Brighter Futures for Families with PKU

May is PKU Awareness Month

By Mary Sowa, MS, RD, CSP, CNSC, CLEC and Jan Skaar, RD, CSP, CNSC, CLE, clinical dietitians at CHOC Children’s

Did you know that one in 10 Americans is living with a rare disease? Phenylketonuria (PKU or PAH) is a rare genetically-inherited disorder that occurs in one in 10,000 to 15,000 newborns in the United States. PKU was the first disorder to be identified at birth by the California Newborn Screening (NBS) program, which now screens for over 70 rare disorders. The main focus for NBS is to detect conditions that can be treated with diet or medications to prevent intellectual and other disabilities.  NBS has been identifying babies born with this condition, allowing early treatment and improved outcomes, for five decades. In decades past, treatment options were limited, often resulting in severe intellectual disabilities.

Individuals with PKU are unable to process the amino acid phenylalanine (Phe), which is an essential amino acid found in foods with protein. Children with the “classic” form of PKU need to avoid meat, chicken, fish, eggs, nuts and other foods with high protein content. They may also need to avoid regular breads, pasta, cereals and grains. It is not just a vegetarian diet. Daily intake of a specialized formula, which provides a source of Phe-free protein, vitamins and minerals, is essential for regulating blood Phe levels. Compliance with the specialized formula and low protein food products is the cornerstone to help prevent complications associated with high Phe levels in the brain. Elevated Phe levels can affect school performance, sleep, disposition and executive functioning. Experts recommend that individuals with PKU follow a “Diet for Life.”

“A disorder that is treatable with a special diet?” That must be the end of the story, you might think. Far from it. Besides having more taste-friendly options on the market for specialized PKU formulas, there have been advances in treatment options that were not available to PKU families a couple of decades ago. These include a medication called sapropterin to lower Phe levels in the blood, therapy with large neutral amino acids, and enzyme substitution.

Sapropterin dihydrochloride is a FDA-approved medication that helps the phenylalanine hydroxylase (PAH) enzyme work more effectively to break down Phe in the body. A trial period of close patient monitoring with frequent blood tests is conducted while initiating the sapropterin. Those individuals that are responders to the medication are able to control their blood Phe levels and have a more liberalized protein intake.

For some patients, it may mean the difference between tasting a hamburger or just dreaming about it.

Large neutral amino acids (LNAA) are another treatment option. They are most often used with older teens or adults who have problems controlling their Phe levels with diet or do not respond to the sapropterin. The individual with PKU has a “flood” of Phe in the blood from protein ingestion and the inability to breakdown the Phe into Tyrosine. The LNAA compete with Phe for transporter cells in the GI tract and later transfer across the blood-brain barrier. The LNAAs are considered “safe” amino acids for the brain and reduce the amount of Phe that enters the brain. A decrease in blood Phe levels may not be evident in the blood, however a decrease in brain Phe may help improve the neurocognitive deficits and executive functioning challenges seen in PKU.

In addition, human trials with an enzyme substitute called phenylalanine ammonia lyase (PAL) have been underway as a new treatment option. This is an injectable form of alternate enzyme found in plants and bacteria that can break down Phe into harmless components. The active compound is coated with ethylene glycol to protect it from the body’s immune system or is “pegylated.” The compound known as “PEG-PAL” must be injected daily and has been shown to lower blood Phe levels.

Significant challenges remain for individuals and families with PKU to achieve and maintain optimal blood Phe control and improved health outcomes. However, there are many more available tools for success than in previous years. Gene therapy is also a potential option on the horizon.

The CHOC Metabolic Clinic team, under the direction of Dr. Jose Abdenur, consists of dedicated staff to help patients with PKU and their families adhere to “diet for life” and other therapies. The team provides ongoing treatment, support and education for our PKU families and includes dietitians with specialized training in medical nutrition therapy for PKU and a variety of other metabolic disorders.

Learn more about CHOC’s Metabolic team.

