Are Eggs Good for You?

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Eggs seem to conjure quite a nutrition debate-the white, the yolk, the cholesterol, the omega-3s, the protein, cage-free, brown, white…  This simple, whole food has been put on the “bad” list as much as it’s on others’ “good” list. Whole eggs have been dissected and rearranged into liquid and powdered egg products. Brown eggs have been bleached white. And some eggs have been fortified. Which are healthiest?

As with many nutrition-related questions, I advocate for food in its whole, most natural form. When it comes to eggs, here are my nutrition bites:

Whole eggs are part of a healthy diet, in moderation.

Eggs are comprised of two things: protein and fat. Eggs are a great source of protein, containing approximately 7 grams per egg. All of the protein is in the egg white. All of the fat is in the egg yolk. If we learned anything from the fat-free craze of the 90s, it’s that not all fat is bad for you. In fact, some fat is essential for health (i.e. omega-3 fatty acids), and eliminating all fat does not result in sustainable health changes.

Regarding egg yolks…

The yolk of the egg contains many vital nutrients that would be used to nourish a new life (a baby chick, that is). In this way, it is one of nature’s perfect foods. Yes, there is cholesterol in the egg yolk, so eating more than two eggs every single day may inch up your blood cholesterol level (although exercise and fiber will inch it down, too).

Eggs are actually low in calories and very filling.

One large egg has only about 70 calories, including the yolk that gets such a bad rap. The reason why eggs are filling is because both protein and fat take longer to digest, and help moderate sugar absorption and blood sugar levels. In other words, having an egg with a typical carbohydrate breakfast food will hold you over longer than if you were to eat just cereal, toast, or pancakes alone.

How the egg is produced and where it comes from matters.

When it comes to animal products, quality matters. A hen’s diet will dictate the nutrition quality of the eggs she produces. The better and healthier her diet and lifestyle are, the better and healthier her eggs will be. Chickens’ natural diet and environment includes roaming around pecking grass, seeds and bugs. Chickens who live and eat this way are often termed “free range” or “cage free”. Modern agriculture practices have tweaked chickens’ natural diet and environment to maximize production and revenue. These chickens live in very close quarters in cages and eat a diet of grain and corn. As you might expect, the yolks of free range-produced eggs have healthier fatty acid content, and these yolks naturally contain omega 3 fatty acids. Furthermore, organic eggs come from chickens that have not been given hormones, antibiotics, and who have been fed an organic diet. In my professional opinion, free-range, organic eggs are the best quality.

Brown vs white

Brown eggs come from brown hens and white eggs come from white hens. Given that all other production factors are equal (see above), brown and white eggs are no different in taste or quality.

I hope this was helpful in deciphering all the ideas out there about eggs. What are your opinions of eggs? What diet myths do you want to investigate further?

Digestive Issues: How to Help with Diet

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Digestive issues are extremely common among kids and adults in our country. So common, in fact, that we often don’t give these issues much thought and accept these feelings as being sort of normal. As a registered dietitian, I can tell you that digestive issues are your body’s way of telling you that some changes need to be made to feel better.

Here are common digestive problems, along with causes and dietary cures:

Acid Reflux

Causes:  Overeating, making the stomach too full and as a result, the stomach contents push up into the esophagus. Reflux can also be caused by food sensitivities or allergies, especially in infants.
Diet Cures:  Eat smaller meals at regular intervals each day (3 meals and 2 snacks). Your stomach is about the size of your two hands cupped together (with two more hands on top to make a sphere), so try eating about this much at meals. Eliminate fried foods. Eat plenty of fruits, vegetables, whole grains and lean meats. Eliminate trigger foods such as caffeine, dairy, and other high fat foods (such as sausage pizza or “loaded” nachos). In infants, rule out food sensitivity or food allergy; common culprits related to reflux in infants are cow’s milk protein (dairy), soy, eggs, and wheat.

General Indigestion

Causes:  Overeating, poor quality of diet, chronic constipation, inflamed enterocytes (cells that line the gastrointestinal tract).
Diet Cures:  Eat smaller meals at regular intervals (see above). Reduce processed foods and focus on whole foods such as legumes, fruits, vegetables, whole grains and lean meats. Drink plenty of water (2+ liters/day). Vary your grain intake (often we eat some form of wheat at all meals and snacks throughout the day). Consume probiotics through quality food sources such as organic yogurt, fermented vegetables (sauerkraut, kimchi, etc), and kefir.

