrient Interactions (NNI) Calcium added to juice & milk alternatives Iron added to breads, cereals & grain products

7 OTC Medications & Supplements ▪ Prevacid and other PPIs= j Iron & B12 Absorption

J Calcium supplements binding up 5O% of Iron

J Drug-Nutrient Interactions (DNI) Metformin= 1 Vitamin B12 and Folate Statins = I Coenzyme Q10 (CoQ10) for cells

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The Top "8" Food Allergies ▪ Cow Milk . Eggs . Peanuts . Tree nuts (e.g. almonds, cashews, walnuts) . Fish (e.g. bass, cod, flounder) ▪ Shellfish (e.g. crab, lobster, shrimp) . Soy . Wheat

Food Allergies & Reactions: Swelling, Hives & Gluten

Other Ways Food Can Affect Kids & Teens

. Weight Loss • Gas and Bloating

• Diarrhea

• Stomach Pains . Anemia

• Fluid Retention

• Abnormal Wt Gain

• Headaches

▪ Rheumatoid Arthritis

• Osteopenia . Chronic Fatigue

• Lack of Appetite

. Nausea Nor Vomiting

Nutrition Solutions — Beyond Diets: March 2014 Kids, Tweens & Teens

WA-NAPNP Conference

Food Intolerances. Children, Tweens & Teens

. Food Intolerances — non-immune system reaction, however, should be considered a medical condition due to symptoms.

• Intolerances to food are often an "enzyme deficiency," such as in lactose intolerance.

. Symptoms include gas, bloating, diarrhea and constipation — there can be others.

Food Sensitivities & Allergies . There are 5 types of antibodies (immunoglobulin)

produced: IgE, IgA, IgG, IgD, and IgM . Production of antibodies to foods is not normal or

healthy . The most obvious symptoms: asthma,

anaphylaxis, hives, eczema, allergic rhinitis • Some symptoms may be delayed but can be

severe and serious . Celiac Disease — an allergy to gluten that is

genetic

It Gluten-Free Diets . Gluten -free food products can be low in

8-vitamins; calcium; vitamin D; iron; zinc; magnesium and fiber

• Gluten-Free refined and processed foods can be high glycemic, high carbohydrate with I calories and low fiber = overnutrition

• Children and teens with either CD or gluten sensitivity often have malnutrition whether they have experienced weight loss or gain.

Beverly Kindblade MS, RD, CD www.SeattleNutrition.com 2

Fatigue — Why Is Everyone So Tired?

• Poor Digestion & Absorption? Iron Deficiency Anemia?

• Low Vitamin B12? Weak Immune System? Lack of Adequate Protein Thyroid Issues?

Nutrition Solutions — Beyond Diets:

March 2014 Kids, Tweens & Teens

WA-NAPNP Conference

Healthy Diets for Kids, Tweens, & Teens

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. Rec: i Fast Food + Processed & Refined foods Solutions - Additions to the Diet: Refer to RD/CD/CN . High-Quality Proteins:

. Grass-Fed, Grass-Finished Meats + Organic Poultry, Pork and Local, Wild Fish & Seafood

. Omega-3 Eggs and Fermented Dairy — Yogurt; Kefir Beans & Legumes

• Colorful Vegetables & Fruits • Sea Vegetables . Healthy Fats:

. Raw, Organic Coconut 011; Milk; Creme (Avoid "Refined')

. Avocado; Grapeseed Oil; EV00 — Organic preferred

. Nuts/Seeds and Nut/Seed "Butters" — Organic preferred

. Omega-3 Fats: Hemp Hearts; Flax; Chia; Black Walnuts

Nutrition Solutions — "Special" Diets nVegan - Refer to RD/CD/CN

• Rec: 1 Vegan processed & refined foods • Solutions - Diet Focus:

• Beans, Legumes, Grains, Nuts/Seeds . Raw, Organic Coconut Oil and Coconut Creme . Colorful Vegetables and 1 Sugar Fruits . Healthy Fats: Avocado, Nut & Seeds & Nut/Seed Butters . Omega-3 Fats: Hemp Hearts, Flax, Chia

