04 Jun Children and Nutrition – Frequently Asked Questions
Summary excerpts from Raising Superheroes – due for publication in September 2015
Why is breastfeeding so important?
Breastfeeding is nutritionally superior to formula feeding, a point that may not be sufficiently stressed in major feeding guidelines. Breast milk is truly a miracle food.47 Thus the health messaging around breastfeeding should be simple:ideally, breastfeed exclusively until weaning begins (at around 6 months), then continue for as long as possible in conjunction with first foods, preferably to 2 years.
But don’t infants need a combination of carbs and protein as soon as possible?
A high-fat diet is optimal for brain development in newborn infants and babies, while carbohydrates should be considered a non-essential foodstuff.The current dietary guidelines overemphasise the need for carbohydrates in part because they fail to appreciate that humans of all ages, but especially newborn infants and babies during the first two years of life, are perfectly adapted to eating low-carb diets. Though there is uncertainty about the correct timing of the introduction of foods to babies, both premature weaning and the late introduction of potentially allergenic foods are best avoided.
But what has changed – what were the guidelines?
The age of introduction of first foods dropped quite markedly in the US during the 20th century and particularly after the success of commercial baby foods from the 1920s – to the point that weaning typically began as early as a month after birth in some populations. There was even that set order of foods: “white cereal rice first, followed by apple-sauce or mashed banana, and progressing on to puréed vegetables and meat”.26 This rigid American approach was and is not followed universally, however, indicating a lack of consensus on the matter. Today advice on “complementary feeding” can vary greatly between countries.
So what would be a better way of weaning?
Wean onto real foods, not onto non-foods such as white rice cereal or porridge, as some guidelines will have you do. The traditional weaning of infants onto white (or even brown) rice cereal is not based on some magical nutritional value exclusive to rice cereals without which infants will not thrive. Rather, it is because that is what was decided was good for babies some eight decades ago. The reality is that rice cereal is a nutritionally deficient foodstuff that contains little other than cheap non-essential carbohydrates. Its popularity has been sustained because of the perception that it is a safe foodstuff that is unlikely to produce allergies, and because it is easily digestible (and thus more suitable for premature weaning).
Has it been proven?
Discomforting evidence has come from the 2002 and 2008 Feeding of Infants and Toddlers Study (FITS).80, 81, 82 This study of the feeding behaviours of 3,000 babies in the US found that by seven months of age some babies had already adopted the industrial American diet low in vegetables and fruits, with the result that by 15 months French fries were the most common “vegetable” consumed. These authors fail to grasp the point that it is a nutrient-poor high-carb low-fat diet of highly processed non-foods that is causing the obesity epidemic amongst these US children. Advising these children to eat high-carb fruits, cereals, grains and porridge, even if iron- fortified (while the iron levels may be higher than some real foods, iron in real foods isn’t fortified and is absorbed differently into the body), and to limit their fat intake, while not warning of the real dangers of sugar and perhaps wheat addiction, programmes the infant to seek foods that are equally highly processed and nutritionally incomplete, and usually high in sugar and refined carbohydrates.
What impact does the first 2 years’ nutrition have on an infant?
Optimum nutrition in the first 24 months of life is critical, and it’s absolutely essential to focus on the foods and nutrients that assist brain development in this time, especially fats, vitamins, iron, iodine, copper, zinc and selenium. The emphasis of the Feeding of Infants and Toddlers Study authors is to encourage infants to eat more carbohydrates in grains and some “healthier fats”, while drinking low-fat milk. In fact, the focus ofearly infant nutrition should be on restricting carbohydrates and emphasising the essential fats, proteins, vitamins and minerals provided by nutrient-dense real foods, especially for the proper development of the brain and circulatory system.
But what about the health benefits of fruit and vegetables?
Consumption of fruit and vegetables every day has been overplayed by the official guidelines, and should be of secondary nutritional concern compared to nutrient-rich fats and proteins. Parents around the world have always struggled to get their kids to eat their fruit and vegetables… But what if they’ve been getting their priorities wrong? Should they in fact be focusing on other foods? The first inkling that this may be the case comes with the realisation that parents haven’t “always” struggled with this problem; the idea that eating a number of servings of fruit and veg each day is healthy is of quite recent origin. Before canning, refrigeration, reliably clean water and the discovery of vitamins, fruits and vegetables were viewed with suspicion since they were often associated with ill health (due to their preparation in bacterially contaminated water).
And what about allergies?
A related matter of timing has to do with the avoidance of allergies. By the early 2000s there was clear evidence for the rising incidence of specific food allergies; for example, the prevalence of peanut allergy in the US quadrupled in the 13 years between 1997 and 2010. As a result the American Academy of Allergy, Asthma and
Immunology has suggested that new foods be introduced to the infant one at a time for a period and only continued if there was no evidence for any allergic reactions. Other authorities have suggested delaying the introduction of potentially allergenic foods. Following these proposals, the introduction of the infant to more solid foods could take many months. More recently, however, the thinking has again changed, as it has become apparent that the late introduction of foods may actually increase
the likelihood that an allergy to that foodstuff will develop, while the early introduction of eggs76 75 and peanuts may reduce the risk that an allergy to that foodstuff will develop. The landmark Learning Early about Peanut Allergy (LEAP) study, led by South African-trained scientist Dr George du Toit in London, found that the early introduction of peanuts reduced the risk that the infant would develop a peanut
allergy by 70-80%.77, 78 As a result the suggestion is now that infants should be introduced to peanuts between 4 and 8 months under controlled conditions. Following the LEAP study, there will likely be an increasing interest in the possible77 role of the earlier introduction of potentially allergenic foods to prevent future food allergies.