Choosing the Right Milk for Your Family

By Rima Kandalaft, MS, RD, CSP, clinical dietitian at CHOC Children’s

Milk is the white liquid that comes out of the udder of cows and other mammals, right? Well mooooove over cows, several plants are being “milked” too. Plant-based milk alternatives have been gaining in popularity recently. Consumers can choose from soy milk, almond milk, rice milk and many others.

A quick stop at the supermarket to grab some milk is not so quick anymore. You walk down the dairy section and you are confronted with endless choices:  cow’s milk with three to four varieties of fat content, with or without lactose, plain or flavored. Not to be outdone, plant-based milk alternatives are also available in several flavors, and with varying fat contents.

Let’s take a look at the nutritional benefits of cow’s milk.

It is packed with good-for-you nutrients like protein, calcium and phosphorous. An 8-ounce cup of whole milk has about 150 calories, 8 grams of protein, 8 grams of fat, and 12 grams of carbohydrates (mostly the milk sugar known as lactose). Skim milk has all the goodness of whole milk, but no fat and only 90 calories. It is an option for those trying to cut back on calories and/or saturated fat and cholesterol.

People who are lactose intolerant don’t have enough lactase, an enzyme necessary for digesting the lactose in milk. Lactose-free milk is processed to break down lactose.

So what about the non-dairy milk beverages available?

Plant-based milk alternatives, such as soy, almond, cashew, rice and coconut milk, are good choices for vegans and vegetarians, or for those with allergy concerns. They are typically fortified with calcium, vitamin D and other nutrients. They are lower in calories than dairy milk, unless they are sweetened. With the exception of soy milk, they are quite low in protein.

You may have heard about a new product on the US market called A2 milk™. It’s produced and marketed by a company based in New Zealand, where A2 milk was introduced about 15 years ago.

Let’s look at basic dairy science. Milk proteins are 80 percent casein and 20 percent whey. Beta-casein is the second major casein protein. The two major genetic variants are A1 and A2 beta-casein. They differ by one amino acid at position 67 in the protein chain.

Regular cows’ milk contains both A1 and A2 beta-casein. The A2 milk™ brandcontains only A2 beta-casein. This is achieved through selective breeding of the dairy herd.

A few studies correlate A1 beta-casein with various adverse health effects, and suggest that for certain individuals, A2 beta-casein may be a better choice.

A pilot study published in 2014 in the European Journal of Clinical Nutrition compared the gastrointestinal effects of A1 versus A2 beta-casein, in 41 males and females. Consumption of A1 beta-casein milk was associated with looser stools than A2 milk™. Fecal calprotectin, a marker of gastrointestinal inflammation, correlated highly with subjective measures of digestive discomfort on the A1 diet but less on the A2 diet.

While the “A1 versus A2” debate continues, we will have to wait for more robust studies to validate the health claims.

In conclusion, the next time you go shopping for milk, arm yourself with a few milk facts to help you pick the right milk for you and your family-one that meets your nutritional needs and taste preference.

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Controlling Seizures with the Ketogenic Diet

Some children who have uncontrolled seizures may benefit from a special way of eating called the ketogenic diet. The diet consists of foods that are high in fat and low in carbohydrates, a combination that helps the body produce ketones which can help minimize seizures. The treatment is very specific and carries some risks, so a child should be monitored closely by a dietitian while on the ketogenic diet.

In this episode of CHOC Radio, clinical dietitians Jessica Brown and Lindsay Rypkema explain:

  • How the ketogenic diet works and who may benefit from it
  • Ways to maintain adequate nutrition while on the diet
  • Sample recipes and ways to alter favorite meals to the plan
  • Current research that considers whether other conditions, like tumors, could be managed by the ketogenic diet
  • How CHOC is assisting families in adapting the ketogenic diet for their child.

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How Nutritious Breakfasts Help Kids Succeed at School

Parents know that breakfast is the most important meal of the day, something that is true for the whole family, but especially for kids. Their brains, bones and muscles need extra nutrients in order to grow and develop properly, says Stephanie Prideaux, a dietetic technician, registered, in CHOC Children’s clinical nutrition and lactation services department.