• Plant Omega-3 Fats (ALA) Conversion in Humans Solutions — Labs to Monitor Digestion/Absorption: • V Iron Studies Panel; V 25(OH) Total Vit D3; Zinc • V Vitamin B12 as MMA; Folate; MTHFR; & Vit A • NOT RECOMMENDED FOR TODDLERS & KIDS

Vegetarian — Lacto, Ovo, Pesca Diets • Rec: 1 Vegetarian processed & refined foods Solutions - Additions to Diet — Refer to RD/CD/CN . High-Quality Protein:

• Beans Nor Legumes (Main Combinations) • Add Grains, Raw Nuts and Seeds or Nut/Seed "Butters' . Add Milk or Eggs or Fish unless strictly plant-food based

. Colorful Vegetables & Fruits

. Sea Vegetables

. Healthy Fats: . Raw, Organic Coconut Oil; Milk; Creme (Avoid "Refined') . Avocado; Grapeseed Oil; EVOO — Organic preferred . Nuts/Seeds and Nut/Seed "Butters" — Organic preferred . Omega-3 Fats: Hemp Hearts; Flax; Chia; Black Walnuts

n Paleo — No Grains/Beans/Legumes/Refined Sugars . Meat, Fish/Seafood & Eggs . Fats & Oils: cold-pressed & organic

• Avocado Oil; Bacon Fat/Lard; Butter; Raw, Organic Coconut Oil; Duck Fat; Ghee; Palm Oil; Suet; Tallow; Walnut Oil; Schmaltz; Macadamia Oil + EVO0

. Nuts & Seeds: no peanuts

. Non-Dairy Beverages + Herbal Teas, Mineral Water, Water and Coconut Water

• Super Foods • Grass-Fed Dairy; Bone Broth; Organ Meats;

Fermented Foods; Sea Vegetables Low-Glycemic Vegetables + Fruits

. NOT RECOMMENDED FOR TODDLERS & KIDS Refer to RD/CD/CN

Paleo Diets in Teens - Issues . Rec: Must keep daily carbohydrates >175 g/d

Solutions — Diet Focus Nutrient-Dense Sources of Paleo Carbs: . Sweet Potatoes, Pumpkins and Parsnips . Butternut Squash and Winter Squash . Rutabaga and Turnips . Spaghetti Squash and Carrots . Plantain . Lotus Root . )icama . Fingerling Potatoes


Why Nutrition Labs Are Critical?

Labs What It Measures Total Protein & Pre-Albumin Total Iron & % Iron Saturation Ferritin Vitamin B12 Folate Vitamin D (250H) Vitamin K 24-hour Urine Calcium Thyroid (TSH; FT3; FT4) Thyroid Antibodies

• Adequate Calories/Protein . Iron-Related Anemia or Excess • Iron Stores/Inflammation • Absorption/Pernicious Anemia • Anemia/Risk for Heart Disease . Immunity/Bone Health/Weight • Bone Health/Blood Clotting • Calcium Deficiency or Excess • Iodine and/or Selenium

Deficits Autoimmune Thyroid Issues

Iron Deficiency Anemia

• Symptoms . Age & Gender Bias . Weak Stomach Acid (HCI) . Lab "Reference Ranges" Recommended: Iron Studies Panel

Total Iron; TIBC; % Iron Saturation (Goals: 90-135; 250-350; 35-45%)

▪Ferritin (iron stores): Goals: 100-150

Immunity Issues

▪Stress & Cortisol • TT Sugars and Refined Carbs ▪ Nutrient Deficiencies ▪ Lack of Adequate Sleep , Flu Shots . Benefits of Sun Exposure ▪ Effects of Sleep, Laughter & Fun

Nutrition Solutions — Beyond Diets: March 2014 Kids, Tweens & Teens WA-NAPNP Conference

