15Dec
Inflammatory bowel disease IBD
Rowinda DimechAdult, Children, Diets, Health

Inflammatory Bowel Disease

Do you feel bloating and gastro intestinal discomfort? 

Does your diet affect these symptoms?

Do you suffer from an intestinal disorders?

 

Intestinal disorders

Intestinal disorders are becoming more common worldwide such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) both in adults and children. The most common factors which may affect these conditions are stress, viral infections, alcohol consumption and poor diet. IBS might be mixed with inflammatory bowel disease, IBD, as they show quite the same type of symptoms. It is important to note that IBS is different from IBD as IBD includes chronic diseases such as Chron’s and Ulcerative Colitis.

 

What is Inflammatory bowel disease?

IBD refers to a group of bowel diseases mainly Crohn’s disease and Ulcerative colitis that cause inflammation in the various areas of the digestive tract. The cause of IBD remains unknown. It is believed that diet and stress aggravate the symptoms but are not the cause therefore it is more likely that genetics and malfunctioning of the immune system is the cause of IBD.

Crohn’s Disease

Crohn’s disease causes inflammation of the digestive tract which can be from the mouth to the anus. Usually, the inflammation part appears in patches next to other healthy tissues. This leads to various symptoms including abdominal pain, diarrhea, fatigue, reduced appetite, weight loss, malnutrition and blood in your stools according to where the inflammatory patch is in your digestive tract. Other signs and symptoms which are not so common are inflammation of the skin, eyes and joints, kidney stones, anemia, and delayed growth and sexual development in children. Crohn’s symptoms also overlaps with diverticulitis. It is also believed that Crohn’s is a secondary reaction of diverticulitis, although more research is still needed.

Ulcerative Colitis (UC)

On the other hand, UC contributes to ulcer formation in the tissues of your digestive tract mainly the large intestines, rectum, and anus. In UC the damaged areas are continuous so if the inflammation starts in the large intestine it continues till the anus. The symptoms are quite similar to Crohn’s disease. These include abdominal pain, fatigue, diarrhea, blood in stools and weight loss. Symptoms usually develop over time and sometimes can be life- threatening.

Inflammatory bowel disease complications

IBD can lead to severe consequences such as malnutrition, colon cancer and blood clots if left untreated and can become life-threatening. Unfortunately, there is no cure for IBD but current medication such as corticosteroids along with diet changes can greatly reduce the symptoms of the disease. Severe IBD may require surgical procedures to remove the damaged parts of the gastrointestinal tract. There are different surgical procedures for Crohn’s and Ulcerative colitis since they affect different parts of the gastrointestinal tract.

IBD may take a long time to diagnose. It can be diagnosed by using a combination of procedures such as endoscopy for Crohn’s and colonoscopy for Ulcerative colitis. Your doctor may also check your stool samples in order to make sure that it is not caused by an infection. In such cases, antibiotics may be prescribed. In addition, probiotics may also be recommended as they can improve symptoms although there is no concrete evidence about this till now.

Appropriate diet

Fortunately, both Crohn’s and Ulcerative Colitis can be improved by adopting the right type of diet. There are various diets which are recommended such as low FODMAP diet, Plant based diet, High fiber diet, Low residue diet, lactose- free diet and gluten-free diet. The recommended diet would be chosen based on the symptoms being experienced by the individual.

As you can see from this blog and other blogs on gastroenterology, there are various intestinal disorders. It is important that if you or your child suspects of any intestinal disorders you contact your doctor and a registered dietitian. In all intestinal disorders, food plays a role in improving symptoms and quality of life!

04Nov
Irritable Bowel Syndrome IBS
Rowinda DimechAdult, Children, Health

Irritable Bowel Syndrome

Do you suffer from bloating?

Or nausea and vomiting?

Did you change your diet to reduce these uncomfortable symptoms?

 

Intestinal disorders

Intestinal disorders are becoming more common worldwide affecting 3 out of 10 people. Irritable bowel syndrome is not a life-threatening condition and it usually affects more women than men. There are numerous factors which may cause this condition. The most common factors are stress, viral infections, alcohol consumption and poor diet. Intestinal disorders can affect both children and adults.

What is Irritable Bowel Syndrome, IBS?

