Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

I did not know about reactive hypoglycemia until recently when a Mom asked me this question on our Facebook page. This week, Registered Dietitian Karman Meyer explains what it is and what you can do to manage the blood sugar levels to avoid potentially life threatening symptoms.

Karman Meyer, RD LDN Education: Dietetic Internship completed at Vanderbilt Medical Center, B.S. in Dietetics from Miami University Certifications: Registered Dietitian, Licensed Dietitian/Nutritionist in Tennessee Experience: Clinical Dietitian, Diabetes Educator, Nutrition Writer Twitter: @food_delights Website: Nutrition Adventures LinkedIn Profile Contact via email: karman.meyer@yahoo.com

Question: I have a profoundly gifted, almost 3 year old, son with reactive hypoglycemia. Would love to know more about keeping his blood sugar level.

Answer:

Reactive hypoglycemia, also known as postprandial or alimentary hypoglycemia, is a rare condition that causes an individuals’ blood sugar, or blood glucose, to drop below 70 mg/dL typically within 4 hours after eating a meal. A significant drop in the blood sugar level after eating is caused by an excess production of insulin for digestion of carbohydrate-rich foods. Symptoms of reactive hypoglycemia are similar to diabetes-related hypoglycemia, which include light-headedness, sweating, confusing, hunger, and weakness. The cause of reactive hypoglycemia is still uncertain, but individuals who have had gastric surgery may develop this disorder.

Because a low blood sugar level can be potentially dangerous if not treated right away, it is best to prevent it from occurring. To help avoid hypoglycemia, individuals with reactive hypoglycemia should try the following:

• Eat small meals or snacks every 3 hours
• Make sure meals and snacks contain foods from a several food groups (protein, dairy, fruits, vegetables, and grains)
• Limit foods that are high in simple sugars (soda, candy, cakes, pastries), especially if eating on an empty stomach
• Choose foods high in soluble fiber (oatmeal, citrus fruits, carrots, and beans)

Be prepared and pack a carbohydrate-containing snack when the next meal is several hours away to prevent drops in blood sugar.  If hypoglycemia does set in, be sure to take action and treat the low blood sugar immediately. Glucose tablets are effective for quickly raising blood sugar levels and should be carried at all times in case food is unavailable.

Living with reactive hypoglycemia can be very manageable. The most important point to remember is that people with reactive hypoglycemia need to eat a variety of foods at meals and snacks, and should eat at least every 3 hours. By planning balanced and appropriate meals and snacks ahead of time, low blood sugars can be prevented.

©2010 Littlestomaks.com. All Rights Reserved

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Registered Dietitian Janice Baker suggests you provide a healthy, balanced nutrition and encourage physical activity to manage your child’s diabetes risk.

Question: What foods can I be feeding my child (as opposed to not feeding her) to help her avoid becoming diabetic since there is a family history?

Answer:

The most important nutrition habits for children, as well as adults, to minimize the risk of obesity and type 2 diabetes include regular balanced meals including whole grains, lean protein sources, lowfat dairy products, fruits and vegetables. Portion sizes  and food types may vary according to your child’s age, appetite and activity level.  Limit juices to 4 ounces per day, avoid soft drinks and sugary drinks, and minimize fast food.  Encourage water as a beverage.  Have meals together as a family as much as possible so that role modeling healthful eating behaviors and choices take place.  And definitely avoid one of those most detrimental habits that can increase a child’s risk of obesity and diabetes- eating in front of the television set! Have your child sit down at a specific area meant for eating for most, if not all, meals and snacks.

Along with this, limit any “screen time” and encourage active play and movement throughout the day.  Kid’s body’s are meant to move!

©2009 Littlestomaks.com. All Rights Reserved

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

It is great to see orange everywhere in the neighborhood these days! Some people have already put up their Halloween decorations. We don’t get to enjoy the Fall colors as much in Florida. So these decorations – along with the cool evening air – remind us of the changing season. It is great to be outdoors these days!

