The Kidfixer Newsletter

A quarterly newsletter from Doctors Mesibov, Altman, Jacobs & Rubinos            Autumn 2018


The Facts about Gluten-Free Eating

From the Tufts Nutrition Newsletter

The gluten-free foods market has exploded in the past decade. It is important for people following or considering a gluten-free diet to know the facts.

Gluten Sensitivities: Gluten refers to a family of proteins found in wheat, barley, rye, and triticale. Gluten proteins give dough its elasticity. For the approximately one percent of the population with celiac disease (a genetically-based autoimmune reaction to gluten) following a gluten-free diet is essential to health.

Data suggest that approximately ten percent of people feel they have sensitivity to wheat, even though they do not have celiac disease. “There is a condition known as non-celiac gluten sensitivity (NCGS),” says John Leung, MD, an allergist, gastroenterologist, and director of the Center for Food Related Diseases at Tufts Medical Center. “Patients present with no evidence of celiac disease in blood tests or biopsies, but they report their gastrointestinal symptoms improve with avoidance of gluten.” However, a large review of studies surprisingly found that most people who follow a gluten-free diet for self-diagnosed NCGS do not actually develop any symptoms after eating gluten. “A recent study published in the journal Gastroenterology provides evidence that many people who think they have gluten sensitivity may actually be reacting to fructans, short-chain carbohydrates found in wheat, onions, and a number of other plant foods,” says Leung.

Around twenty percent of consumers who follow a gluten-free diet do so because they consider it a healthy lifestyle option, but there have been no major studies on the use of a gluten-free diet for general health benefits or for weight loss. “Gluten-free diets may potentially help people move toward a healthier dietary pattern because they prohibit refined wheat products and the added sugars found in many wheat-rich foods,” suggests Dariush Mozaffarian, MD, DrPH, dean of the Friedman School of Nutrition Science and Policy and Editor-in-Chief of Tufts Health & Nutrition Letter, “but few health benefits may occur if gluten-containing foods are simply replaced with white rice and other refined starches.”

The Gluten-Free Diet: For those with celiac disease, following a gluten-free diet involves more than just avoiding wheat, barley, rye, and triticale. “Breads, pastries, baked goods, cereals, and wheat pastas are common gluten-containing foods, but processed foods may contain gluten-containing additives like malts and unprocessed wheat starch,” says Nicola McKeown, PhD, a scientist at Tufts’ Jean Mayer USDA Human Nutrition Research Center on Aging, “so gluten may be hiding in foods like granola bars and salad dressings.” Minimally processed fruits, vegetables, beans, nuts, seeds, and animal proteins are naturally gluten-free, as are a number of grains such as buckwheat, corn, and rice. For processed foods, gluten-free labels can help identify safe choices, although many products are not marked, so learning what to look for on ingredient lists is important.

Some scientists are concerned that replacing gluten-containing foods with gluten-free refined starches may increase risk for nutrient inadequacy. “Processed gluten-free foods, such as gluten-free cookies or snack foods, are often made from unfortified or unenriched rice, tapioca, corn, or potato flours,” says McKeown. “This means they lack certain nutrients (like iron, folic acid, and other B vitamins) that are found in whole grains and typically added to commercial wheat flour. These types of processed gluten-free foods also may be of low nutritional quality, as they are often high in calories, sugar, and sodium, and low in fiber.” Since many processed gluten-free foods are made with rice flour, there is also some concern about over-exposure to arsenic-contaminated rice when following a gluten-free diet. Additionally, data from a recent study in the Journal of Human Nutrition and Dietetics suggest gluten-free processed foods may be more expensive than their gluten-containing counterparts. Replacing gluten-containing foods with naturally gluten-free whole grains (like brown rice, corn, buckwheat, and quinoa) instead of processed gluten-free products should improve the nutritional quality of a gluten-free diet.

While it is possible to construct a nutritious gluten-free diet, this diet should not be undertaken without expert nutritional guidance. Also, other illnesses can present with similar symptoms. “Patients often associate gastrointestinal symptoms with food, however not all gastrointestinal symptoms result from food intolerance or hypersensitivity,” says Leung. “Sometimes there can be an intrinsic gastrointestinal disorder causing the problem, for example chronic pancreatitis, inflammatory bowel disease, ulcerative colitis, or other gastrointestinal diseases.” People who think they are sensitive to gluten should speak with their healthcare provider before beginning a gluten-free diet.

Go Bananas with Bananas (They Beat Sports Drinks!)

From the Tufts Nutrition Newsletter

A study published in 2012 found that competitive cyclists performed better on long rides if they consumed either a banana (plus water) or a sports drink, compared to water alone. Now a follow-up study, recently published in the journal PLOS One, concluded that bananas are even better than sports drinks at helping these athletes recover from extreme exertion.

Twenty cyclists rode in 75-kilometer time trials while ingesting a set amount of carbohydrates from either bananas or a six percent sugar beverage every 15 minutes. Ingesting carbohydrates from either source reduced inflammation compared to water alone, and improved the rate of metabolic recovery from this intense and prolonged exercise. However, bananas appeared to have added metabolic benefits above the impact of the sports drink alone.

