How to Cook For Kids With Food Allergies

The prevalence of food allergies is on the rise. You may have personal experience with food allergies amongst your friends, family, or even your own kids.  I decided to ask my friend David Jeong, M.D. to offer some insight on the topic of food allergies.  Dr. Jeong grew up in Iowa, attended Northwestern University for his undergraduate work, the University of Iowa for medical school, the University of Michigan for his residency in Pediatrics, and the University of Washington for his fellowship training in Allergy/Immunology.  Here is his response to my questions: Thank you Dr. Jeong!

What are some of the common ways food allergies present?

Hives, eczema, diarrhea, nausea/vomiting, abdominal cramping, nasal congestion, watery/red/itchy eyes, cough, and wheezing.

What are some of the more widely accepted theories amongst allergists as to why there has been a dramatic rise in food allergies in recent years?

a) Hygiene hypothesis: lack of early childhood exposure to (allergens)...leads to an imbalanced immune system, skewing its development more toward allergy.

 

b) Food preparation: roasting vs boiling peanuts, for example. Western countries roast more than boil, which leads to higher cooking temps (180C) and leads to increased stability of heat stable proteins in peanut...leading to greater allergenicity.

c) The Dual Exposure Hypothesis. This has to do with what happens to the immune system when a person is exposed to a food by skin contact vs oral ingestion. Incidental skin contact on household surfaces can be (allergy) promoting, and...food exposure via oral ingestion can promote immune tolerance. Up until 2008, in countries like the US, pediatric and allergy guidelines advised avoidance of high risk foods until between one and three years of life, which left the only likely mode of exposure during those years of life through incidental skin contact. Without the oral exposure to...promote immune tolerance, the incidence of allergies began to rise. As of 2008, both the American Academy of Pediatrics and the American Academy of Allergy Asthma & Immunology revised their guidelines to suggest that delayed introduction of milk, eggs, nuts, and seafood may not be the right thing to do. There has been plenty of literature to support this over the last 5-10 years.


What are the most common food allergies?  Is there a mechanism behind why certain foods are more allergenic than others?

Milk, egg, wheat, soy, nuts, and seafood account for more than 90% of all food allergies in western countries. All of these foods are "allergenic" to equal degrees, particularly early in life. What is different is the natural history of certain foods compared to others. Nuts and seafood allergies persist into adulthood to a greater degree (> or = 80% as opposed to less than 20% with the other foods listed), likely because of the very heat stable proteins within these foods, leading to a persistent immune response with repeated exposures.

Why are some food allergies diminished by cooking (i.e. cooked fruits?)

It has to do with the protein structures within the foods. The classic example is oral allergy syndrome, aka pollen food cross-reactivity syndrome. There are proteins in certain fruits, vegetables, and nuts that share a high degree of cross reactivity to pollens from birch tree or timothy grass, to name a few. When a person is allergic to these pollens and then eats a fresh fruit (ie apple), that person could develop a sensation of itching, tingling and a lump in the throat. When that same person eats an apple pie, no reaction! The baking process essentially denatures or destroys the protein, rendering them unrecognizable to the allergic person.

What is the role of blood tests in identifying food allergy?

We have to distinguish whether a person is "positive" without ever having eaten that food versus being "positive" but eats the food regularly without any symptoms.

If the former and the test is done by blood testing...then it is strongly recommended that the patient consult with an allergist. (Allergists use) certain predictive value cut offs based on the medical literature, and these cut offs show that even if a person has a "positive" result it may not be necessary to avoid that food.

If the latter, keep eating the food!! The test is not perfect, and...antibodies can be picked up by testing that have nothing to do with true clinical reaction.

If there is a strong family history of allergy, what can parents do to prevent food allergies from developing in their children?

Remember, blind avoidance is not necessarily required. In this case, innocent until proven guilty. If a mother is pregnant, it is not recommended that she blindly avoid nuts, seafood, or any other food with the thought that it will prevent her soon to be born child from developing food allergies.

The current evidence (suggests that) exposure to a food early and often seems to be more allergy preventive than delayed and infrequent exposure early in life. (i.e. consider introducing peanut containing foods at age one rather than age three).

The only action that has been shown to provide any benefit is if the mother can breastfeed for at least the first four months of life. This could lessen the chance that this child develops allergies down the road.

What resources do you recommend for parents who have kids with allergies?
ww.foodallergy.org
http://www.aaaai.org/conditions-and-treatments/library/allergy-library.aspx
http://www.aaaai.org/conditions-and-treatments/library/at-a-glance/food-allergy.aspx
The handouts from UpToDate for patients (beyond the basics) provide very accurate information. Just search "UpToDate Food Allergy for patients."