It seemed like a busy week for nutrition related news. Probably because I discovered a great website which aggregates news from different sources and organizes them in different categories. It is called Alltop and it is created by none other than the Marketing Guru Guy Kawasaki. I was delighted to see my blog listed on Alltop’s Top Nutrition News page. Check it out!

Here are the 5 nutrition related news that caught my eye this week. Enjoy and drop me a comment to share your thoughts.

Watch out, eating hamburgers can paralyze you

I was shocked beyond belief to read the unfortunate story of 22 years old Stephanie Smith, who got really sick after eating a hamburger contaminated with E. coli. She was so sick that doctors had to put her in a coma for nine weeks, after which she could no longer walk because she was paralyzed from the waist down. A very heavy price to pay for a cheap hamburger all of us assume safe for eating without much thought.

Turns out there are serious gaps in the food inspection system which is supposed to test packaged meat for E. coli contamination. Ground beef is produced by processors from beef trimmings and other parts which they buy from many different suppliers. Not all of these incoming supplies are tested for contamination before grinding. The result is that  contaminated cow parts can sometime enter the ground beef supply undetected. Does not happen very frequently, but it does happen often enough to make the news. 8000 people have become sick from 16 E. coli outbreaks in the last 3 years.

No matter how many regulations and inspections are put in place, there is no way to be 100% safe because of the way meat is processed in modern plants. My advice – cut down on beef in the first place – it has been shown to increase the risk of various types of cancer. And if you do want to enjoy a burger, make sure you follow the safe handling procedures and cook it thoroughly so that the inside of the hamburger reaches 165 °F.

Food insecurity increases the risk of childhood obesity

Sounds paradoxical, doesn’t it? Food insecurity is defined as lack of access to food, or nutritionally adequate food. So it is surprising that new research from the American Dietetic Association concludes that there is a link between food insecurity and childhood obesity. In particular, girls from households facing food insecurity are more likely to be overweight or obese. Girls 2-5 years old from household with food insecurity were 47% more likely to be overweight compared to those from food secure households. Boys of the same age did not show this correlation.

What could be the cause of this? Researchers are not sure yet, but suggests that food insecurity creates stress which affects behavior including food choices. Add to that the availability of cheap, energy dense, nutrient-poor foods and binge eating and you can see why this could happen.

I believe that hunger and obesity are two sides of the same coin. In poor countries, food insecurity is real and energy-dense foods are not affordable. There you see severe malnutrition and low weights. In developed countries, food insecurity causes malnutrition on the other end – that is energy dense foods leading to overweight and obesity. The common factors are distribution, quality and cost of food. This is where organizations like Share Our Strength are so critical. I have supported them by writing blog posts and will continue to do so in future.

Soy isoflavones reduce risk of diabetes and heart disease

I was quite excited to read about new research from UMass (my alma mater!) which attempts to explain how isoflavones from soy rich foods work with fat cells to regulate glucose uptake and increased insulin sensitivity. This mechanism is similar to how anti-diabetic drugs work in the body. This is a very important discovery because soy rich foods have been known to lower diabetes risk, increase insulin sensitivity and reduce cardiovascular disease risk, but the cellular mechanism was not well understood.

Isoflavones are plant-based antioxidants found almost exclusively in beans such as soybeans. They are also known as polyphenols because of their chemical structure. Many of these isoflavones act as dietary estrogens. Some studies have shown a reduced risk of breast cancer especially if the soy-rich diet is given in early childhood.

Although much research still remains to be done, particularly in humans, these results are quite promising.

Michael Pollan considers rules to eat by

What are your rules of thumb that affect your food choices? Do you follow the advice of your Mom or Grandma, or do you make these choices by nutritional labels, diet trends or advertisements? Michael Pollan, the highly acclaimed author of The Omnivores Dilemma is compiling genuinely useful, nutritionally sound examples of popular wisdom about eating via the Well blog on the New York Times. He is writing  a book Food Rules: An Eater’s Manual based on these responses due to be published in January.