Irritable Bowel Syndrome (IBS) is a common disorder that affects the large intestines. This may cause bloating, cramps, diarrhea and constipation. If you have IBS you may experience only 1 symptom such as diarrhea or constipation, every 2 weeks in adults. In children, they might experience IBS symptoms during the exam period only. On the other hand, some people may have diarrhea followed by constipation on a daily basis. Dealing with IBS symptoms everyday may have a big impact on your life and in fact it can cause anxiety. Fortunately, only a small number of people suffering from IBS have severe symptoms. IBS might be mixed with inflammatory bowel disease, IBD, as they show quite the same symptoms. It is important to note that IBS is different from IBD as IBD includes chronic diseases such as Crohn’s and Ulcerative colitis.

IBS can be diagnosed after there are least 3 months period during which you experience either diarrhea, diarrhea followed by constipation, or chronic constipation. Usually, patients affected by IBS show no structural signs in the large intestines and usually have correct medical check-up results including blood test.

 

Coping with IBS

IBS is a chronic condition that you’ll need to cope with it long term, possibly a lifetime. Fortunately, mild symptoms can be prevented or treated by dietary changes, lifestyle changes and minimizing stress as much as possible. While severe symptoms can be managed with medication along with diet and counselling sessions.

The first dietary recommendation for IBS is a lactose free diet along with a low fiber diet. These types of diet are recommended during symptoms of diarrhea. If, the symptoms persist a Low FODMAP diet may be recommended by a dietitian. The word ‘FODMAP’ stands for Fermentable Oligo- Di- and Monosaccharides and Polyols. This diet minimizes the food intake containing short chain carbohydrates which are badly absorbed in the small intestine and may lead to bloating, increased gas production and also have a laxative effect.

High FODMAP products include fresh and dried fruits, fruit juices, fructose as sweetener, high fructose corn syrup, sweeteners like: sorbitol, mannitol, honey, coconut, cruciferous veggies, beans and sprouts. In addition, it’s worth considering writing a food diary including emotions, activities and environment. In certain circumstances, probiotics may also play a role in improving symptoms although there is no concrete research about this till now.

A diet for IBS can be considered quite challenging as it may be time- consuming. In addition, certain foods preferred by the person may have to be eliminated from the diet causing a psychological effect. It is always recommended that any diet changes are first discussed with a registered dietitian, especially in children as they are still growing up. Despite this challenging diet, a diet appropriate for IBS may improve quality of life by reducing intestinal symptoms, so I think it’s definitely worth to try it.

22Oct
Adolescence diet and mental health
Rowinda DimechChildren, Diets, Health

Adolescent Diet and Mental Health

Did you notice any mood changes in your adolescent?

Are you concerned about your adolescent diet?

What is mental health?

Mental health is the emotional, psychological and social well-being as it determines how an individual thinks, feels and acts. There are two types of mental health problems which are; poor mental health and mental illness. Poor mental health is when an individual is experiencing poor mental function affecting his physical, mental and social well-being negatively but is not diagnosed with a mental illness. On the other hand, an individual can be diagnosed with a mental illness but still experiencing good mental health function.

People who suffer from mental health problems may experience signs such as lack of appetite, sleeping too little or too much, lethargy, unexplained pain, substance misuse, feeling confusion or angry, mood swings and inability to perform daily life tasks. These signs lead an individual not to realise his full potential which in turn can lead to loneliness or isolation. It is important to note that if your child is experiencing symptoms such as lack of appetite, lethargy, feeling of confusion or unexplained pain does not mean he has a depression. These symptoms may also be a sign of other medical conditions such as diet related conditions such as coeliac disease, Irritable bowel syndrome (IBS) and Inflammatory bowel disease (IBD).

In 1986, the World Health Organisation (WHO) reported that the Maltese population consume a diet which is mainly based on fats and sugars. European countries such as Italy and Malta the percentage was increased by 30%. In fact, according to the Health Behaviour in school children (HBSC) aged between 11 to 15 years have the highest Body Mass Index (BMI) followed by the USA.

Mental health in adolescents 

It is well known that adolescence who suffer from mental health problems have a higher risk to reoccur in their adult life. In addition, this may lead to a higher risk of other mental disorders and even premature death. Research also suggests that adolescents with depression episodes have a higher risk of suicidal thoughts in adult life.