While this study did not test whether other fruits would work as well, it does lend support to the idea that components of whole foods interact to provide the best health benefits in the body.

Power Down and Sleep Better

From Parenting Magazine

Is your child getting enough rest? The annual Sleep in America poll, conducted by the National Sleep Foundation, finds that most kids are getting at least one hour less sleep per night than experts recommend. The poll examines a variety of sleep-related issues, from how exercise affects rest to how kids sleep on school nights.

According to the foundation, the deficiency in kids' sleep is closely related to the presence of electronic devices in their bedrooms. About 75 percent of elementary school and middle school children have access to electronics in their bedrooms, and the number grows to nearly 90 percent for high schoolers. The extra stimulation, light and sound from electronics make it much harder for children to relax and head into dreamland.

The National Sleep Foundation recommends limiting the amount of screen time near bedtime and eliminating it completely an hour before turning in to ensure children get enough sleep. Instead, the foundation suggests unplugged activities, such as conversation, reading, playing non-electronic games or relaxing in any way that does not involve televisions, tablets or texting.

Keep in mind, adults should lead by example for the kids' sake and for their own. Adults, too, regularly fall short of the recommended amount of sleep, and much of this has to do with having phones and tablets at hand in the bedroom. The foundation's survey showed that parents who enforced a rule of no electronics in the bedroom, including their own, fostered a more well-rested home.

Lack of sleep shouldn't be taken lightly; it's a serious problem for kids and adults of all ages. It can lead to decreased concentration in school, a weakened immune system,increased risk of obesity, and moodiness.  Kids ages 5 to 12 should be getting about 10 to 11 hours of sleep a night. Teenagers need less, but they should still be getting 8.5 to 9.5 hours of sleep. According to the National Sleep Foundation, only about 15 percent of teens are getting the recommended amount of sleep each night.

The Reality of Child Abductions

From Kids Health

News about a kidnapped child or teen can worry parents everywhere. But it's important to remember that most kids pass through childhood safely.

Here are some of the realities of child abduction:

  1. Most kids who are reported missing have run away or there has been a misunderstanding with their parents about where they were supposed to be.

  2. Of the kids and teens who are truly abducted, most are taken by a family member or an acquaintance; 25% of kids are taken by strangers.

  3. Almost all kids kidnapped by strangers are taken by men, and about two thirds of stranger abductions involve female children.

  4. Most abducted kids are in their teens.

  5. Kids are rarely abducted from school grounds.

Ways to Prevent Abductions

About 2,100 missing-children reports are filed each day in the U.S. Many cases can be solved more easily when parents can provide key information about their kids, like: height, weight, eye color, and a clear recent photo.

It's also wise to:

  1. Make sure custody documents are in order.

  2. Have ID-like photos taken of your kids every 6 months and have them fingerprinted. Many local police departments sponsor fingerprinting programs.

  3. Keep your kids' medical and dental records up to date.

  4. Make online safety a priority. The Internet is a great tool, but it's also a place for predators to stalk kids. Be aware of your kids' Internet activities and chat room "friends," and remind them never to give out personal information. Avoid posting identifying information or photos of your kids online.

  5. Set boundaries about the places your kids go. Supervise them in places like malls, movie theaters, parks, public bathrooms, or while fundraising door to door.

  6. Never leave kids alone in a car or stroller, even for a minute.

  7. Choose caregivers —babysitters, childcare providers, and nannies — carefully and check their references. If you've arranged for someone to pick up your kids from school or daycare, discuss the arrangements beforehand with your kids and with the school or childcare center.

  8. Avoid dressing your kids in clothing with their names on it — children tend to trust adults who know their names.

Talking to Kids About Strangers

One of the challenges of being a parent is teaching your kids to be cautious without filling them with fear or anxiety. Talk to your kids often about safety, and give them the basics on how to avoid and escape potentially dangerous situations.

Teach them to:

  1. Never accept candy or gifts from a stranger.

  2. Never go anywhere with a stranger, even if it sounds like fun. Predators can lure kids with questions like "Can you help me find my lost puppy?" or "Do you want to see some cute kittens in my car?" Remind your kids that adults they don't know should never ask them to help or to do things for them.

  3. Run away and scream if someone follows them or tries to force them into a car.

  4. Say no to anyone who tries to make them do something you've said is wrong or touch them in a way that makes them feel uncomfortable.

  5. Always tell you or another trusted adult if a stranger asks personal questions, exposes himself or herself, or otherwise makes them feel uneasy. Reassure kids that it's OK to tell you even if the person made them promise not to or threatened them in some way.

  6. Always ask permission from a parent to leave the house, yard, or play area or to go into someone's home.

Keep these other tips in mind:

  1. Make sure younger kids know their names, address, phone number including area code, and who to call in case of an emergency. Review how to use 911or a local emergency number. Discuss what to do if they get lost in a public place or store — most places have emergency procedures for handling lost kids. Remind them that they should never go to the parking lot to look for you. Instruct kids to ask a cashier for help or stand near the registers or front of the building away from the doors.