Pollan is known for his skepticism about modern nutrition science and food marketing claims. At the core, he believes that how we eat has been, and should be, influenced by culture based on our collective wisdom accumulated over generations. In short, have more faith in what your Mama told you and skip the advice based on nutrition science.

I have a little bit of a problem with this. What is culture? How do we know that the wisdom of culture is still relevant today? I agree, that culture strongly drives our behavior, but culture is constantly changing. More so than ever now because we live in the age of the Internet. I say, listen to your Mama, but also learn the science so you can make your own decisions. If you leave the decision making to others, even if they are scientists, you are really giving up responsibility for your own health. Science and culture are not mutually exclusive; use the power of information to make your own decisions. I would love to hear Michael’s thoughts on this.

What do you think? What are your favorite rules?

Preservative-free doesn’t make salty processed foods any healthier

Annie of PhD In Parenting wrote a very nice post this week about how Nestle responded to her question on high sodium content in Stouffer’s frozen foods. This was precipitated by Nestle’s claim on Twitter that Stouffer’s meals contained no preservatives.

The No Preservative claim on processed foods is getting quite common these days because customers are getting more sensitive to chemical additives in foods. What they don’t realize is that just because a certain processed food claims to contain no preservatives, it doesn’t mean that it is healthy for them. Most of them still contain loads of salt, fat and sugar.

Nestle’s response to Annie’s question based on their expert opinion is quite ridiculous! They want you to control your toddler’s salt intake by managing the portion size – that is don’t give the adult size serving to your toddler! As if your child is a robot that you can dial in a serving size to manage their salt intake. The right thing to do is to reduce the sodium content in the food.

Instead of hiding behind the numbers in their so called “expert” response, I would have liked to see them take ownership of the sodium problem and announce specific goals to reduce them to a certain level in their products ahead of regulations. That would have shown true leadership and concern for the consumer.

What do you think?

Photo source -Barbara L. Hanson on Flickr via everystockphoto
©2009 Littlestomaks.com

Hello everyone! It has taken us a while to get back to normal (whatever that means!) after our week-long Disney vacation. Hope you all have been doing good. Here is this week’s 5 for Fridays where I am once again focusing on the idea of a soda tax. Feel free to share your opinion in comments below.

Calls for soda tax are getting louder

Looks like the pundits have spoken again, this time in a louder, high pitched, unified voice! In a recent health policy report titled The Public Health and Economic Benefits of Taxing Sugar-Sweetened Beverages published in the prestigious New England Journal of Medicine, several “experts” have proposed that a 1 cent tax be imposed for every oz. of a sugar-sweetened soda. They estimate that such a tax will generate about $15 billion in the first year in addition to the state-level revenues. They have even setup an online tax calculator for different states and major cities! They propose that these extra dollars can be used for childhood nutrition programs, obesity prevention programs or healthcare for the uninsured.

Now I am sure that such talk is music to the ears of many people, especially those in the government trying to figure out how to pay for the healthcare reform. It might be appealing to those at the state and local levels also as their budgets are under severe stress. It is not a surprise that this idea has attracted the attention of most of the prominent mass media in recent weeks. Watch out, they are trying to build a mass hysteria!

I think this is a very misguided proposition. I have written about it in a recent post explaining why I don’t believe in a twinkie tax or a soda tax. And just to be clear, my arguments have nothing to do with the politics of the situation, rather they are based on an understanding of how business works.

For this week’s 5 for Fridays, I thought of compiling a summary of various viewpoints I have read on the web lately in response to this idea. Check them out and let me know what you think!

1. An interesting commentary in the New York Times explains why sodas are a tempting tax target. It is quite clear that there is a link between caloric imbalance and obesity. It is also known that soda consumption has skyrocketed over the last few decades. Put the two together and it is easy to see why the sugar-laden soda with its empty calories is the prime suspect for our obesity problem. Let us tax it to reduce its consumption; after all it has worked for tobacco. It is not a basic need anyway and even Adam Smith justified taxing such unnecessary which have become objects of almost universal consumption!