This holiday season, you may be asking yourself, "What should I bring to the holiday party?" Being sensitive to the prevalence of food allergies can ensure that you bring something that everyone can enjoy.  In the following clip, I show you an easy dish that is sure to be a hit at your next holiday party:

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Here is a link to the recipe I used in the above clip:
http://www.inspiredtaste.net/15938/easy-and-smooth-hummus-recipe/
Happy New Year!

How to Cook Healthy Food for Kids : Frozen Food

Fresh food just tastes better.  Therefore, if you want to get your kids to embrace vegetables, serve them fresh vegetables that are in season.  You can check out the application at the bottom of my blog to see what foods are in season in your area.  Unfortunately, if you live in an area like mine that actually has four seasons, nothing is in season right now.

Wintertime is an ideal time to eat frozen vegetables.  Frozen vegetables are picked at peak season, then flash frozen to preserve their freshness.  By cooking frozen vegetables, your kids can continue to enjoy the taste and benefits of vegetables anytime and anywhere.

One of the key historical figures we can thank for high quality frozen vegetables is Clarence Birdseye of the Birds Eye Frozen Food Company.  In his biography, Birdseye: The Adventures of a Curious Man, Mark Kurlansky shows that Birdseye was much more than just a man with a clever name.  He was a brilliant inventor, hunter, entrepreneur, and teacher.  He is also considered to be the founder of the modern frozen food industry.  

While ice fishing with the Intuit, Birdseye discovered that the fish he caught froze instantly and tasted fresh when thawed.  He later discovered that the key to fresh tasting frozen food was how rapidly the food was frozen.  Food that is frozen slowly develops large ice crystals while food that is frozen quickly develops smaller ice crystals.  Larger ice crystals are more damaging to the cellular structure of food.  Additionally, when slowly frozen foods thaw, cellular fluids leak from the ice crystal-damaged tissue, resulting in a mushy and unappetizing consistency to the food.

Birdseye developed new technology to quickly freeze food, preserve their architecture, and enhance their taste.  After running countless experiments, he found that certain types of food such as fish fillets, spinach, and peas are particularly amenable to freezing.  In the following movie trailer, I introduce Dr. Freeze, an infamous character with the power to freeze food.  Happy Holidays!

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For a tasty recipe featuring frozen spinach, try making these spinach croquettes:  http://everydaysisters.blogspot.com/2011/08/spinach-croquettes.html

References

http://en.wikipedia.org/wiki/Clarence_Birdseye

Kurlansky, Mark (2012).  Birdseye : The Adventures of a Curious Man.  New York: Doubleday

How to Cook Healthy Food for Kids : Be a Role Model

Developing healthy eating habits is only partially about distinguishing healthy from unhealthy foods.  It is also about developing a healthy psychology about food choices.  In my previous post, Dr. Stewart Zelman discussed how children use food to express choice.  In this post, Dr. Zelman discusses the importance of modelling healthy eating behaviors for children.   

Chris : What tips do you have to help kids develop positive eating habits?
Dr. Zelman : Be a positive role model for your children.  When you model positive eating habits, they will follow suit.  Children are open to the messages they receive from their environment and are easily influenced.  It is imperative that as a parent, you set a good example for them so that they can carry these positive habits into adulthood.   Drinking water daily, choosing healthy snacks, and moderating portions are all important habits to develop at a young age.  Try to pack your child's lunch as often as you can to continue the positive eating habits you set at home.  Stick to a structured eating schedule with children.  Set aside specified mealtimes and snack times.  Do not force children to eat if they aren't hungry.  Also, do not allow children to replace a skipped meal with an unhealthy snack.  Instead, offer them a healthy snack option and then allow them to eat a full meal at the next mealtime.  

Chris : What do studies show regarding how early eating habits develop in kids and how that affects eating behavior over the long run?
Dr. Zelman : Studies show that kids develop early eating habits from what they observe in their surroundings.  Parents should ensure that they are setting a good example by monitoring their own eating habits, attitudes, and choices.  Children pick up cues very quickly and begin to mimic their parents' behaviors.  Positive eating habits can lead to a child developing positive habits in other domains as well. 

Chris : What tips do you have for picky toddlers?
Dr. Zelman : Toddlers are going to be picky about what they eat and this is a normal part of their development.  Parents should try not to become anxious or overwhelmed by this fact.  You just have to get a little creative.  Also, parents should try to make mealtime as relaxing and anxiety-free for their child as possible.  Eat together as a family.  Children are more likely to feel comfortable with eating particular foods if everyone else is eating the same food at the same time.  They need reassurance that the food is good and safe.  Give small portions to toddlers so that they can taste the food and do not feel too pressured by a large amount of a food.  Also, get your toddler involved not only in meal preparation but in shopping for ingredients as well.  If they are able to see the entire process that goes into preparing the foods they are served, they are less likely to refuse to eat them.   


