When the world ended as we knew it I was determined to cook up lower cost, plant based meals and chalk my freezer full. I wanted to have a great stock pile so that when I eventually returned to work I would have so many […]
Hey! Did you hear that it’s Nutrition Month yet? Maybe you have been blasted all over social media with tons of posts so you already know. If you didn’t know….well…March is Nutrition Month! A Dietitian’s goal every day is to teach people about healthy eating, but Nutrition Month is like our Christmas. We get extra creative and extra loud because we can share our experiences, our knowledge, our tips and tricks and maybe even some of our failures! This year the theme is Unlock the Potential of Food. Simply put…food has limitless potential. Its about so much more than satisfying our hunger! For the purposes of this blog though, I would like to focus in on food’s potential to heal.
If you are new to this diagnosis or you have no idea what Celiac Disease is,
Celiac Disease is an auto immune disease that can cause damage to the small intestine when Gluten is consumed. This damage can lead to nutrient deficiencies which can cause further health complications down the line. Gluten is found in wheat, rye, barley and their hybrid strains.
I often hear…”Have you tried gluten free? We’ve gone gluten free.” as I’m walking through the grocery store or just doing things like standing in line for coffee. I find that there is absolutely nothing wrong with this statement or with the actual act of going gluten free itself. I only ask that people are cautious when it comes to changing their diet. I have heard people say that going gluten free really helped them. Hey…I can’t argue with that! The one thing I ask though, is that you make sure you have ruled out potential health considerations before changing something that might not be helpful.
The Gluten-free diet itself isn’t necessarily a healthy one. Gluten-free foods are not fortified with the same nutrients and they tend to be higher in fat and sugar than their gluten containing counterparts. Individuals who have Celiac might also have many nutrients deficiencies from years of damage to their intestines and they are also susceptible to other autoimmune diseases as well as other health complications in general. That is why it’s extremely important to get the proper diagnosis. The proper diagnosis means proper follow-up throughout your life span.
Why is proper Diagnosis important
If you ACTUALLY have Celiac Disease
- your first degree relatives have a 10-15% increased chance of having this disease. Your proper diagnosis will help your family members and potential future children as well. You’re not the only one affected.
- you must remain on a gluten free diet for life. This is currently the only treatment. This means no cheating at restaurants and special occasions. Consuming gluten can do real damage to your intestines which can lead to other health issues down the line. The more times you “Cheat” on your gluten free diet, the higher your chances of developing another autoimmune disease like Diabetes or Thyroid Disease.
- you are at a higher risk of developing some cancers, osteoporosis, infertility and some nutrient deficiencies. These chances become more likely if you continue to eat gluten or “cheat” on your diet.
- you need to talk to a Dietitian. The gluten free diet on its own is not complete and its important to fill in the gaps and find out what nutrients are important to keep you strong and healthy and living your best life.
This is where I wanted this blog to lead. Having Celiac Disease and being on a Gluten free diet means there are certain nutritional considerations you need to be aware of, both at diagnosis and long term.
At Diagnosis you may have deficiencies or issues with some of the following nutrients
- B Vitamins (Folate and B12)
- Lactose Intolerance
- Vitamin D
Lifelong you will certainly still have to be aware of the above nutrients but we also want to focus on others like:
- Added Sugar
- Fat Content
Iron deficiency can be an issue at diagnosis but also potentially throughout the lifespan. For some people this was the only symptom that indicated Celiac disease. Women have a higher risk of developing iron deficiency as they tend to lose more blood than their male counterparts. You should monitor these levels as they can pinpoint a flare-up or accidental ingestion of gluten long term. Its important to note that one accidental exposure will not cause enough damage to cause deficiencies, we are more worried about repeated exposure over time. To increase your iron stores or keep them up long term, focus on iron rich foods.
There are two types of Iron
- Heme iron is very well absorbed in the body. Its found in meat, fish and poultry.
