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 and certified diabetes educator Tami Ross offers offers practical tips for a stress-free dining out experience if your child has Type 1 diabetes.

Question: My child has Type 1 diabetes. What should I be careful about when eating out in a restaurant? What questions should I ask?

Eating out is an enjoyable part of life for kids of all ages! Eating out with a child that has type 1 diabetes need not be a far different experience than eating out with any other child. Carbohydrate consciousness is top of mind when it comes to blood sugar (blood glucose) control. Most families quickly learn what foods and beverages contain carbohydrate and how much, how carbohydrate affects blood sugar, and how to dose insulin accordingly to keep blood sugars in target. With a little forethought, eating out can be as nutritious as it is tasty, and maintain blood sugar control too!.

Here are my favorite four tips to help make eating out a winning experience for everyone in the family:

Do some research: Check out nutrition information for favorite restaurants and identify healthy options in advance that fit your child’s carbohydrate and nutrition needs. You can find this information online for many restaurants.

Think ahead and time your dining: To avoid waiting for table with a hungry child, make a reservation if possible, or try to avoid times when the restaurant is busiest. Time insulin injections accordingly and have an appropriate snack with you in case blood sugar levels drop while waiting for the food to arrive.

Keep it simple: Choose foods in their simplest forms more often, such as grilled chicken sandwich, rather than chicken nuggets.

Stick with kid size portions: Kids meals are kid-sized and a more favorable portion-controlled option than “value” meals, which mean more calories, carbohydrate, fat, and salt

The following questions may be helpful to ask when ordering at restaurants and fast food favorites. You may have others to add to the list taking into account your child’s specific preferences, allergies, etc.

1. What grilled meat options do you have?  (grilled is lower in fat)
2. Can the sauces/dressings be served on the side?  (so that you can see the actual portion size, and assess how much your child consumes to count carbohydrates accordingly)
3. If your child isn’t a fan of salad, ask: Can we substitute a favorite raw veggie my child likes (such carrot sticks or cherry tomatoes) with small amount of dressing for dipping, or substitute a fruit cup?
4. Is it possible to order thin crust pizza? (fewer carbohydrates than original or thick crust)
5. Can we request fruit instead of fries as a side with the fast food meal? (lower in fat; generally lower in carbohydrate; more nutrients and fiber)
6. May we have low fat milk or water as a beverage (lower carbohydrate; healthier)
7. Are bite size desserts an option (to satisfy the sweet tooth, but control portions)?
8. May we have a to-go box? (to take home extras for later rather than encouraging over-eating to “clean the plate”)

These are all general tips -  I recommend consulting with your child’s diabetes care team about what is best for your child.

Food for Thought…

• Identify 3 meals at your child’s favorite fast-food restaurant that fit their carbohydrate and nutrition needs.
• Check blood glucose 1 ½-2 hours after eating out and see if you’re child is in his/her target range. If not, rethink food choices, portion sizes, carbohydrate estimations, and insulin dosing…maybe they were off a bit? Make note, think about what you’ll do differently next time, and discuss with the diabetes care team.
• Consider cooking up some fun food fast in your own kitchen with kid-friendly recipes like Under the Sea Submarine and Ranch Style Nachos, both which can be found in my book Cooking Up Fun for Kids with Diabetes . A delicious and fun meal is less than 15 minutes away!

For more questions and answers on diabetes please join Tami and the International Food Information Council Foundation for a special diabetes chat on twitter Thursday, April 15 at 1:00 ET, #foodinsight.   A transcript of the chat will also be available afterward at the IFIC website.

©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, Dr. Douglas Husbands provides an update on nutritional supplements with practical application for the health of your children.

Question: What is the latest development in nutritional supplements for children?

Answer:

Hello everyone!  I’m delighted for my second opportunity to guest post here.  Since I just recently came back from the 2009 International and American Associations of Clinical Nutritionists Scientific Symposium, I’d like to share some information on nutrition supplements with practical application for the health of your children.

Vitamin D3

• Adequate to optimal levels of serum vitamin D levels in infants and children (between 30 to 60 ng/ml) are associated with decreased asthma and allergies, better brain development and healthy bone development.
• When visiting your pediatrician or Functional Medicine doctor, serum 25-hydroxyvitamin D levels should be measured.
• It is estimated that between 50,000 to 70,000 deaths per year from various causes could be prevented by having adequate blood vitamin D levels.
• Many infants and children could benefit from supplementing with 1000 to 2000 IU of vitamin D daily, particularly during the winter months, if they cannot tolerate fatty fish, if they are darker skinned, or if their serum vitamin D levels are below 30 ng/ml.

Probiotics

• Probiotics help decrease abnormal intestinal permeability, or “leaky gut”.
• The appendix’s function is now known.  It is a repository for beneficial bacteria (probiotics) for the GI tract.  Supplemental probiotics help replenish the repository after antibiotic use or from use of corticosteroid creams or inhalers.
• Abnormal intestinal permeability allows gut-derived antigen exposure to the bloodstream; thereby distant, seemingly unassociated autoimmune symptoms can arise from a “leaky gut”.
• Due to immature GI tract development, it is best that infants are breastfed for at least his/her first 12 months.
• Many pregnant women and breastfeeding mothers would do well to supplement with the probiotic strain Lactobacillus GG (aka Lactobacillus rhamnosus) at a dose of 4 billion/day and Vitamin D3 at a dose of 4000 IU/day for potentially decreasing likelihood of asthma, eczema, allergies, type 1 diabetes, and autoimmune disorders in their babies.

Curcumin

• Curcumin, a component of turmeric, has powerful anti-inflammatory properties to inhibit inflammatory mediators, exhibiting therapeutic potential in asthma (and other inflammatory disorders)

©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.

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