Are Children Getting the Nutrition They Need on Elimination Diets?

“As more parents turn to elimination diets for their kids, doctors and nutritionists worry that children may not be getting the nutrition they need,” says Special KXAN News Contributor, 

Dermatitis Herpetiformis

AUSTIN (KXAN) — When it is time to eat at the Landau house in north Austin, you won’t find bread, pasta or cow’s milk on the menu. Josh and Amy Landau and their three growing boys cut out those foods and others in an effort to help now 8-year-old Seth. From the time he was 15-months-old, his little body was covered in eczema, an irritating skin condition that made life difficult.

“It was really itchy,” Seth recalled. “I could hardly sleep through the night.”

“It was extremely frustrating,” Seth’s mother Amy said. “We just wanted the child to have relief. We wanted our son to have relief. He couldn’t play, because he was too itchy. He couldn’t sleep, because he was too itchy.”

Over a five-year period, the Landaus took Seth to several conventional doctors and other health providers and tried medications that offered no lasting relief. Doctors found no food allergies, but his parents still wondered if diet played a role.

“I have no other hope. I don’t have anything else to try, because I won’t quit on my child,” said Amy.

“I wasn’t certain that any of the things we tried would work, but we had to,” said Seth’s father Josh. “What we were doing with medicine was not working, so we tried different types of therapies. I didn’t rule anything out.”

Seth's eczema problem
Seth’s eczema problem

After trying what seemed like every medical option, they came across the term “functional medicine” online. The Institute for Functional Medicine defines it as the practice of addressing “the underlying causes of disease” using “a patient-centered approach” rather than the “traditional disease-centered focus.” The family’s search for what seemed like the last possible answer to Seth’s condition led them to Dr. Amy Myers, a functional medicine physician in Austin who says she focuses on getting to the source of the illness. More often than not, it includes changing what her patients eat.

“Patients are demanding that they have more time with their doctor, that they listen to them, that they have more natural ways to treat what they have and really get to the root cause,” said Dr. Myers. “As more and more people hear about it, it’s just exploding across the country.”

Dermatitis Herpetiformis 2Dr. Myers says there is a big connection between the food we put into our gut or intestines and our immune system. According to Myers, a person can develop “leaky gut” and destroy good bacteria in the intestines as the result of years of processed foods, medications like antibiotics, toxins from the environment, infection and stress. The small intestine, which absorbs nutrients into the body, then becomes less permeable. Dr. Myers believes leaky gut keeps people from getting the full nutritional benefit of their food. She also says it causes the walls of the intestine to leak partially digested food and other toxins into the body that the immune system attacks and causes an inflammatory state.

Functional medicine doctors identify certain foods that can cause inflammation in the body as the result of a leaky gut. The inflammatory foods are: gluten (a protein in some grains), dairy, corn, soy, eggs, sugar and yeast. When they initially start on the diet, Dr. Myers often has patients stop eating all of those particular foods–in what’s called an elimination diet. Functional medicine providers may take these foods out of a patient’s diet and then add them back in one at a time to determine if a so-called food sensitivity exists.

“I’m not opposed to conventional medicine at all. We do a really great job at a lot of things in conventional medicine. I don’t think we do a great job in managing chronic disease or find the root cause or prevent,” said Myers.

inflammation food

Doctors, nutritionists warn of elimination diet concerns

While some in the medical community are proponents of elimination diets, Agata Matusz, the Clinical Nutrition Manager at Dell Children’s Medical Center in Austin, told us her staff does all it can to accommodate dietary requests like gluten-free and dairy-free meals, but she worries children on elimination diets may not be getting the nutrition they need.

“I think the big concern is lack of a balanced meal and shortfalls with nutritional deficiencies. We really struggle to make sure children are getting all of the micronutrients, mineral and macronutrients they need. So taking out a big food group may take away some of those vitamins, minerals and macronutrients,” explained Matusz.

Matusz encourages parents to get help from a nutritionist before taking foods out of a child’s diet. She says there are key nutrients children need as they grow that could be replaced with other foods.

“When we see kids take out dairy from their diets, most importantly calcium and vitamin D intake declines. Gluten may not be necessary, however, whole grains in general can be really healthy and beneficial. They give a lot of fiber,” explained Matusz.

“The Academy of Nutrition and Dietetics really recommends a balanced diet. That includes lean meats, fruits and vegetables, low fat dairy and whole grains. So when we see kids start to eliminate, that’s when the nutrition experts need to be involved.”

Matusz also approaches food elimination with caution when treating a child with autism or sensory processing disorder. She said those children often eat fewer foods already or do not like certain food textures, so to eliminate any food can be challenging.