- Non-Heme iron is not absorbed in the body efficiently and requires Vitamin C for optimal absorption
***If iron deficiency persists or is extremely low to start, consider talking to your doctor about a supplement
***Avoid drinking coffee or tea and dairy products with non-heme iron rich foods as these can decrease absorption
|Non-Heme Sources of Iron (plant sources)||Food Sources of Vitamin C|
|Dark Green Veggies||Brussel Sprouts|
|Black Strap Molasses||Oranges|
Snack Ideas Incorporating Non-heme iron and Vitamin C for optimal absorption
- ¼ cup Pumpkin Seeds + Orange slices
- ¼ cup hummus or black bean dip + ½ cup peppers and baby tomatoes
- 1/3 cup homemade trail mix with nuts, seeds and dried fruit
- ½ cup oatmeal with chopped strawberries on top
- Homemade granola bars + kiwi (recipe here)
Folate and Vitamin B12
The levels of these nutrients should increase as healing progresses. Gluten containing foods are often fortified with these nutrients but the same cannot be said for gluten-free foods. Your doctor should monitor these levels if a flare up occurs. Folate is particularly important for pregnant woman as it can help prevent neural tube defects.
If levels do not increase with food consumption supplementation maybe necessary.
|Food Sources of Folate||Food Sources of Vitamin B12|
|Some GF Flours||Meat, poultry and fish|
|Flaxseed meal||Milk, yogourt and cheese|
|Steel cut oats|
|Beans (Pinto, Black, etc)|
|Nuts and Seeds|
|Spinach (most green vegetables)|
Lactose Intolerance, Calcium & Vitamin D
Lactose intolerance is common in newly diagnosed patients but tolerance usually returns as the gut heals. There is no need to avoid dairy however, you can simply just choose the many lactose-free options that are widely available.
Calcium and Vitamin D status is often low at diagnosis and throughout. This is probably due to multiple factors including malabsorption from years of waiting for a diagnosis and decreased intake of dairy because it causes unpleasant symptoms due to intestinal damage.
Bone density can also be affected so its important to insure that your doctor has this on his/her radar!
|Non-Dairy Sources of Calcium||Food Sources of Vitamin D|
|Fortified beverages (i.e. soy milk)||Cod Liver oil|
|Tofu (with calcium sulfate)||Fortified beverages|
|Almonds||Canned salmon with bone in (pink and sockeye)|
|Canned sardines and salmon with bone in (pink and sockeye)||Mackerel (cooked)|
|White beans (cooked)||Mushrooms (exposed to UV light)|
|Collards (cooked)||Yogourt (with Vitamin D added)|
Micronutrients and minerals can also be low in newly diagnosed, specifically, calcium, phosphorus, copper, selenium, and zinc. All of these are absorbed in proximal duodenum where a lot of damage can occur. Zinc deficiency is the most common and symptoms include; dry skin, thinning hair, and brittle nails. Luckily, symptoms usually improve as the gut heals
Food sources of Zinc
- Dairy (Cheese, yogurt, Greek yogurt and milk)
- Seafood (Oysters, crab, lobster)
- Meat (liver, veal, venison, beef and lamb)
- Nuts without the shell (Pine, peanuts, cashews, soy and almond) and Seeds (sunflower, pumpkin and squash)
- Dried, cooked beans, peas and lentils (chickpeas/garbanzo beans, black- eyed, split peas)
The gluten free diet is notoriously low in fibre and high in sugar. The recommended intake of daily fibre is 21-38 grams per day. Make sure you increase intake slowly and add additional fluids, preferably water.
Choose foods high in fibre and natural sugars and spread them throughout the day
- Fruits and vegetables
- Beans, peas and lentils
- Flours, pasta, crackers made from whole grain or high fibre grains, i.e. brown rice flour, bean flours, and oat flour
- Gluten Free Oats
- Ground Flaxseed
- Chia Seed
- Nuts and other seeds
Snack and Meal Ideas
- ½ cup yogourt with 1 Tbsp each of ground flaxseed and chia seeds
- ¼ cup oatmeal with 1 Tbsp each of ground flaxseed and chia seeds
- Add ground flax to different sauces, sprinkle on pizza or casseroles before adding cheese
- Nuts, seeds and their butters paired with fruit, i.e. apple and peanut butter
- Aim to have 2 vegetarian meals each week using beans or lentils (Vegetarian chili, black bean burgers, chick pea salad)
- 1 piece of fruit or 1 cup of chopped fruit or veggies with each meal (raw)
- ½ cup cooked veggies with Lunch or Supper
- Make your own baked goods using high fibre flour (brown rice, buckwheat, bean or oat), beans and lentils and try subbing ground flaxseed in for flour 3:1 ratio
- Always half sugar in any recipe
The gluten free diet can be high in unhealthy fats. Excess fat is often used to improve the texture of gluten free foods. If you are purchasing a lot of pre-packaged baked goods, cookies, and granola bars then this is something you need to be concerned about.
