First as a pharmacist, and then repeatedly as a new mom, a parent in playgroups, a heart patient, and a person heading toward middle age, I notice a trend when the conversation turns to health. Even when the conversation is about a specific health problem, like arthritis, the discussion ends up on diet. Diet in the sense of the foods and nutrients we are taking in, but also diet in the sense of weight loss---and how to do it.
As for the weight loss part, I don't have many answers. I can tell you that completely eliminating wheat will cause the pounds to drop! But I can tell you as a health professional that a drop like that isn't a good one. In fact, I worked with my new wheat-free constraints to get more calories and more nutrients regularly each day until my weight, energy, and GI system stabilized to the new norm.
I'd really like to spend some time on this blog about the nutrition end of eating with food allergies---in particular how to understand where our nutrients come from and how to get the macro and micro-nutrients we need when we adapt ingredients.
Why? First, because changing diets affects not just the allergic person but also the entire family and even the wider circle. Second, because it's hard to see what you are missing in daily or weekly nutritional needs when you're really focused on the safety, and it's easy to redo a diet (for any reason) to one that can hurt you more in the long run---like one that doesn't give you enough protein to keep your body going all day.
Moderation is key, but that doesn't mean it is easy when common foods are eliminated as options.
For today, I'd just like to share a few resources that have come my way from other food allergy (or just mom-friend) families and from health searches I've done before to help out friends and family who changed their diets, often for non-allergy health reasons.
It's almost impossible to find sources that are reliable but not scary or intimidating by just random Google searching these days. Most of the top hits revolve around fad diet trends, famous personalities, or "Dr. X" websites that may or may not be written by medical doctors or people with graduate degrees in a health field like medicine, nutrition, or dietetics.
Check out these links, and let me know if you have any favorites to add. You can find links to other reliable resources on my Useful Resources and Tools I Use pages, too.
Happy Monday, everyone!
A reader whose kids have food allergies and who works to teach other kids about food allergies shared an article from this website with me a long (too long) while back: https://www.dietspotlight.com/diet-watch-common-food-allergies/. Marion and daughter Ashley, thank you!
The direct article link will take you to a page with a thorough but not overwhelming list of reliable sources of information about food allergy reactions, precautions, medical information, and more. I loved that these were collected into one easy list and included places like MayoClinic.org, which I use for personal and work research every week, and the latest ChooseMyPlate materials, including the one aimed at kids.
Although DietSpotlight the company is focused on weight loss products, its approach is well researched, transparent, educational, and friendly. Really, what all medical communication should aim for. I don't use or endorse products for weight loss specifically, but I also realize that many people look for supplements to help them, especially when personal efforts or traditional medicine just aren't enough. So, I scanned through the rest of the site, and I found a lot to like:
Certified or verified vitamins and supplements
Almost 70% of Americans take over-the-counter supplements. Although people should (theoretically) be able to obtain the nutrition they need from daily food intake, the reality is that not everyone---by choice or necessity---eats to make that happen, and numerous chronic diseases can sidetrack the ability to get sufficient nutrition from foods.
So, vitamins and supplements can be good. But. Many people don't realize that these products are not held to the same standards as medications, even over-the-counter medicines. Instead, manufacturing standards apply more often. That doesn't guarantee the quality or quantity of the ingredients, nor does it speak to the success of that ingredient to improve health.
A few organizations are trying to change that, though. In addition to places like Consumer Labs, the US Pharmacopeia rigorously tests vitamins, herbs, and other supplements to confirm the accuracy of labeled ingredients. Products submitted for approval can receive a USP Verified stamp. An example is the NatureMade line of products.
You can find an updated list of verified products at the Quality Supplements website (www.quality-supplements.org/verified-products).
If you are looking for more information specifically on herbal medicines, you can find researched facts about different herbs---searchable online at The Herbal Medicines Compendium---and a list of supplements at the USP websites, too.
Finding Help to Fix a Diet
Sometimes the amount of information out there, or the number of health problems you are trying to balance, becomes just too much. Registered counselors and dietitians or nutritionists are experts in the many reasons and safe ways to rework a diet.
