Friday Mar 15, 2024
Childhood Nutrition and Lifestyle: Combating Obesity, ADHD, and Type 2 Diabetes
When should kids start eating healthy? The answer might surprise you. We all know the rates of childhood obesity are increasing, along with the rates of childhood diabetes and fatty liver. Did you know the rate of childhood obesity has quadrupled in recent years? But how do you get picky kids to eat their vegetables?
What about Attention Deficit Disorder? Does diet affect that?
Learn more in my interview with Dr. Angela Black.
You're listening to "Healthy Looks Great On You," a lifestyle medicine podcast. I'm your host, Dr. Vickie Petz Kasper, and this is episode 110. What Should Kids Eat? I'm so excited to introduce to you today my guest, Dr. Angela Black. Dr. Black is a board-certified pediatrician on a pathway to become board-certified in lifestyle medicine. She received her medical degree from the University of Texas Health Science Center in San Antonio and completed her pediatric residency in Miami, Florida. She currently practices in San Marcos, Texas and has a strong interest in promoting excellent nutrition for her patients. She recently discovered the subspecialty of lifestyle medicine and her long term goal is to shift her practice to a lifestyle medicine model and incorporate food as medicine to help families add more produce into their diet.
She's also the host of a great podcast called "Eat Your Greens with Dr. Black."
Welcome to the show, Dr. Black. I am so excited to have you here today, and I think we're going to have a really big challenge before us because there has been so much interest in the things you have to say.
Dr. Angela Black:
Thank you so much, Dr. Vickie, for having me on "Healthy Looks Great On You." I'm really excited to Be here and talk to you today. And I was really impressed by your listeners, questions that they had and, really appreciated some of their questions.
Dr. Vickie:
Yeah, I think they're going to have to tune in to your podcast, I've listened to several episodes and I think my daughter subscribed and it's just very interesting and it covers a lot of topics and I'm not an expert on pediatrics, so we needed you here today.
Dr. Angela Black:
Oh thank you. And I hope people enjoy it. I hope they find it and, and like it.
Dr. Vickie:
So I have to start out by telling people how we met. And that was at the Lifestyle Medicine Conference in Denver. And we literally just sat down at the table and had dinner together one evening and kind of hung out together the rest of the conference.
Dr. Angela Black:
I had met your hotel roommate. And basically I crashed your dinner with her. You guys were going into the restaurant to have dinner and I just invited myself along and we got to know each other and discovered how much we had in common.
Dr. Vickie:
That's right, and that was awesome. I'm so glad you did that. Well, I think I'd like to start out by talking about attention deficit disorder. There was so much interest in that on my Facebook page, and specifically about red dye, and there was a little bit of interest about autism as well. So, could you just start by outlining your approach to treating a patient who has ADD or ADHD?
Dr. Angela Black:
Well, my approach has definitely evolved over the years, and I would like to just start by saying that there's a lot of misconception about what ADD or ADHD actually is. It's been taken over a little bit in the pseudoscience community, the lay community as being not necessarily a real syndrome. And it definitely is.
There are patients whose brain, and if we want to get nerdy, we can talk about the prefrontal cortex and the areas of our brain that are involved in planning, organization, maintaining attention, resisting impulses, things like that. And, definitely there are people, both children and adults who just have a dysfunction of that part of their brain.
So, it is a real entity. It's not just bad parenting. It's not just too much TV. Definitely electronic media has its role in contributing to the development of it and the symptoms. So, just to start out by saying, it is a real entity. I do treat it with medication. But my approach to doing that has evolved over the years where we start out with an in-depth evaluation.