Being a positive role model for you kids is easier than you might think.  I show you just how easy, in the following clip:

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Biography:

Dr. Stewart Zelman, Ph.D. is a psychologist and founder of the Centers for Motivation. During his thirty years of professional practice, he has developed a deep understanding of human potential and motivation. He is the author of Think: Mindful and Mindless Tools For Weight Management, and an expert on cognitive behavioral management of food. He has also contributed his time and expertise to the treatment of physically and emotionally challenged youth. I attribute and thank Dr. Stewart Zelman and the Centers for Motivation for their contribution to this post.
References

C. Vereecken et al.  Associations of parenting styles, parental feeding practices and child characteristics with young children's fruit and vegetable consumption.  Appetitie 2010 55(3):589-596.

Bao Y. et al.  Association of nut consumption with total and cause-specific mortality.  NEJM 2013 369;21:2001-11. 

How to Cook Healthy Food for Kids : Healthy Spaghetti Squash Recipe

Who is in control in your household?  There is a clear hierarchy in my house.   Colin and Cailya are at the top, Cassie is a strong second, and if you squint hard enough, you can see me way down at the bottom.  A perfect example of this hierarchy is watching the dynamic at our kitchen table.  Although we serve our meals on our kitchen table, sometimes it feels more like a poker table.

Perhaps you have had your fair share of table-side negotiations, bluffs, and power struggles with your own children.  Introduction of new foods, designated mealtimes, and eating out are all opportunities for kids to exercise control.  Rather than approach these impasses in a confrontational way, you can take the opportunity to teach your kids important life skills like decision making, compromise, and independence.

To gain more insight into the psychology of kids, I interviewed the brilliant cognitive behavioral psychologist, Dr. Stewart Zelman (biography below).  Here is what he had to say:

Chris : What should I do when my kid refuses to try something new?
Dr. Zelman : New foods can be an opportunity for a child to exert power and control in their lives.  Children who are managed by teachers and parents, or older siblings, find that this is one of their few opportunities to be in charge.  Look at the bigger picture and see if your child has the chance to take charge of his or her life in other areas.  Then a request that they try one bite of the new food will not be so much of a struggle.  Also, it is helpful to create a culture that the whole family tries a new food once a week.  Implement the new food you want  your child to try during mealtime and let them be a part of the meal preparation.  They will want to eat what they helped to create.  


Chris : What should parents do when kids no longer want to eat their favorite foods?
Dr. Zelman : Perhaps your child has grown tired of eating that food.  This is a good opportunity to introduce new foods to your kids.  Parents can try to remove some of their favorite foods for a while and  then try to reintroduce the favorite foods at a later point.  We can all grow tired of eating the same foods regularly.  Toddlers are still developing and may be developing new food interests as well.  Allow them to explore their eating options and never forget to make mealtime fun and interesting.  

Chris : What suggestions do you have for parents trying to "reason" with their kids?
Dr. Zelman: Explain to children that it is their choice whether or not they would like to eat.  However, there are certain foods that they should eat and certain other foods that are not good for them.  Give children some choices and some control over what they can eat, so that they are equipped to make good decisions in the future about their eating habits.  For example, if they do not want to eat their dinner that night, explain that if they are not hungry, they do not have to eat but that they cannot have any snacks or dessert in place of dinner.  If they are truly hungry, they will eat dinner.  Also, explaining to a child that you would like them to eat what has been prepared so that they can be healthy and grow strong can be helpful.  

Chris : What tips do you have for taking kids out to eat?
Dr. Zelman : Make sure that you are taking your child to a family restaurant that is kid-friendly.  Never bring a tired child out to eat because this will increase the likelihood that they will be fussy and picky.  Be sure that the establishment has a kids menu or that you can order a smaller portion size.  Some menus are over-spiced or too salty for a child's taste.  Review the menu before your child does, and pick out the ones you find to be most healthy or appropriate.  Give your child an option out of the ones you think will be best for them.  This way, they will be eating healthy and they will also be a part of the decision-making.  