The Chrysalis Group serves the DC metro area and offers specialized support for kids with food allergies. Perhaps even more useful, the "Find a Health Professional" website has a database of dietitians who focus on food allergies, wherever you live.
As we (okay, I) accept more and more that we live an urban lifestyle---one of my choosing, in fact!---we have moved from growing our own items (darn those squirrels) to shopping the weekly farmer’s market to considering support of one of the many local CSA options. But, in a family with dozens (at least) of food allergies between us, is a CSA really the right move?
CSA, if you don’t yet know, stands for community-supported agriculture. Where I grew up, this was just called shopping. The groceries were filled with local items (especially the smaller grocers, Italian or otherwise), and sometimes neighbors swapped foods for others that they didn’t grow themselves. One of my early memories in our “new” house when I was 10 was giving peppers from our garden to other people and getting brown bags of fresh-picked corn from a local friend/colleague of my parents.
In cities, CSAs are the organized move to support the nearby farming communities and to show them that we city folk still appreciate them and want to rely on them, not global preserved shipments, for good food.
I’ll be honest: I’m a tough mom who makes my kids eat foods that aren’t their favorites at the dinner table. So the variety of foods, and the lack of well-in-advance notice about the box contents, was not ideal for planner-me, but it was not a large barrier.
The bigger problem really was the cost. I like to plan my budget, so having a weekly payment was nice on one hand. On the other, though, was that I was locked into a weekly payment. In a house with a government salary (read: not going up or getting bonuses anytime soon) and a freelance “salary” of mine that varied by the day, months of a weekly payment for anything is something I like to avoid.
Even if the CSA cost is less than I might possibly spend at the farmer’s market or grocery, I like the idea of being able to spend at those places and support those businesses more when I am earning more, but less when it doesn’t work for us that week.
We’ve considered splitting a CSA, because I really do think it’s cost effective in the long run, and having a partner to swap with seemed like a good compromise to the cost, frequency, and quantities. But we never really found an ideal partnership for that.
Now that we’re removing wheat from my diet, and our dishes are starting to center more on the veggie and less on the grain, I decided to give CSAs another hard look. It’s almost the end of summer here in the DC metro area, and our local market will wind down soon. Having fresh options to pick up or be delivered to our door would be a wonderful self-birthday gift to last all winter, and it would be a great way to celebrate my 1-year anniversary of heart surgery, too, to keep a healthy diet going when it’s just too darn cold to go out!
Locally, the CSA options are varied enough to make your head spin, though. All, or at least most, seemed reliable, often organic, and principled. As far as convenience to us, I wanted, at the very least
I used localharvest.org as well as good old Google searches to determine what fit our needs. From options like Kuhn’s order-as-you-go to Groundworks' on-farm membership, I got down to these few that met our needs:
What we ended up with, though, was none of these, at least not this year. Instead, we’re trying Washington Green Grocer, a CSA collaborative, so to speak. Washington Green Grocer delivers products from different local farmers in a single box right to your door. Choices include a vegetable-only box, a standard fruit and veg option, an organic-only box, and small-business add-ons like eggs or vegan waffles. At least two box sizes are offered, each at a flat fee.
Unlike a CSA, there is no member enrollment in WGG; instead, you pay weekly when you order a delivery. There’s no requirement to order each week, either. So far, the only downside from my point of view was that all items appear packed in a shared box, so allergic foods could be jostled with safe ones.
So what convinced me to give this a go? WGG orders are set online, within 1-2 weeks ahead of delivery, and the site offers a detailed “never order” and “always order” page. Yep—I can never get those highly allergenic bananas, even if they’re scheduled to be in the box. Never and always selections can be entire food groups or just single items.
And it gets better: If you don't want the planned box that week but don't want to skip it entirely, you can opt for a different size or type of box, or you can even build your own custom box! When I sent a question about my first order to their email address, I received a text response directly from Zeke within the hour. So I already feel like my family is in good hands, before we even get our first delivery.
This somewhat personalized CSA-like option sounds too good to be true for food allergy families. We’re trying our first box on August 16th, and I can’t wait to see how it turns out. Look for an update here this fall!
