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SilverSlipper

Fats, Calories And Celiac Kids

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My daughter is low-weight for her age. She'll be 10 yrs old in August, is about 4'2 inches and 48 lbs. She typically drops on and off the growth chart. Our pediatrician has always been comfortable with the fact that she's growing, just not a lot, but she is growing - she's physically active (plays soccer) and does well in school (straight A's). Our previous gastro had concerns about her weight, but said to give it another year. Both suggested a high fat/high calorie diet.

This year, our insurance changed so we went to a new gastro. He has a special interest in Celiac Disease as he has family members (children) with it. (Really nice to talk to a gastro who is 'up' on the latest in gluten free food and where to find it). Because of his interest in Celiac Disease, he has a large practice of kids with celiac disease. He stated that my daughter was one of the smallest kids he has seen (with celiac disease as the only medical condition) even taking into account that she has celiac disease. He stated that at her age, she needs to weigh more, since her body will be going through changes in the next few years that can be complicated by low weight. He said that he was hoping that since school just let out that perhaps she was lower than normal and that summer would 'fatten her up' a bit. He wants to see her again in October and said that if she still hadn't gained a few pounds then he would want to run more tests and probably put her on special vitamins and drinks, etc. He was teasing her a bit and told her that she needed to drink milkshakes and eat ice cream every day. He told me he was only partly joking and to give her lots of high calorie, high fat foods (including ice cream and milkshakes) and to limit clear liquids. He said that her diet would be the exact opposite of the diet suggested to the majority of kids in the US.

I came home and posted a comment on facebook which basically said that my daughter had a new favorite doctor because of the ice cream, milkshake diet. It was a light-hearted comment to update relatives/friends about the doc appointment and I mentioned that she was underweight which was a concern. The majority of people took it in a light-hearted manner but I've had a few friends go a bit nuts that he would suggest ice cream and milkshakes. They are saying that this will put her at risk for potential cholesterol problems later in life and poor health. (As a side note, we try to not create bad eating habits when we do her diet - the ice cream would be the most dramatic, mostly we put higher fat/calorie items in the foods we cook rather than stuffing her with candy and cake).

I plan to follow what our gastro told us but I was curious about whether we are setting her up for cholesterol problems later in life as well as suggestions for higher fat/calorie foods/snacks. She's not picky about eating. Actually, if offered a choice between a cookie and raw asparagus, she'll take the raw veggie every time. Our pediatrician has commented before that she eats TOO healthily which is part of her weight issue. I'd love some thoughts about what the doctor is saying and suggestions. Thank you!

Edited to add - Nutritionists aren't covered by our insurance and are about $250 an hour (and have already mentioned that they may need more than one hour during a session). So, I can't consult one.

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For your FB friends: Oh for goodness sake! Chill people! Give her some ice cream before bed everynight. She is old enough to know that this is a temporary thing - enjoy it while you can.

You could add healthy fats to her food. You can sneak a little olive oil into or on a lot of stuff like that asparagus. Avocado & coconut if she will eat them. Extra PB, even on a spoon.

Will she eat nuts? Peanuts or others. Sunflower seeds?

We make fruit smoothies that really have a lot of calories for a drink. 3 cups of fruit is 300-350 calories plus 6 oz of OJ & add full fat yogurt if you want.

If her energy level for soccer is good, she probably is doing OK.

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Giving her full fat items is not the same as changing her to an all fried food diet. It's not like your dr said to take her to McDonalds everyday or something (which isn't a good idea because of the celiac anyway but you get what I mean I think). I think your FB friends need to chill. So many foods are high in fat and good for raising the good cholesterol levels, which she really needs right now. If she has malabsorption that can include malabsorption of cholesterol. Eating healthy fats in addition to the healthy diet she is already on will not hurt her. Her body needs the fat to function well and to grow.

Give her real butter, olive oil, avocado, coconut oil/coconut milk, whole milk products, nuts, sunflower seeds, and plenty of lean meats. Ice cream or milkshakes a few times a week won't hurt her. You can mix in lots of fruit if you want.

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I recently went to a conference where the doc speaking mentioned that there is no real evidence that dietary fat intake affects cholesterol levels. So since you posed the question, I just spent the last ten minutes going through pub med trying to find out if that's the case.

I couldn't find any studies showing that dietary fat intake affects serum cholesterol unless the caloric in take is in excess of what the body needs. I also found studies showing that calorie restriction lowers serum cholesterol levels whether it's by restricting carbohydrates or by restricting fats. Also increased exercise, and increased plant-based food intake lowers cholesterol. I also saw one study where they fed starving children (in Thailand?) eggs and found that their serum cholesterol levels went down.

This suggests to me that cholesterol is a response to stress (too much food, not enough exercise, not enough food, etc) rather than related to what you eat.

So you may actually be improving your daughter's health by giving her ice cream. Just watch the sugar....

