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Healthy Eating, Healthy Tummies: How Nutrition Affects GI Health

Prakash Chandran: You're listening to Children's Health Checkup where we answer parent's most common questions about raising healthy and happy kids. Today our topic will be healthy eating healthy tummies. A pediatric GI doctor explains nutrition and lifestyle choices that can improve your child's gut health. Joining us is our expert, Dr. Kendall Brown, a pediatric gastroenterologist and the Medical Director of Pediatric Gastroenterology at Children's Medical Center Plano. We'll learn about gut health and how you can promote good gut health in your home. This is Children's Health Checkup, the podcast from Children's Health. I'm Prakash Chandran. So Dr. Brown, can you explain to parents what gut health is and how it affects their child's health?

Dr. Brown: Well, I guess we can start with the old cliché: we are what we eat. And, certainly, our diet impacts our child's growth, energy, their biological, as well as their social wellbeing. We all require calories for energy. We require nutrients and even micronutrients or vitamins for our essential biologic metabolism. A child's normal growth depends on adequate calories to meet those needs. And, more importantly, and I think that a subject that's often missed in this conversation is the social aspect of nutrition. Age-appropriate diet for the child's development, age-appropriate diet that the child can pay attention to and peer-related interaction and food skills. So a healthy diet is a very multifactorial subject that can encompass all of these subjects.

Host: Yeah, and as we move forward, I'm wondering if you can break down the difference between a healthy gut and a healthy diet and maybe they're the same, maybe they're different, but maybe start by explaining the differences between the two.

Dr. Brown: As far as gut health, again, the quality, the amount of what we eat, the environment and how we eat. These are all learned responses during growth and development that we will carry with us as our dietary habits as one gets older in age. It is, I think imperative, that the children and their family spend time together in the act of planning and the act of preparation and the act of consuming a meal, not only from a nutritional standpoint, but from a social and interactive standpoint. Meal planning and preparation is a family event that really all ages can participate in. And I think even early on you can allow your child to help in the process or in the preparation of a meal, in age-appropriate manners so that they grow up in the environment of food and how food is important for day-to-day activity. We will learn how to cook, we will learn how to eat, we will learn our habits from our parents. I mean, you talk to most young adults - where did you learn to cook? Well, most of them learned to cook from other family members or they have their mother's recipe or their grandmother's recipe. Although in this day and age with all the different media that we have, there is a plethora of availability of cooking shows and recipes and competitions where actually being a chef or doing culinary arts is kind of a hip media event now, almost a superstar status in some of these cultures.

Host: Yeah, absolutely. And I, you know, you touched on something that I want to comment on. Certainly while I was growing up, you know, eating at home and having that routine really conformed how I grew up and how I thought about eating, the quality of food, how going to fast food just didn't quite taste like the food that I had at home. So what I'm hearing you say is that instilling that in an early age is important for a child and what their mindset is around food and how they evolve with food moving forward in life. Wouldn't you say?

Dr. Brown: Absolutely. Touching on the subject of fast food, understand. I mean, there's certainly a place for that. I mean, there's a place socially for it, even in our own household. Sure. We eat out once or twice a week, usually on a weekend to take a break from the daily meal preparation that we have at the house. We don't have really a set routine on cuisine. I mean we use different protein choices and different recipes and some is cooked in, some is grilled out. It's really the variety that makes it fun. As far as the experience, I think everything in moderation is certainly acceptable. I don't think that we need to be afraid of food. We don't need to be demonizing prepared food or fast foods, but we want to use it in context and moderation so that we have a good balance in our diet and a balance of choices. Understand your fast foods just by the nature of the process, many of those foods are fried and the temperature is going to break down many of the nutrients. You're going to have a higher fat content. The freshness in many items is going to be variable, or in some instances, highly suspect and the portion sizes are, and many times over the calorie amount that the individual may need, especially in children. And so, in many instances, it may promote overeating because just the size of the bag of fries, they're going to go all the way to the bottom of the carton. Where their appetite may have been telling them, hey, I'm full and we're good with only half the amount that was given to us for our meal that we just purchased.

Host: Right, right. And you know, I think one of the things that you mentioned there is everything in moderation. So even though, you know, fast food may be something that you can have for one night or a certain circumstance where you're on the road and you need something quick, it's not something that you want all the time for the reasons that you just mentioned. So I want to talk a little bit more about things that families should completely avoid eating that could negatively impact gut health.

Dr. Brown: I think a stable diet of high processed foods is certainly to be avoided. The NIH, CDC as well as the American Academy is very clear to avoid fructose flavored beverages. That is the common sweetener used in many of your sport drinks. Many of your over the counter fruit drinks, many of your carbonated beverages. The fructose is a hard sugar for the body to metabolize. It's a hard sugar for the body to regulate as far as insulin regulation, and it somewhat circumvents the normal calorie intake switch to appetite, to where it's really easy and habit forming to go from a 12 ounce beverage to a 16 ounce beverage to a 32 ounce beverage of nothing but a simple carbohydrate. Which can somewhat circumvent and forge the normal sugar insulin access and certainly high fructose beverages have a high incidence in correlation with Type 2 diabetes in children in this country.