It is known there might be a parallel link between the type of adolescent diet and mental health. In fact, a US report found that the adolescent’s diet trend has decreased in fruit, vegetables and dairy products consumption. During this time, it was noticed that there was an increase in high calorific foods such as junk food and sugary drinks. These type of foods will also lead to weight gain and obesity. In young age overweight and obesity may lead to poor mental health and the arising of eating disorders such as anorexia nervosa and bulimia nervosa.

Diet and mental health

Healthy food such as unrefined carbohydrates, lean meat and oily fish contain a variety of vitamins, minerals and anti-oxidants which in turn are important for the immune system to function properly. Lack of such nutrition in the diet lead the immune system to increase in physiological stress causing inflammation and therefore more production of oxidative stress. Oxidative stress is a known factor of depressive illness. Patients who suffer from depression have higher markers of systemic inflammation which results from poor immune system function which positively correlates with poor diet. Research shows that high sugar and high fat diets can also negatively affect proteins during brain development. These type of diets are also linked with psychiatric distress and violent behaviours in adolescents in both males and females. A positive link in children and adolescents between junk food consumption and mental health problems such as dizziness, anxiety and feelings of worthlessness. The results were independent of family history, level of exercise, weight and socioeconomic status.

Ideally, an adolescent child start his day with breakfast in the morning, lunch at around lunchtime and dinner in the evening. Healthy snacks should also be included in between meals. These may vary according to the level of physical activities and any medical conditions such as waking up with heart burn, obesity, diabetes, picky eating, etc. In addition, it is important to include a variety of wholegrain carbs, fruit, vegetables and a good portion of proteins for proper growth and development. Diet is always important to be a balanced one especially during this period of time.

Finally, I wrote my first blog on mental health!! In my profession I am intrigued by this subject as I find it fascinated. Considering that mental health is still a taboo and not a lot of people want to discuss it, I think that it is marvellous how a diet can help you feel better on a daily basis. These type of diets don’t help you with the physical aspect only but also the way you feel 🙂

 

18Sep
Lactose Intolerance
Rowinda DimechAdult, Children

Lactose Intolerance

Do you suffer from bloating?

Did you every think of an intolerance?

Is lactose intolerance different in adults and children?

 

lactose intolerance

 

Lactose intolerance is a digestive disorder. It happens when the small intestines in your body is unable to digest lactose. Lactose is a type of carbohydrate which is found mainly in cow’s milk, dairy products and any food derived from cow’s milk. This lactose is broken down by an enzyme called lactase which is produced in the small intestines only. Therefore, if not enough lactase is produced you may develop lactose intolerance.

There are different severity of lactose intolerance. Some people who suffer from lactose intolerance may not tolerate any lactose in their diet completely. On the other hand some may tolerate small amounts of lactose such as from cheese.

The severity of symptoms are influenced by various factors such as lactase activity, colonic mucosal absorptive capacity, faecal bacterial metabolites, gastric emptying time and intestinal transit time. When lactose remains in the gut for a prolonged time it is fermented by the gut bacteria. This results in the production of gas leading to bloating. The most common symptoms of lactose intolerance include abdominal pain, nausea, vomiting, cramps, bloating and diarrhoea.

A clinical diagnosis of lactose intolerance can be confirmed by a dietetic assessment, lactose tolerance tests and hydrogen breath tests. Therefore, this intolerance can be identified by a registered dietitian or a doctor. The diagnosis can be done based on your symptoms and your body’s response to a reduction of dairy food products in your diet. I strongly recommend from my daily experience in this field that if you are suffering from any mentioned symptoms you don’t make a self diagnosis as the mentioned symptoms are very similar to other intolerances such as gluten intolerance, diseases such as inflammatory bowel disease, Irritable bowel syndrome and milk allergy.

