Low Carb Pediatrician

As parents, we have all struggled when it comes to feeding our children healthy food. Certainly, there are children who simply need to be reminded who is in charge – you!! Removing refined sugar, wheat and corn from your home is an excellent start. This will help to accomplish two things. First, your child will not be watching other members of the household (siblings, parents, etc.) eating the junk food. This will help YOU to set a good example. Remember, they watch everything you do! Second, when your child refuses to eat the REAL food you have prepared, you won’t be tempted to cave-in and feed them junk food.

Also, remember, there are children (particularly toddler-age and preschool) who will have varying appetites at any given meal and sometimes during a given day. Some children will eat 2 bites at one meal and devour the next. This is a normal feeding pattern for many children. If your child tends to eat this way and he/she is growing at a normal rate, be patient and avoid a power struggle when he/she has a poor appetite.

Food generally tastes good for one of two reasons. Either it is extremely sweet (often the items we are trying to avoid) or there is healthy dietary fat (saturated and monounsaturated) in the food. This is why cheese with butter or berries with heavy whipping cream taste good! Be sure to look at the low carb/paleo recipe books for ideas on this.

Two of my recent favorites, are Kate Evans Scott’s books Paleo Kid Snacks and The Paleo Kid. She recommends a couple of “Tricks of the Trade” that I really like. If your child is just too busy to stop and eat, trying to put him in a high chair or booster seat often fails. Instead, as she recommends, “The best trick for the busy child is to set out a plate of food where they can see it and graze.” These children will often grab a bite while they play.

Some children take picky eating to a whole new level. My wife and I have dealt with this in our home. We learned early on to use a bit of reverse psychology. In her book, Kate Evans Scott calls it the “My snack” trick. In her words, “Instead of sitting down with a turkey-pesto rollup and telling her to eat, quietly make the dish and sit down with it yourself. Relax, grab a cup of tea, and enjoy your delicious snack. Soon enough, you are sure to have your daughter up on your lap asking what you’re eating. Say, ‘Oh, it’s a rollup.’ Take a bite and look like you really enjoy it, but don’t push it on her. When your child asks if she can have a bite say, ‘Hmmmmm… I’m not sure.’ Before you know it, she will be begging for one! If she tries it and doesn’t like it, be patient. It takes about 3 times tasting a new food before a child will become accustomed to the flavor.” I love this trick!

Wow, are these good! My wife whipped these up the other day and they were devoured quickly. Simple to make – whip up heavy whipping cream (can use an immersion blender) until it forms soft peaks. If you wish to sweeten/flavor a bit, add stevia or extract (almond, lemon, vanilla, etc.) to taste while whipping. Place this in a zip-lock bag and seal. Using scissors, cut off a corner of the bag to make a dime sized hole. Place a piece of waxpaper on a cookie sheet or plastic cutting board. Squeeze out half-dollar sized portions spaced an inch or so from each other. Top with your favorite frozen berry! You can eat these immediately or freeze for later.

Looking for some creative ways to feed your children slow carb/paleo food?

Over the weekend, I happened to stumble upon some new kid-friendly low carb/paleo style cookbooks that I want to pass on. Whether you are new to low carb/paleo eating or a seasoned veteran, you will find some appealing food ideas for your children.

First, Sarah Fragoso, author of Everyday Paleo, has a new cookbook out called
Paleo Pals: Jimmy and the Carrot Rocket Ship. This cookbook includes a story about a young boy, Jimmy, who is eating an unhealthy high carb diet. Fortunately, he finds some friends, the Paleo Pals, who show him how healthy and tasty the paleo lifestyle can be! She includes some wonderful recipes as well.

In addition, I discovered Kate Evans Scott’s cookbooks, The Paleo Kid: 26 Easy Recipes That Will Transform Your Family and Paleo Kid Snacks: 27 Recipes That Kids Can’t Get Enough Of. Both books will enable you, as a parent, to take control of your child’s diet and teach them healthy lifelong eating habits.

