Healthy Kids, Happy Moms Read online

  Encopresis can be a complex interplay among inflammation, poor nutrition, food allergies or sensitivities, emotions, or a problem with his nervous system that doesn’t allow for stool to be properly eliminated.

  Before coming to see me, the family had been working on this issue for years. He had seen two gastroenterologists. Those doctors prescribed Benefiber and MiraLAX, but the medications weren’t working. The doctors instructed Barry’s mom to increase the dosage, but it didn’t solve the issue.

  Barry had some bloodwork done, including environmental and food IgE allergy testing, and the results were all negative. He had not had an endoscopy or a colonoscopy. His mother’s intuition told her there was something deeper to Barry’s issue. She felt that the Benefiber and MiraLAX weren’t addressing the underlying cause but were simply treating his symptoms.

  Barry’s mother eventually took him to see a naturopathic doctor (ND). From my introduction, you might recall that NDs often see patients after the conventional medical route leaves them on prescription medications but still experiencing symptoms. NDs are trained to take diet and other environmental and lifestyle factors into consideration as they create treatment plans. This ND did a full IgG food sensitivity panel on Barry. Many food results came up positive, and she advised Barry’s mother to take him off those foods. She also recommended several supplements. (Food sensitivities are different from food allergies. I will cover this in more depth in chapter 4.)

  Barry’s mother got nervous about taking him off all those foods and brought him to see me. She wanted input from an integrative pediatrician. What I usually do in these cases is give the parents a concrete timeframe to see improvements. If Barry wasn’t getting better in three months, I told her I’d recommend they return to the GI doctor to get an endoscopy and possibly a colonoscopy along with a rectal biopsy, to see if he had something called Hirschsprung’s disease (a disease where the nerves in a child’s rectum haven’t formed properly). Fortunately for Barry, he did not have to get these tests.

  Barry and his mother agreed to a three-month plan. We eliminated the foods his tests had shown sensitivities to on the IgG test: eggs, milk, beef, wheat, crab, pork, walnuts, peanuts, and salmon. Within two to three weeks of being off the foods, Barry’s lifelong constipation nearly resolved. They were over-the-moon excited, and so was I!

  One of the challenges along Barry’s road to recovery was that his body no longer felt the urge to defecate. We had to get creative to help him through this. I had Mom buy him a wristwatch to remind him to go to the bathroom every two hours. Simultaneously, we gradually decreased his systemic inflammation and allowed his rectum to start working properly again. Eventually, he began to sense an impending bowel movement, and we were able to stop using his watch to remind him to go. The critical factor here was that he was in charge of deciding when he was ready to give up the watch. Our goal was to give him as much control over the situation as possible.

  Finally, we also used supplements, a probiotic (I didn’t know about the power of digestive enzymes back then), magnesium, omega-3 fats, vitamin D, and a whole food supplement. Barry’s improvements happened quite rapidly; within two weeks he was no longer soiling his underwear. I often find this to be the case with kids. Once we remove whatever is triggering their inflammation, their bodies move back into balance fairly quickly, anywhere from two weeks to six months.

  After the initial three months, we were able to add most of the eliminated foods back into his diet one at a time for a week at a time. He tolerated everything except the gluten and dairy. When these were added back in, the constipation returned. So we kept them out for the next six months to allow full gut healing. When we added them back after his gut was able to fully heal, he could tolerate them. However, if he ate too much pizza (gluten and dairy) all at once, or if he was eating too much dairy and gluten on a weekly basis, the constipation would return. What he was experiencing is cumulative inflammation. Too much gluten and dairy filled up his glass of inflammation too high and then he would get symptoms. However, if he was mindful and only had two pieces of pizza and didn’t have any dairy or gluten for a least a week before and after their yummy pizza night, he was okay. Or if there was a birthday party or special occasion coming up and he knew he wanted to enjoy cake or Thanksgiving stuffing, he would just think ahead and set things up so he could eat it without having issues.

  GARY’S CUP OF INFLAMMATION

  It’s when we eat our inflammatory trigger foods continuously (like me in college) that we run into problems. If we don’t give our system a chance to catch up and decrease the gut and systemic inflammation, it leads cumulative inflammation. (I will ask you to be mindful of cumulative inflammation when you get to the food reintroduction phase of the program.) The goal is to get the gut and system functioning well, so the kids don’t have to stay on a super restrictive diet for too long. It doesn’t mean eating junk food all the time. But it means understanding that the food a child eats at a typical birthday party could take their system days to recover from. Let’s get their system ready for this, and if they want to partake in the pizza and cake, I would like them to be able to do it without coming home and not being able to poop for three days or vomiting with a stomachache—all of which I have seen happen with my patients after parties or after Disney World food binges!

  Barry occasionally had issues with constipation (if he ate too much gluten and dairy all at once, say, in a pizza), or if he was eating it once or twice a week over several weeks. Since Barry’s parents understood the concept of cumulative inflammation, they were well equipped and could always figure out the trigger behind his intermittent constipation. Together, we learned so much about what his trigger foods were that his family could plan meals and special occasion treats accordingly so Barry didn’t feel deprived.

