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.

Monday, August 23, 2010

#7 Two Salads to Go: Hold the receipts

“You should read this,” my husband declared while sliding an article in front of me.

“What is it about?” I asked suspiciously. Jeff is very thoughtful about digging up interesting items for me to read but has been known to occasionally slip in something about global transfer pricing or taxation of international financial instruments. As a result, I know more about Subpart F of the Internal Revenue Code than the average nutritionist, the only purpose of which is to make me a better conversational partner when he wants to talk about work.

“You won’t believe it,” he says cryptically and dashes off to work.

The article was written by Dr. David Williams, a clever, holistically oriented physician who produces a subscription newsletter and sells his own line of supplements. The subject was a nasty chemical called bisphenol A (BPA). BPA is used in the manufacture of polycarbonate plastics, such as water and baby bottles. It is one reason we have been warned to minimize drinking out of plastic bottles.

I have dutifully informed my clients not to microwave in plastic and encourage the use of glass storage containers to reduce BPA exposure. While scientists continue to debate exactly how dangerous BPA (a known hormone disruptor/synthetic estrogen) is, I figure it is better to be safe while the industry subsidized “experts” duke it out.

Williams’ report claimed a new study suggested all this fuss about BPA in plastic bottles is misplaced. The major danger from BPA actually comes from store receipts. Huh?

You could chew plastic bottles all day, he asserts and only accumulate a small percentage of the BPA you could get from TOUCHING grocery store and post office receipts. The culprit is the thermal ink-less paper used to print receipts at big retailers, restaurants, gas stations and practically any place else one shops. They are coated with tons of the toxin which absorbs right through your skin.

All this time I have been trying to figure out which number plastic bottle is safest and the real health danger is shopping!

Further research on my part discovered an Environmental Working Group ( report which found BPA in 40% of the receipts they collected from stores. Another study found 80%. In 2006, the nation’s largest manufacture of this poison paper dropped BPA from its formulation because of “growing concerns” about its safety.

The US Postal Service stopped buying BPA coated paper in Sept. 2009 but samples taken in March 2010 were still all positive for BPA. I go to the post office all the time! Perhaps I should collect hazard pay for mailing boxes. I try not to be a nut about my living habits but these findings call for action.

My action plan is to only accept the receipts I need for tax or record keeping purposes. Good thing all my reading on obscure parts of the tax code allows me to immediately identify the important receipts. I now wash my hands as soon as possible after handling receipts and no longer throw them on top of my food or newly purchased underwear.

Unfortunately, these behavioral changes move me one step closer to the “out there” level of healthy/environmentally sound living. I already take my own bags, even to the mall, much to the distress of my teenage daughter. Imagine her mortifications when I whip out my cotton gloves before taking the receipt. I am not sure I am ready for that step.

She is also about to start a job in retail sales. Are the potential long term dangers of exposure to BPA for such a benign occupation now to be compared to working in a coal mine? If she can’t have children one day, will we be blaming all that receipt handling?

This scenario sounds ridiculous yet that is exactly the kind of detective work I employed this week with one of my 60 year old clients with complex medical problems. Some of her symptoms harken back to her employment in a perfume factory while in college. Who knows what class of possible poisons were used to create scents in the 70’s and what effect it could be having on her present health. Perfume may sound innocent, pleasant even but we suspect the effect of the chemical exposure is still significant today.

Now consider the innocent receipt…….

Sunday, August 15, 2010

#6 The Secret Life of a Nutritionist

Because I am a nutritionist, people think I eat nothing but braised bean sprouts or that I spend an inordinate amount of time taking the personal eating inventory of all those around me. Sometimes if I am eating out with new acquaintances they will eye the menu nervously and then ask what I am ordering, imagining that I am carefully cataloging their every nutritional move for later dissection and harsh judgment. Mothers of my daughter’s friends regularly ask her what I eat and what it is like to live with a nutritionist.

