The Powerful Effect Of Nutrition On Children’s Behavior

Episode Transcript

Dr. Nicole Beurkens:   
           
Hi everybody. Welcome to the show. I’m Dr. Nicole Beurkens, and today I’m really excited to have, as my guest, Judy Converse. Judy is a pediatric nutritionist, and she and I have been colleagues for many years. And I greatly admire the pioneering work that she has done in the realm of nutrition and child health and development and mental health, and she really is one of the people who first got me interested in looking at the connection between nutrition and physical health and the kinds of neurodevelopmental and mental health issues that I was seeing in my patients and in my own personal kid. So it’s really a delight for me to have her on the show today.

Judy is a licensed registered dietician nutritionist with graduate and undergraduate degrees in nutrition. She has a private practice called Nutrition Care for Children that she established in 1999. She has three published print books, and I will say I recommend those books very widely, so definitely check those out. Two e-books, numerous articles on nutrition support for children with conditions like autism, ADHD, allergies, FPIES, growth, feeding issues, behavior and conduct disorders, constipation, and more. Judy works with children of all ages in person or remotely to customize nutrition strategies so that they can learn, grow, and thrive, and she has expertise in a wide variety of specialized dietary interventions like GAPS, gluten free, casein free, ketogenic diets, and more. Judy, welcome to the show.

Judy Converse:   
Thank you, Nicole. Thank you.

Nicole:               
So I’d love for us to start out by just having you share a little bit about how you got into doing the kind of work that you’re doing with kids and with families.

Judy:         
Sure. Well, kind of it happened to me, basically. You know, I was a mom, became a mom, and had a circumstance with my son that was just really, really stressful, frightening, and we were not helped. We were talking to top people in the country and our major medical center, and it started right from the get-go at near birth. There were lots of feeding issues.              
 
He had a condition which wasn’t, at that time, recognized. It’s called FPIES, which is Food Protein Induced Enterocolitis Syndrome, and at the time, that was not even a diagnosis, and we were simply told that either it wasn’t happening or I was too nervous. We had no help, and that’s really what turned me around. I was already a dietician. I’d already done work in different settings. I had never planned to work exclusively with kids, but at that time, I was thinking, “Oh wow. This can’t be true that I’m the only mom seeing this happen and this is the only baby.”

So he’s almost 22 now, so that was a long time ago.

Nicole:
Yeah.

Judy:             
But there wasn’t really an internet or anything like that, so it was really just digging back into my training, which was very deep in maternal and child health, infant health, and charting a course for him. And from there, that’s where this really grew. It’s kind of an organic process.

Nicole:
Yeah, and it’s awesome in finding solutions for him and for your family, you then were able to extend that to helping so many other people, and unfortunately, I know that you’ve seen, as well as I’ve seen, over the last 20 years, the number of kids with these kinds of issues has just grown astronomically. So there are so many more families that need this kind of support.

So there’s a lot of different directions that we could take our conversation today ’cause there’s certainly so many things that you have great expertise about, but specifically, we want to focus on the connection between behavioral issues, conduct disorders, those kinds of things, and nutrition because these really are areas that people are not talking about and a lot of parents and professionals, for that matter, don’t understand the connection between nutrition and the kinds of behaviors and conduct related things that their kids are experiencing.

So, you know, kids on the autism spectrum, kids with ADHD, sensory processing issues, those types of kids all have a lot of different types of behavior challenges and often end up, just by default, on medication, right? I mean, parents go in, “My kid’s having these issues.” You’ve experienced this personally, as have I, like, “Oh, well here’s your prescription,” right? After a very brief office visit, “Well, here’s your prescription for Ritalin, for Stratera, for Prozac, for something even more powerful.”

So what I’d like to spend sometime talking is with these kinds of kids, what have you seen as far as nutrition support and what do you see as far as possibilities for these kids without medication? What role can nutrition support play in that?

