So I discovered Paleo around Christmas and I've been trying to find the right balance for myself. It's working pretty well (after a few bumps) and I've decided it might be a really good choice for my 4 year old son Caleb who has had digestive issues his whole life. A little background:
1) He's a twin, they were born 30 weeks premature
2) He was in hospital for 4 months with lots of breathing issues and lots of feeding issues. He was mainly fed expressed breast milk through a feeding tube, but the doctor's insisted he aslo have a dairy based "fortifier" because of his slow weight gain.
3) Since being home he has had ongoing issues with digestion (bloating, diarrhea, stomach cramps) and he is super, super skinny (other than his huge bloated belly).
4) He has been tested for celiac, allergies (allergic to milk), he's had a gastrointestinal scope. He's had way too many doctors appointment - but he's a great sport and has decided he's going to be a doctor when he grows up :)
I recently switched him to a paleo elimination diet - no dairy (he actually hasn't had dairy for years), no grains, no sugar (except a tiny amount of maple syrup sometimes) and no processed food. I've also excluded eggs, nuts, tomatoes, potatoes and peppers. I give him kids digeestive enzymes, probiotics and a gluten free multivitamin.
It's only been about 4 days and he was seeming to be a bit better (slightly less digestive problems), but today he got really sick again and his belly got all bloated. We've been keeping a food diary and I can't see what might have caused it so I'm wondering:
1) Could fruit be a problem? I am not at all worried about him gaining weight (in fact I would jump with joy if he gained a pound - it has taken him a year to gain the last pound and he only weighs 29 pounds). I've been letting him have almost as much fruit as he wants as long as he eats his meat first.
2) Should I eliminate coconut? He really likes it but I'm worried it could be an irritant. We've been giving him lots of coconut milk, coconut oil, avocado, bacon - any other ideas for kid-friendly high calorie food?
3) How long before we really see a change? Should we expect him to have belly problems as he heals or should we tighten his diet even more when he has these outbreaks (maybe exclude fruit)?
Any ideas, thoughts, criticisms would be really appreciated. I would do anything to see him as healthy and thriving as his twin (fraternal not identical).
Thanks for reading this long ass question :)
Thanks everyone for all you input. Just to let you know Caleb seems to be doing much better in the past two days - as the fructose intolerance wikipedia entry suggested we cut out the highest fructose fruits (apples and pears which he was eating lots of) and it does seem to have helped. His bloated belly has gone from 25inches to 20inches and his poops are better. I'm really hopeful that we may have found a way to control this for him so he can gain some weight and grow big and strong :)
I'll keep you all posted - thanks again for your comments and suggestions. Feels so nice to meet people who are willing to help.
Um, wow, the timing of your question is remarkable. Did you see Kurt Harris' recent blog post?
"5) When there is fructose in excess of glucose, or even when there is a large amount of fructose with glucose, there is often malabsorption in the small bowel – this can lead to rapid fermentation by bacteria in the colon, or abnormal overgrowth of bacteria in the distal small bowel. I speculate that fructose malabsorption is actually a defense mechanism to keep the liver from being overwhelmed by this metabolic poison, and the fact that we have not evolved a mechanism to handle big-gulp doses of fructose to the small bowel indicates modern quantities are likely outside of our evolutionary experience – the EM2."
...just don't send him an email asking medical advice. He hates that. :-)
Good luck. I can't imagine there's much in life more difficult than helping a child through a chronic medical condition.
Want him to gain? Grassfed Beef, lots of it. Whole Eggs are great growth food too.
Drop the Fruit, you're feeding bad bacteria in a gut that's clearly suffering from Bacteria issues. Once he's FULLY healed you Might consider adding it back in.
VLC is best for resetting gut bacteria. Tho if you can introduce naturally fermented foods, they do wonders.
Your kid is very lucky to have you.