Breakfast eaters are more productive, have better problem-solving skills, and increased mental clarity, says Prideaux. This sets up children for better success in school. Eating a well-balanced breakfast can also help children keep their weight under control, and have lower cholesterol levels.

While eating something in the morning is better than nothing, says Prideaux, there are certain nutrients that can give kids an extra boost at school. Foods rich in whole grains, fiber and protein, while also low in added sugar may boost kids’ attention span, concentration and memory, which they need to learn in school. Children who skip breakfast are unlikely to make up those missed nutrients to meet their daily requirement, says Prideaux. Learn more about the daily nutrients your child needs. Good sources of these nutrients include:

  • Carbohydrates: whole-grain cereals, brown rice, whole-grain breads and muffins, fruits, vegetables
  • Protein: low-fat or nonfat dairy products, lean meats, eggs, nuts (including nut butters)
  • Fiber: whole-grain breads, waffles and  cereals; bran and other grains, fruits, vegetables, beans, nuts

If kids aren’t hungry early in the morning, be sure to pack a breakfast they can eat later on, in the car or before class, says Prideaux. Portable ideas for breakfast include: a peanut butter and banana sandwich on whole-grain bread, or fresh fruit with nuts or dry cereal. Think outside the box when putting together breakfasts for your family, and don’t stick to traditional American breakfast foods, Prideaux says, which may be high in sugar and fat. As long as kids are getting the nutrients they need, breakfast can be anything—even last night’s leftovers.

Try some of these make-ahead recipes to make sure your kids get the nutrients they need, even on busy mornings, to be successful at school all day:

  • Smoothies: blend fruit with yogurt and peanut butter or oats in the evening, and grab one when you’re headed out the door
  • Chocolate zucchini cupcakes: make a batch of these delicious treats before your week begins and kids can eat one on the way to school
  • Slow cooker oatmeal: try a 4-to-1 ratio of water to steel-cut oats, plus spices as desired. Cook on low for 7-8 hours, and top with fresh fruit or nuts.

Learn more about Clinical Nutrition and Lactation Services at CHOC.

National Nutrition Month 2016: Savor the Flavor of Eating Right

By Stephanie Prideaux, dietetic technician, registered

Good food is a powerful thing.  Take a moment, if you will, to remember the last time you had a bite of something truly amazing.  Maybe it was your mom’s apple pie, Abuelita’s Christmas tamales, or something you only eat at the county fair.  Did time seem to stop?  Did you almost cry?  Did it seem to nourish your soul (or inner child)?

This National Nutrition Month®, the Academy of Nutrition and Dietetics is calling on all of us to celebrate food traditions and all the simple pleasures they add to our lives.  Eating right is not only delicious and a smart way to live, but something that can be done with infinite creativity.  There are more foods and combinations of flavors around the world than we can imagine.  Taking part in the traditions of other cultures is easy and very healthy.


Benefits of Intercultural Foods

It is well known that a balanced and varied diet provides benefits throughout life.  Foreign foods are no exception.  In fact, many ingredients used worldwide are great sources of micronutrients, antioxidants, and other phytochemicals that protect health.

Used extensively in Indian, Middle Eastern and Southeast Asian cooking, the yellow spice turmeric is a good source of manganese and iron.  It is currently being researched for its anti-inflammatory properties.

Hibiscus flower tea (or punch) is consumed in Mexico, the Caribbean, southern Europe, the Middle East, India, the Philippines and some parts of Africa.  This drink) is high in iron and vitamin C as well as being a good source of vitamin A.  The tea’s purple-red color reveals the antioxidant content.  It has some documented effectiveness in treating mild hypertension.

Where to Go

When looking to try new flavors, Orange County is an incredible place to start.  Many residents have no idea about the cornucopia of flavors, ingredients, and social experiences waiting to be discovered—often right down the street! Check out the list below for a few of the great types of markets in our community where you can explore new flavors.