What I did like about this article is that it tries to address the bigger problem and talks about a broader Pigovian approach to get rid of the subsidies for corn syrup. Much more difficult to accomplish politically I am sure.

2. Another commentary on Forbes.com shows a serious skepticism about the effect of a soda tax on obesity and makes its case using numbers. Data suggests that even a 58% tax on soda, which is equivalent to the combined federal and state taxes on cigarettes, could at most lead to a mean BMI reduction of 0.16 points. Moderate decrease in consumption is expected in response to taxes, however there is a belief that people will simply switch to the diet option or other drinks. The return on these tax dollars in other words is not expected to be significant.

Let us leave the numbers aside for a minute – people can argue over them endlessly in my opinion. But I agree that the soda tax does not change the demand in any fundamental way.

3. In an excellent review Dr Ayala digs deeper into why these health experts favor taxing sugary drinks and offers her opinions on why such a tax should be supported. What I liked the most about her review is that she actually takes the time to explain why excessive consumption of sugary drinks leads to obesity and serious health problems.

Dr. Ayala is a pediatrician and an outspoken supporter of obesity prevention, healthy lifestyle and good nutrition choices. I respect her a lot, but on this matter we have a difference of opinion. I am personally no fan of soda anymore, but that is by choice not because of price. I do agree with her that a public debate on the ills of sugary drinks regardless of whether a tax is imposed on them or not will be good for everybody.

4. The Health Blog on the Wall Street Journal presents an interesting calculation to show that even when the penny an ounce tax is imposed on the soda and it is completely passed on to the customer, it will still be cheaper to buy soda than orange juice. The main idea is to show that the tax will have to be much higher in order to bring the price of soda in line with other so-called healthy options.

One observant reader left a comment that the box of orange juice also shows a lot of sugar per serving, so probably not a good example. Great point, and I agree because there is a lot of added sugar in these ready-to-serve orange juices. The underlying point however is that consumers should really read the labels and decide for themselves if they should be buying a particular food item or not. When consumers make healthy choices they are truly empowered and demand will change in a fundamental way.

5. Fooducate blog, which I read regularly, suggests we consider a calorie offset instead of the soda tax. Here is how it will work – for every ton of added sweetener, a company would contribute $3000 to a government program aimed at obesity reduction. This is equivalent to the penny an ounce tax on the finished product.

Interesting idea because it directly affects the cost of production rather than price of the product. It also encourages the manufacturer to reduce the sugar content or switch to healthier products. I also suggested several other ideas that can affect the cost of production in my post on twinkie tax.

This is a good debate. However we should focus on the big picture and not try to put a band-aid on it by using taxes. I think the experts have their heart in the right place because they are worried about our health problems and lack of effective policy. But they need to get more creative and offer something better than a soda tax!

Enjoy your weekend!

Photo source -macrophile on Flickr via everystockphoto
©2009 Littlestomaks.com

It should not come as a surprise to anyone that we are addicted to sugar! What might surprise you though is just how much added sugar we Americans consume every day. A whopping 22 teaspoons according to the news I covered in last week’s Five for Fridays. That comes to about 355 calories or nearly 20% of the recommended 2000 daily calories. Most of this added sugar comes from regular soft drinks, soda, candy and desserts such as cakes, cookies and pies. Consuming this much added sugar is really not necessary because it does not provide any added nutritional value, just empty calories.

It is true that there is no clear link between added sugar, weight gain and obesity. But common sense tells us that if we consume more calories than we can spend by physical activity and exercise, those extra calories will add up. Excessive sugar can also result in insulin resistance leading to Type 2 diabetes. In short, too much sugar is not good in the long run no matter how you look at it.

I think that it is important to tame your child’s sweet tooth by keeping a close eye on it early on. All children love sweet treats, some more than others. At times you may be tempted to give in and just accept that your child might be hardwired for a sweet tooth. But that is no reason for a child to be introduced to soda at a young age. In my opinion, that can count for child abuse! I can live with children enjoying desserts and candy in moderation, but when it comes to soda, I have to draw the line!