Choose foods low in unhealthy fat or high in heart healthy fats
- Low fat dairy products
- Lean cuts of meat
- Fish (salmon, mackerel, tuna)
- Nuts and Seeds
- Canola and Olive Oil
- Chia seeds
- Ground flaxseed
Meal and Snack Ideas
- ¼ cup of nuts or seeds
- 1 Tbsp of chia and flax to yogurt or oatmeal
- Crackers with 2 oz of low fat cheese
- Aim to have fish 2 times per week
- Use canola oil in cooking and baking
- Use olive oil to make your own salad dressings
- Use Avocado as a spread instead of mayo
- Choose Greek yogurt rather than sour cream
- Make your own baked goods using new Becel margaine or canola oil
So there you have it. I want to emphasize again that its extremely important to get your Celiac Diagnosis because of the above nutrition implications. If you are experiementing with a Gluten-free diet or cutting other things out of your diet…always remember…if you take something out, add something in…otherwise you might be missing some key nutrients!
Check out www.celiac.ca for tons of great information!
Hope that helps! Happy Nutrition Month everyone!
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While I have been plugging away these past few years writing blogs about food I always wanted to delve into writing a lifestyle blog. It appears I didn’t feel like I had a lot to say until I had my own little guy! Having a baby certainly changed the way I practice dietetics and I find myself gravitating much more towards baby, children and family nutrition.
I was so excited when I became pregnant and friends started adding me to mom groups on Facebook. There were mom groups, play groups, Breast Feeding Support groups and Baby Led Weaning groups. I loved these groups but I quickly saw a trend. Worried momma’s getting online and sharing their baby’s issues with other mom’s in the hope of getting advice…but sometimes this advice was medical in nature and certainly not something they were quailifed to give and often incorrect. This lead me to take 2 actions. Firstly, I started my own Baby Led Weaning Workshop so I could help mom’s navigate the tricky world of online information and provide real, evidence based information about when baby was ready to start solids, what foods should be offered first, how these foods should be prepared and how to offer them. The Second thing that came from this experience was seeking out medical help more readily myself.
I hit my first roadblock when baby was about 6 weeks old. My little guy was spiting up SO MUCH. I mean it went from the occasional spit up to me wondering if I should call a priest to perform an exorcism…it was BAD! SO many mom’s had also written about this experience on the mom groups. Their solution, which was suggested by other mom’s in some cases and their family doctor’s in others, was to give up dairy, soy and gluten. Being a Dietitian I knew that this was uneccesary and also detrimental to Mom’s nutrition. You need all the energy, protein and especially calcium you can get when you are breastfeeding! Aside from this, cutting out these foods is completely unnecessary because only true allergens can cross the breast milk. Baby might appear to be fussy after you eat certain things but there is little that crosses through the breast milk besides drugs (including alcohol, caffeine and marijuana) and these allergens. Don’t get me wrong, true milk allergies are common but before you go cutting dairy from you diet it’s extremely important to explore other possibilities.
Let me bring this back around to my little guy. First I sought out a lactation consultant. My nipples had tears in them and I had developed a case of mastitis along with the issues my baby was experiencing. I so desperately wanted to continue breastfeeding but the pain was unbearable. It turned out he had a shallow latch and was taking in too much air when he fed (thus increasing the amount of gas and discomfort in his stomach). Second, I bought him into the children’s hospital. He was gaining great, almost a pound a week, but there was something to this spitting up. He did it so often and so much. The Peaditrician saw him, examined him, took the time to ask me specific questions and told me something that made COMEPLETE sense (he even drew a diagram!). We all may know (or might not know, hey, everyday is a new experience) that baby’s muscle tone is not fully developed for the first few months and that is why their movements are uncoordinated and jerky. BUT did you know that the throat musculature is the same!? Reflux in babies is extremely common and most often caused by immature muscles in the throat. There is a ring of muscle fibers whose job is to prevent food at the top of the stomach from moving back up into the esophagus This valve is meant to be only one way. If this muscle does not close well, which it often does not in new babies, food can leak back into the esophagus. This is called gastroesophageal reflux.