What are the potential risks of the current high carb, low fat diet?
There is increasing evidence, often overlooked in the dietary guidelines, that the consumption of gluten-containing grains, including wheat, barley and rye, can cause a variety of health problems, especially in the genetically-predisposed. There is a growing concern that gluten- containing grains like wheat, barley and rye directly cause long-term ill health. The concern was perhaps first popularised by US cardiologist Dr William Davis102, followed by his countryman Dr David Perlmutter103, a neurologist. More recently, the champion of this cause has become Dr Alessio Fasano of the Harvard Medical School.104, 105
Dr Fasano is a potential future Nobel Laureate for his discovery of the manner in which gluten in wheat causes the auto-immune disease coeliac disease, and perhaps other auto-immune conditions.106 On purely scientific grounds, Dr Fasano will become an increasingly irresistible candidate as his ideas become increasingly mainstream.
What are some of the other downsides to popular guidelines?
Major dentalproblems. But if you feed your child a cereal-free diet full of vitamin D, fats and calcium provided by real foods – in contrast to some older guidelines that are effectively the ideal dietary prescription for the promotion of dental cavities – you will diminish the possibility of dental problems. Before the agricultural revolution and the introduction of grains into the human diet, humans did not suffer widely from dental cavities (except for one group of North Americans eating acorns), a perhaps obvious realisation, since without easy access to dentists those with cavities must live painful lives and will likely die from dental abscesses.
How do we reverse the obesity/ diabetes epidemic?
All it requires is that we stop eating addictive, highly palatable foods and that each of us eats only that amount of dietary carbohydrate that our individual bodies are able to tolerate. As our work on The Real Meal Revolution has shown, when the formerly obese follow these rules and begin to eat real foods, they can quite easily reverse their “sloth and gluttony”, becoming lean and healthy with minimal effort and without ever again having to suffer perpetual hunger.
The three fundamental pillars of advice are the following:
- eliminate (or drastically reduce) sugar from your child’s diet;
- eliminate (or drastically reduce) refined carbohydrates from your child’s diet;
- include real, non-processed whole foods rather than non-nutritious, unhealthy processed foods in your child’s diet.
- 26. A Bentley. Inventing Baby Food. Oakland, California: University of California Press;
- 47. O Ballard and AL Morrow. “Human milk composition: Nutrients and bioactive
factors”; Pediatric Clinics of North America; 2013; 60 (1): 49-74
- 75. BI Nwaru, et al. “Age at the introduction of solid foods during the first year and
allergic sensitization at age 5 years”; Pediatrics; 2010; 125 (1): 50-59
- 76. JJ Koplin, et al. “Can early introduction of egg prevent egg allergy in infants?
A population-based study”; Journal of Allergy and Clinical Immunology; 2010;
126 (4): 807-813
- 77. G Du Toit, et al. “Randomized trial of peanut consumption in infants at risk for
peanut allergy”; The New England Journal of Medicine; 2015; 372 (9): 803-813
- 78. RS Gruchalla and HA Sampson. “Preventing peanut allergy through early
consumption – ready for prime time?”; The New England Journal of Medicine;
2015; 372 (9): 875-877
- 80. MK Fox, et al. “Feeding infants and toddlers study: What foods are infants
and toddlers eating?”; Journal of the American Dietetic Association; 2004;
104 (1 Suppl 1): s22-s30
- 81. MK Fox, et al. “Food consumption patterns of young preschoolers: Are they starting
off on the right path?”; Journal of the American Dietetic Association; 2010; 110 (12 Suppl): S52-S59
- 82. JT Dwyer, et al. “FITS: New insights and lessons learned”; Journal of the American Dietetic Association; 2004; 104 (1 Suppl 1): s5-s7
- 102. W Davis. Wheat Belly. New York: Rodale; 201
- 103. D Perlmutter. Grain Brain. New York: Little, Brown and Company; 2013
- 104. A Fasano. Gluten Freedom: The nation’s leading expert offers the essential guide
to a healthy, gluten-free lifestyle. Bognor Regis, UK: Wiley; 2014
- 105. A Fasano. A Clinical Guide to Gluten related Disorders. Philadelphia: Lippincott, Williams & Wilkins; 2014
- 106. A Fasano. “Zonulin and its regulation of intestinal barrier function: The biological
door to inflammation, autoimmunity, and cancer”; Physiological Reviews; 2011;
91 (1): 151-175
- 107. Table 5: reproduced from A Fasano.