Chronic Constipation

Causes:  A diet that is high in refined carbs, low in fiber, and inadequate in fluids. Constipation worsens with inadequate physical activity and long sedentary periods. Kids may be constipated if they consume too much dairy.
Diet Cures:  Eat fresh fruit at least twice per day and vegetables at least 2-3 times per day. Replace refined grains with whole grains. Other foods high in fiber include legumes, nuts and seeds. Drink 2+ liters of water per day. Limit dairy to 12-24 oz per day. Engage in physical activity throughout the day; even walking and doing house chores are helpful.

Frequent Loose Stools

Causes:  Excessive intake of sugary beverages, including juice, as well as excessive intake of “diet sugars”. Can also be caused by food sensitivity/food allergy. Another cause may be imbalanced gut flora, which can occur after taking antibiotics or with prolonged poor quality of diet.
Diet Cures:  Eliminate sugary beverages and replace with water or milk (given dairy is tolerated). Limit diet beverages to 8 oz per day or less. Trial an elimination diet of common food allergens for two weeks to see if symptoms improve (dairy, wheat, soy, eggs, nuts, fish, shellfish). Consume quality probiotic food sources (see above), as well as soluble fiber which is found in foods such as bananas, oatmeal, applesauce, dried peas as in pea soup, carrots, cucumbers.

Stomach Pain, with Gas and Bloating

Causes:  Food intolerance, sensitivity or allergy. Also these symptoms occur with general overeating of unhealthy food choices.
Diet Cures:  Trial elimination of common culprits for two weeks, including lactose (in dairy), wheat, legumes including beans and nuts, eggs, and soy. Eliminate sugary beverages as well. If symptoms do not improve, investigate fructose intolerance by working with a registered dietitian. Eat smaller meals and regular intervals throughout the day reflecting the Healthy Plate Model.

If you didn’t see your digestive issues listed above, or for more specific questions, leave a comment in the section below. For more guidance on helping your family overcome digestive issues, make an appointment with a registered dietitian at North Shore Pediatric Therapy.

Baby Food Pouches: Bad for Baby’s Health?

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A recent statement from the American Academy of Pediatric Dentistry warns parents of the possible side effects to prolonged usage of baby food pouches. They compare the squeeze pouches to that of giving babies juice in sippy cups and bottles, and they indicate that tooth decay may develop if babies are given frequent access to the pouches.

What Harm Can Baby Food Pouches Cause?

The squeeze pouches, while convenient for families on the go, often contain sugary fruit blends which can reek havoc on developing teeth. Over time, the constant exposure of the foods directly to the teeth may begin to break down tooth enamel. However, further research will determine if there is a true correlation between the squeeze pouches and cavities in young children. It is indicated that if parents do allow for their children to eat from the pouches, that they continue to follow the recommendation  of brushing their children’s teeth 2x per day and giving them water and milk to drink instead of juice.

Should I Allow My Child to Use Baby Food Pouches?

While the jury is still out on the actual effects of the pouches on little teeth, the old adage of “everything in moderation” holds true. Busy parents should not be discouraged from using the pouches in a pinch, but spoon feedings are still preferred. Feeding your child from a spoon not only contributes to functional oral motor development, but increases the social aspects of mealtimes. Parents are able to connect with their children during meals and if children are allowed access to constant drinking from the pouches, they are missing out on opportunities to practice developmental feeding skills when fed via spoon.

Click here to read more about oral motor and feeding difficulties in children.

My Child Is Tongue Tied: What Does This Mean?

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What is Tongue Tie (Ankyloglossia)?

Ankyloglossia, or more commonly referred to as Tongue Tie, occurs when the lingual frenulum (the thin band of tissue that connects the bottom of the tongue to the mouth) is too short and tight. Reports on the prevalence of tongue tie in newborns is conflicting, though current research indicates that this occurs in approximately 1-4% of newborns. Tongue tie may interfere with breastfeeding, and your newborn my present with significant challenges latching, remaining on the nipple when feeding, and fussiness during feeds. Nursing mothers may also experience significant pain when breastfeeding, even after repositioning.  You may notice that your baby has difficulty sticking their tongue out and the tongue shape may resemble a heart, as observed by a “V” indentation in the tip.  If tongue movement is restricted, tongue elevation, lateralization, and protrusion may be negatively impacted.  Tongue tie is not commonly identified at birth, however if you do have concerns, you should speak with a lactation consultant, speech-language pathologist, or your pediatrician.