Vitamin B12 Deficiency • Symptoms ti . Age & Gender Bias . Weak Stomach Acid (HCI) ir;\ • Drug/OTC Medication Interactions Recommended Labs & Goals: .., Vitamin B12 >600 (800-1200) 1111 Folate >10 ▪MTHFR Mutations *Negative

Healthy Immune System - 111 Vitamin A & Beta Carotene

▪ Protects the body's skin cells • Protects cells that line the intestinal

tract & lungs against attacks by bacteria, viruses & parasites

. Supports the regeneration of immune cells that maintain the body's ability to fight off infections


Your Immune System & Vitamin The Sunshine Vitamin

. Vitamin D is made in the skin frc cholesterol then stored Pacific NW - June to Sept— your body uses your "stores" the rest of the year.

. Labs: aim for 60 -80 — only labs show absorption & stores of vitamin D

. Vitamin D helps your immune system kill bacteria and viruses & 1 cancer risks

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The Role of Other Nutrients

. Vitamin C and Vitamin E Selenium Copper

• Chromium ▪Zinc • Flavanoids • Carotenoids

Nutrition Solutions — Beyond Diets:

March 2014 Kids, Tweens & Teens

WA-NAPNP Conference

Protein & Immunity

• Protein Goals: to optimize health —revisiting the RDA

• Your body uses protein as a calorie source if calories are too low

• Your immune system depends on high-

quality protein to function properly

Metabolism, Energy & Weight Control Assessing Risks and Issues in Children & Teens

•:. Thyroid testing — Optimal "Reference Ranges"

TSH: 0.34-2.0; FT3: 3.5-3.75; Free Thyroxine: 1.0-1.15

• Thyroid Antibodies & Immunity

Anti-Thyroglobulin: Lab Goal: 0-4 IU /mL

Anti-TPO: Lab Goal: 0-9 IU/mL

Nutrition Interventions: Strengthen Immunity

Iodine & Selenium Deficiencies

When To Refer to an Endocrinologist?

Issues in Children & Teens: Obesity Nutrition Solutions

. Eat Breakfast!

. Eat Protein Foods 1 st at Meals & Snacks ▪Chew Food Until "Liquid" in Mouth

Before Swallowing • Avoid Beverages with Meals & Snacks • Decrease Stress & Distractions

Issues in Children & Teens: Nutrition Solutions

• Heart Disease & Hypercholesterolemia . Avoid Cottonseed Oil and Palm Kernels Oils

n TT Omega-3 Fat Sources — especially fish oil

. Add Plant Omega Sources — Hemp Hearts, Flaxseed & Chia Seeds

• Consider CoQ10 as Ubiquinol-QH at bedtime

• Decrease Grains and Grain-Fed Meats to Omega-6 Food Sources that Promote Inflammation


Issues in Children & Teens: Inflammation Nutrition Solutions

. Hypertension • High Sodium and Low Potassium Issues . Low Dietary Magnesium

Solutions — Diet and Sea Salt Fresh Vegetables & Low-Sugar Fruits/Fresh Juices

• Nitrate-free Bacon, Deli Meats

• Sea Salt Contains 80-90 Minerals To j BP

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T2DM — Solutions for Kids & Teens *Diets & Beyond Diets*

• New Focus for Diabetic Diets? • How does body respond to foods?

a J blood glucose; I fluid retention ? • Goal: Food Sources of Inflammation

. Food Cravings • Sugars and Carbs = Need to Increase Dietary Protein

• Eat protein foods i st to stimulate CCK = 11 appetite • Cravings for Red Meats = Iron-Def Anemia

▪ Cravings for High-Fat = II Healthy Fats, esp. Omega-3 Fats

Nutrition Supplements -I"

• Self-Prescribing & Patient Education • "Total Omega-3 Fats" (Back of Labels) . Fish oil vs. Plant Oils- Flax, Hemp, Chia • Vitamin D3 vs. Vitamin D2 • Multi Vitamin/Mineral Supplements ? . Vitamin B12 —"Sublingual Methyl" B-12 . Iron Supplements — "Time-Release"

Supplement, Medication & Nutrient Interactions

• Iron/Calcium Supplements • Thyroid Medications • Cholesterol Medications • Statins and CoQ10 • GERD & Reflux Medications

