Toby is the founder of Toby Amidor Nutrition where she provides food and nutrition consulting services. She has served as the Nutrition Expert for FoodNetwork.com and Nutrition Advisor for Sear’s FitStudio.com, adjunct professor at Teachers College, Columbia University and at Hunter College in New York City.
This 5-part Eczema Kids’ Nutrition series was in collaboration with Toby Amidor, whereby MarcieMom would share different topics on kids’ nutrition and Toby provide her insights. It has since been combined into one longer informative post.
Inflammation is a protective response of our body to remove injured cells or irritants and helps heal our body. The problem, however, is chronic inflammation where there is an excess of pro-inflammatory immune cells in our body and damages healthy parts of our body. Chronic inflammation is associated with, among others, arthritis, diabetes, eczema, high blood pressure, inflammatory bowel disease and obesity.
Which are the Inflammatory Foods?
Food that increases the production of inflammatory substances include:
- Sugar – Sugar is the most common inflammatory food, and comes in soft drinks, pastries, candies, bread and is also listed as corn syrup, frutose, sucrose and maltose. Sugar increases insulin level and increases pro-inflammatory hormones eicosanoids.
- Vegetable oils – Oils from safflower, soy, sunflower, corn, peanut are polyunsaturated fats that are high in omega 6, linoleicacid. The body convert these to arachidonic acid, which is pro-inflammatory.
- Trans Fat – Trans fat is present in fried food, fast food, commercially baked food and also listed as hydrogenated oil and vegetable shortening. Trans fat increases free radicals that damage health cells and trigger inflammation.
- Dairy products and feed-lot raised meat that comes from animals fed with soy and corn (that is mentioned above to promote inflammation) or injected with hormones and antibiotics is also an inflammatory food.
A worth mentioning research related to infant is that milk formula has been studied to contain Advanced Glycation End Products which can increase the risk of diabetes in young children. This can be transferred by mom to fetus and also in milk formula.
MarcieMom: Can you share with us how can parents manage the amount of sugar in our kids’ diet? Do we have to monitor the glycemic index?
Toby: Absolutely not! There is no need to monitor the glycemic index of food unless it is for a diabetic.
Parents can manage the amount of sugar in their kids’ diet by being conscious of the foods they buy. Sugary beverages like soda and juice drinks are typically the number 1 source of sugar. In addition, the guidelines for 100% juice is 4-fluid ounces per day for a younger child— which makes it tough to follow if you buy the individual juice boxes which usually 6.75-ounces. Get your kids used to good old water—there is nothing more refreshing!
A note on Trans Fat – Zero Trans Fat is not NONE
MarcieMom: I’ve read that zero trans fat could still contain trans fat if less than 0.5g. Is that right? Should parents go by food label or should the ingredient list be scrutinized?
Toby: Yes, that is correct. According to the food labelling guidelines, anything that has less than 0.5 grams of trans fat can be labelled as ‘trans fat free’. That is why it is important to read the ingredient list carefully—look for words like partially hydrogenated or hydrogenated to indicate if trans fat is in the product.
MarcieMom: I’ve also read that fruits like apples, oranges, strawberries, kiwi, grapes are also inflammatory. Is that right?
Toby: Fruits contain antioxidants, vitamins, minerals, fiber, and phytonutrients, plant chemicals that help prevent disease and promote health. They provide so many beneficial nutrients that I never suggest avoiding them (unless a child was allergic).
Antioxidants and Skin
Before I go on, I have to give a spoiler that I don’t have the answer to whether it’s proven without a doubt that antioxidants can benefit the skin of our children with eczema. However, after researching this topic, I believe it’s beneficial to eat antioxidant-rich food, so let’s start by looking at what’s antioxidant!
Antioxidants are vitamins and nutrients, including Vitamin A, C, E and selenium, that helps to protect our cells from the damaging effects of free radicals. Through our exposure to sun and digestion, free radicals (which are unstable molecules) form and they promote inflammation and damage skin cells. Antioxidants are able to inhibit oxidation and damage to the skin cells and speed up repair of the damaged cells.
Limited Resource on Impact on Skin
While there are many products that want us to eat antioxidant in the form of supplements or apply them onto our skin, I couldn’t find many studies in this area. There’s one research published in European Journal of Clinical Nutrition that linked increased intake of antioxidant (namely, beta-cartoene and Vitamin E) to reduced risk of atopic dermatitis in children. However, there’s another research that linked increased risk of skin cancer in women who took antioxidant capsules.
What are the Antioxidant Rich Foods?