Lactose- free diet

 

Till now there’s no cure for lactose intolerance. If you have lactose intolerance you can control your symptoms by making dietary changes. Lactose is found mainly in cow’s milk and dairy products such as butter, cheese, cream and yogurts. Although these are the main sources of lactose unfortunately it is also found in other foods such as powdered soups, party dips, milk chocolate, biscuits, cakes and ice- cream. These foods should be avoided according to your lactose intolerance severity. It is very important that you always check the food label before you consume food. In the food label you should check that ‘milk’ is not listed in the ingredients section. In addition, in the section ‘may contain’ or ‘contain’ section of the food label, it is good to note if milk is listed there. As a dietitian, I strongly recommend to continue eating lactose containing foods which you can tolerate so for example hard cheese such as grana contains very little lactose which a lot of people who are lactose intolerance can still tolerate and enjoy eating.

Lactose control without diet changes

Besides the dietary changes, you may also make use of lactase tablets, liquid drops or capsules that contain lactase. These replace the lactase which is unable to be produced by the small intestine. Therefore they can reduce symptoms by helping your body digest lactose found in your meals more easily. I would recommend that these lactase replacement are not used on a daily basis. But I would strongly recommend to be used for social events such as weddings so that you can still have fun and enjoy the ‘special wedding’ foods without having to make up to it later at night 😉

It is important to distinguish between lactose intolerance and milk allergy. Milk allergy is different than lactose intolerant because it is an immune response by the immune system. The symptoms experienced by a milk allergy are different than those experienced that lactose intolerance. Some symptoms of milk allergy are wheezing, itching, swelling of the lips and tongue, runny nose, loose stools and colic in babies.

This type of intolerance works the same for both adults and children. So if you or your child suffers from lactose intolerance a balanced diet including 3 portions of calcium should still be consumed. If, you are in doubt I recommend to contact us to provide you with a meal plan specifically for you, especially if you or your child suffers from other medical conditions as well.

 

 

 

28Jul
Coeliac Disease in children and adults
Rowinda DimechAdult, Children

Coeliac Disease in children and adults

What is coeliac disease (CD)?

Coeliac disease can affect both children and adults gut health. It is an autoimmune disease meaning that the immune system starts to attack healthy body tissue, in this case the small intestines. As a result, there is a chronic inflammation of the small intestinal mucosa. Patients suffering from coeliac disease have an immunologic reaction to a specific protein, known as gluten. In coeliac disease the immune system mixes gluten as a dangerous substance for the body and therefore it tries to eliminate it. When a person with coeliac disease consumes foods containing gluten the intestinal villa flattens which leads to malabsorption of nutrients.

The factors that causes coeliac disease is not entirely clear, but it seems that there is an association between genetics and environmental factors.  Coeliac disease can have the onset at any age after an individual consumes foods or even medicines that contain gluten. When left untreated, the disease can contribute to serious health problems such as iron deficiency anemia, folate deficiency, osteoporosis, malnutrition, lactose intolerance and cancer.

The most common symptoms are diarrhea, bloating, abdominal cramps, malabsorption and weight loss. Children who suffer from coeliac disease may also experience growth failure, delayed puberty and chronic fatigue. Patients affected by coeliac disease may not experience all the symptoms mentioned in fact a lot of people only experience one or two symptoms. Another disease linked with coeliac disease is Duhring’s disease. This is characterized by an extremely itchy bumps and blisters scattered mainly on forearms near the elbows, on the knees and buttocks. This happens when immunological residue that eliminated gluten from the small intestines resides under the skin causing the itchy bumps and blisters.

 

What is the diagnosis and treatment for CD?

 

If you or your child are experiencing symptoms or have a family history of disease you should speak with a healthcare professional to test for Coeliac. The test for coeliac disease is done taking a blood test, first. If, you have a positive result for gluten then a biopsy need to be carried out in order to confirm the diagnosis. It is important that if you are being tested for coeliac disease you are on gluten containing foods otherwise you will have a negative result and a misdiagnosis for coeliac disease. This method described works for both adults and children although recently in September 2019 ESPGHAN recommended that a no-biopsy diagnosis can be offered to children with coeliac who are asymptomatic.

 

If you or your child are diagnosed with coeliac disease you should change to a gluten-free diet. Sticking to a lifelong gluten-free diet reduces the prevalence of abdominal discomfort like diarrhea, constipation, gas, bloating, nausea or vomiting, gastroparesis and prolonged transit time. This diet excludes all foods containing rye, wheat, barley and any products derived from them. Alternative foods such as rice, corn, quinoa, millet, buckwheat, potato, soy, legumes and nuts are allowed on a gluten-free diet. Below are some examples of foods containing gluten which should be avoided.