Mexican Markets- great for fruits, vegetables, herbs, meats, and bulk dried beans, chilies, and flowers.

Asian Markets- great for exotic fruits, vegetables, herbs, meats, seafood, vegetarian items, pickled foods, rice, and noodles.

Middle Eastern Markets- great for fruits, vegetables, fresh beans, bulk spices and nuts, exotic dairy products, lamb, and goat.

Try this easily customizable hibiscus punch recipe for refreshing and sugar-free hydration:

Agua De Jamaica (Hibiscus Water)


  • 2 cups of dried hibiscus flowers (flores de Jamaica)
    Found in bulk or in packets at Mexican markets.
  • 3 quarts water

Optional Ingredients (to taste):

  • Fresh ginger slices
  • Lemon juice
  • Cinnamon sticks
  • Allspice berries, ground or whole
  • Ground cloves
  • Ground nutmeg


  1. Boil all ingredients, and then reduce to a simmer.
  2. When water is a deep red, strain liquid into a pitcher to remove the flowers—pressing out as much liquid as possible.
  3. Add ice and refrigerate to cool or overnight for best flavor.

Potatoes: A Winter Comfort Food

By Janelle Sanchez, RD, clinical dietitian at CHOC Children’s

Whether they are mashed, roasted, baked, or served as pancakes, hash browns, or scalloped, potatoes are a delicious comfort food perfect for this winter season! Today the potato is produced in more than 100 countries and is the fourth largest food crop worldwide, following wheat, corn, and rice.

With more than 4,000 potato varieties, the debate continues as to which is the best.

Russets are classically used for baking, french fries, hash browns, mashed potatoes, and potato pancakes because of their ability to hold together. Waxy potato varieties are best for making chowder, potato salad, and scalloped potatoes. Learn more about cooking with different varieties.

You may be asking, “Are potatoes healthy?” Of course they are! Let’s take a look at their composition:

  • Carbohydrates– Despite the common misconception that carbohydrates make you gain weight, we know a balanced diet without excessive intake of any food or food group is healthy. That being said, potatoes are primarily composed of carbohydrate, your body’s most important source of energy.
  • Potassium– Potatoes with skin are packed with potassium, an essential element your body needs. Diets high in potassium may reduce the risk of hypertension and stroke.
  • Vitamin C– This is important for healthy skin and gums, and may also help support the body’s immune system.
  • Vitamin B6 –Some of the functions in this extremely versatile vitamin include converting food into glucose to be used for energy, maintaining normal nerve function, and contributing to protein metabolism.
  • Antioxidants Substances like carotenoids and anthocyanins help prevent the damaging effects of oxidation on cells throughout your body. It is best to include an assortment of colors and kinds of potatoes in your diet, as the amount and types of antioxidants are dependent on the potato variety.
  • Calories vary depending on the potato variety. For example a large russet potato provides about 300 calories, versus a large sweet potato at 160 calories.

There are a few ways to create a health-conscious potato dish. Choose to bake instead of fry those sweet potato fries, french fries and tater tots. Brush potatoes with a little olive oil and seasonings or herbs to flavor instead of butter. When picking out toppings or additives, select low-fat or nonfat dairy products including cheese, sour cream, cream cheese.

Try these tasty recipes for a healthy way to incorporate potatoes into your family’s diet.

Out with the French Fries, in with the Oven Fries:


  • 2 large Yukon Gold Potatoes, cut into wedges
  • 4 teaspoons extra virgin olive oil (just enough to lightly coat)
  • ½ teaspoon salt
  • ½ teaspoon dried thyme


  1. Preheat oven to 450°F.
  2. Toss potato wedges with oil, salt and thyme (if using). Spread the wedges out on a rimmed baking sheet.
  3. Bake until browned and tender, turning once, about 20 minutes total.