“She has a huge sweet tooth, “ my 19 year old daughter, Tory will divulge conspiratorially. Then she will come home and lament the fact that her friends and their mothers are all obsessed with food. “It’s annoying,” she complains while rummaging through the refrigerator. “Do we have any sushi?”

“Did you tell them that we drink a pureed chard drink for breakfast?” I asked once, figuring it is always good to keep the mystique going though this is true.

“No, I told them you sometimes hide candy in your office drawer,” she says as she eyes the refrigerator contents critically. This is also true. “Did you make any salsa?”

I had.

The next morning, Miriam came to the office. She is 83 and a real firecracker but I had not seen her for over 8 months. Most of my clients drop by or call if there is a problem so while I was happy to see her, I was concerned something might have happened. “I spent Saturday at the emergency room,” she said without much preamble. “ I am dehydrated and look awful,” she continued. “What in the world are you drinking?”

It was chard, spinach, parsley, apples, blueberries and grapes Vitamixed into my morning drink.

“It looks awful,” she opined distracted for the moment. “I would never drink that.”

I assured her it was very tasty and asked if she wanted to try it.

“You would have to blindfold me first,” she replied. “It looks like pond scum.”

I started to laugh. “Well, it does,” she insisted unfazed. “So explain to me what these tests mean,” she demanded pulling out a stack of papers from her hospital visit. “My doctor won’t tell me anything.”

So, not everyone cares about what I eat and my personal consumption is not necessarily relevant to anyone else. Like most nutritionists, I have played extensively with my diet because it is interesting to me and I want to experience what I recommend. Through the years I have toyed with macrobiotic, raw, vegetarian and vegan diets. I have tried dairy free, gluten free and sugar free elimination routines. Most nutritionists I know are also diet dabblers.

In the end, we figure out what works for us, personally and develop a bag of tools for everyone else. For example, I consume almost no alcohol because it makes me tired but realize this experience has limited application to most people in my practice. On the other hand, I avoid artificial colors, sweeteners and flavors and eat plenty of fruits/ vegetables and believe these principles have general application. Most other factors, especially when it comes to food avoidance, applies to some people but not others. Other nutritionists I know imbibe with abandon, are vegetarians or are not, smoke pot, avoid hemp, eat cheese, don’t eat cheese; We are pretty much all over the place in diet and personality.

The one consistent factor is a vast majority of us are not obese. We are an intimidating group of thin-ish women in a society rift with distorted body images and unhealthy relationships to food. I believe this is the real source of questions from the mothers of Tory’s friends. They do not ask me directly what I eat because I might ask them back. Better to secretly compare what they are eating to someone who, in theory, knows what they are doing and is thin. The question they are really asking is the dietary equivalent of, “does this skirt make me look fat?” That is, does my diet look like it is making me fat?

As any husband knows, answering THAT question is a minefield.

Monday, August 9, 2010

#5 Me and the GI Guy

“The GI (gastrointestinal specialist) agrees with you,” my neighbor announced triumphantly when I opened the door.

“Then it must be right,” I drawled dryly.

Undaunted, she walked in and happily relayed the details. Several weeks ago, she had approached me with the seductive come on…”I know how much you like medical mysteries…..”

She then went on to explain a strange vomiting illness that she developed every time she went to visit her husband who worked and lived in another city. After 24 hours, she would be overcome with a flu-like illness and have to spend a day or two in bed. She and her husband traveled extensively but this situation only occurred and it occurred every time, she went to their apartment in New York. China, Rome and Chicago: No problem. New York: Two days in the bathroom.

She had already talked to several doctors and specialists when she approached me and they were all “baffled”, in her words. She had been given a clean bill of health and sent from one specialist to the next.

I started with the kind of questions that come to mind when the unusual occurs….
Did it ever happen, even once, somewhere else?


Are the symptoms always the same?

Yes. I am fine for the first 24 hours and then get the same vomiting illness.

Are there any other symptoms? Itching? Fever? Tingling of the hands?