Gluten containing Foods
Contain gluten May contain gluten
Cereals and flours Wheat, rye, barley, bulgar wheat, durum wheat, spelt, triticale, wheat flour, wheat bran, oat bran, semolina, couscous, malt and malted barley

 

 Oats
Bread, cakes and biscuits Bread, croissants, brioche, naan bread, pitta bread, ordinary biscuits, crackers, ordinary cakes, muffins, pizza, pastry, croutons, pancake, Yorkshire pudding

 
Pasta Fresh, dried or canned pasta and noodles

 

 Rice noodles
Breakfast cereals Wheat based breakfast cereals, muesli

 

 Cornflakes, rice cereals, porridge oats and oatmeal
Fruit and vegetables Fruit and vegetable coated with breadcrumbs or butter or flour

 

 Processed chips, mashed potatoes, canned fruit
Pulses and nuts Canned baked beans, dry roasted nuts

 
Milk and dairy products Milk with added fibre, yogurt containing cereals Coffee, tea, artificial cream, whiteners, yogurts and fromage fraise

 
Meat and meat products Meat pies and puddings , sausages, faggots

 

 Beef burgers, canned meat products, meat pastes
Fish and shellfish Fish cakes, fish fingers

 

 Fish in sauce, fish pates
Eggs Scotch eggs Egg substitutes
Desserts and puddings Macaroni milk puddings, trifle, sponge and suet puddings

 

 Ice cream, instant desserts and mousses
Fats and oils Suet
Soups, sauces and seasonings Soy sauce, mixed seasonings and spices (check label) Canned and packet soups, sauces, ketchup, stock cubes, mustard, mayonnaise, salad cream. Salad dressings, pickles and chutneys Tamari (Japanese soy sauce)

 
Savoury snacks Pretzels, snacks containing wheat, rye or barley Flavoured crisps
Preserves and spreads Mincemeat, lemon curds, chocolate, sweet spreads

 
Confectionery Sweet, iced lollies, chewing gum, toffee, chocolate

 
Beverages Vending machine chocolate drinks, Barley waters, fizzy drinks, malted milk drinks, beer, lager, ale, stout and low alcohol beers

 

 Herbal teas, cloudy fizzy drinks, chocolate powders, milk shakes and mixes sport and health drinks
Miscellaneous Ice-cream cones, wafers, communion wafers and Quorn

 

Baking powder

 

Till now a lifelong gluten free diet is the only medical treatment for Coeliac disease. A gluten-free diet manages to heal the small intestines mucosal injuries and therefore gluten induced symptoms and signs disappears. Fortunately, for future generations scientist are working on a vaccine development which induce tolerance towards gluten for both children and adults.

25Feb
Diet related conditions in children
Rowinda DimechChildren, Diets, Health

Diet Related Conditions in Children

Are you concerned about your child not eating enough?

Are you concerned that your child is losing weight or not growing enough?

Does your child have adverse reactions to food or diet related medical conditions?

 

Diet related conditions in children might affect your child’s eating, sleeping, playing and growing effecting his overall health, both physically and mentally. When infants and toddlers lose weight or don’t grow normally it is known as faltering growth as a result of malnutrition. In most cases, faltering growth is due to underlying conditions such as lack of appetite, poor food intake, poor nutrient absorption in the intestines and medical conditions such as celiac disease.

Cow’s Milk Allergy

The most common diet related condition in infants is cow’s milk allergy (CMA). In fact, CMA affects 1 in 20 babies in the first year. This happens when the baby’s immune system over-reacts to proteins found in cow’s milk. If your child has CMA he may show various symptoms that usually are related to their skin, gut or breathing. The most common symptoms are itching, hives, vomiting, diarrhea, blood in stools and wheezing. CMA usually stops when the child is 1 year of age but some grow out of at the age of 3 years.

Fussy eaters

Most common feeding difficulties in childhood that affect toddlers (1 to 2 years) are food refusal and constipation. Food refusal is a normal phase of early childhood, which peaks around 18 months of age but some children develop extreme food refusal. This extreme food refusal may starts at around 3 years when children experience intense fear for food. This fear towards food could be sensory including the sight, smell, touch, taste and texture of food. Or else it could also be behavioral, lack of certain micronutrients and medical conditions.