I would suspect that fruit/fructose would be the problem. This would be present in the sweetener and in any fruit. Switch him to something like potato instead for a while and see how he does.
Boy, I must give you kudos...sounds like you have done a ton of great testing and work. With a 4 yr old I can only imagine what it is like doing so many food changes.
My only thought, have you done any candida elimination diets?...essentially low sugar in all forms with natural antifungals (combined with everything else you are already doing...probiotics, eliminating known allergens).
Some items like coconut oil which are anti fungals can cause a large die off which can cause bloating and discomfort/fatigue....so those might need to be added slowly. After a period of very low sugar, slowly add back in some carbs (like potatoes rather then fructose) to aid in weight gain. Use ghee, avo, eggs, and fatty meats in the meantime to keep calories up.
Seriously, best of luck, hate seeing kids uncomfortable.
Poor thing! That's terrible. He must be really tough. I can only think you will need to try eliminating what you think is the most likely culprit and go one thing at a time and monitor very closely. However, it's only been 4 days on paleo so it's probably too early to really know for sure what direction it is going. Keep up with the food diary of course. You can probably let him have sweet potatoes as they are not nightshades and are not usually a prob. They should be no worse than fruit. What I might do if I were you is moderate fruit intake, allow some sweet potato, keep up with the rest of the paleo, and just wait a bit more and see how it goes. I know there is a strong instinct to fix it immediately, but sometimes/often rapid switching things around just creates more problems than it solves and doesn't give you enough data to really figure out what is working. Another thing might be to just try to keep everything in balance. Too much fruit at once can even cause the trots in many adults, so don't let him tank up all at once. Instead, a bit of sweat potato would be easy on the stomach. Also consider feeding more bland easy to digest food like banana and applesauce as the fruits. And the sweet potato is also easy to digest and easy on the stomach. If that doesn't work, then you will have to try eliminating more things. But I'd say just give it a bit of time and also, might want to make changes gradually for him so as not to shock his system too much. LIke if you decide to cut down fruit intake, might not want to do it suddenly but slowly instead. If you are just eliminating one food, it's not so hard, bu tif you are eliminating a whole food GROUP, it could be much harder for him to adapt quickly.
Also, another clue here that was not much talked about is you said he is a twin. Is he an identical twin? If so, interesting the other did not get this same prob. It would point to it not being entirely genetic but also very environmental. I keep thinking about how your doc said that you HAD to give a diary fortifier and then later he tested as allergic to diary. Good way to really mess up the gut flora and intestines of the poor kid. Makes me really wonder what was in that fortifier. Other supposedly 'nutritious' supplements I have seen seem to consist mostly of corn oil. Ick.
Poor little guy! I hope he feels better soon; he is lucky to have a paleo-mom! I have heard that eating fruit on top of other foods can cause bloating; food timing and combining might be something to play around with- maybe just let him have fruit in the morning?
He sounds like me, poor baby. It's very probable I have fructose malabsorption, I am also highly sensitive to gluten and most grains. You've gotten excellent advice already. I'll just echo to ADD LOTS OF CLEAN STARCHES (potatoes, sweet potatoes, squash, roots, white rice). High calorie, high fat, plenty of starch, lots of seafood/meat/eggs, low toxins.
pecanbread.com is a helpful site for families with kids who have gut issues; the nutritional approach is the specific carbohydrate diet, with a special focus on special kids. Perhaps this, along with all the wonderful work you are doing, will be what works. Elaine Gottshcall's book, Breaking the Vicious Cycle, explains her specific carbohydrate approach. There are certain carbohydrates that cause problems; very compatible it seems to me with a paleo approach.
You are an awesome mom! Coconut can sometimes be a tree nut allergy, due to it being a tree nut. It was recently classified as a tree nut. My daughter has a tree nut allergy, but isn't alleric to coconut, but HATES it. I agree with the fructose issue, maybe some lower sugar fruits just to let him have some (berries). Your son is very lucky to have you!
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