If there’s one question I get asked often, it’s this one. And I understand why. Anyone who knows me, and knows how obsessed I am with everything I do, knows there is one thing on earth I cherish more than anything else – my daughter.
Any of you reading this post who are parents know exactly what I’m talking about. My daughter, and I know the same is true for Gary with his boys, is one of the greatest driving forces behind us founding NuSI. Why?
Picture the United States as a cruise ship. Overall, it’s a wonderful place to be. We have so many things to be thankful for (as do many folks outside of the U.S.). But, there are icebergs out there. If we continue the course we’re on, our fate will be similar to that of the Titanic. Unlike the Titanic, though, we actually have several icebergs in our path. That is, there are many different forces in the world today that – if left unchecked – could easily disrupt our way of living. I won’t go into detail about what I think the list of potential threats to our economic and social freedoms are – pension overhead, national security, energy security, structural problems with education – but I’ll assert my opinion on the first problem we need to get a handle on. If we don’t figure out a way to curb the twin epidemics of obesity and diabetes, our healthcare spending alone will bankrupt us. No one can pinpoint the day this will happen, but if not in my lifetime, I’d bet anything it will be in my daughter’s lifetime. In other words, of all the icebergs we need to skirt past, this one is the closest to our vessel.
So, back to the question. While we wait a decade or so for NuSI to fund the type of science that will unambiguously resolve the jugular question — What should people eat to maximize their chances for greatest health? — what do we do? If you’ve been reading this blog, you’ll certainly have a great idea for what I do, based on my interpretation of the data currently at our fingertips. But ambiguity remains, especially when asking an even more important question than what do I eat. Since my daughter (and presumably your children, for those of you with children) is infinitely more important to me than anything else, including myself, how do I interpret current data around what she should eat?
Principle 1: Excess sugar is not conducive to good health for anyone
I don’t think I need to spend any additional time reviewing the harm of sugar (e.g., sucrose, high fructose corn syrup, beet sugar, cane sugar, brown sugar). If you do want a quick refresher on this, you can read this post. If you can only make one intervention in the dietary pattern of your child, make it this one. Based on our experience and the experience I’ve had with clients, friends, and family, a trend has emerged. It seems the longer you wait to make changes in this area, the more difficult it can be. Not always, but often. Sugar is very habit forming, and from a neurochemical standpoint an addiction to sugar is not unlike an addiction to gambling, alcohol, or heroin. Yes, they all have nuanced differences, but each of these addictive patterns or behaviors results in stimulation of the dopaminergic pathways of the brain.
How do we translate this intent into practice? The easiest thing to do is to minimize the amount of sugar brought into the house. This means we don’t have soda, cookies, candies, cakes, cupcakes, and other similar nutritional weapons of mass destruction lying around. This doesn’t mean we never have them lying around. Invariably, a grandparent or neighbor will bring over a lollipop or some cookies, but this is an exception, not a rule.
Furthermore, we don’t have any juice in our house. Our daughter (who is 4) drinks whole milk and water. That’s it. Amazingly, she no longer finds sweet beverages enjoyable. Recently, at a birthday party, she was given one of those Capri Sun sugar-syrup drinks. She took one sip and asked for a bottle of water. It was actually too sweet for her.
As I explain below, she still gets some sugar in her diet, but it’s probably about 20% of what the average kid her age is consuming. And she gets plenty of fructose in the form of fruit. But when she eats fruit, it’s usually lower fructose fruits (e.g., raspberries, blueberries, strawberries) rather than higher fructose fruits (e.g., watermelon, banana).
Principle 2: The less processed the food is, the better the food probably is
As an extension of the first principle, if you always make trade-offs in favor of cooking your food, rather than pulling it out of a box or jar, you’ll win many of these day-to-day battles. At least half the week our daughter asks for cereal for breakfast (instead of bacon and eggs). Rather than dump her a bowl of sugar-laden cereal, my wife or I will make her steel-cut oatmeal, to which she’ll add milk and a few raisins and walnuts. Sure, it’s more carbs in one meal than I eat in 3 days, but it doesn’t contain sugar (beyond the fructose in the raisins).
When she wants spaghetti for dinner, we make her real sauce out of real tomatoes and garlic. No added sugar, of course.
This requires extra work, as you can imagine. It’s much easier to dump cereal out of a box or pasta sauce out of a jar. But if I need to sleep 15 minutes less or my wife needs to cut her run short 15 minutes to make it happen, is it worth it? For us, the answer is yes. But, it is a choice – of both time and money – every parent needs to make.