We, look at the symptoms in the home, we look at the symptoms at school, and in other settings. Can the family go to restaurants, or do they never get to go out and enjoy time in public settings because of the behavioral issues? The impulsivity that goes with ADHD, things like that. Can they go to church or their, or their local religious organization and participate? So we want to see that the symptoms occur in multiple settings. The symptoms need to have started before the age of seven. So we really want to make sure that the child meets the diagnostic criteria. And then we also want to see that they've been evaluated for learning disabilities, intellectual disabilities, other diagnosis that may be affecting their ability to pay attention in class, and follow along. Because if it's a matter of not being able to understand the material and the child is bored because they just can't follow along, it's going to look like ADHD. They're not going to pay attention. They're going to be bored. They're going to get up out of their chair. So we want to make sure we're ruling out other diagnosis and really doing a good job that the child meets the diagnostic criteria. And then we talk about treatment, and that's either going to be pharmacologic medication or non pharmacologic, and both have their role.
Non-pharmacologic treatments definitely work best in the younger child. So we write a letter for the school and the parent can sit down with their educational team and develop what's called a 504 plan. 504 is under the Americans with Disabilities Act, and it applies to children with any diagnosis that affects their ability to participate and learn in the classroom setting that's not intellectual disability. So they may have Asthma; asthma would qualify for a 504 plan if the child has to have frequent absences or has such a severe disease that they can't learn in the classroom and they need some change to their plan that would help them do that.
So, the parents will sit down with the educational team and develop a 504 plan so that the child has accommodations to their educational plan that help them reduce those impulses, maintain focus, stay on task. And that's individualized from child to child. There are some tips and tricks that we tell families that they can do at home, for instance, helping them get through homework time, things like that.
And then when available, if we can get them in with a child psychologist who specializes in behavior to help the families develop a positive discipline plan to help reinforce the desired behaviors and minimize the undesired behaviors. But as we know, mental health care in this country is another health care crisis.
You know, accessing that is simply not realistic for many people. So that's all of the non- pharmacologic treatments. I do also talk about some dietary changes that we can make and I know that's what many of your listeners had questions about - the dietary recommendations. And then, when appropriate, we do prescribe medications. There are both stimulants and non stimulant medications available.
Dr. Vickie:
You know, I think that's important to say because medications definitely have a place. And this can be a debilitating disease. It can make a child completely fail. And medication can mean the difference between success and failure. But I think the frustration is the knee jerk response to prescribed medication rather than to either trial other things, or to do the thorough evaluation to see if medication really is necessary and if that's really the diagnosis.
So I think that's the frustration, not just with the medication, but with the healthcare system in general.
Dr. Angela Black:
Right, and unfortunately, it is faster, easier, more efficient to just write a prescription. Now, as you know, physicians don't get any, like I'm not selling the medication. I don't run a pharmacy. I don't get any financial incentive to prescribe medications. I do get some financial disincentive to do the right thing and really spend that time with the parents because unfortunately, insurance, especially Medicaid, just don't reimburse very well.
And so the amount of time that it takes as a primary care physician to really sit down, have those conversations, explore what non-pharmacologic treatments are going to work and what accommodations the child might benefit from, that that's my time. That's not really being reimbursed very well by the third party payers.
So there is actually a disincentive for me to practice medicine the best way. And it is true that with the high rates of physician burnout, many doctors just don't have the time, the energy to put into it. And it's just a lot easier to write a prescription. So it's not that they're, purposefully not practicing good medicine. It's the system is definitely, unfortunately weighted against primary care physicians.
Dr. Vickie
Well, that brings up a good point, and I share that with my listeners often. It's not just the doctor, it's the patient too. As a patient, when you call, you want an appointment, and you want it soon because you've got an issue. And if the doctor is spending a lot of time with each of their patients, then it's going to take longer for you to get in and get an appointment. And then when you get there, you don't want to sit in the waiting room all day long while they talk to someone for an hour about lifestyle changes. And I think that's why lifestyle medicine is really coming to the forefront, because it does need to be a subspecialty in and of itself because of the time constraint on other physicians and the shortage of primary care physicians.
Dr. Angela Black:
Right. Exactly.
Dr. Vickie:
So let's go back and talk about diabetes and fatty liver and childhood obesity. I love one of the things you said on my Facebook page today, and that was that healthy eating for a child starts..