Central Texas pediatricians report an increase in the number of parents asking them if eliminating certain foods from their child’s diet may help conditions from allergies to ADHD. The diet change trend is evident online and in your neighborhood grocery store. More stores are stocking shelf space with gluten-free and dairy-free items as well as organic and non-genetically modified food items. Gluten-free market sales reached $973 million at the end of 2014, according to market research publisher Packaged Facts.

Baylor Scott & White Health pediatrician Dr. Brad Berg has parents ask him about the elimination diet trend all the time. He said parents ask about cutting foods out of their child’s diet to treat conditions like eczema, gastrointestinal issues, autism, attention deficit hyperactivity disorder and depression. His philosophy is to always consider the individual patient, and it does not hurt to try a diet change. He tells patients to try cutting out a small number of foods to see if conditions improve. However if a parent wants to try a larger elimination diet, he suggests getting help from the diet experts.

“It’s so difficult to get a well-balanced diet nutritionally with vitamins and minerals and especially the amino acids and proteins,” said Baylor Scott & White Health pediatrician Dr. Brad Berg. “If you do a large cross section elimination diet, you want to have that dietician involved. If it’s gluten you have to watch out, because there’s a lot of gluten-free foods out there now which are packed full of sugar and packed full of fat.”

Dermatitis Herpetiformis 3

The waiting game for Seth’s results

Under the guidance of a nutritionist in Dr. Myers’ office, Seth cut out more than seven foods and took dozens of supplements. The entire family decided to go on the diet to support Seth in December 2012.

The foods in the kitchen pantry vastly changed. There were no more cereal boxes and pizza crusts. The family eliminated all bread items from their diet. The Landaus started stocking the pantry full of fresh vegetables, nut butters, oils and coconut milk. They also started buying locally produced eggs and meats delivered to their home.

Amy admits the grocery bill has gone up, and the food adjustments took time, but it was all worth it.

“To follow the diet protocol and follow the supplements and keep up with that wasn’t nearly as difficult as seeing my child suffer,” Amy said.

The Landaus knew to not expect an overnight change in his skin. They knew it would take time, but a few months of being on the new diet and taking the supplements, Seth’s skin began clearing up.

“It was about the 5-month mark when I noticed a critical change, because Seth no longer needed to apply his steroid creams.” But Amy said that lead to another problem: Seth went through steroid cream withdrawal. She ended up help and support for the condition from the International Topical Steroid Network.

Seth’s hands that were once swollen with eczema now fill his house with music. He loves playing the piano! The Landaus claim changing what they eat has changed everyone in the family for the better, especially Seth.

“There’s no question that what he went through has shaped him. He seems to always find the positive in things. He emits a positive energy that the whole family is lifted by,” said Josh.

His wife echoes the same statement. “I don’t need science to back it up, because I have in plain sight how he was before and how he is now. I can see from the outside he’s healthy, but I know from the inside he’s healthy too.”

Research on food sensitivities

Research on food sensitivities is a controversial topic. Pediatric gastroenterologist Dr. Murali Jatla with Baylor Scott & White Health believes a strong gut-nervous system connection exists, especially in children. However, he said there are not great controlled scientific studies to prove some food sensitivities are real health problems. He said there is not enough money behind any effort for research and no lawmakers are calling for it. He also sees ethical issues with food sensitivities research on children.

Pediatrician Dr. Brad Berg with Baylor Scott & White Health considers the gut-immune system connection to be the medicine of the future. “There are some studies that say that it works, some studies that say that it doesn’t and a lot of studies that say that it might,” Dr. Berg said.

One of the leading researchers on gluten intolerance is Dr. Alessio Fasano, the Division Chief in the Department of Pediatric Gastroenterology and Nutrition at Massachusetts General Hospital. Much of his work focuses on the leaky gut and the autoimmune diseases like type 1 diabetes, multiple sclerosis and rheumatoid arthritis he says it can cause. His research website also indicates he is currently looking into whether gluten intolerance may play a role in a certain set of people with autism or schizophrenia.

Another researcher who has received much attention for the study of gluten sensitivity is Dr. Peter Gibson, the Director of Gastroenterology at Monash University in Australia. In 2011, one of his studies suggested gluten could trigger bloating and gas in people with sensitive intestines. In 2014, he published work in the journal Gastroenterology that found the intestinal problems may be caused by certain carbohydrates in grains and not the gluten.

One of the most recent studies released on gluten-free and dairy-free diets relates to autism spectrum and is out of the University of Rochester Medical Center. The study published in the Journal of Autism and Developmental Disorders in September 2015 found the popular gluten-free, dairy-free diets had no effect on a child’s behavior, sleep or bowel patterns.

Dr. Amy Myers cites research in her book, The Autoimmune Solution.