I have written about how to manage daily sugar for your child in the past. Recently I posed this question to some of my Twitter followers for their tips. Here is some of what I heard back.

@notdiyheather tweeted about how she does not keep sugar drinks and snacks at home:

She also tries to teach her child that sugary treats are for special occasions and prefers water over juice:

Dr. Taffy Wagner @moneyinmarriage, a mom of twins, has a little more strict approach to managing sugar:

@TheMommyChef suggested that you make your own homemade sweet treats with natural sugars and reduce the amount:

@mamahall offered an interesting formula to control how much candy the children get:

She also suggested to dilute sugary drinks with water when giving them to children on special occasions:

Registered Dietitian @MiltonStokes cautioned against too much control:

Bottom line: it is important to put some boundaries but not too many. I should add that there should not be a different set of rule for adults. As a parent, you have to be a role model and practice what you preach. We don’t drink soda in our household or while eating out – period.

What are your rules and tips for managing sugar for your child? Please leave a comment, I would love to hear from you!

Photo source – GlamourFood by suiker on Flickr via everystockphoto
©2009 Littlestomaks.com

There is a certain perception, especially outside the US, that Americans are fat and lazy. Even our own media bombards us with stories of poor eating habits (think cheeseburgers and fries) and inactive lifestyle (think couch potatoes). Then there are alarming statistics on rising rates of obesity, diabetes and heart disease. And you really begin to pay attention, and raise the volume on the TV, if the story is focused on weight problems in children. After all, who would want their children to grow up in poor health?

But is it really that bad? Is it simply an American issue?

Check this out..

This came from a report issued by the WHO Regional Office for Europe following a November 2006 Ministerial Conference held in Istanbul, Turkey.

What’s wrong with this picture? Our media shows us images of slim, healthy-looking Europeans biking to work, eating healthy-looking food and living a stress-free life. On the other hand, the Americans are shown eating junk food, driving to work in gas-guzzling SUV’s and living a hectic stressed-out life. And all this is supported by “facts” and “numbers” with fancy charts and interviews with “experts”.

Now, let us not stop there…here is another interesting fact:

I don’t have anything against the Europeans or the Aussies. In fact, I have many good (and very healthy) friends from both of these continents. And before you get the urge to say that “you got your head in the sand“, let me say that we do need to pay attention to the numbers and make smart nutrition choices for ourselves and our children. After all, that is why I am writing this blog!

As a parent, it is natural to be concerned. Concern leads to caring; caring leads to action; and action leads to results. All I am trying to say is that it is not useful to be alarmed by the so called news in the mainstream media. In this age of short attention spans and low ratings, the media needs a big horn to get the message across. It is up to us to filter the noise, take a deep breath, and look at the data in a calm manner so we can make our own decisions.

It is my intention to help you do exactly that through this blog. Let me know how I am doing.

The theme for this year’s World Diabetes Day was Diabetes in Children and Adolescents. That is exactly what caught my attention.

The World Diabetes Day recognizes the global scale of the diabetes epidemic. Organized each year on November 14 by the International Diabetes Federation (IDF) and the World Health Organization, this day is also the official United Nations World Health Day. One of the cool things about this campaign is that hundreds of well-known monuments all across the world are lit in blue on this day, which is also the color of the World Diabetes Day logo. The pictures of the more than 1000 monuments that were lit this year are simply breathtaking. I am posting a few of my favorites; for the complete list, go to World Diabetes Day gallery.

Here are few facts I did not know:

1. November 14 is the birthday of Frederick Banting, a Canadian medical scientist, who discovered insulin in 1921. He won the Nobel Prize for Medicine in 1923 for his achievement.
2. It is well-known that more than 250 million people worldwide suffer from diabetes. What is less known is the fact that the type 1 diabetes is rapidly increasing in pre-school children at 5% annually. Unfortunately, it is not well-understood and there is no way to prevent it.
3. Type 2 diabetes is now reported in children as young as 8 years old. According to the IDF:“Global studies have shown that type 2 diabetes can be prevented by enabling individuals to lose 7-10% of their body weight, and by increasing their physical activity to a modest level“. Think about this for a moment – this disease is totally preventable! It is all about nutrition and lifestyle.