Do you have any other medical problems or are you taking any medication that could sometimes cause these symptoms?

My internist says, “no”.

Does it happen if you stay other places in New York?

Not sure because I always stay at the apartment.

Is the apartment in an old building?

Yes, but we renovated it.

The insides are new?


I told her I was suspicious about the building and suspected a reaction to mold. I had run into several cases of building mold causing strange symptoms and too many were linked to pre-war buildings in New York City. Nonetheless, I asked her if I could present her case to a medical study group I belong to, to see if any of the doctors or therapists in it had any additional ideas. She agreed and until she rang my doorbell, I had not seen her for several weeks.

The study group had two alternate lines of consideration. One line was psychological and the other biochemical. Was she emotionally reacting to moving between two very different lives: one here and the other in the big city? Interestingly, the doctors in the group were curious about psychological causes. The other idea was solvents from sealing floors or other chemicals used to renovate.

I presented both these possibilities to her. She balked at the psychological suggestion claiming it was more relaxing in New York than being here where she was on frequent grandmother duty (which she loved but was exhausting). The floors were installed pre-finished, so there was no off-gasing, there. The paint had dried and aired out long ago.

So, we were back to GI guy agreeing it was something in the apartment and reconsidering mold. I gave her the number of a great company that sells mold test plates and she said she would run the tests. (FYI…the company is called Tennessee Mold Consultants and not only do they run a mean test, the results provide specific counts and mold type.)

Will let you know what happens.

Sunday, August 1, 2010

# 4 Looking for Mr. Rightcheese

Cheese substitutes for the dairy-free have traditionally been pitiful. Without casein, the most abundant protein in milk products, the darn things won’t melt. Like a wad of rubber cement, they lay on your faux pizza defying any amount of heat a conventional oven can muster. I often wondered if an acetylene torch could do the job but my husband will not let me near one. Besides, there would still be the unappealing taste to contend with.

Through the years I would watch one digestion disturbing contender after another appear then disappear from the shelves of the nearby health food markets. I would imagine the dairy free newbie demanding their local establishment stock these alternatives and then buy exactly one package. I know I did. However, one taste and the verdict was inevitably, “blech”. The remaining packages would sit in the dairy case until the expiration date arrived. Then the unsold items would be tossed away and the product unavailable until the next unsuspecting consumer approached the store buyer and the whole cycle started again.

Every year I went to the National Health Expo, where new products for the health food industry are rolled out and dutifully tasted any new cheese substitute offering. About 10 years ago, a melting soy based product was introduced. It was soy-y tasting but acceptable and it melted without the addition of casein. I was hopeful, but the company was not viable and the product died a quiet death before anyone even heard of it.

A few months ago, a client reported they had found a great cheese substitute. Since we were speaking by phone, I could roll my eyes with abandon. I asked the critical questions:

Does it melt?

“It does,” she swore.

Does it taste like old socks?

“Not a bit,” she claimed.

I dutifully wrote the name down in case I ever ran into it. (A good detective checks things out.)

The product is called, Daiya and within a week, I spotted a package at Whole Foods. It comes shredded in two flavors, cheddar and mozzarella. I bought the mozzarella version and for the first time in many years, I made a pizza.

The good news is that it is tasty though Wisconsin does not have to worry about losing its share of the cheese market to it. Nobody who eats cheese would willingly choose Daiya. It does indeed melt and within a few weeks, Whole Foods was using it to make a vegan pizza alternative.

Now, the bad news: it is not health food. The main component is tapioca. The result is 6 grams of carbohydrate and one gram of protein per serving, it is about the nutritional equivalent of putting white rice on your pizza. Still, if you load your pizza shell with tomato sauce and vegetables, a sprinkling of Daiya makes it much more like regular pizza. Or if you use a little to melt on top of a turkey sandwich or vegetables rather than trying to make a plain “cheese” sandwich with it, there should not be too many nutritional concerns.

Bottom line: Daiya is a useful condiment.