Whole foods are recommended and foods rich in antioxidants are berries, beans, dark and orange vegetables. There’s an interesting WebMD article I’ve found that rank vegetables in terms of their antioxidant levels and most of them are higher in antioxidants after cooking! Some of these vegetables include spinach, potatoes and eggplants. Foods that are rich in Vitamin C, E and selenium include citrus fruits, red pepper, broccoli, whole grains, brazil nuts and turkey.
Another WebMD article stated that in terms of antioxidant creams, the concentration may be too low to be useful and potent creams ought to have 15-20% Vitamin C, 2-5% Vitamin E and 0.2-0.5% Selenium. Do note that Vitamin E is on the list of allergen, so do always test on a small patch of your child’s skin before using a cream with Vitamin E.
MarcieMom: I’ve read that whole foods are preferred to supplements because the former contain enzymes that cannot be manufactured into a supplement. Is that true and can you share with us how enzymes help in the anti-oxidative process?
Toby: Whole foods are preferred over supplements because they contain phytonutrients, which are plant chemicals that have health benefits and can help protect against disease. Many of these phytonutrients have not been isolated into supplements, plus there is not enough research to know if they work well alone or in conjunction with other nutrients in the foods they are found in. For example, a phytonutrient called anthocyanin is powerful anti-inflammatory antioxidant found in berries. Studies show they may help lower the risk of some forms of cancer.
Is it harmful to take an excess of antioxidants?
Toby: Taking in too many antioxidants can be harmful. More is definitely not better and many of the antioxidants can potentially be toxic when taken in excess, especially through supplementation. Children should eat a well-balanced diet of whole foods including plenty of fruits, veggies, whole grains, lean proteins, nuts and seeds in order to get their daily dose of antioxidants.
Fluid Intake and Skin
Water and Our Body
We know that water is critical to the proper functioning of our body, which includes ensuring proper digestion, brain function, blood and oxygen circulation and regulating the body temperature. We hear we’ve to drink more water for glowing skin, but that is not exactly correct because water that we drink goes to the intestines, blood streams, filtered by kidneys instead of directly to the skin.
Water we Drink does not go directly to our Skin
A review has been conducted by the British Nutrition Foundation that concludes drinking water does not impact skin’s appearance. So, while we know that taking fluids is not the way to rehydrate our child’s skin, using sunscreen, balanced diet are essential for our child’s skin, and moisturizing is a must for those with eczema.
How Much Fluid Should Your Child Drink?
Ensuring sufficient fluid intake is important for your child and my recommendation (based on what I’ve read) is not to count glasses of water but to encourage our children to drink water throughout the day and more, if they are exercising or outdoors. Children, being smaller in size and not sweating as much, have a higher risk of dehydration and harder for them to cool off. To know how much fluid our child has lost after exercise, we can weigh him/her before and after exercise and normally, note the color of our child’s urine and whether their lips are dry.
What Fluids to Take and Which to Avoid for Your Child
Water serves its purpose by being water, so it’s always best to get your child to get used to drinking it once they start on solids. Eating fruits and vegetables also count towards their water intake, as are drinking milk and fuit juice. For children above 2 year old, low or non-fat milk can be taken and for kids below 6 year old, 4-6 ounces of juice per day can be given.
What NOT to drink is obviously artificially colored or sweetened empty calories, like soda and drinks containing hugh frutose corn syrup, no matter how kids’ appealing the packaging looks! Moreover, sugar is inflammatory and not good for our child. Vitamin water is also not recommended as vitamins added to water and consumed individually may not reap any benefit.
Will Drinking Softened Water Help Your Child’s Eczema?
Many parents have feedback that softened water helps but unfortunately, based on the softened water eczema trial conducted by Prof Hywel Williams and Dr Kim Thomas of the Centre of Evidence Based Dermatology at the University of Nottingham, there was no difference noticed in the trial that involved 336 children whose homes were fitted with water softener.
MarcieMom: We know that ensuring sufficient fluid intake is important, what guidelines would you give to parents who want to ensure that their children consume sufficient fluid?
Toby: Have children sip water throughout the day and learn to recognize when they are thirsty before they start becoming dehydrated, especially on a hot day or after intense exercise. Also, be sure they are using the restroom to urinate on a regular basis—this is also a good sign of proper hydration. Eating plenty of fruits and veggies can also help contribute to hydration.
More Fluid Intake for Dry Skin?
MarcieMom: For parents whose child’s skin is inherently dry, should they give their child more water than a child with normal skin?