Case Studies: 2012-2014 Case Study #1: Malaise with Fatigue in Teen

• Pesco Vegetarian Diet w/Abnormal Weight Gain

• Nov 2012: TSH: 16.820; FT3=222; Free Thyroxine:1.21

• July 2013: TSH: 7.98; FT3=Q; Free Thyroxine:1.07

Anti-Thyroglobulin: >2510; Anti-TPO: 89 (Hashimoto's)

• Sept 2013: TSH: 0.827; FT3=3.5; Free Thyroxine: 1.23 Ferritin=3814. (Goal: 50-90); Vit D: 31.2 (Goal: 50-60) Meds: Synthroid Cytomel Diet: Low Inflammatory; High Protein; Healthy Fats; I Fiber Supplements: Fish Oil; ThyroMend (Kelp); Time-Release Iron; 27 mg/d; Vit D3: 5000 IU/d



Issues in Children & Teens: T2DM Nutrition Solutions

. T2DM • Determine How Individual Foods Impact

FBG/PPBG • Add Foods to Lower Inflammation . Trial Diets

. Food Elimination Protocols

• Foods that Stabilize Blood Sugar


Case Studies: 2012-2014 Case Study #2: Severe Dairy Allergy • 19 yo w/ weight loss; severe acne- entire

body; nausea and fatigue; 5' 9" ; 115.8#

• +1 — IgE to Dairy — Whey and Casein

• Elimination Diet x 4 weeks: Dairy-Free

• Outcomes: . Day 3: Initial Addt'l Weight Loss of 3.2# . Weight Gain over 4 Weeks: 2.6#

. Acne — Cleared Over Entire Body

• Nausea Resolved within 24 hours

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References & Resources Complete Reference list provided by request: BevelitSeattleNutrition.con

Food Allergy and Anaphylaxis Network: http://wwkvfoodallercw.org Gluten-Free Food Service Accreditation Organization: htto'//www.genydservice.org DHA and Pregnancy Outcomes. Am ) Clin Nut, 2013 Apc97(4):808-15. doi: 10.3945/ajcn.112.050021. Epub 2013 Feb 20. hUlawww.ncbi.nlm.nih.00v/pubmed/234260333 Improved Neonatal Outcomes with Probiotics. Shane AL et al. JAMA Pediatr. 2013;167(10).885-886. doi:10.1001/jamapediatrics.2013.2590 NHANES— National Youth Fitness Survey (NNYFS) + NHANES 2011-2012 Symposium: Vitamin D Insufficiency: A Significant Risk Factor in Chronic Diseases and Potential Disease-Specific Biomarkers of Vitamin D Sufficiency. Journal of Nutrition, 2005. Hornocysteine and MTHFR Mutations, Varga, EA et al. htto://circ.ahajournals.oro/content/111119/e289.full Linus Pauling Institute, Micronutrient Information Center, Oregon State University: tmillpi oregonstate edujinfocenterAdflarnmabon.htrn1



Case Studies: 2012-2014 Case Study #3: T2DM • Feb 2012: 575 11/2"; 186.3# . FBG: 180-200+; HbA1c: 6.1-7.3% • Meds: Metformin; Glypizide; Omeprazole;

Simvastatin . May 2012 - Interventions: 7 Day Diet Trial© +

Low Inflammation Diet . Outcomes: May-June 2012

. 13.5# wt loss in 4 weeks

. FBG: 84-105; HbAlC: 5.9%

. Oct 2013 — maintaining FBG: 85-90; 40# overall wt loss

2014- Changes in Healthcare

Nutrition for Prevention and Wellness Essential Nutrition Benefits — 100% Coverage Obesity Prevention Chronic Disease Management

Thanks for Attending Today!

• Seattle Nutrition - Questions ??? ▪Call Beve @ 206-920-7676 ▪ Evening & Weekend Appointments a Accepting New Patients a Accept Most Health Insurance Plans ▪ www.SeattleNutrition.com


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