Host: Yeah, absolutely. And this is something that I remember when I was growing up as a kid of the 80’s. I basically lived my life on those high fructose juice boxes. You know, I think that it was like one of the cool things to do and it's so funny, my parents and I were just talking about that this weekend just around how they wished they didn't give that to me. But at the time that's what was recommended and so now we're learning for, you know, because of all the reasons that you mentioned that's not necessarily good. So, you know, more water and again if you're going to have those high fructose drinks, certainly in moderation, right?

Dr. Brown: Well I think using them as a treat rather than your primary source of hydration is certainly to be desired. I think that the convenience of prepackaged beverages certainly is alluring for many people. The packaging, the presentation of many of the products available to the consumer are very cleverly done. I mean the food industry and the ad industry; they are very good at their craft in order to present food in a social context or an immediate gratification reward context that would encourage more consumption. Your cereal boxes with cartoon characters or the marketing techniques that are used with some of your fast food restaurants via cartoon figures or larger-than-life figures that somewhat detach the act of eating and the purpose of the eating and place it more in a media consumption environment that in some way distances the individual from eating. And I feel full and I'm done versus I'm just eating because I'm now participating.

Host: Absolutely. That makes sense. And, related to that, it seems like probiotics are something that you see advertised everywhere. But I feel like the general public doesn't really understand what probiotics are except that they might potentially be good for your health or your gut. So, what is your best advice when it comes to probiotics, especially in improving gut health in our children?

Dr. Brown: Well, I am very minimalist as far as intervention goes, meaning I think that less is more. I think if you are on a highly varied diet with lots of fresh fruits and vegetables and adequate amounts of fiber, adequate amounts of water, and if you are in a environment where you're not exposed to antibiotics on a frequent basis, nor do you have any type of chronic illness or chronic inflammatory process, you may not need a probiotic at all because nature is already providing that. There's been a lot of research in the human biome and the contribution of our probiotics for the innate immunity at the interface between our food and our gut and how our gut protects us from different toxins and viruses and bacteria in our environment. It's a very unclear science right now. There's been multiple studies looking at the benefits of probiotics in children in particular, and unfortunately, there's been no real clear consensus on the specific probiotic that does have the probiotic or the benefit, or more importantly, the cost benefit ratio. In the context of ordinarily healthy children, and we'll use that to frame our conversation today. So this is not in context with the patients with chronic illnesses or chronic medications or immunosuppression. There's actually been a few very nice meta analysis studies, and meta analysis means they take lots of these smaller studies that may not have the power of the numbers to make a definitive conclusion and they group them all together and try to make all the criteria look the same for all of these so that you get a bigger number of patients to make a conclusion. And there's been some very nice meta analysis over the past year or two looking specifically at the benefit of probiotics in pediatric patients. And, two probiotics in particular, there's one called lactobacillus GG and another one called Saccharomyces boulardii. And these seem to have the most impact in patients either in the context of response to an infectious diarrhea, or protection from respiratory illnesses in a daycare setting or protecting or insulating someone from the ill effects of treatment with antibiotics. In particular, antibiotic-associated diarrhea or a bacterial overgrowth resulting in a type of colitis called pseudomembranous colitis. In that context, in those patients, the utilization of those probiotics may be beneficial, especially younger children in a daycare setting in the winter time, you may be beneficial. Define beneficial, well, an infectious diarrhea, we may be talking in reality that their diarrhea may get better several hours sooner, maybe a day sooner. It may not be protective, but it seems to warrant or dampen the effect of the primary illness.

Host: You know, just as we wrap up here, we've talked about the benefits of eating together as a family. We've talked about things in moderation. I'm curious as to if you have any final tips that families can employ just to encourage better gut health at home.

Dr. Brown: Well, I think the important part is make it fun. I think if you make it fun, children are inquisitive, they love to explore, they love to try new things, they like to be considered a part of the family. Make it inclusive and make it fun. You know, many times I'll just say start simple. If cooking is not a big part of your family's routine, just start by making pizza at home. All children love pizza. You can do store bought pizza and just bring it home and bake it. You can do it by component where you buy a premade crust and then you add your sauce and you add your toppings and even a young child can pick their different toppings and they can do their designs and they could do all these fun things that just make it very interesting to them and then you can build from there. The lovely part about this is you can get a much healthier alternative to a delivered pizza. It's infinitely less expensive and the house smells wonderful because you cooked it in your own house and that even enhances the eating experience because you have the aroma, you have the experience, and as that child gets older, these are the things that they will remember with their mother and their father and their siblings. Hey, we did this. We did that. I'm going to do that for my kids because it meant that much to me when I was growing up. And that's how we change our current fast food culture. Just one step at a time and one event at a time and it makes all the difference in the world.

Host: Absolutely. I couldn't agree with you more. And I do think that it's something that is a dying art. You know, with all of these apps where you can order food and it's just so convenient, you forget the importance of that family meal and everything that that encourages and instills, including good gut health. So thank you so much, Dr. Brown, I really appreciate your time today. That's Dr. Kendall Brown, a pediatric gastroenterologist and the Medical Director of Pediatric Gastroenterology at Children's Medical Center Plano. Thanks for listening to Children's Health Checkup, head to childrens.com/GI for more information. If you found this podcast helpful, please rate and review or share the episode and please follow Children's Health on your social channels. Thanks and we'll talk next time.