Constipation is very common especially when they are being potty trained at around 2 – 3 years, can also lead to poor food intake. Constipation is when your child has difficulty to pass stools. This can be treated by encouraging your child to make small dietary changes such as increase the water intake and fiber in his diet.

Food allergies and intolerances

Food allergies and intolerances can affect all age groups. Food allergies occur when your child ingest a certain type of food and there is an immune response to that particular food. Most food allergies in young children are outgrown by puberty but those diagnosed in late childhood often require life-long careful dietary management. Some common food allergies are egg allergy, milk allergy and peanut allergy.

On the other hand, food intolerances don’t produce an immune response. This means that in food intolerances your child may not always experience symptoms. It is recommended that unless your child experience symptoms he continues to eat that particular food. But if your child is experiencing migraines, diarrhea or abdo pain the intolerant food is eliminated from his diet. The most common food intolerance in children especially in teenage years is lactose intolerance. Both allergies and intolerance can be well managed by a proper dietetic assessment and dietary measures.

Gastrointestinal problems

Gastrointestinal problems are mostly common in infancy, toddlers and teenagers some of which are abdominal pain, acid reflux and chronic diarrhea. The good news is that these can be treated by dietary changes. In severe cases, these might lead to dehydration, mental fatigue and faltering growth. Some common digestive problems are Eosinophilic Gastrointestinal Disorders (EGID), Celiac disease, Inflammatory Bowel Syndrome (IBD) and Lactose intolerance. You can check my other blog about gastrointestinal problems in children for further detailed information.

Eating Disorders

In young children, as young as 9 years old and teenagers eating disorders such as anorexia nervosa and bulimia nervosa might kick in. Eating disorders continue on the increase in teenagers and can affect boys as well as girls.  Being aware of the signs of persistent damaging eating behaviour will help you to seek help when needed.  Doing this at an early stage is important, and prevents escalation of a problem which may spiral out of control. These are both serious mental health problems which require frequent and intense dietetic intervention.

I strongly recommend that if you notice any signs in your child’s behavior or symptoms it is important to seek professional advice. When there is any diet related conditions in children, it is important to speak to a dietitian who is specifically trained in the pediatric field and qualified in children.

26Jan
GasChildren and Gut health Nutrition and Diet
Rowinda DimechChildren, Diets, Health, Nutritonist

Children and Gut Health

How important is gut health in children?

Does your child suffer from abdominal pain?

Is it negatively affecting his nutritional intake?

 

In children, gut health is one of the most important as it can affect all the other organs and body parts. The gastrointestinal system or gut is the body’s largest organ system. It is responsible for digestion, absorption and elimination of food and bacterial waste.

Your child should always be given sufficient time to eat his food without distractions. It is also important to calmly encourage your child to chew food well. This will result in enough time for your child’s gut to release digestive enzymes to help in digestion. Hunger and appetite are controlled by internal digestive hormones and external influences such as the sight and smell of food. Simple as it sounds, the act of chewing food well, signals satisfaction to the brain, which in turn helps control hunger and appetite.

Digestion begins in the mouth, with the production of salivary amylase. It continues in the stomach and upper intestines, stimulating the production of digestive enzymes and hormones. The gut illustrates its adaptive qualities by regulating nutrient absorption depending on your child’s needs.

Gastrointestinal problems are common in infancy, toddlers, children and teenagers. There are various gastro symptoms which can be controlled or treated by diet. These include difficulty swallowing, poor appetite, indigestion, acid reflux, nausea, stomachache, vomiting, bloating, chronic diarrhea and constipation. These symptoms can be identified quickly from your observations as a parent as you might see tantrums during feeding your child or discomfort, vomiting, pain and faltering growth. In addition, your child may be grown enough to express his own symptoms to you himself.

Common digestive disorders in children are:

  1. Eosinophilic Gastrointestinal Disorders (EGID)

These are disorders in which white blood cells in your child’s digestive tract causes inflammation and swelling. This results in pain, discomfort and may even result in swallowing difficulty. The most common is known as eosinophilic esophagitis. Unfortunately, there is no cure but proper diet and steroid medication will help your child to control his symptoms. Diet plays an important role as certain foods might be causing the allergic reaction in your child’s gut.