Dr. Angela Black:
Before they're born.
Dr. Vickie:
Right, prenatally. So now you're touching an issue that's dear to my heart because I was an obstetrician. And so, let's talk about the impact of prenatal diet, because there is some evidence that a mom who has obesity is more likely to have a child who has obesity independent of how they eat afterwards.
Dr. Angela Black
Those nutrients or not nutrients are crossing the placenta and affecting the baby in those critical stages of development when the baby's brain nervous system are developing. So there's that. And then there's mounting evidence that the health of mom's gut microbiome also can affect baby's development. Not only do those bacteria that in mom's gut produce chemicals called short chain fatty acids that also cross the placenta and affect baby's development, but even the bacteria themselves. Apparently there is some evidence that they can leave mom's colon And cross the placenta and the baby starts developing their own microbiome, even in the womb. And for centuries, we thought that that was a completely sterile environment and there was no bacteria at all. And that may not be true. So there's a number of ways that the mother's diet affects the baby. And then last, again, I try to rein it in, but sometimes I get a little too nerdy about things, there's something called epigenetics, right? So our genetics is our DNA, it's the blueprint for everything, every aspect of our being, but epigenetics are the genetic switches that get turned on and off that dictate whether or not a gene will be expressed or not. And there are genes that impact our rates of obesity, diabetes, heart disease, and those epigenetic switches can get turned on or off based on the mom's environment, her diet, her stress levels, sleep levels.
You know, so many factors go into that and that's what really plays a big role in why you're going to see certain diseases like obesity, heart disease, diabetes run in families.
Dr. Vickie:
Oh, I love that you talk about the science. My listeners are used to me taking them to mini medical school, so they've come here to learn.
Dr. Angela Black:
Great. Well, I often talk about the rates of things like diabetes. When I was in medical school and training, this was in the early to mid-nineties, they were just starting to recognize that children can have type two diabetes. Back when I was in training, we called it adult onset diabetes. And there was a lot of skepticism about whether or not. children could get type two diabetes. Now, fast forward, I don't even want to say it - almost 30 years later, it's not in doubt. It's not even rare. I diagnose this in young teens. I have diagnosed children as young as 10 years of age with type 2 diabetes. And I definitely see pre-diabetes very often. Several times a year we'll have a teen in our practice develop actual type 2 diabetes. So the rates have really skyrocketed. The Lancet recently came out with a publication documenting that the rates of diabetes have quadrupled since the 90s, in children aged 12 to 19 year old, and they're continuing to climb. And so it's really becoming a healthcare crisis. Not only because of the diabetes itself and the cost of care, the cost of insulin, the cost of blood sugar monitoring, but also the secondary effects of having a high blood sugar on the person's health over time.
Right? So if you're 60 and developing type 2 diabetes, how many years do you have to develop kidney damage, eye damage, damage to your blood vessels. Now we're talking about kids in their teens. So they're really going to have a shortened lifespan. The quality of life is going to be greatly impacted. They're going to be developing those other chronic diseases so much younger than what we have seen in previous generations.
Dr. Vickie:
So what symptoms should parents look for if they're concerned about type 2 diabetes in childhood?
Dr. Angela Black:
Type 2 diabetes specifically, now it is a myth that people who have a normal body weight cannot develop type 2 diabetes. Type 2 diabetes is caused by insulin resistance. So your pancreas, the organ that makes insulin, is working fine, but the cells can't use that insulin to take the sugar out of the blood and use it for energy.
So some of the signs that the insulin level is starting to rise are Acanthosis nigricans. So that's darkening of the skin in the creases. Often it starts on the back of the neck, but you can also see it in the armpit folds, under the breasts, around the waist. So if you're starting to see what looks like dirt that doesn't wash off on your child's neck, you might want to talk to your doctor about having some blood tests.
Dr. Vickie:
So when my daughter was probably in junior high school, we spent a lot of time out in the sun and we were in the pool and she had what I thought looked like acanthosis in her armpits. And I made her go in and have blood work done. And she was like, mom, you're always finding stuff wrong with me.