Toby: No, studies do not show that more water means moister skin. Just keep them hydrated like everyone else. No more, no less.
MarcieMom: At what age would you recommend starting on fresh milk or UHT milk, instead of milk formula? Do you think that today’s milk formula with added probiotics and DHA is essential as part of our toddler’s diet or should children be getting what they need from eating a balanced diet?
Toby: The American Academy of Paediatrics recommends whole milk at 1 year of age, going to 2% (reduced fat milk) at 2 years and whole milk by 3 years of age.
Formula should be used until about 18 months— at that time, the child should be eating a varied diet of fruits, veggies, whole grains, lean meats, healthy fat, and dairy which will provide sufficient nutritional value.
Water or Juice for Young Children?
MarcieMom: Finally, for children who already dislikes water, what tips do you have for their parents to get the child interested in water? (I dilute all of Marcie’s juice and let her drink ice water from the adult cup in restaurant, just like we do!)
Toby: Don’t give up when it comes to water. As any food or beverage, it takes time to enjoy it. If you want to increase the flavor, add lemon, lime, or orange slices. Children should not taste juice until at least 2 years of age—the more water is a part of their regular diet, the more they will accept it. Parents should also lead by example and serve water to the entire family.
Starting Fish from Young (or not)
Fish – A Common Food Allergen to Introduce Early?
There are six common foods that make up majority of the allergic foods, and fish is one of them (the other five foods are milk, egg, soy, peanuts and wheat). Yet, there were a few studies conducted in Sweden and Norway that indicated a lower rate of eczema for children who started fish in their diets early. In a 2008 study, introduction of fish to babies before 9 month-old showed 24% less likelihood of getting eczema by one year old. In another study, one to two year old who ate fish once a week had 38% less likelihood of eczema. In the journal by American Academy of Pediatrics, late introduction of fish was strongly related to inhalant sensitization. Research had not measured notable reduction in eczema with intake of supplements nor were there differences between eating fish vis-à-vis omega-3 rich fish. It is also observed in countries that typically introduce fish in children’s diet early that there is a lower rate of fish allergy.
What’s in a Fish and What’s Omega-3?
Fish is a source of protein that contains taurine, zinc, selenium, iodine, Vitamin D and Vitamin B12. Of interest for the past decade, is the Omega-3 that is contained in fish. Omega-3 is one of the fatty acids that cannot be manufactured by the body. The long chains of the fatty acids, namely EPA and DHA, have been reported to have health benefits, including brain development of babies. Fish that are rich in Omega-3 include salmon, sardines and mackerel but for a child, intake must not be overdone as fish are also rich in mercury, especially shark, swordfish, king mackerel and tile fish.
How does Fish affect Eczema?
This has no conclusive answer. From what I’ve looked up, the body is able to convert DHA to RvD2 which is a Resolvin that can regulate inflammatory responses. I’ve also read that fish oil may help to reduce leukotriene B4, which is an inflammatory substance. However, eating more fish alone may not be enough as there’s increasing suggestion that it’s the balance of Omega 3 and Omega 6 (from vegetable oils) that regulates inflammation.
What’s the recommended intake of fish for an infant below 1 year old?
Toby: Since there is a higher chance of an allergic reaction to fish, it should not be introduced until the child is 1 year into the diet. If there is a family history of allergies, then even longer.
You also need to remember that many of the fish high in omega-3 fats like tuna and salmon have a very strong flavor. Kids have more taste buds than adults, so even if you do introduce them at 1-year, the kids may not accept them very easily. I suggest introducing more mild tasting fish like mahi-mahi and red snapper as a first step.
Would you recommend taking fish supplements?
Toby: If a parent is worried about their child getting enough omega-3 fats, then they should seek professional guidance from a registered dietitian before giving their child fish supplements. This is especially important if a child (usually under the age of 1) is taking in formula or is still breastfeeding since they are probably getting enough. You don’t want to give too much either—there are always side effects.
How can a parent help a child who has eczema balance his/her intake of Omega 3 and Omega 6?
Toby: Giving a child a well-balanced diet should do the trick. Also, if a child is breastfeeding or on formula, they should be getting enough of both nutrients. Once they get off the formula and/or breast milk then introducing every food group to the child to help create a healthful diet is important.
Genetically Modified GM Foods
What’s Genetically Modified Food?
Genetically modified (GM) food or genetically engineered (GE) food are foods which genome has been modified by having another gene selected and transferred to it, encoded for a specific protein. GM food came into the supermarket around 1994, starting with tomatoes being approved for consumption and since, the majority of soy, corn, cottonseed and canola are genetically modified.