Judy:                 
Right. Well, I’ve seen kids make complete turnarounds with nutrition support and I have to be super careful. A,s a nutritionist dietician I’m not allowed to say I treat anything because I’m not a doctor. I don’t. I don’t claim to treat anything. All I’m doing is providing nutrition support and the dilemma is those are generally overlooked in medicine and in pediatrics. Those aren’t engaged and it’s not because there isn’t an evidence base out there that supports it and it’s not because it’s too feeble modality, none of that is true. The issue really is it’s about the economics of delivering nutrition care. It’s time-consuming. There’s not patented procedures or products, or devices, or drugs. There’s no profit in it.

The other dilemma is that most physicians don’t receive training in this. So they aren’t going to be the ones to tell you anything about this and what I usually see is when I get an opportunity to work with a family I find multiple nutrition deficits for these kids and they can be growing fine, they can look okay on a growth chart, this may be completely under the radar, but unless you do some deeper looking and assessing of what’s actually reaching that child’s brain then you aren’t going to find a problem.

I do that. I investigate. I do each child as an individual case and I find a number of issues, and typically when those issues are supported or corrected, we have a different child and they are able to calm down, behave, focus, eat, poop. Do whatever. Gosh, there are so many possibilities to look at. You have to remember we, as far as nutrients that we know about in kind of a conservative context that we are quote essential, there are still dozens of them. Then there’s a whole world of other substances that are natural phytonutrients, and herbs and all kinds of things that have also a role in supporting these kids.

So it’s big  , and once you apply it really I’ve seen very miraculous things happen. Even after twenty years, there are times where I go, “Wow, really? Geez, that’s great. It really worked.” That’s the best part.

Nicole:                  
Yeah, and I appreciate what you said a moment ago about this idea that well maybe nutrition is not a strong enough intervention. You know you said we’ve got this huge toolbox and often people discount that, right and go, “Oh, well what can nutrition really do? My kids got these serious problems. My kid has these serious behaviors,” or kids even who have been hospitalized for mental health issues for behavior challenges. Those kinds of things.

I think often the idea that nutrition could be a pivotal part of addressing what’s going on for that child. I think that really gets overlooked and people just think, “Oh, maybe that’s something as an extra but that’s not a core part of what we are doing here,” and I know you believe as I do that this really is the core of what we are doing. So can you talk a little about that? This idea that nutrition really isn’t a strong enough thing to be worried about doing?

Judy:                  
Yeah, so it’s the other way around. You are absolutely right. Nutrition is the core, the strongest part. The only reason why your child is visible in front of you is because they ate food and turned it into their body. That’s what they are made of. That sounds quaint and all, but it’s true and yeah absolutely. It’s essential. Typically I will often hear parents come in and they say, “Well we thought we’d try the drug first.” Well, of course, it’s easy, and it’s a wonderful fairy tale. Maybe that’s unfair, but to think that you can just take one little pill and all these problems will go away and I know that there are people and there are kids for whom medications have really done some great things, and that’s great.

There are also many, many families for whom it’s not a great bargain and there are side effects, there are other problems, there’s an escalation. You know we end up on multiple drugs, but right. Fundamentally your child’s body is built to function and feel good, and thrive, and if that is not happening then there is a reason.

I will say, also in all my years I’ve very rarely if ever, encountered a case where parents will come in and say, “Well we are told it’s just behavior that my child is doing.” I usually find that children want to be happy. They want to be well. They want to be loved. They want to be accepted. They don’t want to do things just to make you miserable or to make themselves miserable, and although we know how manipulative children can be, I so often find there was an underlying physiological piece that was disrupting behavior that can be repaired, and suddenly, this intractable behavior fades away.

Nicole:     
Mm-hmm (affirmative).

Judy:       
Because we repaired what was driving it on the inside, physically, for the child.

Nicole:
Yeah, getting really to that root issue. To me, the behavioral things that we see on the outside are just symptoms of the bigger problem. They’re not the problem themselves, they’re just symptoms of the bigger problem, and we dig down to figure out what is the root level or are the root level issues here, and we address those. Then everything can shift, in terms of, those behaviors and the symptoms, so I’m sure as to have you talk a bit about some of the things that you often see in kids with these kinds of behavioral challenges, these types of symptoms, just to give people an idea ’cause I know there’s a lot of parents listening who really have not received any information about this to know, “Well gosh, what would I be looking for in the realm of nutrition?” Or, “What are some of the common things that can come up that fall in the realm of nutrition that can impact my child’s behavior?”