Dr. Angela Black:
On the other hand, I did recently have a child come in whose parent was really concerned about diabetes because of some brown on their neck and it was on the front and usually acanthosis is on the back. And I was looking and I got a little paper towel and scrubbed it and yeah, it was actually just dirt.
So it's not always a bad sign, maybe they're just not scrubbing enough in the bath. Now as it progresses what you're going to see that if the child is actually developing diabetes is the common symptoms associated with a high blood sugar will be increased thirst and increased urine output.
So if they can't be more than two feet away from their water bottle, they're waking up three or four times a night to pee, or they're having wetting accidents, That's another reason to consider getting their blood sugar checked. And that's true whether it's type one or type two diabetes because the increased sugar causes more water to be put into the urine. So they're peeing more and then as a consequence, they're more thirsty. Also, if they don't have energy, they're feeling sick a lot of the time. If they have some skin infections that aren't healing well, even early in diabetes. I think the most common time that I've diagnosed kids with type 2 diabetes, they came in for an ingrown toenail that wasn't getting better. And I asked them about other symptoms and checked their blood sugar and sure enough, it was over 400.
Dr. Vickie:
Wow, that's really interesting. Also increased hunger. I've actually been diabetic before when I was on prednisone. And then I had pre diabetes. And I'm normal weight, but it runs really strong in my family.
But when your blood sugar is going up, your body is actually starving because your body can't move that blood sugar into the cells for energy. And so, it increases your appetite, which becomes a vicious cycle. And I reversed it with plant-based eating, and that's when I really became a believer in that.
And I'm not exclusively plant-based by any stretch of the imagination, but I try to get the majority of my calories from plants. And that's what I always try to explain to people. It's not necessarily vegetarian and it's not necessarily vegan. It's plant-based. And so if you can get the majority of your calories from plants, because I feel like there's some resistance among parents to try to feed their kids a plant based diet.
Dr. Angela Black:
Right. And I did see some questions about how to do that, especially if your child is picky. How do you get a picky kid to accept healthier foods? And, I give my families a similar message to what you're saying, you don't have to go 100%. Now I do think that's the gold standard. Just like we would never tell somebody, "Oh, you know, just cut back to half a pack of cigarettes a day. That's fine. Just, you know, smoke every once in a while." We're not saying that for a reason. I do think that the more plant-based, the more plant-based foods that you can incorporate and the fewer ultra processed foods and high fat animal foods that you can put in your diet, the better. So I would hold out a 100 percent whole food plant-based diet as the gold standard. But I also know that that's not accessible to many people and it's not going to help them, make changes for me to say that. So I usually say, any movement you can make in that direction, you're going to get some health benefits. And then you build on it. So some tips for getting kids to accept more variety of plant based foods: Number one, sorry parents, but you're going to have to eat it yourself. You have to set the example. You have to have it in the house and with the meals every single day and that's a really good way. Kids will eat what the family eats often. So, I have plenty of parents that tell me, "Well, he keeps sneaking my soda." I'm like, well, why are you drinking soda? You know, so they are setting the example. And then the other two techniques that are really effective are, getting the kids involved in the planning and cooking process. So let them go on the internet and pick some recipes that they think would taste good that include fruits and vegetables, and then let them at an age appropriate level, chop and prepare and, and work with you in the kitchen, and then make family dinner time a priority. Make it happy and fun and really make that part of the routine.
Those have been shown in the data, in the science. And I try to always look at the actual evidence to be some of the most effective ways of getting kids to actually accept and eat the foods that you're trying to make. So you don't have to sneak it in there and they won't even know those vegetables are in there. Well, that is a good technique that I recommend often while you're working on the other things, right? We want them ultimately to be on board with eating them and enjoy it without you having to hide it, or sneak it in their nuggets. But, definitely in the short term, being a little sneaky is never a bad idea.