What are the effects of my baby having Ankyloglossia?

However, it is presumed that long-term effects are not commonly seen in children with tongue tie. As an infant continues to grow, the frenulum in turn stretches and allows for increased tongue movement.  In rare cases, speech development may be negatively impacted by the severity of the tongue tie, as the tongue is unable to coordinate specific movements to produce targeted sounds. In cases where tongue range-of- motion are profoundly impacted by the tongue tie, the child may undergo a frenotomy or  frenulectomy in which the lingual frenulum is clipped to increase tongue movement.  There is continued debate about whether it is beneficial to “clip or not to clip”, as many healthcare professionals disagree on the effectiveness and supposed outcomes of the surgery. Each case is unique however, therefore an extensive oral-motor and feeding evaluation should be completed in order to assess the severity of the tongue tie, in order to determine the best plan of care for the child.

Understanding Your Child’s Growth Chart

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Growth charts are tools that medical professionals use to track trends in your child’s growth. They are also used to diagnose conditions that indicate growth issues, such as obesity or failure to thrive. For more information about how growth charts are used and interpreted, read on.

Understanding when to use which growth chart:

The Centers for Disease Control and Prevention’s website provides growth charts used for the majority of typically developing kids. It is important that medical professionals use the right growth chart for their patient.

  • For kids < 2 years old:  The growth charts labeled 0-2 years old from the World Health Organization should be used until age two. Recently, growth charts for this age were updated using data that is representative of a wider range of ethnicities and primarily breastfed babies.
  • The “Birth-36 months” growth charts:  These should be used when the child’s length is measured recumbently (lying down). If the practitioner is able to get repeatedly accurate standing height measurements of the child age 24-36 months, then the “2-20 years old” growth chart would be used to plot height and BMI. Weight-for-length is plotted using recumbent length, and BMI is calculated and plotted using standing height.
  • The “2-20” growth charts: These are used for typically developing kids in this age range, and for kids ages 2-3 if their height has been measured standing up. These are also used for kids with special needs or specific diagnoses, such as Down Syndrome and Cerebral Palsy, according to recent recommendations. However, it is imperative that a trained medical professional interpret growth of kids with special needs on standard growth charts. I find it useful to use both standard growth charts and growth charts designed for kids with specific diagnoses as multiple pieces of information in overall growth assessment.

BMI Measurements:

  • Weight for Length and BMI. This single data point is very important, as opposed to the other growth measurements where the overall trend is more important. These growth charts are used diagnostically as follows:
  • Weight-for-length or BMI < 5th percentile. This is considered “underweight”, which means that the infant or child does not have adequate body mass for how long he or she is. Kids who are underweight may be at higher risk for nutrient deficiencies, compromised immune function, lethargy, impaired cognitive development, and more. These cases should be referred to a pediatric dietitian. If underweight status worsens over time or is a chronic issue, the child may be diagnosed failure to thrive.
  • BMI 85th – 94th percentile. This is diagnosed as overweight. Weight loss is not recommended for these kids, but rather weight maintenance. Then as their heightcontinues to increase, the BMI will normalize.
  • BMI > 95th percentile. This is diagnosed as obese. These kids should be referred to a pediatric dietitian for assessment and a weight management plan.
  • Note, children under 2 years old are not diagnosed overweight and obese. This is because growth patterns are very different in infants than older kids. Many factors should be taken into consideration by the trained medical professional for infants who have weight-for-length > 95th percentile before changes to their diet intake are made.

“Within Normal Limits”

This phrase describes the percentiles of the growth chart that are considered to be within a normal range of growth for kids that age. The normal range concept applies mostly to the BMI growth chart and the Weight-for-Length growth chart. BMI is within normal limits if it falls between the 5th and 85th percentiles.

It’s all about the trend.

When it comes to weight and length or height, in most cases, the bigger picture is more important than individual measurements. This means that as long as your child’s growth is “tracking along its usual curve”, his or her growth is probably normal for them. If weight or length/height drop or increase more than two growth channels over a span of 6 months, this is cause for concern and needs further evaluation by the pediatrician and dietitian.

Click here for strategies to talk to your kids about weight and healthy eating.