  As of this writing, Barry is fifteen years old; he is five feet, eleven inches tall and thriving. He still has to watch what he eats and not ingest too much dairy and gluten. He cannot eat pizza two days in a row without having a problem (but who can, right?), and he and his family understand how to keep his bowels healthy and moving daily.

  How powerful is it that Barry now understands his body so well?

  A WORD ABOUT BARRY’S FOOD SENSITIVITY TESTING

  Had I known when I first saw Barry what I know now, I would not have asked him to take all the foods his test results were positive for on the food sensitivity test out of his diet. I would have begun with having him remove the foods we remove during the Mini Cleanse for Kids (found in section II) along with dairy and gluten. I am pretty sure that by removing those and adding in probiotics, digestive enzymes, omega-3 fats, a whole food supplement, vitamin D, and magnesium, we would have seen the same results. I say this because I don’t want anyone to think they have to run out and get a food sensitivity test done. Sometimes those tests can be more overwhelming to families than they are helpful, and their results not necessarily reproducible. (I review testing in more detail in chapter 4.)

  Research is rapidly changing

  TAKEAWAYS

  The key to health is establishing a strong gut.

  The gut is the hub for about 70 percent of the immune system.

  Undigested food particles (especially protein) contribute to inflammation in the gut. When the gut is inflamed, our bodies struggle to effectively absorb nutrients from our food.

  Foods that many of us think are a healthy part of the diet may actually contribute to inflammation for some people, specifically gluten and dairy.

  Other triggers of inflammation are processed foods, artificial dyes, and refined sugar.

  Restoring integrity to the cells that line the gut (the tight junctions) is the first step in bringing your child back into balance.

  As gut inflammation decreases over time, the inflammatory symptoms start to lessen.

  Heal the gut using the 5 Rs:

  CHAPTER 4

  five ways food triggers inflammation in our bodies

  REWIND THE CLOCK TO the
fall of 2005. I started my first job as a general pediatrician at the same practice where I had worked for three years during residency. They hired me but literally had no room in the clinic for me. So they kicked out the urologist who was renting space in the office. I took over his cubby in the back corner facing three lovely cement walls with the fourth side open to the hallway where my patient rooms were. It was perfect for a newbie. Nobody could see me sweat when I got nervous about what I was doing. And seriously . . . windows are so overrated.

  One of the things I didn’t learn about in training that is an ever-present part of life in a busy doctor’s office is maneuvering through the many people who want to tell you about their products, including pharmaceutical reps. I was very focused on the rooms of patients who were waiting. You have three patients in rooms ready to be seen. You have a child in the middle of an asthma exacerbation getting a breathing treatment whom you saw an hour ago and you need to go back and listen to his lungs. You have a drug rep staring you down, and you have to go to the bathroom. I was still trying to find my rhythm of seeing patients, and I was not always super friendly when the reps came in during the middle of a busy clinic. Every day felt like I was stepping into a pressure cooker, but you just have to keep moving so the top doesn’t blow. Many days, I barely made it to the bathroom.

  However, I must recontextualize this scenario in the bigger picture of life and medicine. Healthcare workers in emergency departments, trauma centers, and hospitals and many physicians in other countries have far more stress and intensity. My job was a cakewalk compared to their intense moments of life and death. I am just giving you readers a taste of my mindset as a new doctor.

  Fresh out of residency, I quickly realized that most of my patients whose illnesses were poorly controlled were struggling with the issues I am writing about in this book: reflux, eczema, recurrent ear and sinus infections, chronic runny nose, allergies, asthma, stomach pain, and constipation or loose stools (yes, I know you know this list). I was constantly writing prescriptions for increasingly stronger steroids (topical, inhaled, or ingested), antibiotics, and antacids.

  Nothing about it felt right to me, and this is around the time that the voice in my head started talking to me. “There is something else going on here! There is something you are missing, Sheila!” I think I was subconsciously channeling my mother. I knew there was a deeper piece to this but didn’t know what that piece was. I really did not like putting young children on all these medications.

  Then one afternoon in the windowless corner of my office, I had a chance encounter that changed everything . . . a dark-haired Italian man walked into the clinic and our eyes locked . . . just kidding.

  What really happened is a representative stopped in to talk to me. When he initially approached me in between patients, I actually thought he worked for the hospital that owned our clinic, so I didn’t have my pharmaceutical rep guard up. This turned out to be a godsend for me and my patients because Mike worked for a company that offered allergy testing. I was intrigued immediately. You know when you hear something and you go, that is extremely important information. That’s how I felt when he started talking.

  He told me about a blood test on the market that would allow me to check my patients for food and environmental allergies right in the office. It was a simple blood test I could use in certain situations instead of having to refer patients to an allergist for skin-prick testing all the time. I devoured the information he gave me. I then made a follow-up call to the medical director of the company to clarify what I didn’t understand and got started.