Finally, if you haven’t picked up a copy of Eat Like a Dinosaur by The Paleo Parents, I would strongly encourage you to do so.

Be sure to check them out!

Milk. Most of us drink it – at home, at school, and at work. Thirty years ago, we were told to lower our fat intake – therefore, many of us opted for skim. For those of us who cannot stand the taste of skim, we go for 1% or 2%. Aside from limiting fat intake, low fat milk has fewer calories. And a calorie is a calorie (sarcastic wink). As quickly as we are able to, we have our children drinking the same. It’s healthier, right? Plus, who wants to buy 2 or 3 different kinds of milk? Who drinks whole milk anymore?

I do. My family does. My patients who listen to me do as well. We know that a calorie is NOT a calorie. We know that low fat is a BUST when it comes to maintaining a healthy weight status and a foundation for wellness.

Let’s examine the path that too many children follow when it comes to milk consumption. First, most parents and healthcare professionals are aware that breastfeeding is the preferred method of feeding newborns. Breast milk is the superior source of nutrition for newborns and infants. If we are unable to breastfeed, we choose a formula which is similar in terms of fat composition to breast milk. Even the companies who make our formulas acknowledge breast milk is preferable. Accordingly, each likes to portray its product as the closest thing to breastmilk with the exception of, well, breast milk.

Once our children reach 12 months, it is common to switch from formula or breast milk over to whole milk. It is cheaper and the G.I. tracts of our infants are better able to tolerate cows milk at that age. Pediatricians recommend using whole milk from 12 months until age 2. The reasoning behind this is to ensure adequate growth and central nervous system/brain development. After age 2, the prevailing consensus is to switch to a lower fat milk (2%, 1%, or skim).

Next, let’s look at the fat content of each type of milk (listed in g/100ml)

1. Human breast milk – 4.5g (average)
2. Standard formula – between 3.5 and 4.5g
3. Whole Cow’s Milk – 3.8g
4. 2% Cow’s Milk – 2.0g
5. 1% Cow’s Milk – 1.0g
6. Skim Milk – 0.3g

Is the change to a lower fat milk truly beneficial for our children? Does low fat milk limit BMI growth velocity? What do we really know about CNS/brain development that would lead us to believe 24 months is an appropriate point to limit normal diatary fat in a child’s diet? Have you ever wondered why, when it comes to fat content, it makes sense to suddenly deviate from nature’s best (breast milk) in our preschool age children? I’ve wondered. Likewise, how does this change alter the growth patterns and developmental course for our young people? I wonder about that too.

Now lets look at what evidence is currently available. With regards to growth and specifically weight gain, we know that there is overwhelming evidence that normal dietary fat is not the culprit in our child obesity pandemic. The evidence, in fact, points to fast carbohydrates and sugar. Since milk is a major dietary constituent for most children, shouldn’t we closely examine the “low-fat milk” theory? One recently published study does just that:

Longitudinal Evaluation of Milk Type Consumed and Weight Status in Preschoolers

As the study indicates, consumption of low fat milk is associated with weight gain and BMI increase. Increasing fat content in the type of milk consumed was inversely associated with BMI score. Since this is a cohort study, there is plenty of room for interpretation. Accordingly, in the discussion section of the study, the authors hypothesize that perhaps parents of overweight children were more likely to use lower fat milk. However, further along in the discussion of the paper, the authors do acknowledge that there is “prospective research which associates whole milk intake with lower BMI than low-fat milk intake. At least theoretically high-fat milk intake may result in less weight gain if its consumption leads to an overall decrease in calories consumed. The presence of fat can induce satiety through the release of cholecystokinin (CCK) and other factors. This could potentially lower appetite for other calorically dense foods…”

The results of the study and its discussion should not surprise anyone who has kept up with the latest in nutritional research. We understand the basic physiological principles at play. Normal dietary fat does NOT activate release of the the fat storage hormone insulin. In addition, it does mediate satiety through CCK and leptin (which act synergistically to reduce body weight). The idea that whole milk would decrease BMI growth velocity makes perfect sense. The study supports this and certainly is a good starting point. In order to determine the longterm impact on BMI change of low-fat vs. whole milk consumption in our children, we need to conduct controlled studies – studies that, to my knowledge, have not been performed. Alas, given the declining health status of our children today, this particular RCT is long overdue.