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My daughter is also extremely small for her age - she is 12, 4' 4 1/4" tall, and 56 lbs. She has NEVER placed on the growth chart, and has dropped away from it. She was also a very picky eater - preferring fresh vegetables and fruits and anything full of sugar. She was actually vegetarian from ages 4-11 as well.

We did a full panel test for celiac, which was negative, and she doesn't have the genetic markers either. We ended up going to a pediatric endocrinologist who did a bone age assessment which put her at age 9.4. This is a good thing, as it means that she still has "room to grow." (Though it's kind of tough now that all her friends are entering puberty and at least a foot taller than she is.) They also tested for Turner's syndrome (which was negative). Has your daughter had these screenings, too?

I think your friends on facebook don't know what they are talking about. The science that tells that saturated fat is the devil is outdated. What's been found is that not all fats are equal - fat from a CAFO cow is different (worse) for you than fat from a pastured cow. Transfats are terrible, while saturated fats are important. And the way fat acts in the body isn't about how much you eat, but it is about the state of your body and what else you are eating.

It's been found, for example, that cholesterol build up in the arteries is not due to eating a bunch of cholesterol - it's because the body is so inflamed (often from eating too much sugar) and the body is trying to patch itself up. If damage is continuous, those cholesterol "bandaids" block the arteries. We need to work WITH our body's inclination to heal itself and fix the underlying problems, not remove the resources it uses to do the repair.

While an ice cream all the time diet doesn't sound like a great idea to me, I think anyone should have been able to recognize you weren't advocating feeding your kid nothing but ice cream.

That said, I'd be very wary of both sugar and dairy - especially with a celiac child. Our family is now on a very high fat diet, but we don't eat any fresh dairy (only yogurt, dairy kefir, ghee, and the rest of the family is now ok with aged cheeses), and we don't eat sugar except from honey and fruit in moderation. You can read all about the stuff we're eating on our blog (linked from my profile).

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As I write, my 17 y.o. son is making three scrambled eggs with 4T of butter and 2T of cream to go with his 2 cup glass of whole milk. His typical breakfast. We go through a half gallon of ice cream every three days. He eats bacon regularly. Cheese is good too. He has a basket of chocolate in his room to eat all day. We added avocados in desperation to reach his caloric needs, but he is still a slender 40th percentile weight. My point being, you should be so lucky as to worry about her weight or her cholesterol at this point! We do try to do the calorie loading with fats, not sugars, since celiacs often develop diabetes and who needs that, but his GI and dietician agreed that calories -- in whatever form -- are what he needs most. Ice cream is your friend, right now :)

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Thanks everyone :) I guess I was mostly surprised (and a bit embarrassed) that such a big deal was made of it publicly. People frequently comment about how small she is and I like to let others know casually that we are aware of her size and her pediatrician is on top of things. My facebook comment was very much low key and I thought it was perfect. For others to challenge what I feed her and what our doctor's were saying made me a bit defensive. (I become a beast at times when I feel my parenting skills are questioned, particularly when I'm frustrated at not being able to 'fix' something).

Karen, I agree, they are way too serious over this, and she has another check up in Oct. Four months of ice cream won't hurt her. Yes, she eats nuts, loves boiled peanuts, raw almonds, walnuts and all seeds (pumpkin, sunflower). I'll try the olive oil as well and she loves avocado. And yes, her energy level is super-high. She's the only person on the soccer team who doesn't take a break during the game - she runs constantly. She just signed up for cheerleading (for when she's not playing soccer) and is at a karate camp this week (2 hour classes daily). She's the fastest runner on her soccer team according to her coach. She's incredibly active.

GFManna, we can do those things and yes, she adds fruit to her ice cream. (We live in the country so have unlimited access to numerous berries and fruits).

JestGar, thanks for the scientific approach. ;) I found the article VERY helpful and it helped me understand the foods approach a little better. Thank you.

domesticactivist - no, she's had no other screenings. Our gastro suggested that perhaps he would do some if her weight didn't pick up in a few months, but he didn't say which ones. Our daughters sound very similar. :) Her ice cream intake is basically once a day and sometimes a milkshake at night. Actually, we are all doing that since it's hard to ignore when the ice cream is brought out. ;) My husband would love it if we did away with sugar but for me, I'm not ready to take that step yet. I find cooking to still be challenging at times and I'd rather stay in my comfort zone. Thanks for the blog link, I'll be checking it out. I'd love to read more about it.

Ryebaby - when I was pregnant, I lost significant amounts of weight and ice cream was my friend then as well. I suppose that's why I didn't worry about it - I know ice cream seems to be a calorie boost from a doctor's point of view.