  2. Point out the homes of friends around the neighborhood where your kids can go in case of trouble.

  3. Be sure your kids know whose cars they may ride in and whose they may not. Teach them to move away from any car that pulls up beside them and is driven by a stranger, even if that person looks lost or confused. Develop code words for caregivers other than mom or dad, and remind your kids never to tell anyone the code word. Teach them not to ride with anyone they don't know or with anyone who doesn't know the code word.

  4. If your kids are old enough to stay home alone, make sure they keep the door locked and never tell anyone who knocks or calls they are home alone.

If Your Child Is Abducted

The first few hours are the most critical in missing-child cases. So it's important to contact your local police and give them information about your child right away.

They'll ask you for a recent picture of your child, what your child was wearing, and details about when and where you last saw your child.

You can ask that your child's case be entered into the National Crime and Information Center (NCIC). Other clearinghouses such as the National Center for Missing and Exploited Children ([800] 843-5678) can offer information and support during your search.

After notifying the authorities, try to stay calm. You'll be able to remember details about your child's disappearance more easily if you do.

Is Football Safe for Kids?

From NBC News

After 25 years of playing football, six of them in the NFL, former Minnesota Viking Greg DeLong feels like a "walking time bomb" who could end up with brain disease from all the hits he took on the field.

And now DeLong has another reason to worry: His 12-year-old son Jake has followed him onto the gridiron —and is part of a groundbreaking study that found brain changes in children after just one season of suiting up.

The more head blows a child sustained, the more changes were seen in their brain tissue, according to the study released Monday. The effect was seen even in young players who did not have a concussion.

Although the preliminary findings don't show whether the brain changes are permanent or will cause disease, they have some parents like DeLong questioning whether the sport is worth the risk.

"Football's important to us, but there are other things out there that are more important," he said.

Three million American kids take part in tackle football programs, and research has largely focused on the long-term effects of concussions, a form of traumatic brain injury.

A team from Wake Forest Baptist Medical Center decided to look beyond concussions to the hundreds of less serious head blows a player might receive during practices and games over the course of a season.

"This is important, particularly for children, because their brains are undergoing such rapid change, particularly in the age category from maybe 9 to 18. And we just don't know a lot of about it," said Dr. Chris Whitlow, one of the lead researchers.

The Wake Forest group studied 25 players between the ages of 8 and 13 in the South Fork Panthers youth football program in Winston-Salem, North Carolina.

Each boy was given a helmet outfitted with sensors that measured the frequency and severity of impacts — 60 percent of them absorbed during practice — and transmitted the information to a laptop on the sidelines.

Dr. Alex Powers, a pediatric neurosurgeon involved in the research, said it was surprising to see how forceful the grade-schoolers' hits were.

"They are hitting at extremely high levels," he said.

The collected data was analyzed against pre-season and post-season MRIs of the players' brains. The high-tech scans looked for tiny changes in white matter, which is the tissue that connects the neuron-rich gray matter, the researchers said.

"We have detected some changes in the white matter," Whitlow said. "And the importance of those changes is that the more exposure you have to head impacts, the more change you have."

Just as important, Whitlow said, are the questions unresolved by the study.

"Do these changes persist over time or do they just simply go away? Do you get more changes with more seasons of play? And most importantly, do these changes result in any kind of long-term change in function like memory or attention or anything that would be important in your ability to function day to day?"

Answers may be years away. For now, all the Panthers' parents know is that based on the study published by the journal Radiology, something is happening to their children's brains during the season.

Kindra Ritzie-Worthy has two sons who play, 13-year-old Jahvaree and 11-year-old Jahnaul. She said their love of the sport is "beyond words."

"They bring the football to church. They bring the football to track practice," she said. "Actually, my oldest — I found out he was sleeping with the football."

Ritzie-Worthy said she frets about her boys' safety, but the study isn't making her have second thoughts about football until she knows more. Sports, she said, motivates her sons to keep up their grades and teaches them how to chase their dreams.

"Worth the risk?" she said. "I say absolutely."

DeLong, who has seen NFL alums like himself felled by the brain disease chronic traumatic encephalopathy, said he wishes the Wake Forest research existed three decades ago when he was a young man.

Although he is troubled by the initial findings, he's torn about whether to act on them. He made Jake take a two-year break from football because of headaches, but then allowed him to return to the sport this year.

"Until he stops loving football, he's gonna continue to play," DeLong said.

Then he threw out a caveat.

"If there's a change in our son's scan at the end of this season, we're probably gonna pull him," he said. "It's just not worth it."

His hope is that the research can be used to retool drills and rules to protect all the kids who trot out onto the field with Super Bowl fantasies in their head and a drive to crush the competition in their heart.

"You're gonna get hurt," DeLong said. "It's a bunch of gladiators out there. It's a very aggressive game. You can't take that out of football. But you can make it safer."

Answers may be years away. For now, all the Panthers' parents know is that based on the study published by the journal Radiology, something is happening to their children's brains during the season.