Dr. Vickie:
I think it's important in developing the palate because both of my adult children eat fairly healthy and I think they just grew up eating that way and that's what they're used to but what I've seen in my grandkids and this is interesting because my oldest grandson is four and he just loved to eat vegetables. He just loved it and they did the baby-led weaning and so he just ate whatever they were eating and they ate healthy stuff. But then, he went to daycare, and at daycare they were feeding him pizza rolls and French toast sticks. And his palate changed, and suddenly he didn't want vegetables anymore.
He just wanted junk food because he had gotten a little taste of it at daycare. And that's a challenge, because what are you going to do? I mean, daycare is expensive, and food is expensive, and they're trying to take care of a lot of kids, and just keep costs down, so they're going to buy the cheap stuff, which unfortunately is the ultra processed stuff.
Dr. Angela Black:
Right. And it's a good point because those foods are designed to really hit that right combination of sugar, fat, and salt that releases that flood of dopamine and really lights up those pleasure centers in the brain. And unfortunately, broccoli just doesn't. does not do that. So when kids get introduced to those foods, it can be difficult, which brings up a few of the points.
First of all, going back to good nutrition starts before birth. Some of those flavor molecules from the food that moms eat also cross the placenta and babies can start tasting very early in gestation. So those receptors on the tongue are actually active. And then once they're ready to start solid foods, introducing a variety of different flavors between six months and a year, not only flavors, but textures. And make sure you include bitter things like kale and broccoli. And really those first thousand days, the first three years of life to the extent possible, lay a strong foundation of good, healthy eating with a variety of healthy whole plant-based foods. Even if they go through those picky phases later, they're more likely to come back around and accept those healthier foods later.
Dr. Vickie:
And I think it's so important because I've eaten healthy for a number of years even though, like I said before, especially years ago, I wasn't necessarily eating plant-based, but I didn't eat ultra processed food. And in fact, one year, I even put dried fruit in the kids Easter basket. And they were like, Mom, you've gone too far. We want chocolate bunnies. And I said, OK, OK, you're right. And, you know, today's Friday, but yesterday was Pie Day. And so, I said this on Facebook, Just go ahead, have a slice of pie.
Dr. Angela Black:
Have your pie on pie day. I already had mine and it was not vegan. I don't bake myself and so I'm not going to make a vegan pie crust. I just got a yummy, it was fruit based, at least there's that. But traditional cherry pie from my grocery store and I had my big piece of pie.
One of your, listeners on Facebook asked, "How rigid should we be?"
When it comes to allowing kids to have foods at school, should you try to cut it out entirely? And that has really been shown to backfire. So if you are super rigid, we never eat this food, I'm going to send your special food to school with you. What about birthday parties? Things like that. You know, especially as they get a little older, preteens, teens, it's really important for them to be similar to their peers. And if you are too rigid in excluding those foods, they're going to rebel. They're going to hide it and sneak it. And they're also going to develop an unhealthy relationship with food that may set up feelings of guilt and shame and could even set them up for eating disorders. So again, what you do most of the time, what you do at home on a regular basis is really the important thing and having some flexibility, will ultimately lead to kids with healthier eating habits in the long run. So I would avoid being overly rigid.
Dr. Vickie:
So my kids were right about the Easter basket and the chocolate bunnies.
Dr. Angela Black:
They were right.
Dr. Vickie:
Darn it.
Dr. Angela Black:
Right.
Dr. Vickie:
My daughter was the one that actually asked about daycare because that's an issue right now. Her youngest is going to be one in April. And she's like, what do I do? They're going to be eating what they're going to be eating. And she's tried to talk to them about, okay, if you're having pizza, mashed potato, and peas, eat the peas, eat the mashed potatoes, but skip the pizza. And you know they're not going to follow that. They have too many kids to take care of. So I guess she just does the best she can do when she's at home.