Did I blow your mind? I mean I knew it couldn’t just be the food but this made complete sense to me. I was so relieved. I have Celiac Disease myself and having to restrict my diet any more than I already have was a stressful thought to me.
So what did this doctor suggest? He told me after each feed to make sure baby was sitting up for 30 minutes or so. Lying baby flat increases the chance that milk will move back up the stomach and into the throat if the valve isn’t closing properly. Keeping baby upright helps them digest better and prevents this backflow from happening. He also suggested to keep baby still for 30 minutes. So no joslting, bouncing, or sitting up quickly. Again this is to let milk settle and prevent a backflow issue. Lastly, he prescribed reflux medication. As I am not always a fan of medication, I decided to try his other suggestions first before resorting to that. I will add though, he told me that the medication would do nothing to STOP the spitting up, only relieve any discomfort that my baby was feeling from the acidic juices coming back into the throat.
I practiced this advice for a couple of days and I saw great results. My baby still spit up but it would only be 2-3 times per week and if I moved him too quickly after a feed. It was nothing like the previous multiple times per day. I did end up giving him the medication a couple times, but only when he appeared to be particulay uncomfortable. With the improvement of his latch breastfeeding also became more enjoyable and I finally started to heal.
I am not a pediatrician and I’m not saying you should follow my advice…what I’m saying is that I’m a Dietitian and I knew that I shouldn’t cut food out of my diet so I consulted with a Paediatrician. Sure enough there was an alternate solution to my problem. The moral of this story is to seek out the right professional for the job. Mom’s are great and offer great advice, but you want to make sure you are looking out for your health as well as your babies. I always love the saying “you can’t pour from an empty cup” and you can’t. Now if your baby does have a true milk allergy then you should certainly consult with a Dietitian so they can help you decipher which foods you need to avoid as well as helping you incorporate other sources of calcium into your diet AND your baby’s when it comes to introducing solids.
When it came to introducing solids I offered all the allergenic foods first at 6 months and one at a time. Health Canada now suggests offering these foods sooner (at 6 months opposed to a year) as research shows it can prevent allergies. My little guy had egg, peanut butter, gluten, soy and the list goes on. I had Benedryl and a phone on hand but he was a-ok. But wait…didn’t I say I had Celiac and didn’t I just admit I gave my baby gluten? Yes I did both and yes he is at in increased chance of having celiac, but only 15%. There is a huge psychological component in children who have food allergies and cannot participate in regular activities like other children. So even though there is some chance my baby might have Celiac, ruling out this possibility so he can have a normal childhood and go to a birthday party and eat cake like all the other children is so much more important for his mental health. Its not just the nutritional component we worry about either.
Mom’s, I am just sharing my experience as a mom and a Dietitian so that another perspective is offered. It isn’t easy to cut foods from your diet, especially if you are exhausted and caring for a small life. Your Nutrition can suffer, your mental health can suffer and so can your baby’s. So always seek other alternatives. Cutting food out might seem like the lesser of some evils but it isn’t. Often there are other things going on in the background and if you don’t solve the underlying issue, you might not be able to solve the problem in entirety. At the end of the day everyone will be much more happy if they can eat whatever they want.
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The term Baby Led Weaning (BLW) is popping up all over the place these days. It is met with skepticism by some health professionals to total cult movements in some parenting groups. BLW is essentially a way of feeding your baby that completely by-passes the spoon feeding/puree stage when they are ready for solids and goes directly to the solid foods stage. Now I’m not saying give your Six month old a raw carrot and let them go at it! Foods need to be cooked and there are still foods that are off limits. For more information on BLW you can check out an earlier blog I wrote on just that here. Today’s blog is about a more important topic WITHIN BLW.
I am part of a lot of parenting groups on Facebook, including a BLW group. I also offer BLW workshops bi-monthly so it’s a passion of mine. I have to say though, due to the fact that some health professionals are so against BLW (due to iron supplementation, potentially higher risk of choking? and energy intake) there is a lot of confusion about foods, implementation, supplementation and how to deal with aspects such as choking. My experience is that parents are going to do what they want with their children anyways so give them the tools they need. Educate yourselves because lack of education is what leads to confusion, mistakes and accidents. This is what concerns me. Many parents are not starting with the right foods…just the easiest foods and they are depending on support groups with no health professional present and articles on the internet with no scientific backing.