One final point which I would like to include in this post. Let’s consider central nervous system (brain) development. In the past, changes in CNS development have been difficult to measure throughout childhood and adolescence. Progress in safe longitudinal neuroimaging (MRI) in recent years provides a wonderful opportunity to gain insight in the anatomical and physiological changes that take place. The development of a child’s brain certainly continues well past the age of 24 months. A preponderance of recent evidence suggests a gradual maturation during late childhood and adolescense. Understanding the cerebral cortex, its thickness and, more importantly, the trajectory of change in the thickness continues to be a central focus in neuroscience. Certainly, normal rates of myelinization would be essential to the workings of neural circuits and understanding deviations are crucial. Inborn/genetic factors certainly play a role. Environmental factors such as proper sleep and exercise are vital. But let us not forget the function of dietary lipid. Dietary fat intake has long been established to enhance myelination of cortical nerves. Although extremely complex, early research in variations of cortical thickness and altered rates of myelinogenesis would imply changes in cognition, emotion and behavior.

The crickets have been chirping on this blog for quite some time!  Let’s end that today.  First, thanks to the many visitors we receive each day from around the world.  It is my goal to provide the groundwork for a healthy generation of young people.  I passionately feel our children deserve every opportunity to learn about eating REAL food which will provide them with a lifetime of optimum health and energy. Likewise, my sincere gratitude to those who have supported me at lowcarbpediatrician.com!  This blog truly would not be possible without the encouragement of some amazing people.  I look forward to sharing information that has continued to benefit the patients in my practice and enabled these young people to be the best that they can be.

I want to highlight the results of a well designed study looking at overweight children using a low carb diet (also known as a ketogenic diet) . The randomized controlled study, which took place in Greece, included 58 patients who were followed over the course of 6 months. Half of the patients were placed on the low carb diet and half were placed on a low fat, calorie restricted diet. In addition to weight loss, metabolic indices were followed. It should come as no surprise as to which group came out healthier (and also less hungry!) We can add this to the growing body of evidence which clearly concludes low carb to be a much healthier and sustainable lifestyle change for the increasing number of overweight/obese children in our society. I continue to work with these families in my office – they are as excited and motivated as ever!

I hope you have a peaceful holiday season!  Dr. Hoop.

I wanted to take a moment to say THANK YOU to everyone who has been a part of lowcarbpediatrician.com.  I’m excited to be a pediatric voice in building a healthy nutritional future for our young people.  I really enjoy watching my young patients, who have worked so hard, develop a foundation for wellness.  I also wanted to pass along a great article from fitness and low carb guru Fred Hahn which discusses a healthy low carb Thanksgiving meal for our children. Happy Thanksgiving!

After delivery, I recommend breastfeeding only from 0 to 6 months of age. I am acutely aware of the pitfalls that breastfeeding mothers can run into. Do the best you can and be sure to seek help from a licensed lactation consultant when needed. Some parents decide to pump and bottle feed only. If you decide to formula feed your baby, that is ok too.

In the past, at 6 months of age, we have traditionally added cereal, fruits and vegetables – predominantly carbohydrate. In particular, the purpose of the cereal is to supply iron. In the interest of reducing your infant’s carbohydrate intake, you have the option of adding meat, fish and egg that is safely prepared to reduce risk of choking hazard. Interestingly enough, there are now recommendations in Canada advising parents on this very issue. ( Here is an alternative link) This may be done soon after 6 months. Although it may require patience and persistence as success will depend on the baby’s sensitivity to the texture of the food. There are many websites which discuss preparing meat for infants. Here is one example. A hemoglobin, which is an indirect way to monitor iron, should be checked at 9 months and can be done in the office. This is a standard American Academy of Pediatrics recommendation and will help ensure that your baby is receiving enough iron for proper development. Have a good day!