Dr. Angela Black:
You do the best you can. Now, I have had families in a similar situation. I have written letters for daycare because the daycare director said, "Well, we can't feed them anything different without a doctor's note," meaning they have to have some medical diagnosis. And this is a perfectly healthy child with no lactose intolerance or something. So I have been known to write letters stating, this child must be allowed to have healthy foods brought from home and should limit intake of ultra processed foods. Like, it's stupid. But I have written that letter. Here's a note from my doctor stating my kid has to have vegetables.
Dr. Vickie:
I think that just gives us a little insight, a little window into the mentality that we have. Like, I just think about it in the past, it seemed like kids could eat whatever they wanted and get away with it. And then you went to college and gained the freshman 15. And then there came a time when there was a day of reckoning and you had to make some changes because it sort of caught up with you. But now it seems like kids are just affected so much younger.
Dr. Angela Black:
There are so many reasons. It's very complex, right? And it's not just bad parenting. It's not ignorance on the part of the parents. By and large, parents want to do what's right for their children. They want their children to be healthy. They want to feed them healthy foods. And we really have to be careful not to make judgments about why families aren't feeding their kids healthy.
There is a significant problem with food insecurity in our country, especially in marginalized communities or in people of color. And paradoxically, obesity goes hand in hand with food insecurity because of access. They don't have access to healthy foods and they would love to feed their kids healthy foods if they could, or they're exhausted, working several jobs. They don't have the energy to put into cooking. And so they're resorting to ultra processed foods, fast foods, things like that. So we know that. Eating a whole food plant-based diet is the best way to ensure health, to maintain a healthy weight, and so the cause of obesity and these chronic diseases is not in question. It's definitely our diet. The reasons that we eat an unhealthy diet or feed our children a less than optimal diet are very complex, and they're going to require changes at really the national level, the community level, you know, ensuring that people really have access to healthy foods. And, that's a whole 'nother podcast episode, but so many changes need to be made.
I mean, it just shows what what doctors like you and I are up against. We're trying to promote lifestyle medicine and healthy lifestyle choices, but gosh, I mean, even at the daycare level, it's, it's very difficult.
Dr. Vickie:
And so it's part of a bigger complex issue. It's not just, oh well, everyone just needs to eat plant-based because that's so unrealistic. You have to make other changes to facilitate that. And, and some of those can be very expensive. It's much cheaper to go to the grocery store and buy a box of macaroni and cheese than it is to buy enough vegetables to cook, and then time is a factor before. And like you said, that's a whole 'nother podcast.
Dr. Angela Black:
So it's like many things in life. You can actually make a plant-based diet cheaper than an ultra processed food diet. In fact, when they've studied it, it can be up to $500 per year cheaper for your grocery budget. People who follow a whole food plant-based diet actually spend less on their groceries. But what you sacrifice is the time for planning and cooking and prepping. So just like many things, you have to pick one.
Dr. Vickie:
It's the convenience factor. We all live in a fast paced world. I mean, I'm semi retired at this point, and I can cook every day, and I can go to the grocery store every day, and it takes a huge chunk of my time. Huge. And you know, when you're raising a family and working a job, and your kids are involved in extracurricular activity, it feels nearly impossible.
I had a friend one time whose son was having significant GI distress at a very young age. He was 8 or 9 and just had constant stomach problems and acid reflux. And the doctor asked, "What do you eat?" And they said, "Well, we eat hot dogs at the ballpark every night because we're playing travel baseball."
Dr. Angela Black:
Right, right.
Dr. Vickie:
And it's so hard because we eat on the go and parents who have kids, especially with ADD, they want to know, can we just eat carrots or can we just eat blueberries? Is there something in particular that we can eat to make it better? Or does red dye make it worse? So, can we talk about that a little bit? Or autism.
Dr. Angela Black:
There was a lot of questions about dye. And I really, that was the one question that I really appreciated because when I recommend dietary changes for ADHD, I do start by saying, unfortunately, there's not. One food or type of food that you can add or remove and expect to see a big difference.