Health Canada and The World Health Organization recommends exclusive breastfeeding up until 6 months of age, the same goes for formula feeding. Babies are ready to start solids at around 6 months of age. Where does this number come from? The main concern is iron stores. At this age, baby’s iron stores from birth start to diminish so there is a big push to include iron in a baby’s diet. That is why you will find that Doctors, Nurses and Dietitians recommend starting your baby on an iron supplemented cereal. As a Dietitian and a Mommy I can’t imagine my baby’s first food being something as highly processed as baby cereal after consuming only breast milk for the first 6 months of life! So, what is the alternative? Iron rich foods of course!
Why is iron so important? First of all, it’s one of the most common deficiencies in infants and children, secondly, rapid growth and development in children makes it a priority nutrient and thirdly, deficiency can cause major developmental delays. But consuming iron isn’t the only thing you need to be aware of. There are nutrients that help our bodies absorb iron better and some nutrients that block iron absorption. Vitamin C is a big one. Consuming Vitamin C increases iron absorption, particularly in foods that are plant based. Calcium/Cow’s milk can block iron absorption.
So bringing all this information together I want to recommend FIVE great starting foods for BLW that focus on Iron, Vitamin C and Calcium/Cow’s milk.
- Eggs! Omelettes are super fluffy so a baby will have no trouble gumming and sucking on them. Personally I think that eggs are the best starting foods. We no longer have to wait to introduce allergen foods to our babies so why not start with this one. Not only does it contain iron but it’s also a component of so many other foods like baked goods and homemade burgers.
- point to consider: Although introducing allergen foods is no longer a concern at a particular age it is still extremely important to pay extra attention when introducing one of the highly allergenic foods. Check the Government of Canada’s site here for more information. Insure that you introduce these foods one at a time and watch for a reaction. Introducing more than one allergenic food can lead to confusion if there is a reaction. This is why I suggest starting eggs first. You can then safely add them to anything without worry if no reaction occurs during introduction, plus they are great on their own.
- Homemade Meat sticks. Ground beef, chicken and turkey are high in iron and can be made in any form. Not only this, but they are tender and crumbly and easy to suck on.
- point to consider: roll into a stick form rather than a ball form to start because baby’s control is not 100% yet and sticks are easier to hold and maneuver than balls which is why I say meat sticks instead of meatballs.
- Homemade Fish Sticks. Fish is high in iron and omega-3 fats, which are important for baby’s developing brain. Salmon and Tuna are particularly high in these fats.
- Oranges, strawberries, peppers and broccoli. These are all high in Vitamin C. Once baby has mastered the iron rich foods, start incorporating a food high in Vitamin C along with it to ensure they are absorbing as much as possible. Veggies should be steamed for approximately 6 minutes or until al dante so that they aren’t too hard or too mushy for baby to handle. Most fruits are fine raw but I would suggest avoiding apple since it could pose a choking risk is small babies just starting out.
- Avocado and Nut or Seed butters are a great way to get healthy fats into a baby’s diet. Baby’s brain and body cells require fat for growing. Make sure they get a variety of fat sources. Babies should never get anything fat free (with the exception of meat which should be a lean source). Avocado can be cut in slices or mashed and put on toast. Nut and seed butters should be spread thinly over toast.
- points to consider 1. Nut butters are a high allergen food. Make sure you watch for a reaction upon first and second introduction 2. Nut and seed butters should not be spread thickly as they can pose a choking hazard 3. Actual nuts and seeds should be completely avoided until at least the age of 4 as children tend to have all of their teeth by this time and are better equipped for chewing.
One last note or two: Cow’s milk should not be offered until 9 months of age and should be offered in between meals so that it does not interfere with iron absorption. Lastly, continue breastfeeding or formula feeding your baby as normal and do not decrease the amount of feeds until you feel your baby is eating enough food. They should wean themselves off of some of their feeds naturally once they start consuming more calories.
Have fun with it! If Baby led weaning doesn’t work for you and your baby then stick with the traditional ways. Feeding your baby is supposed to be an enjoyable, fun and positive experience so make sure you choose something that works for you both.
Good luck and have fun!
Nutrition expert and Registered Dietitian