In the following video, I play food poker with Colin.  See who wins:

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In the above video, I used recipes from the following sites:
http://www.foodnetwork.com/recipes/easy-entertaining-with-michael-chiarello/spaghetti-squash-with-marinara-recipe/index.html
http://aquietlifeacademy.blogspot.com/2011/07/homemade-prego-spaghetti-sauce.html

Biography:

Dr. Stewart Zelman, Ph.D. is a psychologist, trainer and founder of the Centers for Motivation.  During his thirty years of professional practice, he has developed a deep understanding of human potential and motivation.  He is the author of Think: Mindful and Mindless Tools For Weight Management, and an expert on cognitive behavioral management of food.  He has also contributed his time and expertise to the treatment of physically and emotionally challenged youth.  I attribute and thank Dr. Stewart Zelman and the Centers for Motivation for their contribution to this post.  

How to Cook Healthy Food for Kids : Kabocha Squash Recipe

Why don't more Americans cook?  Some common excuses include not having enough time, not wanting to go shopping for ingredients, not wanting to clean up afterwards, or just plain not knowing how to cook.  What is the most frequently cited reason people give for not cooking?  They let their spouses do all the cooking!

I used to be guilty of every one of those excuses myself.  In fact, I still find myself making excuses even though I have a cooking blog!  The problem with cooking is it is inconvenient.  After a long day at work, it is just easier to pick up a package from a convenience store and serve that up for dinner.  It's just easier to buy processed food and store it indefinitely in your pantry rather than shop for fresh food.  That's part of the appeal of processed food.  Removing fiber and adding preservatives, salt, and trans fats to processed foods enhances their shelf-life and their convenience. 

There's no doubt that processed food is convenient.  But I question whether or not we can really consider these products food.  The reason processed foods don't spoil is because bacteria and fungi don't recognize them as food!   Bacteria and fungi won't touch the stuff and yet we call this stuff food and give it to our kids!

But nature provides a solution to the inconvenience of spoiling food.  The tough exterior of seeds, nuts, and gourds protect these organic foods from spoiling.  You can buy a winter squash and stick it on your kitchen counter for one to two months!  Now that is a convenient, real food that is good enough to eat!  In the following video, I pit the American pumpkin against Kabocha, the so-called Japanese pumpkin, in a movie meal called, "Glory of the Gourds".

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References

http://www.huffingtonpost.com/2011/09/09/cooking-survey_n_955600.html

http://en.wikipedia.org/wiki/Kabocha

http://www.eatbydate.com/fruits/fresh/how-long-does-winter-squash-last/

How to Cook Healthy Food for Kids : Make Vegan Quinoa Chili Recipe

What kind of potato do you plan to serve this Thanksgiving?   Possible choices run the gamut from white to orange to purple.  There are also many possible ways to prepare your potatoes from mashed to fried to baked.  Which potato is the most nutritious and which method is the healthiest way of preparing potatoes?

White potatoes are very high in glycemic index and are one of the most fattening whole foods.   For instance, mashed white potatoes have a glycemic index close to pure glucose.  Also, in a study looking at the weight gain potential of over fifteen categories of food, potatoes and potato chips topped the list at numbers one and two.

Compared to white potatoes, sweet potatoes provide significantly greater amounts of essential vitamins and minerals.  Sweet potatoes are a rich source of vitamins A and C, and are a good source of fiber.  Sweet potatoes are also a good source of the antioxidant beta carotene, which gives sweet potatoes their orange color. 

In general, sweet potatoes are lower in glycemic index than white potatoes, but this can vary depending on what you add to and how you cook your sweet potato.  Many recipes for sweet potatoes include added sweeteners such as brown sugar, maple syrup, or marshmallows.  Why these recipes insist on drowning out the natural sweetness of a sweet potato with the deafening notes of these added sweeteners is beyond me.  They're called sweet potatoes for a reason! 

The method you use to cook your sweet potato can also alter its glycemic index.  One study tested the glycemic responses to cooking potatoes in different ways--roasting, baking, frying, and boiling.  This study found that sweet potatoes prepared by baking or roasting were associated with the highest glycemic indices, around eighty.  On the other hand, sweet potatoes prepared by boiling had the lowest glycemic indices, around forty.  In this video, I show you how to make a sweet potato puree for your baby and a spicy sweet potato chili for your toddler, courtesy of Kristen Leidelmeijer, the personal chef who helps my patients eat healthier:

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So this Thanksgiving, consider skipping the white potatoes altogether and try some sweet potatoes.  Consider boiling your sweet potatoes and skip the brown sugar and maple syrup.  Now that's a sweet meal that you can be thankful for!

References

Mozaffarian D et al.  Changes in Diet and Lifestyle and LongTerm Weight Gain in Women and Men.  N Engl J Med 2011;364:2392-404.