 

 

  1. Celiac Disease

Celiac disease is a serious reaction when your child eats gluten which is found mainly in wheat, barley and rye. This condition can only be treated by a gluten free diet which will stop the damage being done to your child’s intestines. On another side note, it is important that gluten should be part of a normal diet if celiac disease is undiagnosed. This will prevent future health complications such as developing celiac disease itself.

  1. Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease is a term used to describe certain disorders such as ulcerative colitis and Crohn’s disease. These types of disorders involve chronic inflammation of your child’s digestive tract. IBD is most commonly found in teenagers. In both types of IBD, your child experience reduced appetite, diarrhea, rectal bleeding, abdominal pain, fatigue and weight loss. There are various types of diets that can be used such as gluten free diet, lactose free diet, low fiber diet or high fiber diet and low FODMAP diet.

  1. Lactose Intolerance

Lactose intolerance is very rare in young children. Usually, lactase production remains quite active until children are at least 10-12 years old. Studies show that European children are less likely to develop lactose intolerance, even as they grow older.

Lactose is a type of carbohydrate therefore it causes an intolerance. Food intolerance is different from a food allergy. In a food allergy, your child’s body develop an immune system reaction towards that particular food. If, your child has a true milk allergy he must not ingest even trace amounts of any form of milk or dairy products. If, your child has lactose intolerance he can still consume lactose-free milk and dairy products.

If, your child is suffering from any gastrointestinal problems I strongly recommend you to pay a visit to your child’s pediatrician. Then, if your child’s gastrointestinal issues directly relates to food I strongly encourage you to speak with a dietitian. This is of utmost importance that your child have good gut health as it affects your child’s physical, psychological and emotional wellbeing.

 

04Dec
Child's sugar craving dietitian Europe
seederChildren

How to handle your child’s sugar craving

Is your child constantly craving for sweets and chocolate?

Is your child begging you to buy him sweets at the supermarket?

Is your child eating sweets and hiding the wrapping under his bed?

If your child is constantly craving sugary foods, you might be worried. As a result, you might be experiencing fear or anxiety that your child is developing a sugar addiction. As a parent you might adopt statements like “eat less sweets”, “eat sweets in moderation” or “avoid all sweets.” In fact, some parents may fall into the “no sweets at all” removing any food that contains sugars from home, hoping to improve their child’s situation with sugary foods.

This scenario of food restriction, although done with good intentions, can cause your child to lose their sense of hunger and fullness. They may overeat when those limited foods become available. This may happen when children are away from the watchful eyes of mom and dad. For example, if your child slips into the kitchen when you go change out the laundry, this may be a sign of food sneaking. If you find hidden wrappers under the bed, this too, may be a concerning sign.

In addition, kids may become “obsessed” with the foods that are limited or forbidden.

Over time, feelings of deprivation may set in. Kids may feel left out or deprived when they don’t have the freedom to choose what or how much they want to eat. Like adults, kids want what they can’t or don’t have. In other words, if you take away the sweets your child cannot stop thinking about sweets! In my dietetic practice, I’ve seen the research evidence come true when restrictive eating is imposed on kids. Restrictive feeding promotes overeating.

Kids are naturally drawn to sweets, so it isn’t their fault if they like to eat them. It’s not your fault either. Don’t blame your child or yourself if his taste buds like sweets. You can offer sweets every day and it is ok. The World Health Organization (WHO) suggests no more than 5% of daily total calories should come from added sugar. In other words, the WHO advises families to keep sweets to one or two items per day if the child is a healthy, normally growing, and active child.

In conclusion, it is best to accept it as a natural part of the childhood nutrition experience. As you might have noticed by now from my other blogs, I am totally against restriction in adults and this counts for toddlers and children as well.

 

12Nov
Nutrition in children dietitian
seederChildren

Nutrition in children

Importance of good nutrition in children

In Malta, our children have one of the highest BMI in the world, after USA. Although there is plenty of information at our fingertips, it can be difficult to conclude what a balanced diet and healthy lifestyle would look like for your unique child. In order to implement a sustainable and healthy lifestyle for your child, it is important to understand what good nutrition consists of, how it can affect childhood development, and the steps you can take to ensure your child is on-board with the diet.