Recipe makes servings. Per serving: 102 calories; 5 g fat (1 g sat, 4 g mono); 0 mg cholesterol; 13 g carbohydrates; 0 g added sugars; 2 g protein; 1 g fiber; 291 mg sodium; 405 mg potassium.


Warm up with a bowl of Healthy Potato and Vegetable Soup:


  •  1 teaspoon olive oil
  • 2 ounces pancetta, chopped
  • 1 cup chopped onion
  • 3 garlic cloves, minced
  • 2 cups cubed peeled acorn squash
  • 2 cups diced peeled red potato
  • 1/2 cup chopped celery
  • 1/2 cup chopped carrot
  • 1 teaspoon dried basil
  • 1/4 teaspoon ground cinnamon
  • 1/4 teaspoon dried thyme
  • 1 (28-ounce) can whole tomatoes, drained and chopped
  • 2 (14 1/2-ounce) cans fat-free, less-sodium chicken broth
  • 4 cups chopped kale
  • 1 (15.5-ounce) can navy beans or other small white beans, rinsed and drained


Heat oil in a Dutch oven over medium-high heat. Add pancetta; sauté 3 minutes. Add onion and garlic; sauté 3 minutes. Add squash and next 6 ingredients (squash through thyme), stirring to combine; cook 4 minutes, stirring occasionally.  Add tomatoes; cook 2 minutes. Stir in broth; bring to a boil. Reduce heat; simmer 8 minutes. Add kale; simmer 5 minutes. Add beans; simmer 4 minutes or until potato and kale are tender.


Recipe makes 4 servings. Per serving: 349 calories; 10.4 g fat (3.3 g sat, 4.6 g mono, 1.4 g poly); 10 mg cholesterol; 55 g carbohydrates; 14.4 g protein; 10.5 g fiber; 405 mg potassium


Optimizing Your Omega-3 Intake

By Emily Barr, MS, RD, CSP, CLEC, clinical dietitian at CHOC Children’s

You’ve probably heard the many health benefits associated with eating omega-3 fatty acids, but it’s easy to be confused by each variety. Which one is the one you need? Where can you find it? And most importantly, how much? Let this be your guide to sorting out the confusion.

Essential Fats

Omega-3 fat is an umbrella term for the polyunsaturated fat family.  There are three main fats in this group:  Eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-Linolenic acid (ALA). These fats are essential because the body cannot make them on its own; it relies 100 percent on you to include these foods in your diet.  A small amount of ALA can convert into EPA and DHA in the body, but since the process is not efficient, it’s important to eat a variety of foods rich in omega-3s.

An Important Part of Heart Health

Omega-3 fats have anti-clotting effects that help prevent heart disease and stroke. They also help your heart keep a steady beat, preventing it from increasing in rhythm, which puts your heart at risk. These fats also help lower your blood pressure, keep your blood vessels healthier, and lower your triglycerides.

As an anti-inflammatory, omega-3s can reduce your risk of clogged arteries, as well as help with conditions like eczema and arthritis. Omega-3 consumption has also been linked to lower risks of cancer. DHA specifically provides additional benefits to your brain health and functioning.

Recommended Intake

The suggested daily intake for ALA varies between 0.7-1.6 grams per day depending on age and gender. The Academy of Nutrition and Dietetics, the American Heart Association, and the World Health Organization agree that your diet should consist of 500 mg DHA/EPA per day, which is equivalent to eating fatty fish twice a week. The highest amounts of EPA and DHA are found in fatty fish including salmon, tuna, halibut, mackerel, cod, and if you dare, anchovies and sardines.

If fish is not on your weekly menu, you may want to consider some of the following sources of omega-3s. ALA are found in vegetarian fats, especially rich in vegetable oils (canola, flaxseed, soybean, and walnut oils), nuts, seeds (flax, hemp and chia seeds), and leafy vegetables including Brussel sprouts, kale and spinach.