Atkinson FS et al.  International tables of glycemic index and glycemic load values: 2008.  Diabetes Care 2008 Dec 31(12):2281-3

http://aggie-horticulture.tamu.edu/archives/parsons/vegetables/sweetpotato.html

Bahado-Singh PS et al.  Relationship between processing method and the glycemic indices of ten sweet potato (Ipomoea batatas) cultivars commonly consumed in Jamaica.   J Nutr & Met 2011:1-6.

How to Cook Healthy Food for Kids : Vegan Quinoa and Sweet Potato Chili Recipe

Here is another fabulous recipe from Kristen Leidelmeijer.  You may need to adjust the spices, particularly the chili powder, which may be too intense for some kids. 
  
Vegan Quinoa and Sweet Potato Chili
6 Hearty Bowls of Chili

 Ingredients

• 29 oz can black beans, rinsed and drained                                                                        
• 6 oz can tomato paste
• 32 oz vegetable stock
• 1 onion, chopped
• 5 cloves garlic, minced
• 1 tablespoon chili powder
• 1 tablespoon cumin
• 1 teaspoon oregano
• 1 tablespoon olive oil
• 1 sweet potato, peeled and cut into bite sized chunks
• 1 cup dry quinoa
• salt and pepper to taste
• avocado, cilantro for garnish (optional)

Directions

1. Heat the oil in a large heavy soup pot over medium low heat.  Add onions, and cook until soft (about 10 minutes)
2. Add the garlic and cook for about 2 minutes.  Add the tomato paste, chili powder, cumin, and oregano and cook for about 2 minutes, stirring constantly. 
3. Add the beans, stock, and potatoes, and season with salt and pepper.  Cook for about 5 minutes.  
4. Add quinoa and continue cooking for about 15-30 minutes, stirring frequently.  Cook until quinoa and potatoes are cooked and the chili has thickened.  Add water if the chili becomes to thick for your liking.  
5. Top with avocado and chopped cilantro.

 

How to Cook Healthy Food for Kids : Eat Like The French

Food can serve as a window into different cultures.  Exposing your kids to various ethnic cuisine is not only a great way to give them flavor variety, it is also a nice way of exposing them to different backgrounds and traditions.  One country that carries a rich tradition in cooking and a deep appreciation for gastronomy in general is France.


Interestingly, France is the 128th fattest country and claims one of the lowest obesity rates in Europe.  This might partially be explained by the fact that the French have a profound respect for the labor that goes into cooking food and traditionally eat more freshly prepared food than processed food.   An interesting book by Karen Le Billon called, French Kids Eat Everything makes the point that the French are distinct not just in what they eat, but when, where, and how they eat.

Because of this book, I decided to look a little deeper into how French traditions differ from American traditions when it comes to kids and food.  So I went to the source.  I interviewed my friend Sabrina Keller, a French native.   Many thanks Sabrina!

Chris: How many meals do French kids eat per day?

Sabrina: Generally three standard meals and one after-school snack

Chris: Do kids and adults eat the same food?

Sabrina: Yes.  In fact, a jar of baby food is commonly the same meal that an adult would eat, only pureed.  One good example is lamb and leeks.

Chris: What do French kids drink?

Sabrina: Milk, water, some juice, and traditionally very little soda.  Fresh milk is really only sold in two versions: whole and half fat.  Usually the only skim milk you can find is the long-conservation/unrefrigerated stuff. Most French kids start their day with a big bowl of warm milk mixed with something like Banania (http://en.wikipedia.org/wiki/Banania). 

Chris: Do kids help themselves to snacks? 

Sabrina: Not that I've ever seen.  In general I would say the adults are in complete control.

Chris: In what ways do the French eat differently compared to other cultures? 

Sabrina: I would say second servings are rare, although that of course depends on the family.  A traditional French meal is usually composed of several smaller courses, so there really isn't room or time to have seconds of any particular course; you just move on to the next one!  And because the meal is slower, you feel fuller sooner.  Utensils are used rather than finger foods (except for babies and toddlers).  People made fun of me when I moved here and cut up my pizza with a fork and knife. 

Also, food is rarely eaten on the go.  

Chris: Are desserts like cakes and pastries eaten regularly?  What kind of portions?

Sabrina:  Even though France is known for its desserts and pastries, I feel like those are reserved for special occasions. One exception is a morning croissant with your espresso.

Chris: How often are meals eaten in restaurants?

Sabrina:  Pretty often.  Meals out are usually long, and rarely just one course.  There is no such thing as "multiple seatings"  at a restaurant or a rush to turn the tables - a waiter will never hurry you.  (Tourists often complain about the slow service because of that!)  The waiters are also not working for tips, which probably plays a part.