Foods are genetically engineered mainly (i) to be tolerant to herbicides and (ii) to be able to produce its own pesticides that kill the pests feeding on them. To be tolerant of herbicides meant that farmers could say, spray Roundup herbicide (produced by Monsanto) and kill the weeds but not kill the vegetables, known as Roundup Ready soybeans, cotton etc. which seeds are also sold by Monsanto.
How did GM or GE Food Come About?
Crops can be genetically modified to be easier and faster to grow, and more resistant to drought, pests and diseases, thereby increasing food supply in our increasingly populated world. As mentioned above, the vegetables can also be engineered to be tolerant to herbicides. Some foods are genetically modified to improve its nutritional value by say, introducing antioxidants to vegetables that are lower in it.
So What’s the Problem?
The problem seems to be that we know little of the extent of the problem. There is a growing opposition against genetically modified food and some articles on the web have summarized it:
The main worries are:
Risk of increased allergy – for instance, there’s a soy allergen, trypsin inhibitor, which normally would reduce if the soy has been cooked. However, if the soy has been genetically modified, cooking didn’t reduce the amount of the allergic protein.
Risk of antibiotic resistance markers in human – if the markers are added to the GM food, there’s a risk of horizontal gene transfer whereby the antibiotic resistant gene will be transferred to bacteria in human intestine.
Risk of increased herbicide or pesticide – Although GM food would need less herbicide, farmers may end up using more of it since the crops are tolerant to it!
Risk of SuperPests – The pests turn ‘super’ because they have also adjusted to the GM food and thus stronger pest-resistant crops need to be engineered which may set off harmful effect on the food chain.
Risk of harm to organs – Some studies showed that rats had higher mortality rates and damages to their body organs and mouse had reduced enzyme production after consuming GM food.
Should it be Avoided for a Child with Allergy or Eczema?
There is no straight answer to this, though pregnant woman and young children may want to be more aware of this since the brain and immune system of foetus and young children are not well developed. There is no study directly linking children with allergy or eczema to GM food, and parents who are worried about GM food can opt for organic, which means not genetically modified, no synthetic pesticides, no irradiation or bio-solids added as fertilizer.
The Dirt Dozen Foods (Updated 2019)
Below are the ‘Dirty Dozen’ foods that contain the most pesticides, in a study done by non-profit organization Environmental Working Group.
Most of the foods above are so rich in vitamins which I give lots to my girl! Buying organic for the top pesticide food and top GM food would target the most risky ones and be less costly than switching all food to organic.
MarcieMom: Would you recommend a parent to always buy organic if they can afford it? And if they can’t, what food would you say ‘It’s better to eat the non-organic ones than not eat it’ and for what food would you say ‘Forget about feeding your child this if you can’t find an organic version’?
Toby: I would suggest going by the Environmental Working Groups Dirty Dozen and Clean 15 lists. The dirty dozen contains the highest levels of contaminants and includes apples, celery, strawberries, peaches, spinach, imported nectarines, imported grapes, sweet bell peppers, potatoes, domestic blueberries, lettuce and kale/collard greens. I suggest to spend your organic dollar on those 12 foods. Another option is local—visit your local farmer’s market and speak to your local farmer about what they grow and the techniques they use. They are typically very happy to discuss this information!
MarcieMom: The foods that are genetically modified such as soy, cottonseed, corn and canola are used in many processed foods, including soy lecithin used in chocolates, corn syrup in many sugary snacks and canola in oil. Would you recommend parents to read the label for all the food items and not buy if they contain soy, corn, cotton or canola? Or would your advice be to avoid certain category of food, say snacks and cookies, which aren’t healthy anyway?
Toby: These ingredients are found in such high amounts in our society, but we need to balance the good with the not-so-good. In general, all these oils are unsaturated and better for heart health. Using them within your repertoire of oils in moderation is healthy. And if you choose more whole foods over highly processed ones, you could pretty much avoid many of those other ingredients and higher calorie foods that should really be limited in your child’s diet.
MarcieMom: Will feeding our children supplements for the nutrients or vitamins we want them to consume get around this problem of pesticide and GM food?
Toby: NO! Whole foods provide so much more than can be isolated in a pill. The nutrients found in food work with one another to provide your child with maximum health benefits. Furthermore, eating food helps maintain the integrity of your gut. You also want to get your child to get used to eating well-balanced meals together with the family—they will learn about healthy eating and spend more time with the family too.