Principle 3: Insulin and insulin-like-growth-factor (IGF) are important for childhood development
This topic is highly complex. For anyone who has studied IGF-1, GH, IGF-BP3, STATb5, or any of the hundred other molecules involved in the highly regulated pathways of growth, don’t be offended. It would take another series the lengths of the cholesterol series to give this topic its fair shake. However, a few key points are worth noting. There is sufficient evidence, for me at least, that a growing child needs a modest dose of insulin to capture their genetic (vertical) growth potential. In fact, stunted growth is one of the documented side-effects of children on ketogenic diets, though there may be several factors accounting for that beyond the role of insulin and IGF (e.g., protein deficiency, caloric deficiency).
Ketogenic diets are a medically accepted treatment for recalcitrant seizures. About half the children whose seizures don’t respond to any medications almost immediately stop seizure activity once they are in ketosis. Some investigators, including Dr. Elizabeth Thiele, Director of the pediatric epilepsy program at Harvard’s Mass General Hospital, are investigating this approach in adults. I had breakfast with Dr. Thiele recently and had an amazing opportunity to learn from someone with enormous experience treating children with ketogenic diets (over bacon and eggs, of course). According to Dr. Thiele, who described some really amazing in vivo and in vitro research, the reason for the effectiveness is not entirely clear. That is, it’s not clear if the seizure activity is ameliorated by the presence of B-OHB (beta-hydroxyburyrate) or the stark reduction in glucose or the insulin, or some combination of these, or even something altogether different.
Of course, having too much insulin-like-growth factor is even worse. There are numerous medical reports that describe the opposite “growth” scenario – too much IGF-1, for example, being associated with increased childhood malignancy.
Everyone wants to know if my (non-epileptic) daughter is on a ketogenic diet. The answer is no. If I had to guess, she probably gets 40% of total calories in the form of carbohydrates, and very few of them are sugar. That said, she’s so used to seeing her daddy give himself “boo-boos” on his finger every day to check his ketone levels that I think she’s getting curious…but that will have to wait a long while.
Principle 4: Fat is fine
As much as you’ve heard me espouse the benefits of fat intake in adults, it’s equally or even more true in children. As the Harvard anthropologist Daniel Lieberman points out, as we evolved from chimps to homo erectus about 1.5 million years ago, and to homo sapien about 200,000 years ago, we required an increase in our storage of body fat (from about 4-5% to 7-8% to 12-14%). Why? Most likely to support the requirements of our rapidly growing and developing brains. At no point in our development is this more necessary than as children.
My daughter certainly consumes less fat than I do, but she still gets about 35-40% of her total caloric intake via fats – saturated, monounsaturated, and polyunsaturated. Perhaps her favorite breakfast of all is bacon and eggs with cream cheese. She likes to wrap a piece of cream cheese and scrambled eggs with a strip of bacon which she calls a “cooc-a-mooc.” Don’t ask me how she thought of that, but she loves them. She drinks whole milk (it’s always struck me as strange that the American College of Pediatrics recommends children switch from whole milk to skim milk abruptly at the age of 2), avocado by the truckload, and a wide variety of quality meats.
Principle 5: They are, after all, still children
My wife and I agreed a long time ago that we were not going to restrict our daughter’s eating when she was at birthday parties, on Easter egg hunts, out for Halloween, or on other “special” occasions. A few weeks ago we took her to Disneyland for her 4th birthday. (Anyone want to guess what it’s like for an ISTJ to spend 2 days at Disneyland? Were it not for the look on her face, I’m not sure I could have survived.) We decided, for these 2 days, she could eat whatever she wanted. The day started with a bag of cotton candy larger than her head. I couldn’t resist looking at the package to see that it contained 90 gm of sugar. I did the quick math on converting that dose of sugar from her weight (35 pounds) to mine (165 pounds) and realized it was like me eating 450 gm of pure sugar in 20 minutes – the length of time it took her to inhale it! That’s about 12 cans of soda. She went on to have pretzles and cookies for lunch and, of course, a cake for dessert after dinner.
The entire time I was watching her mainline sugar – more in one day than I consume in a year – I couldn’t help but chuckle. I sent pictures to my friends all day long. In the end, she was pretty sick of all the junk she consumed and welcomed her usual meals. But, for a couple of days she ate just like most any other 4-year-old would on her birthday.
Principle 6: No two kids are the same
As you’re reading this keep in mind, this is an anecdotal account of my life and my child. Yours will be different. What works for our child may not work for your child or children. Don’t worry about it! In the end you’ll be the best judge of what the optimal zone is. I really believe my daughter will live a healthier life because of the way she eats growing up. One day, of course, she’ll have to make her own choices. Will she completely rebel against everything we’ve tried to teach her? Perhaps, but I don’t think so. I really believe that kids are the product of the example set by their parents.
I used to always wonder where my tendencies came from. Not surprisingly, much of who I am today is the result of the behaviors I observed in my parents. It’s my belief that if my daughter grows up in an environment where an emphasis is placed on eating well, it will become a natural extension of her behavior, too.