  CASE STUDY

  JAVIER

  SYMPTOMS: STOMACHACHES AND CONSTIPATION

  The first patient I used the blood allergy test on was Javier, a nine-year-old boy. He was a patient of one of the other doctors in the office, but since my partner’s schedule was full, he was put on my schedule for a same-day sick visit. We new docs on the block typically have more room in our schedules to accommodate last-minute sick visits.

  When Javier and his mother first came to see me, he was having terrible stomach pains and was missing a lot of school. His chart was about two inches thick (yes, we still used paper charts in those days), and while my schedule didn’t permit me to read the whole thing before his visit, I spent two hours over the next two evenings going through his records.

  It was eye-opening. Javier had been on seven rounds of antibiotics in just two-and-a-half years. Four of those were for strep throat, one for pneumonia, and two for sinusitis. He had also been to the clinic twice for viral gastroenteritis (diarrhea). He was now having stomachaches and was constipated on top of all of these recurrent illnesses.

  I didn’t understand why one child would be getting sick so often. The only thing I knew to do at that time was to start him on MiraLAX, a prescription laxative. I knew this was just a Band-Aid for the situation. My question became: how do I figure out what is causing not only the constipation but also his recurrent illnesses?

  So I dipped my toes into the world of allergies and nutrition with Javier. General pediatrics is filled with kids who have chronic runny noses, poorly controlled eczema, and asthma, and many of them need allergy testing. I was referring one or two patients a week to the allergist. The kids would go and get their testing done and the allergist would put them on three or four meds to control their symptoms—an antihistamine, a nasal steroid spray, topical steroids for the eczema, and a stronger inhaled steroid for the asthma. Families would come back to me and not be happy with having to take so many meds.

  I ordered the food and environmental allergy panels for Javier. The technical term for this bloodwork is a serum IgE panel. It looks at the same protein as skin prick tests, the test you get when you go see an allergist and they prick your back with a variety of allergens. The thought of saving patients a trip to the allergist, and a copay, and at the same time getting better continuity with the child regarding allergy treatment was very appealing.

  Of course, I will always need to refer to allergists; I do not even begin to pretend I understand allergies to the depth and breadth of a trained allergist. I see myself as the first line of defense for my patients and their families.

  Many things came up positive for allergies on Javier’s results. Most of the foods we tested were positive, as were the environmental allergens. These results both surprised and didn’t surprise me. The surprising part was that he did not have what we think of as classic environmental allergy type symptoms: runny nose, watery itchy eyes, and a cough. Instead, he had constipation, abdominal pain, and recurrent strep throat.

  What started to make sense is that what he was eating and being exposed to in his environment was triggering the inflammation that was contributing to a lot of his symptoms. It gave me hope that I could help him. This is when the idea of an overflowing cup of inflammation (which you’ve already heard me talk about a couple of times) came to me.

  JAVIER’S CUP OF INFLAMMATION

  The foods that tested positive were egg white, milk, codfish, soybean, corn, and peanuts.

  The environmental allergy testing results were all categorized as indoor allergens: cat, dog, cockroaches, dust mites (two different species), and mold (four different species). Molds can be found indoors and outdoors.

  I gave Javier an EpiPen for the peanut allergy and referred him to a pediatric allergist to help us navigate all of these allergies. In the meantime, I asked his mother to take him off all the foods he tested positive for. I had no idea at the time how difficult it would be for the family to radically change Javier’s diet. But Javier’s symptoms were so severe and chronic that his mother was willing to do it.

  Within a week, Javier’s symptoms began to improve. I couldn’t believe what I was seeing, but I also knew it was not a coincidence. His symptoms were directly related to the food he was eating. His abdominal pain resolved very quickly, and his bowel movements became easier and easier. Eventually he was having an easy daily bowel movement and we were able to wean him off t
he MiraLAX.

  A month later Javier came in for a follow-up visit. I couldn’t believe the change in him. His mother and I talked about the fact that some foods that are marketed as healthy were actually making him sick and that removing them from his diet could restore his health. The disco ball dropped once more. He continued to do great and didn’t need a single round of antibiotics that ensuing year.

  Disco ball - my AH moment!

  I remember his case so well, not only because it was the first time I had to fill out a school dietary form but also because he began to improve so quickly once he was off of those foods. All of a sudden, a family I was seeing almost monthly was not coming in as much. I was able to stay in touch with his case because of that school dietary form. (His mother had to be vigilant with the school so they would honor the changes in his diet that we were implementing, so I had to get very precise on the form, giving the cafeteria examples of what foods might contain dairy, for example.) When she saw the profound improvements in Javier’s health, she was highly motivated to maintain the right nutrition for him at home and at school.

  Javier’s case helped me correctly deduce two things. First, once his systemic inflammation was in the right balance, his immune system could function more efficiently. Second, by decreasing the processed food he had been eating, the oppressive hold sugar had on his immune system would be lifted and he was able to move out of the sick cycle.1

  MANY SHADES OF GRAY—FOOD ALLERGY TESTING

  The more aware I became about excess inflammation in the body and how it contributed to symptoms, the more I realized how often environmental allergies and foods were part of the underlying triggers in my patients. Excess inflammation seemed to be present in about 60 to 70 percent of the kids I was seeing on a daily basis.