Monday, August 30, 2010

#8 And you thought your teenager was tough.....

I was asked to write an article for an online site about food reactions and performance. I decided to tell the story of a teenager I saw this week. Here is the grittier blog version…..

When I looked at my schedule at the beginning of the summer and saw Sam’s name, I sighed. Sam is a thirteen year old boy that defines the concept of a child “only his mother could love”. I have known him since he was seven. Being kind one might say he had a tendency to be negative but defiant, belligerent, argumentative and angry were more accurate.

I always use to think there is not enough money in the world for someone to want to deal with young teenage boys. They are sullen, mouthy and generally smelly. One had to admire middle and high school teachers for their commitment to this age group and I thought their work was a kind of calling, like the priesthood. (It pays about as well, too.) So, inexplicably I have found I love dealing with the these little hormone bombs professionally. Most of them are fun and interesting if you can get them talking and I do not take the sullenness too seriously because I understand the chemistry of it. They rarely get to me.

Sam, unfortunately, is the exception.

He was so difficult at age seven that his parents gave up before they were able to put into practice any of the dietary changes I had suggested. Sam was a rigid, fussy eater and refused to eat at all if mom did not make exactly what he wanted. His parents worried about his size (extra small) and his temperament (extra prickly) but decided medication was the way to go. It was an ongoing disaster.

His mother dragged him to see me every few years between medication trials with the same results. We would develop a plan which he would dig in his heals and refuse to do. At one visit when he was ten, he glared at me and then yelled at his mother, “I like being small.” When concerns about academic performance were raised he declared that he “hated school” and his teachers “sucked”.

I could only imagine how much more impossible he was going to be as a fullblown teenager. It was a spiritual practice staying calm under his provocative attacks. Change can take a long time, however and I had to give his mother points for tenaciousness. Maybe this would be the year.

Gloomy as ever, Sam plopped himself into a chair and narrowed his eyes, ready to rumble. What it must have taken his mother to get him here! He was still peanut size and his diet remained mostly pizza, cereal, pasta and sugar with a little meat thrown in from time to time. There was a new development however; he now had chronic stomach pain. His doctor had prescribed a reflux medicine which helped a little.

Food reactions do not always affect behavior and performance. When they do, the substance most likely to cause stomach pain and make a child chronically angry is gluten. Throw in poor growth as a symptom and the result is practically a textbook case of gluten sensitivity (and maybe even celiac disease). Gluten is a protein found in many grains like wheat, rye and spelt. There are gluten like substances in all grains and many families of gluten. Consequently, what contains gluten and what does not can be arguable.

To simplify matters for an initial trial, I often recommend just removing anything made with wheat or rye flour. Foods like quiche, pasta, bread, croutons, bagels, pizza and cereal are eliminated or a gluten free alternative chosen. Minor gluten ingredients are present/hidden in many processed foods such as salad dressings, soy and other sauces. If celiac disease (an autoimmune condition associated with gluten intolerance) is suspected, all gluten sources must be strictly avoided. With gluten sensitivity, sometimes small amounts can be tolerated and allowing more flexibility in the beginning is less intimidating. Highly sensitive children are discovered quickly when reactive foods are removed but by then, the parents are more comfortable with elimination and can tighten up.

I had been trying to get Sam’s parents to remove all gluten based foods from his diet for six years because of he was so difficult and not growing. Now there was chronic tummy pain to add to the list. During one of our aborted trials, his mother had stopped eating gluten herself as a gesture of support and felt so much better that she had stayed off.

Getting a few fruits and vegetables in would also have been nice, but my first concern was getting the gluten out. Occasionally, that will miraculously open the rest of the diet. Besides, I was getting nowhere, so I was down to one change.

I have found with angry teenage boys, truthful and straightforward work best. Luckily, I can be straightforward to the point of bluntness. “How is the small thing working for you these days?” I asked looking straight at him. Apparently: not so well. Sam was an excellent athlete despite (and possibly because of, if you watch professional sports) his temper. I don’t know how he lasted through a game with his diet, but he had until his stomach started acting up. Now, he was trying out for the high school team and was nervous.

I pounced. “You have a month before try-outs start to straighten out your stomach and get growing. This is the perfect time, “ I shamelessly enthused. “Just say you’ll try it.”

He glared at me.

“Come on, Sam. Just say, ‘yes’,” I coaxed. I shamelessly use the used car salesman just-say-yes-to something trick often and successfully. Research on persuasion has found that once a person says, “yes” to one thing, they are more likely to be open to a bigger commitment. This is why a common first question asked when you walk into a car showroom is, “you want to save money don’t you?” Of course you do, so you say, “yes”. Then before you know it, you have bought a previously owned Hummer.

I cajoled and prompted; bullied and soothed and he folded.

“Fine,” he muttered and the no gluten diet trial was in place.

The half smile when he returned a month later was thus significant. A month is not enough time to evaluate growth but the stomach pains were gone and he was pleasant. Reluctantly, he agreed to continue if he could cheat once a month. “Absolutely, try,” I explained. Some people can have small amounts of the problem food without symptoms and others cannot. It is all trial and terror to find out who belongs in what group.

In the meantime, this school year is looking a whole lot better and in a few months we will see if he is growing. I am sending him to an endocrinologist, just in case we are too late with the dietary changes and he needs growth hormone. Shockingly, he agreed to go even when I told him there would be a blood test.

I actually think he has felt bad all of his life and for the first time is feeling, dare I say, pleasant. All I know is there will be a lot less groaning on my end next time I see he is coming in. That has got to be a good thing.

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