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I'm glad you're feeling better about it and keeping it all in perspective. Your daughter sounds like a delight :)

A bit more info on the screenings:

The bone age test is just a wrist X-ray. Then they compare it to charts (in an actual book, I could barely believe it!) that show typical bone development. The radiologist put her at around 10, but the endocrinologist was more precise. Girls don't grow much after puberty, so the longer they have until then, the taller they will be. I was a late bloomer, too. I was 4'7" at my 13th birthday, and 5'2" three months later. My mom swears my daughter is smaller for her age than I was. We'll see.

The possibility of Turner's Syndrome had me scared. It is a genetic disorder (not hereditary) and girls who have it often have a characteristic physical appearance. That's not always the case, though. It is connected to many health problems, and girls who have it often don't get a menstrual cycle and are sterile. It is very easy to screen for - it's a blood draw so they can do a karyotype test.

One more test I forgot to mention is for nutrient deficiencies. Especially with celiac, she could have a malabsorbtion issue.

Anyway, in the meantime, enjoy the ice cream! I hope your follow up visit goes well. We have our follow up in September. If you find out any other screenings or potential issues that could be causing the short stature, I'd love if you could think of me and let me know!

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people complaining and critising have no idea, my daughter also has anaphylactic milk and egg allergies, so we really have to up the fat and protein, we've been there too..my SIL saw our daughter eating bacon and made comments on how badly she eats, my reply was "doctor's orders, she needs the calories, she's even been told to eat the skin on chicken" bearing in mind the woman complaining only lets her child eat rice, noodles meat and veg, vey little fruit, sweetcorn was banned until a month go because it's "sweet'. poor kid isnt even allowed to decide when he is full.. he's nearly 2 and screams he's done, and she fills him up til his tummy is rock hard, he's going to live in McDonalds when those rebellious years hit!!!!

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domesticactivist, I read your blog (well a good bit of it anyway) and all I can say is, "Wow!" and I wish you all lived next door! Kudos on getting everyone in (and out) of your household on a specialized diet. I wish you all the best. And yes, I'll let you know if our gastro says anything else that might be good to test for. I'll check on a nutritional deficiency testing as well.

stanleymonkey, I am always so thankful that we have no ana reactions here. That must be so scary. I suppose part of the reason I am so annoyed at the facebook drama was that the person who started it all, went on to lecture me about what SHE feeds her children for weight gain and offered to share her recipes with me. I told her I would love to have them but she never sent them. It was like she wanted to start a drama, maximize her maternal superiority and appear generous by offering to help, but never helped.

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Thanks for checking out my blog! It's actually easier to have us *all* on the diet than having to feed everyone something special. If only we could all go on an ice cream diet!!! :D

As for the drama, yeah, that is really annoying. The public announcement and offers to help without any follow through are so obnoxious. I'd be pissed, too. In the long term people see through it, though. Hold your head up high like you've been doing.

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one thing we found good for calories is tahini, we use it as dip, our daughter loves it.

we also found a cocnut milk beverage, its actually soooo good

our dietician also suggested adding a blob of margarine to everything she eats, like potatoes and rice

and the milkshakes we make have soy milk cocnut milk and then we add fruit and veg for extra vitamins

we also make sure she eats every 2 hours and it seems to have maintained her weight

our dietician said pretty much what your doc did, our daughetr is eating the eact oposite of what every canadian kid is being told to eat!

we were also told...health problmes from weight loss and malabsorption cannot always be rectified...bad eating habits can...give her the ce cream and worry about it later!!! did i mention we love our dieticin almost as much as our daughter does

and your friend sounds a bit like my SIL...thinks shes the perfect parent

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Our daughter's dietician suggested adding skim milk powder to her milk to increase her protein intake. She said to use this milk in her icecream milkshakes too. If you add the powder to the milk and mix it in a jug and let it sit in the fridge overnight, then the texture is much better than if you add the powder and drink it right away. In a milkshake with fruit, it's not even noticeable. :) Adding peanut butter to a milkshake is another idea. Happy icecream eating!

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My DD is 13 yo & is 4'8 & 74 lbs. She is the shortest girl in 7th gr, but she has grown 1 inch since Mar & I swear I can see her growing now. Her bone age scan In dec was age 10. She's been about 90% gluten-free for 2 wks and she sleeps like 12 hrs a dy. I have been giving her a nightly milkshake almost daily for the past month. She also takes gluten-free vits & calcium supplement & well as xtr vit D. She also loves bacon which she eats about 3 dys a wk.

She doesn't get enough calories due to her long sleeping stretches so the milkshake is a necessity I feel. I might even add a 2nd milkshake as I will be home more often starting next week. She is a picky eater so I would love to get some xtra calories in her any way possible. The skim milk powder sounds like a good idea for xtra protein I will try that.

So silverslipper there are many children in the same boat. We just do the best we can. I will continue to give my DD nightly milkshakes you shld too. I think whoever made that comment to you is probably passive-aggressive so ignore them

Best of luck to you & your DD : )

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