There's a lot out there in the junk science world. You know, a lot of supplements on the market and people say, "Oh, I cut gluten out of my child's diet and they did better." You know, if your child doesn't already have a reason to be sensitive to gluten or not tolerate gluten, scientifically, the evidence does not support that gluten is a cause of ADHD. So you really do have to do a whole food plant-based diet and variety is key. And again, that goes back to the microbiome, including a variety of different plants and their associated different types of fiber supports a higher diversity of gut bacteria. And that in turn can affect a lot of things, including brain health, cognitive health, memory, focus. Even they're looking at some studies on Alzheimer's, things like that. Having said that, the reason I was very grateful to your listeners, I had never actually looked to see what the science says about dyes specifically, because if I'm going to advocate for a whole food plant-based diet, that's automatically going to cut dyes out.
So I hadn't looked. And my assumption was that there was no evidence to support that. And I was wrong. There are good, randomized placebo controlled trials showing that dyes not just red, also blue, and so I suspect, by extension, any of them. Children can have worsening ADHD symptoms, and, conversely, an improvement in their symptoms.
When those are removed, so there is actual data supporting that dyes can contribute to ADHD symptoms, but again, it's not changing my recommendations because I recommend a whole food plant-based diet with a variety of diversity of various plant based foods.
Dr. Vickie:
Right. Apples are red. You don't have to add dye to make them red, and blueberries are already blue.
Dr. Angela Black:
And you mentioned autism. There are some studies in rats where the female was fed a junk food diet equivalent to an ultra processed diet like humans eat here in the West, and the pups had behavioral symptoms consistent with autism. There is some evidence that the mom's diet can play a role in neurodevelopment and development of autism. It's very complex, though, again, because we don't really understand completely what causes autism. It's a complex disorder that likely has many causes, not just one. So the evidence is emerging and it's being studied.
Dr. Vickie:
That's interesting. Now, I want to be sure we cover all of the topics and the questions that we got on the Facebook page and one of them was about the food that kids are given if they're in the hospital. And this is something that I've recently experienced, I had a family member who had surgery and was given a breaded chicken patty that was so tough that I couldn't even chew it. And so, I really think it's more of a systemic issue.
Dr. Angela Black:
It is, you're right. It's a systemic issue. You know, if it was a cardiac cath patient or somebody who was hospitalized for a heart attack, the doctor is going to write dietary orders, you know, low salt diet or whatever special diet for that disorder. But when it comes to children who don't necessarily have those diseases, they're going to say regular diet is the orders that they're given. It's really up to the individual hospital, what kind of foods they have in their cafeteria, what they're offering. And I do think that is an area that the consumer has some input, you know, people can talk to their hospitals, they can ask for healthier options.
I have a special needs daughter. She has a genetic syndrome with epilepsy and we've been in and out of the hospital a lot over her life. She's a young adult now, but we always were given a menu. So I could at least choose slightly healthier options if I wanted to, but, yeah, burgers and nuggets were always high on the list and the kids menu in the hospital. And so I do think that at the educational level for health care professionals, whether it's even dieticians, physicians, definitely, a big change needs to happen in education. My daughter has a G tube, so, she was having very active seizures and she couldn't really eat. She would have lots of seizures overnight, she would get lots of drugs to stop the seizures, and then she would sleep the whole next day and not eat. And it was very difficult and she wasn't gaining weight, so we ended up having a G tube placed so we could give medications and fluids and then feed her on those days when she wasn't able to just wake up and eat.
G tubes, you know, it's a tube that goes directly into the stomach and you can put either formula or different foods. And one of the things that people do is what's called a pureed diet where you can take healthy food, you know, spinach, broccoli, healthy sources of protein, blend them up in your high speed blender and And give that as the meal instead of the commercially prepared formulas, which are often high fructose corn syrup and, things like that. And there's families that want to do that. And I actually had a family whose dietician refused to let them do that because it had never been studied. It's like, well, if the kid could eat by mouth, we would be giving them these foods. What's the difference putting it in the mouth and swallowing it versus putting it directly into the stomach through this little tube? There's no difference. But the dietician would not allow it.