“Boy Sleeping On Bull”

Parents have been bringing their overweight children to me for well over 10 years now – desperate for answers. Over that period of time, the number of children that come into my office with an unhealthy BMI has steadily risen – ask any pediatrician and they will tell you the same thing. In the beginning of my career, I can remember repeating the same old dietary rhetoric. “It’s just a matter of calories in vs. calories out,” I would say, or “You need to decrease the fat in your diet” As I think about that today, I cringe. The results were never very good – the parents would stop asking me or they would search for an answer elsewhere. I would continue treating their kids for other basic pediatric issues.

As physicians and dieticians, it is not uncommon when you are faced with such failure, to blame the patient. Rather than question the approach, it is much easier to question patient compliance. “They didn’t follow my instructions regarding diet and/or exercise.” Move on to the next patient. As the “monday morning quarterback,” it is easy for me now to look at the failed “Low Fat, Calories In Calories Out” approach and see the inherent problems from both a physiological and behavioral perspective. Indeed, not only did I experience this frustration as a physician, but as a patient too! Then I started talking to successful LCHF adult patients and I started reading anything that I could put my hands on regarding nutritional research – either in the bookstores or on the internet. Once I switched to an LCHF diet, the success was almost immediate. At that point I realized the vast majority of my overweight patients were NOT ignoring my advice and this was not a purely motivational issue – I was giving them the wrong information. It became obvious to me right away that parents and kids (particularly my overweight teens) would try ANYTHING to beat this problem and I needed to offer them Low Carb. So I started teaching the Low Carb (LCHF) diet to my patients about 3 years ago.

At the annual checkup appointments, parents will often ask about their child’s weight as a primary concern. Sometimes, I have to broach the subject. I will show the parent/teen the BMI chart and point out the problem. “Does this worry you at all?” I might ask. “I noticed that the BMI is starting to rise a little bit” is another lead in statement that I use. From there I can better gauge the level of concern. If there appears to be no real interest, which does not happen as often as you might think, I always finish by saying “You can always let me know if you want more information on nutrition and diet.”

If I am working with my patient at the checkup, I often hand them a printed version of my “Food Choices” page and I include the “Quick Low Carb/Paleo Snacks” page. I send them to my blog and direct them to those pages as starting points. We will run through a few details and I advise them to follow up if they have further questions. In addition to the checkup visit, I make myself available for more intensive, detail-oriented nutritional sessions. We call these “nutritional consults” and we block off an hour for these kids/families – particularly the kids who are well over the 97th percentile for BMI. In these sessions, I can spend more time targeting specific nutritional problem areas for the child. Are the breakfasts or lunches a bigger problem? What happens when the child is at mom’s house vs. dad’s house? Are there other medical issues that could be contributing (i.e. sleep apnea, thyroid issues)? We spend time discussing how normal saturated dietary fat is NOT the problem and is, in fact, quite healthy. I often discuss basic physiological principles such as glycemic index, the role of insulin as a fat storage hormone, and the liver’s infinite ability to convert excess blood sugar into fat. We go through the cookbooks and look at recipes. I emphasize that feeling hungry is NOT part of the program. We routinely run screening labs that look at, among other things, triglyceride/hdl ratios and diabetic risk factors. I ask the families to keep food diaries – an essential tool in fine-tuning problem areas in the diet. Finally, depending on the parental/patient level of comfort and also depending on BMI itself – we decide on followup intervals. Sometimes, I see the patients monthly (the appointments are shorter in duration). Sometimes, 3-6 months is appropriate (but I always make sure to let the family know they can come back sooner).

What I don’t do: I do not tell my patients to count calories or consciously control portions. I point out that if they follow my suggestions regarding foods that they should eat and foods they should not eat, portions will naturally control themselves through hormonal feedback.

My patients and their families have inspired me by their eagerness to embrace the latest in nutritional science. They energize me with their enthusiasm. They take the information and they go to work! When I recently asked a few if I could share their BMI chart on my blog, they wholeheartedly agreed! THEY want YOU to see what is possible!