Chris: Are kids taught how to cook?

Sabrina:  Yes!

Sticking with the French theme, I thought I'd try my hand at some "French" cooking. What's more French than a souffle? I found a healthy soufflé recipe using non-fat Greek yogurt instead of heavy cream at the following link:

http://bakingbites.com/2008/06/yogurt-cheesecake-souffles/

References

http://en.wikipedia.org/wiki/Obesity_in_France

Le Billon, Karen.   French Kids Eat Everything.  New York: Harper Collins, 2012

How to Cook Healthy Food for Kids : Make Chia Salmon Burger Recipe

Chia pet!  Chia tree!  Chia Obama!  Chia figurines grown from chia seeds gained popularity in the 1980s thanks in large part to clever advertising and a fantastically catchy jingle.  Recently, chia seeds have gained new-found popularity thanks to the associated health benefits of eating chia seeds.

Chia seeds are a good source of protein, fiber, and antioxidants.   They are also a notably rich source of essential omega-3 fatty acids.  In fact, 60% of the fats contained in chia seeds are omega-3 fats.  To read more about the importance of incorporating omega-3 fats into your diet, read my previous post: http://www.doctorchrisko.blogspot.com/2013/07/cooking-for-your-kids-good-bad-and.html

While studies on the health benefits of chia seeds are limited, consumption of chia seeds have been associated with improved circulating levels of healthy polyunsaturated fatty acids in the bloodstream, improved weight control, and reductions in blood triglyceride and glucose levels.  Because chia seeds are considered healthy, they have made their way into various food products from smoothies to breakfast bars.

And while chia seeds have a healthy nutrition profile, they are not a panacea to unhealthy eating!  Simply adding chia seeds to a sugary smoothie or chasing a burger with chia seeds doesn't turn an unhealthy food into a healthy food.  The antidote to unhealthy eating is not addition but subtraction.  Rather than add chia seeds to counteract an unhealthy diet, chia seeds can be added in a myriad of creative ways to enhance your healthy diet.  In particular, if you don't like the taste of fish and other seafood, you can add chia seeds to your yogurt, salads, and lean meats to ensure that you get an adequate amount of essential omega-3 fatty acids in your diet.

In the following video, I demonstrate how easy it is to incorporate chh- chh- chh- chia seeds into your diet.

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You can find the recipe I used in the above clip at the following link: http://recipes.sparkpeople.com/recipe-detail.asp?recipe=1764698
I modified the above recipe by using my Vitamix dry blade container to grind up whole oats instead of using bread crumbs.
      
References:

Norlaily MA et al.  The Promising Future of Chia, Salvia hispanica L.  J Biomed & Biotech 2012:1-9.

How to Cook Healthy Food for Kids : Make Roasted Chicken For the Lazy Eater

When I was a kid, I was a lazy eater.  It took me FOREVER to finish a meal.  I found eating to be tiring.  I needed to take multiple breaks over the course of dinner.   At restaurants, I needed to stretch out on two adjoined chairs.   And I did NOT like to work at my food.   I still remember how my dad would cut up my pizza into bite size chunks whenever we went out to Pizza Hut.

Sounds pretty bad huh?  The problem is, we are bringing up a generation of lazy eaters.   Kids today drink their food.   Kids today require that the crusts of their sandwiches be cut off.  Fruit is being stripped of fiber, steeped in sugary juice, and served out of a can rather than being eaten whole with the peel on.  Whole chicken is being processed into bite-sized chicken nuggets.

Yes, food should be approachable.   Yes, food should be fun.  But this lazy eater will be the first to admit that convenient food lends itself to lazy eaters.  When I was a kid, I would scour the chicken bucket for chicken legs because they were easy to eat.  Breast or thigh?  Heck no!  That would require a knife and fork!

As foods become more and more processed, whole foods become less recognizable.  It is important that kids recognize whole foods so they have a better understanding of where their food comes from.   In fact, ignorance of where our food comes from is what Michael Pollan, a prolific journalist and author of Omnivore's Dilemma argues is the fundamental problem with our food system.

The other day we went out to a Peruvian restaurant.  They served roasted chicken that was succulent and juicy.  Not only did Cassie and I love it, so did the kids!  And we weren't the only ones.  The restaurant was packed with other families.  It was really refreshing to see kids enjoying chicken that wasn't served in a fast food establishment and wasn't shaped like a nugget.