Get the Family Healthy in 2014, Part 2 of 2

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Last week, I discussed three New Year’s resolutions to help get your family healthier in 2014. Here are some more ideas. Like I said in last week’s post, adopt as many of these as you think are realistic for your family. Or pick one change to implement each month as the year goes on. By summer, you will see some real changes!

More Fixes for Healthy Family Eating:

1. Eliminate sugary beverages, including juice. This change is pretty simple and can have a huge impact. Sugary beverages are problematic because it’s easy to quickly consume a lot of calories without feeling full. Juice and sports drinks are not ideal drink choices either, as they are just as calorie-dense as other sugary beverages like soda. It is better to get the vitamin C and electrolytes from healthy food choices. Kids rarely need sports drinks to replace electrolytes during or after physical activity unless they are involved in multiple hours of continuous physical activity and are sweating a lot. Chocolate milk is also considered a sugary beverage, and should be replaced with plain milk. If you are wondering how much sugar is in some of your family’s favorite drinks, measure out one teaspoon of table sugar for every 4 grams of sugar in the “Total Sugar” content on the Nutrition Facts Label. Be sure to look at what the serving size is and how many servings your family member is consuming. I have done this experiment with many families, and they are always shocked since no one (not even the kids) would consider drinking that heap of table sugar.

2. Do something active for at least 60 minutes, every day. Encourage your child to be active by having plenty of outlets for physical activity all year round. For days the weather is not conducive for outdoor play, have a bin filled with things like jump ropes, hula hoops, balls, and other toys. Encourage your child to participate in sports or other hobbies that involve physical activity. Be a good example. Find ways to be physically active as a family, such as walking places within a mile or so instead of driving. This is possible even in cold winter months as long as you dress warmly. If your child is resistant to doing fun physical activities, then offer another option— house chores.

3. Limit screen time to less than 2 hours per day. When you think about how many hours your child spends sitting at school, then how many hours they spend sitting doing homework, then how many hours they spend sitting watching TV or playing on the computer—it adds up to a pretty sedentary lifestyle. This is one of the biggest implications of childhood obesity in our culture today. We have transitioned from a society that relied on physical labor to complete daily tasks, to a society that relies on convenience. Kids used to play outdoor games and sports for fun, and now they play video games. I have had some school-age kids tell me that they just don’t know how to play. Set boundaries around screen time. One idea is to have the kids earn screen time by doing 60+ minutes of physical activity and completing homework.

Any of these New Year’s resolutions will make a healthy impact on your family, especially if the whole family is on-board and participating together. The resolutions described are all simple changes, but can be challenging to implement and sustain without commitment. For more personalized planning and troubleshooting, make an appointment with a registered dietitian at North Shore Pediatric Therapy.

Click here if you missed part 1 of this series, Get Your Family Healthy in 2014.

Get the Family Healthy in 2014, Part 1 of 2

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The New Year is here, and it’s a great time to make a resolution to get healthy. In order to stick to that New Year’s resolution, be specific about what changes to make. This can help your family execute a plan to ensure positive outcomes. Here are some specific changes that you as a parent can implement to bring about real change for your family’s health this year. I recommend choosing as many of these as you think are realistic to do in your household. Even one real change is better than a handful of half attempts that fail. Good luck!

Easy New Year Health Swaps for the Family:

  1. Replace the refined grains with whole grains. This advice might sound like a broken record, but based on the wide range of clientele I work with, this healthy change is not actually happening in real families. Whole grains maintain the natural fiber, vitamins and minerals that have been stripped from their refined counterparts. Whole grains include whole grain bread, oatmeal, whole grain pancakes, whole grain pasta, brown rice, quinoa, millet, and whole grain cereals. Refined grains are the “white” carbs, such as white bread, white pasta, and the wide variety of processed foods that are made from refined flours. Sometimes it is harder for parents to make this change than it is for the kids, since our generation was raised on refined flours. Trust me, you will get used to it and soon the refined stuff will taste bland and leave you hungry an hour or so after eating. Because whole grains have fiber, they take longer to digest (making you full sooner and longer). Whole grain fiber also plays an important role in binding and excreting fat, both in digestion and circulating lipids in the bloodstream. From the very beginning of feeding your kids as infants and toddlers, remember- kids do not need “kid food”, and they can enjoy whole grain pancakes and whole grain pasta just as much as the white stuff. Be a good example for your kids.
  2. Replace snack foods with fruits or vegetables. And while you’re at it, limit snacks to two per day (one mid-morning or before bed, and one mid-afternoon). This might be the most effective change you can make if you or your family members are big snackers and grazers. Your job is to make sure there are always plenty of fresh, colorful fruits and vegetables available to your kids. When it comes to produce, quality matters. Kids will more readily accept things that look and taste fresh, so choose wisely. Local and organic produce is usually more fresh and flavorful than something that may have traveled half way around the world and then sat frozen in a warehouse for months. Enforce this change by telling the kids what their snack options are, then encouraging them to go play or do homework before the next meal (or bedtime).
  3. Limit eating out to once per week or less. Although it is possible to eat healthy when eating out, often it is easier to make unhealthy choices and overeat when eating at restaurants. It may be even more difficult for your kids to eat healthy when eating out as many kids’ menus are limited to foods high in fat and sodium and low in fiber. This may be a challenge for the busy parent who is not used to cooking. If you choose this resolution, be prepared to plan, grocery shop, and cook. Cut corners by using time-saving and healthy cooking methods such as the slow-cooker and stir-frying lean meats and veggies. It may be a difficult change to implement, but it will be very rewarding from a health perspective (and on your budget).