 

How nutrition affects children?

A proper nutritional diet and healthy lifestyle can affect young children throughout the rest of their lives. During early development, children are highly impressionable and start to implement routines and tools that they carry with them into adulthood. Aside from habits and routines created, children who do not obtain proper nutrients as they develop, can suffer from physical and medical conditions. Some of the most common issues for malnourished children include obesity, osteoporosis, decreased muscle mass, changes in hair volume and texture, fatigue, irritability, and type 2 diabetes.

Overweight and obesity are a growing epidemic affecting children at an alarming rate. Overweight and obesity refers when children have excess body fat. Children who do not have a well-balanced diet and consume high amounts of fat, sugar, and processed carbohydrates are at risk of obesity. Obesity can lead to several health problems that can affect children for the rest of their lives including high blood pressure, type 2 diabetes, elevated cholesterol and emotional problems. Young children are highly impressionable and can be subject to body shame and emotional issues linked to the food they consume.

The choices that children and parents make early on regarding nutrition and lifestyle can affect children for the rest of their lives. As most people reach their peak bone mass at age 20, it is important to build muscle and bone mass during the early stages of childhood. Children who are overweight tend to have fatigue and irritability that can lead to depression. Children that are overweight have difficulty with physical activity. This can cause emotional isolation and can set the groundwork for poor social interactions and low self-esteem. Overall, a well-balanced and healthy nutritional diet is of utmost importance in developing children.

 

What is the best nutrition?

Nutrition for children is based on the same core principles as nutrition for adults. The five main food groups include grains, dairy, protein, vegetables, and fruit, and are generally a good starting point for any diet. The portions of each respective food group will depend heavily on age, genetic makeup, and physical activity. In other words, all children can eat the same type of foods but with different portion sizes.

Grains: can be split into two categories: whole and refined grains. Whole grains are more nutritious because they contain more vitamins and minerals therefore, whole grains tend to be a better option. Some examples of refined grains include cereal, tortillas, white bread, and white rice.

Vegetables: can be raw, cooked, dehydrated, canned, whole, juiced, or mashed and are separated into 5 subcategories including dark-green vegetables, starchy vegetables, red and orange vegetables, beans and peas, and other vegetables. The portion size of each will depend on which subcategory it belongs to considering that some vegetables are more nutrient dense and nutrient packed than others.

Fruit: Fruit can be canned, frozen, dried, pureed, or juiced. Due to the high sugar content of fruit, it is advisable to construct a dietary balance based on age, activity levels, and gender.

Protein and diary: The protein food group is made up of foods that are primarily protein sources such as meat, poultry, beans, peas, eggs, seafood, and nuts. It is advisable that meat and poultry sources be lean and low fat. All fluid milk products and products made primarily from milk belong to the dairy food group. This includes items such a milk, yogurt, and cheese. In recent years, dairy has been a controversial member of the food group and as such, many nutritionally comparable dairy alternatives have been provided with greater nutritional value. As such, this group also contains fortified dairy-alternative products such as soy, almond, and cashew milk and nut cheeses.

Lack of calcium absorption can lead to osteoporosis. Osteoporosis is a degenerative bone disease that results in porous, weak, and brittle bones. Contrary to popular belief, Calcium is not best obtained through traditional dairy milk. This is because the calcium provided in dairy milk is less bioavailable to developing bodies. It is best to obtain calcium through dark leafy greens like kale and broccoli.

Ideally, children start their day with breakfast in the morning, lunch at around lunchtime and dinner in the evening. Healthy snacks should also be included in between meals. These may vary according to the level of physical activities and any medical conditions such as waking up with heart burn, obesity, diabetes, picky eating, etc.

In conclusion, research shows that it is best to avoid battles over food and meals. Ideally, parents provide regular snacks and meals. Children can be picky and, at times, avoidant or inflexible. If your young child refuses certain foods, it is best to let it go and try again at another time. Chances are, they will start to warm up to the options provided. As previously mentioned, young children are developing their independence and opinions and, as such, they are subject to vary.

Based on the age and unique genetic makeup of your child, their diet and lifestyle may look different and have emphasis on certain nutritional guidelines during one age range and much different guidelines during another. If, in doubt about your child’s diet always seek professional advice from a dietitian.

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