Foods fortified with omega-3s include:

  • Eggs
  • Buttery spreads
  • Milk
  • Juice
  • Yogurt
  • Some bread and pasta

Introduce a few omega-3 rich foods into your diet, and in time you will be replacing unhealthy fats with healthy ones. Try the recipe below for an omega 3-rich smoothie as an easy way to start incorporating these essential fatty acids into your diet.

“Oh-MEGA-3” Fruit Smoothie

1 cup Mixed Frozen Fruit

1 Tablespoon Flaxseed

1 Tablespoon Hemp or Chia Seed

½ Banana

½ cup Milk or Omega-3 fortified Orange Juice

Blend all ingredients and enjoy!

December 14 is National Roast Chestnuts Day

By Jill Nowak, RD, CDE, clinical dietitian at CHOC Children’s

It’s that time of year we sing about “Chestnuts roasting on an open fire….” But, did you know that this delicious chestnut is packed with numerous health benefits?  They are moderately lower in calories and contain less fat than other nuts and seeds.  A 1 ounce serving provides 69 calories and 0.6g fat.  Sounds like the perfect snack this holiday season!

Chestnuts are the edible seeds of the chestnut tree.  The sweet, starchy seeds sit inside a prickly outer shell called the burr, which splits open as they ripen.  Chestnuts are in season and available in markets from October through March. Fresh chestnuts are often displayed and sold in the fresh produce section. You can also buy chestnuts dried, vacuum-packed, or canned.  To verify freshness look for creamy white seeds. Avoid a greenish, mold-like appearance. When preparing fresh chestnuts, they must be peeled and cooked before consuming.

Add cooked, peeled chestnuts to stuffing, rice or savory pie filling. Incorporate cooked chestnuts into soups, stews, casseroles, or vegetable dishes. Or add pureed chestnuts to mashed potatoes.

Here are additional health benefits from chestnuts:

  • Chestnuts are rich in vitamin C. They are the only nuts that contain this vitamin. They also contain B-vitamins and folate.
  • Chestnuts contain a rich source of mono-unsaturated fatty acid (MUFAs). MUFAs are part of a healthy diet and help to improve our lipid blood profile by reducing LDL (bad cholesterol) and increasing HDL (good cholesterol) levels.
  • Chestnuts are a good source of potassium, which helps in lowering blood pressure. In addition, they are good sources of copper, manganese, and selenium, which are all important components in the body’s antioxidant and anti-flammatory responses to harmful free radicals.

 Wild Rice with Water Chestnuts and Mushrooms

1 13 cup wild blend brown rice

2 23 cup 99% fat free chicken broth

1 8oz can water chestnuts (drained)

1 can (8 oz dry weight) mushroom pieces and stems (drained)

1 tbsp butter


Cook rice in chicken broth – bring to a boil then simmer, covered for 45 minutes.  Sauté water chestnuts and mushrooms in butter. When rice is done, add together and stir well.

Nutritional Information:

Servings per Recipe: 5, Serving Size: 1 cup

Calories: 202, Total Fat: 3.9 g, Total Carbs: 41.9 g, Dietary Fiber: 4.5 g, Protein: 5.8 g

Source: and

Avoid Becoming Thank-“full” this Holiday

By Sarah Kavlich, RD, CLEC, clinical dietitian at CHOC Children’s 

Today, in many American households, the Thanksgiving celebration is centered on gratitude and sharing a bountiful meal with family and friends. The star of the Thanksgiving meal is arguably a stuffed turkey; and often times after a day of feasting, that may not be too far off from the way we feel. You and your family can avoid overeating this holiday season with these easy steps:

  • Eat breakfast! Although known as the most important meal of the day, it is often thrown by the wayside, especially when we anticipate a larger meal to come. Instead, have a light breakfast before your feast, which can help keep you from overdoing it later.
  • Use smaller plates. We eat with our eyes and when we see a large plate with a lot of empty space, our brain has a tendency to think we are still hungry once we are finished. Instead, serve your appropriate portions on a smaller plate. Once you’ve finished your meal, you’ll be able to listen to your stomach when it tells you you’re full.
  • Load up on non-starchy veggies like salad and green beans. These sides can offer plenty of fiber, which can fill you up with out adding extra calories. If you are the cook, try a new spin on green bean casserole (see below), with all of the traditional flavors but without all of the traditional fat.
  • Hold the gravy. Did you know that gravy alone can add up to 170 calories in a half cup? Try your meal without it this year.
  • Skip the seconds. Just because it’s a holiday doesn’t mean your health goals need to take a holiday too. Focus on visiting with friends and family and not just eating. If you are truly still hungry later in the day, have a light snack to hold you over.
  • Stay active. Use this opportunity to spend time with those you love by going on a walk together before or after your meal.

Green Beans with Shallots and Almonds
2 pounds green beans, cut into 1 inch pieces
2 tablespoons olive oil
2 cups sliced shallots (about 4 large)
2 tablespoons unsalted butter, at room temperature
1/2 cup sliced almonds, toasted

Fill a large bowl with ice cubes and water. Bring a large pot of salted water to a boil. Add green beans to pot and cook until crisp-tender, about 5 minutes. Drain and plunge beans into an ice bath. Drain beans again and dry on paper towels.

Warm olive oil in a large skillet over medium heat. Add shallots and sauté until softened and lightly browned, about 7 minutes. Add green beans and butter and cook until beans are heated through, about 2 minutes. Sprinkle with toasted almonds and serve.

Yield: 8 servings, 150 calories, 10g fat, 4g protein, 14g carbohydrate, 4g fiber, 8mg cholesterol, 164mg sodium. Source:

Learn more about CHOC Clinical Nutrition and Lactation Services.

Calories In, Calories Out? — May Not Always Be the Simple Equation to Weight Loss

By Jessica Brown, RD, CSP, CNSC, clinical dietitian at CHOC Children’s

The appreciation for bacteria living in our gut, and how it affects our health, is quickly gaining traction. Studies have shown that the 100 trillion microbes that live in and on the human body, called the microbiome, play an important role in overall health, including diabetes, celiac disease, allergy and autism.

Growing evidence over the past 10 years has even linked the gut microbiome to obesity. A study published in Science, a leading scientific journal, in 2013 contributed to this association. Researchers transplanted germ-free mice with fecal microbiota from obese and lean adult twins. They found that those mice transplanted with the obese gut microbiota had an increase in body mass and fat accumulation compared to those transplanted with lean gut microbes. One of the proposed theories is that obese microbiomes can harvest or release more energy from dietary components, such as non-digestible fiber, which contributes to weight gain. Further, this study showed that a lean gut microbiome can displace an obese one, preventing weight gain, if they consumed a healthy diet.

There are multiple influences to our microbiome at an early age, including what type of birth, (C-section versus natural birth), what type of feeding (formula versus breastmilk), and early exposure to antibiotics. Other influences include our environment and diet.

Eating a high-fiber diet, rich in fruits and vegetables and low in meats, refined carbohydrates, and artificial sweeteners has been shown to increase the beneficial bacteria in our gut.

Prebiotic foods such as asparagus, artichokes, garlic, leeks, onions, oats and lentils have been shown to keep our microbiome healthy. Fermented foods such as sauerkraut, kimchi and kefir are also beneficial.

A recent report published in the Diabetes and Metabolism Journal summarized multiple studies that demonstrate the potential benefits of probiotics – live bacteria and yeasts that are good for your digestive system — on the prevention and treatment of obesity and inflammation. It is important to realize that there are multiple strains of probiotics, and each strain has different effects. The effects of probiotics and obesity deserves further attention before specific recommendations can be made in the health care setting.

With the increasing prevalence in obesity, it is exciting that the manipulation of gut flora may be an integral part of weight loss and disease prevention in the future. So, it may not be just about how many calories you eat and how much you exercise that determines your weight, but what you eat and the health of your gut bacteria.

Learn more about CHOC Children’s Clinical Nutrition and Lactation Services.

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