I decided to attempt a version of a Peruvian roasted chicken, which is featured in the following video:

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Here's the link to the recipe I used: http://www.food.com/recipe/el-pollo-restaurant-peruvian-roasted-chicken-231211

References

Pollan, Michael. The Omnivore's Dilemma: A Natural History of Four Meals. New York: Penguin, 2006. 

How to Cook Healthy Food for Kids : Make Chicken Satay Recipe

My first day of school was a scary experience.  I remember feeling anxious about riding the school bus and I didn't even want to step foot into my elementary school.  When I finally worked up the courage to enter that foreign building, I instinctively clung to my older brother and followed him into his class.  He shooed me away like I was some sort of gnat, pointed towards another class and said, "Those kids look about your height.  Go join that class!"  On the other hand, when I dropped Colin off at his new preschool, he cheerfully turned to me and said, "Goodbye!  See you later!"  It seems as if everyone is all too eager to get rid of me.

Like going to school for the first time, trying new foods can be a scary experience for kids.  Kids may find new foods to be unfamiliar, intimidating, or scary looking.  The important thing to realize is that just because your kid rejects a new food item on the first attempt, it doesn't mean you can't try again. 

In fact, multiple studies show that repeated exposure to a particular food increases acceptance to that food amongst children an infants.  For example, studies have found that infants eat significantly more of a particular pureed vegetable after repeated exposure over a period of eight or nine days.  Additionally, the more variety you expose your kids to, the more familiar their palate will become to different tastes.  This will further enhance their acceptance of new foods as kids are more accepting of novel flavors if they already have experience with flavor variety. 

In the following Halloween video, I show you another tip you can use to make foods less scary for your kids.  I suggest you mummies try this out on your little gremlins this Halloween for a howling good time!  Incidentally, I don't find this video to be scary, but your kids might.  Viewer discretion is advised.

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Here is the link to the recipe used in the above video:
http://www.foodnetwork.com/recipes/tyler-florence/chicken-satay-with-peanut-sauce-recipe/index.html

References

Forestell CA & Mennella JA.  Early Determinants of Fruit and Vegetable Acceptance.  Pediatrics 2007 Dec;120(6):1247-1254.

Mennella JA et al.  Variety is the spice of life: Strategies for promoting fruit and vegetable acceptance during infancy.  Physiol Behav 2008 April 22;94(1):29-38.

Mennella JA & Trabulsi JC.  Complementary Foods and Flavor Experiences: Setting the Foundation Ann Nutr Metab 2012;60(suppl 2):40-50.

How to Cook Healthy Food for Kids : Healthy Mushroom Soup Recipe

 

Deadly White Powder

What do you consider to be a deadly white powder?  Obvious toxic substances like cocaine or anthrax may come to mind.  But what about common white powders we ingest every day?  In my previous post, I argued that added sugars should be considered lethal:  http://www.doctorchrisko.blogspot.com/2013/06/cooking-for-your-kids-simply-infused.html
In still another post, I argued that any highly processed grain such as commercially produced flour should be considered unhealthy: http://www.doctorchrisko.blogspot.com/2013/08/cooking-for-your-kids-carbs-gone-bad_25.html
But what about salt?  Should salt be considered a deadly white powder?  Is salt itself deadly or is it deadly by association? 

Salt And Blood Pressure

The words salt and sodium are often used interchangeably because 90% of the sodium we consume is in the form of salt.  One gram of salt contains 400mg of sodium.  The average American eats about 3400 milligrams of sodium or about nine grams of salt per day.  Many consider salt to be a dietary evil because population studies have demonstrated an association between increased dietary sodium intake and elevations in blood pressure.  Based on this, the American Heart Association recommends keeping sodium intake to less than 1500 milligrams per day.  However, guidelines like these are not only impractical, they are also based on mistaking association for cause and effect. 

Salt Restriction

Because salt intake is associated with blood pressure, it is tempting to conclude that elevating salt intake causes elevations in blood pressure and lowering salt intake lowers blood pressure.  However, studies of lowering salt intake as a means to reduce blood pressure have yielded equivocal findings.  For instance, multiple studies show that salt restriction in healthy children has no appreciable effect on blood pressure.  And while some studies in hypertensive adults have demonstrated reductions in blood pressure with salt restriction, a recent review using the strongest statistical methodology available found that the benefit of salt restriction on blood pressure is actually quite small.  On average, reducing salt intake to less than 2 grams per day was associated with only a 3.47 and 1.81 millimeter drop in systolic and diastolic blood pressure numbers (top and bottom numbers in blood pressure measurement). 