Update 1: August 26, 2017
Oh my, is everyone in the house awfully happy with our CSA pick. For week 2, we opted for a small box custom-revised to include only a handful of food types instead of the usual variety. We got extra romaine lettuce, extra ginger gold apples, and some beautiful orange tomatoes---and we're packing it all for our beach vacation!
Also included, sweet potatoes and fresh green beans. Check out the lovely heart-healthy fries we had for our dinner side last night:
Update 2: September 7, 2017
To start off the school year, after a couple of weeks of low work on my end, we stuck with a small farm box from WGG. I definitely feel like we get more bang for our buck with the larger boxes, but I love the chance to downgrade when I don't want all that's offered or I only have a few days' need before our own local market comes.
Our new favorite safe-for-everyone dinner for the fall seems clear already AND relies on this week's fruits, veggies, and starches from WGG: Lean pork loin roasted with diced sweet potatoes and apples, crusted with fennel and sprinkled with cloves, cinnamon, and coriander. Fresh green beans sauteed for the side. It's already gone, so there's not even a photo to show it off!
2017-18 School Year Update
Seven days into the new school year, I was feeling pretty accomplished. I sent off one seventh grader to her bus, kissed my fourth grader goodbye at our door as she left to bus with her dad, and managed to keep them both on their allergy shot schedules (more or less). I even kept the 504 meeting to within the time limit and bragged about how amazing and independent my daughter has become with the school's safety and care.
Then she came home from school and I fed her a snack bar with cashews in it. For real. You can read a bit about the reaction, if you want, on Freedible (I'm nvanhoey). Long story short, she is doing great and recovered physically and emotionally 100%. (I'm getting there.)
This post update came about because I've just now stopped to think about whether this pocket card would have walked Jo through giving herself an Epi, if necessary. And I'm happy to say that it completely aligns with the grey area that was her reaction!
If she had to make the decision alone to Epi or not, she should have erred on the side of using it. Always, if she eats the food and isn't well. But in this case, she had one very major symptom (a deep red rash all over her body) that continued to worsen and one major symptom (extreme vomiting) that stopped quickly. Two major symptoms = EpiPen.
We didn't, though. Because the vomiting stopped, and because she never had airway/breathing symptoms, we headed to an urgent care to monitor the rash instead. And that was okay, because I was there to make that call and she had multiple health care experts monitoring her. But Epi would have been okay, too, and would have been the very safest thing for her to do if alone.
So, now we know:
1) She's still allergic to cashews.
2) The pocket card would work for her decision making all alone.
3) She's still most likely to get fed an unsafe food right at home from her mom. Ah, parenting with food allergies! :-}
I posted early this spring about advance planning for my tween's food allergies: updated 504 accommodations, learning to self-inject EpiPens, and the like. As we face growing older with food allergies, I find myself unable to rely on the basic parent-centered tenets I used in the playdate phase of life:
Now, we are shifting to tenets of self care, so soon and too suddenly (for me, at least!):
Mostly, this is going well. I have found myself searching out resources again, though, much like when we first found out about the severity of these food allergies. This time, I have a ton of great places to go already---from Kids With Food Allergies to the AAFA, FARE, ACAAI, and more. Still, I sometimes come up short with just where we need help (like when we looked for role-playing examples of how a child can speak with an adult who really isn't understanding the seriousness of her food avoidance needs).
My latest search is for a pocket card about when to use the EpiPen.
We figured out quickly that Jo needs not only to know HOW to use the pen correctly but also WHEN. And, truly, that's something that is still unclear to a lot of adults, especially when we are in the middle of a scary situation. To ask a child of any age to do it too weighs on my shoulders. Knowing how and when to do this goes hand in hand with her independence, though, and the card has to be small enough to go with her pens but in clear enough language for anyone of any age to understand it quickly. That's a lot to ask from a 3x5 piece of paper!
I've found some great posters, action plans, and other full-page resources from the usual amazing sites:
This 2013 ACAAI anaphylaxis card via Kids With Food Allergies comes close to what I'm seeking, but it doesn't give as much clarity as I'd like for our specific needs. Something between these medical basics and the details of the posters would be ideal, really.
So, for now, I decided to make our own personalized, plain-language "When to Use Epi" card and try it out for the summer. After talking through scenarios with Jo and her allergist, I decided to include more common food experiences that might not need epinephrine but might be confusing to a tween with food allergies when a parent isn't nearby. We'll laminate a copy of this for her new purse-pack and for the swim bag.