There are other scary statistics, but I don’t want to go into that. You can get a lot of information from CDC’s website. For now, I just want to enjoy these beautiful pictures! You can also find them on Flickr.

Niagara-Falls - by Screechydialup	Roman Temple, Evora, Portugal - by international diabetes federation	PB111166 London Eye - by mike.felton
Four Freedoms Monument Evansville IN USA - by international diabetes federation	Great Buddah of Kotokuin Kanagawa Japan - by international diabetes federation	European Parlement Strasbourg - by patrick_wdd_france
Sydney Opera House - by international diabetes federation	Bosphorus Bridge Istanbul - by international diabetes federation	PB091135 Shell WDD 14 Nov - by mike.felton

Basmati rice has a regular place on our dinner table, and I am glad that our twins have already developed a taste for it. They like to nibble on the long, flaky, bright white grains of Basmati rice. Sometimes, we mix it with yogurt or lentil soup for them. The only problem is that they make a terrible mess out of it, and we end up having to pick it up – grain by grain – from the floor under their booster seats. Oh well, that’s what you get when you try to feed the two-and-a-half-year olds!

But seriously, it is also good for you

Taste and fragrance aside, the main reason why we like Basmati rice is because of its medium glycemic index (GI). Basmati rice is a good source of carbohydrates, and according to the Canadian Diabetes Association , it has a medium glycemic index. Glucose, by definition, has a GI of 100. Foods with low GI are less than 55, medium GI are 56 – 69, and high GI are 70 – 100. High GI foods, such as white bread, baked potato, corn flakes, cereals, watermelon and jasmine rice, increase the blood glucose levels very quickly right after they are eaten. This results in a rapid release of insulin from the pancreas. Low GI foods, such as whole grain bread, vegetables, fruits (except watermelon), pasta, fish and eggs, do not increase the blood glucose levels that quickly; so the insulin levels are also low after eating. Uneven production of insulin over time can lead to insulin resistance and Type II diabetes. It has been shown that following a low GI diet over a long period of time can result in reducing the risk of developing Type II diabetes and heart disease.

Where to buy Basmati rice

Basmati rice is available in Costco and Sam’s Club in 20 lb bags. We buy a brand called Royal Basmati Rice , which at Costco costs about $25 per bag. Many other brands of Basmati rice are available in both white and brown varieties. Bags of smaller sizes may also be available in supermarkets and local grocery stores. You can also check out several online distributors for more options.

How to cook Basmati rice

Cooking Basmati rice is very simple. Add 2 cups water to 1 cup Basmati rice in a 1 quart saucepan. Although, many recipes suggest washing the rice in water to remove its starches, we don’t follow that advice. It saves time! Add a little salt and 2 tbsp olive oil and mix well. Uncovered, bring to boil. Reduce heat to the lowest setting and cover tightly. We cover the saucepan with a paper towel before putting the lid on. This way, the steam escapes very slowly. In about 15 – 20 minutes, the rice will be ready. Do not stir. When cooked well, the grains do not stick to each other; they should remain separate and flaky. Typical serving size is about 50g (1/4 cup), which packs about 180 calories, 5 g fat, 41 g (14%) carbohydrate and 4g protein.

Ready to try it out?

Follow the method described above if you are cooking for your toddler. If you want to try a few different (and very delicious!) recipes for yourself, and if you have a taste for Indian spices, here are a few recipes you can check out (I have not tried them, but they look great):

1. Lime flavored rice with split peas - Lisa’s Kitchen
2. Lamb chops with organic saffron basmati rice – Organictobe.org
3. Navratna Pulao – Mom’s Recipes
4. Basmati rice with Cinnamon and Saffron by Madhur Jaffrey

If you want to read up on Glycemic Index, here is a great technical report.