Check the blog next week for more healthy New Year’s resolutions for your family!

Click here for more advice on how to set achievable goals for the new year.

Infant Feeding Series: Starting Solids

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After the first several months of life, your baby is approaching that age when either of one of two scenarios occurs:

1. Baby is practically grabbing the spoon out of your hand when you’re eating and seems so eager to eat some of that!

2. Friends, family members, and even the pediatrician keep asking when you plan to start solids.

What is the right age, what is the right first food, and how exactly do you go from there? This blog covers a plan that is based on research, professional, and personal experience. The important thing is to follow your baby’s lead. It is up to your baby to learn to eat at his or her own pace, not up to you to make them eat.

What is the right age to start solids?

According to the current recommendations from the American Academy of Pediatrics, the age to consider starting solids is 6 months old. This is later than previous recommendations and probably later than our parents started feeding us foods. There are several reasons why this age is recommended, which include developmental milestones and readiness, digestive system maturity, and long-term studies looking at outcomes of risk for developing issues like food allergies, digestive disorders, obesity, diabetes, etc. In addition to watching the calendar for that 6-month birthday, watch your baby closely for signs of readiness as well.

Here are some things to watch for to make sure your baby is ready to transition to solids (and is more likely to be successful doing so):

  • Baby can sit with minimal support, and has very stable head control. Read more

How to Talk to Your Kids about Weight and Healthy Eating

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We all want our kids to be the healthiest they can be. In recent years, we are seeing serious health problems presenting in young kids and adolescents. An unhealthy diet and lifestyle affects kids’ quality of life, and this is often what hurts them most. Kids with weight issues may get teased at school or start to withdraw from activities that were once a big part of their life, such as sports. This can make the weight issues even worse for them.

If you find yourself in a position of having to talk to your child about his or her weight, consider some of the points below. These tips apply to both overweight and underweight issues.

Explain BMI and the importance of being in a healthy range.

BMI stands for body mass index. Your child’s pediatrician should be measuring your child at well checkups and plotting their BMI on a growth chart. You can explain BMI to kids by saying, “BMI is a measurement of how much weight is on your body for how tall you are.” Read more

Halloween Candy: Gluten Free, Peanut Free, and What to Do with All of It

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Halloween is just a few days away. If you have a child with diet restrictions, or if you need to send candy to school, it can be a little overwhelming figuring out which candies are ok to have. To be safe, it is a good idea to send peanut free candies to school since chances are, there is a child who has a peanut allergy in the classroom. For kids with Celiac disease, or for those who require a gluten free diet, see the list below for candy they can have. The starred candies are those that are both gluten free and peanut free.

Peanut Free Candy:

  • Twizzlers
  • Smarties*
  • Tootsie Pops*
  • Dum Dum Pops
  • Junior Mints*
  • Dots*
  • Whoppers
  • Skittles
  • Mike and Ike Originals*
  • Starburst

Gluten Free Candy:

  • York Peppermint Patties
  • Heath Bars
  • Tootsie Rolls
  • Tootsie Pops*
  • Dots*
  • Junior Mints*
  • Charleston Chew
  • Caramel Apple Pops
  • Charms Blow Pops
  • Mike and Ike Originals*(along with several other Mike and Ike flavors- see website below)
  • Neccos Read more