I've added the downloadable PDF version of our front-back card here in case any of you are seeking similar* portable cheat sheets for your growing kids with food allergies.
*Medical disclaimer time: The instructions I put on OUR card are instructions from OUR allergist to my daughter for her particular situation at this particular time. Although anaphylaxis does have some consistent presentations, its triggers, speed of onset, and treatment plans vary slightly for every person and situation. Please feel free to use this card only as an example of how you might formulate your own card with your allergist's help. I highly suggest taking any example of your own to the allergist for approval, too.
Today is Wear Red Day for heart disease awareness, one of the many efforts to kick off National Heart Awareness month this February. This is the perfect time to honor all of the doctors, nurses, surgeons, cardiac techs, nutritionists, rehab specialists, and so many others who work daily to help keep hearts healthy. It's also a good time to assess our own efforts at heart health, no matter what your age, exercise routine, or family history. Like so many chronic conditions, heart disease is a hidden problem---it can build slowly like a sneak attack on your health. I've actually lived with an imperfect heart valve my entire life, but it took preparing for and recovering from open heart surgery to really dive into the February and year-round heart awareness efforts.
You might wonder how heart month is relevant to food allergies, or to kids at all. Actually, kids with allergies could have up to twice the risk of heart disease, according to a large study published about a year ago in the Journal of Allergy and Clinical Immunology. Other research makes connections between asthma, allergies, and heart health, too, in kids and adults.
Luckily, kids aren't forgotten by the American Heart Association, and neither is family time in the kitchen. The AHA's Life's Simple 7 for Kids helps families teach kids to make good food and lifestyle choices as part of their daily routine, setting them up for a lifetime of good self care in so many ways. And their Simple Cooking With Heart for Kids models their adult recipe collection and starts teaching kids the tools they need to enjoy making homemade healthy meals for the rest of their lives. These and other tools aren't just good for kids with heart disease risks or allergies; they're good for all kids, anywhere.
Although the processes---including inflammation from allergies potentially damaging healthy tissue or lifestyle choices from immune conditions leading to obesity or poor food choices, for example---are still unclear, the bottom line really is that all of us should consider ways to keep our hearts in the best conditions possible. And the food choices we make play a large role in that condition.
So, on a practical level, both food allergy and heart disease patients need to keep a careful eye on their diets. Whether the concerns are cholesterol and sodium content or a top-8 allergen, learning to plan every meal can be daunting at first but ultimately lifesaving for both groups.
My family now adapts to a plethora of dietary needs: we avoid a long list of food allergens (different for each of the four of us, naturally) and we try to make low-cholesterol, low-sodium options, too. Sometimes that means reworking a recipe that is allergy-safe but uses a vegan margarine or salt into one that uses a healthy oil or herbal flavorings instead. Our mealtimes usually work out pretty well; snacking turns out to be the most challenging time for food choices.
I've found that my favorite snacks need to have a crunch to them to stay satisfying. My top three heart-healthy, allergy-safe munchies right now are carrot sticks, air-popped popcorn with light olive oil and different seasonings, and our personal homemade unbaked chex mix.
All three are quick to make and portable. I'm always on the lookout for something else to add variety, though. What are your favorite healthy snack ideas?
Hi, I'm Nicole.
ABOUT THE BLOG
An apothecary is a person or a place. Either one implies healing and relates to pharmacy in its truest sense, as a source of treatment and advice.
This blog is my way of uniting my pharmacy training with my efforts to provide a healthy and safe lifestyle for my family. In true apothecary form, I research and prescribe alternative ingredients that work just right in each specific recipe, and I would like to share the results with anyone who needs help making their own family’s kitchen allergy safe and heart healthy.
Nicole Van Hoey's books on Goodreads
Bakery Bites: Breads and Treats Without Dairy, Eggs, Nuts, Seeds, or Soy
ratings: 1 (avg rating 5.00)
Kitchen Adventures With Multiple Food Allergies: A Recipe Collection for Celebrations Without Dairy, Eggs, Peanuts, Tree Nuts, Seeds, or Soy