Dr. Vickie:
Protocols, protocols, and I also think if you're a patient, or if your family member is a patient, you have to be an advocate. I remember when I was in the hospital and I was a diabetic, they brought me chocolate cake. I was like, really? Chocolate cake? That's the last thing I need.
But really, to be honest, 9 out of 10 families would probably say, Bring me the chicken nuggets and the fries. But there's definitely an opportunity for education among healthcare professionals.
Dr. Angela Black:
Right. And they've, they've done studies, actually, it was at a presentation at the Lifestyle Medicine Conference that we went to in Denver where they went into communities and worked with some restaurants and they still had the nuggets and fries available, but on the menu in the kids section, they listed the healthy options and if the parents wanted nuggets and fries, they had to ask for them.
"Do you have this?" And then they say," Oh yes." And you know, they could serve it. But, when the healthy options were just placed on the menu in an area of prominence, people ordered it more often and the kids ate it. But what we do is that the chicken nuggets and fries and burgers you know, here's the kid's menu and that's all it is. And we just assume that's all they're going to eat, but it's not true. Kids will eat healthier food. Often when given the option.
Dr. Vickie:
Yeah, and that's just marketing.
Dr. Angela Black:
Yeah, that's marketing. So just making if we can, if we can, you know, go in and talk to our local restaurant owners and say, "I would love to eat here more. Have you considered making this change?" You never know. They might be willing to give it a go. And the restaurants reported that their revenues did not drop.
That was the important thing because initially there was pushback, like, "Oh, we're not going to make any money. People aren't going to come here." And that was not the case.
Dr. Vickie:
I'm sure a contributing factor is just eating out in general and how convenient that is and so very bad for you. I know that's one of my weaknesses. I mean, I can be much more strict about eating plant-based when I'm home. But when I'm eating out, it's a lot more difficult to choose. Also the portions are so huge, so that's a problem. And also, you can eat plant-based and be very unhealthy.
Dr. Angela Black:
Right? Exactly. Yeah, processed plant-based diet is almost as unhealthy as a standard American diet and restaurant food is, terrible and expensive.
So I have one episode and I hope to do more where I find local restaurants in our community here in Central Texas where they offer whole food plant based options. It's not necessarily a vegan restaurant, but they have options on their menu. And I interviewed a local restaurant owner and it was actually one of my most successful episodes to date. So I think people really want to hear about that. Where can we have the convenience of going out to eat but still be healthy.
And where can we go? We just don't know. So I hope to have more of those episodes where I look at local options here around the Austin to San Antonio area.
Dr. Vickie:
I like that. I love the community advocacy. That's so important.
I'm sure there are other things that we didn't touch on, but I think we could probably talk for six or eight hours. Hopefully, this will give you some ideas about things to feature on your podcast, "Eat your greens with Dr. Black," and of course I will put links in the show notes can find Dr. Angela Black and her podcast.
Dr. Angela Black:
We could go on and on. So I think we covered the bases and answered most of the topics that your listeners were asking. And it was great talking to you too. Thank you very much for inviting me onto your show.
Dr. Vickie:
And I would encourage anyone to just talk to their pediatrician if they are interested in pursuing a healthier lifestyle for their kids. Because I promise you, your doctor wants you to be well, and they're interested in your kid's health. Even if they're rushed, and even if they have a waiting room full of patients, they will welcome your input, and they will work with you.
And like Dr. Black said, your kids will follow your example. So if you're ready to get started with a healthier lifestyle,
You can sign up to receive this podcast by email. And as a bonus, you'll get "Seven day Prescription for Change," which is a downloadable workbook and seven days of emails to help you identify what lifestyle changes you'd like to get started with and how to implement those. Just look in the show notes for a link.
The information contained in this podcast is for educational purposes only and is not considered to be a substitute for medical advice. You should continue to follow up with your physician or healthcare provider and take medication as prescribed. Though the information in this podcast is evidence based, new research may develop and recommendations may change.
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