Furthermore, although elevated blood pressure contributes to heart disease, a recent critical review of multiple studies found no evidence to show that reducing salt intake prevents heart disease or helps you to live longer.  In fact, some evidence actually shows that extreme salt restriction is associated with more heart disease and lower life expectancy!  (However, sodium restriction is important for certain populations who are susceptible to fluid retention such as people with kidney, liver, or heart failure.)

Salt in Processed Foods

Why is salt restriction only weakly effective at lowering blood pressure?  Could it be because salt intake is not itself deadly but instead is associated with the intake of something much more sinister?  65% of salt intake comes from processed foods and another 25% comes from eating out at restaurants.  In particular, amongst the top ten foods that contribute the most sodium in the American diet, half come from processed grains such as bread, rolls, pizza, sandwiches, and savory snacks (i.e. chips, popcorn, and pretzels).  Additionally, ready-to-eat cereal ranks in the top ten dietary sources of sodium amongst kids ages two through nineteen.

Because so much of our salt intake comes from eating processed foods, the salty American diet is really just a high processed food diet.  The association between salt intake and blood pressure may not be a causal relationship but instead be related to a third variable--processed grains that are high in glycemic index.  For instance, studies show that diets that are high in glycemic index are associated with elevated blood pressure.  So while salt often gets the blame, the problem may not be the salt itself, but that salt comes packaged with another deadly weapon. 

This is an important distinction to make.  Rather than shun salt, health conscious individuals should shun the processed foods that are high in salt.  Not only is most processed food bad for your kids, but the inherent high salt content makes processed food more palatable so they want to eat more of it.  On top of that, all that salt in processed foods make kids thirsty for sugary beverages like soda, which compounds the problem.   So while salt may not be causing America's health problems, it certainly drives us to eat the processed foods that do cause health problems.  

A Home Chef Worth Their Salt

Distinguishing between salt as the problem versus salty processed foods as the problem is especially important so that home chefs don't develop a fear of using salt in their meals.  Processed food giants inherently know that salt enhances flavor.  By the same token, you can get your kids to eat healthy food that you prepare for them simply by using salt to enhance the flavor of home cooked meals.  If you judiciously use salt to bring out the natural taste of the foods you prepare at home, your kids will be more likely to enjoy real food.  By eating more good stuff and less processed junk, your kids will head down a much healthier path.   

One great way of using salt to flavor food and increase your kid's vegetable intake at the same time is to use vegetable or chicken broth to make a homemade soup.  In the following video, I demonstrate an easy mushroom soup recipe that your kids are sure to crave. 

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The recipe featured in this video can be found at the following link: 
http://tribecanutrition.com/2013/05/pureed-vegetable-soups/

Hopefully this post encouraged you to do more home cooking and eat less processed foods so that you and your family will no longer be victims of assault with a deadly weapon! 

References

1. Intersalt Cooperative Research Group.  Intersalt: an international study of electrolyte excretion and blood pressure: results for 24 hour urinary sodium and potassium excretion.  BMJ 1988;297(6644):319-28. 

2. Tzoulaki I et al.  A nutrient-wide association study on blood pressure.  Circulation 2012;126(21):2456-2464. 

3. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Sodium-Salt-or-Sodium-Chloride_UCM_303290_Article.jsp

4. Miller JZ et al.   Blood pressure response to dietary sodium restriction in healthy normotensive children.  Am J Clin Nutr 1988;47:113-9.  

5. Gillum RF et al.  Changing sodium intake in children : the Minneapolis children's blood pressure study.  Hypertension 1981:698-703.

6. Sacks FM et al.  Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet.  NEJM 2001;344(1):3-10.

7. Cook NR et al.  Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP).  BMJ 2007:1-8

8. Aburto NJ et al.  Effect of lower sodium intake on health: systematic review and meta-analyses.  BMJ 2013:1-20. 

9. Taylor RS et al.  Reduced dietary salt for the prevention of cardiovascular disease.  Cochrane Database Syst Rev.  2011;(7).

10. Stolarz-Skrzypek K et al.  Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion.  JAMA 2011;305(17): 1777-1785. 

11. Ekinci El et al.  Dietary salt intake and mortality in patients with type 2 diabetes.  Diabetes Care 2011;34(3):703-709. 

12. http://www.cdc.gov/salt/food.htm.

13. Vital signs: Food categories contributing the most to sodium consumption -- United States, 2007-2008.  MMWR 2012;61(5): 92-98.

14. Jalal DI et al.  Increased fructose associates with elevated blood pressure.  J Am Soc Nephrol 2010;21 (9): 1543-1549.

15. Gopinath B et al.  Influence of high glycemic index and glycemic load diets on blood pressure during adolescence.  Hypertension 2012;59(6):1272-7.