Judy:                  
Right. Well, first of all, I really want to emphasize it’s really important, in my opinion, not to do a lot of dabbling and tinkering as a parent. I do know that that is very frustrating. You really need a thorough professional assessment and kind of, “Okay, here’s the found problems nutritionally. Here’s the order in which we can address them.”

You can’t fix them all at once, usually, so parents will typically try, “Oh, I tried fish oil. Oh, I tried gluten-free,” and usually they’re doing it wrong. They did the wrong dose, the wrong product, so all kinds of things went wrong. Don’t waste your time. Please don’t. Get professional help with this ’cause it’s complicated. It’s complicated and although it seems simple and nutrition should be free and it’s on the internet, it’s not really like that.

Nicole:         
Right.

Judy:       
So the kinds of things I’ve seen, I guess very common deficits relate to. This is also quite an emerging area of research, which is great, finally, is what’s going on in a child’s intestinal, in their gut.

Nicole:        
 Yeah.

Judy:   
The gut biome. If you’ve heard about probiotics or you’ve heard about gut biome and or gut bacteria, and how essential a beneficial cohort, if you will, of microbes are. That’s very important for mood and function, all kinds of things. We’re finally getting some data out, some research on what it really means to harbor a healthy gut biome in your intestine.

Nicole:
Right.

Judy:     
And oh my goodness, what have we done spending the last three decades or four decades giving kids antibiotics pretty frequently? So that is not benign, after all. So that’s number one. Usually, my first task is assessing that, and there are some very interesting tools now, at hand, to do that, and re-directing that, those microbes are going to affect your child’s behavior. So that’s very interesting, and then also very common is growth problems.

Nicole:
Mm-hmm (affirmative).

Judy:                  
Children are usually not growing as they should, and this, again, is not something your pediatrician is probably are gonna tell you unless your child has really failed and gotten at the very bottom of the chart. Then they will refer you to a GI doctor who will probably give you Pediasure, which is maybe I wasn’t supposed to name a product, but that is one of my least …

Nicole:      
Uh-huh.

Judy:         
I do get pushback for this, but …

Nicole:   
Corn syrup in a can.

Judy:        
Well, if your child’s growth impairment is partly due to the fact that maybe they don’t tolerate dairy protein.

Nicole:  
Yep.

Judy:    
Pediasure is a dairy protein. There’s also soy protein in there. I can’t tell you how many even tube fed children I’ve worked with, but I do work with very medically fragile kids also who are being given a formula to resolve a growth problem that caused their growth problem in the first place anyway.

Nicole:   
Yeah.

Judy:    
But yeah, that’s a real common thing is how are kids tolerating the food they are eating?

Nicole:          
Mm-hmm (affirmative).

Judy:        
Is it working for them or is it sending false neurotransmitters to the brain that are affecting behavior, and this can happen. There are lab options to scrutinize all this.

Nicole:   
Right.

Judy:
Also very common is for me to find that kids are marginal for iron status. Again, not anemic, per say, but in this gray zone, this purgatory called pre-anemia, where functioning falters, including, specifically, the ability to learn math as well, which is interesting. There’s data on iron status and math.

Nicole:  
Yeah.

Judy:  
And what a lot of people don’t also realize is you need iron to make and break down serotonin and dopamine, so this will affect your mood and your focus.

Nicole:     
Mm-hmm (affirmative).

Judy:
So there’s like, again, I just hit on two things. There are dozens of things that I look at, and usually, no one has turned over those stones.

Nicole:           
Right.

Judy:  
Yeah.

Nicole:   
So in specific to the idea of the gut microbiome and things like that. Let’s talk about some of the signs, or some of the things that parents might start to connect. Like so you mentioned antibiotics. So kids who have been on antibiotics quite a bit. It’s like, “Oh, if my child is having some of these behavioral challenges, some of these things,” and maybe they had a history of chronic ear infections or various things that they run antibiotics for that’s sort of a red flag that maybe that gut microbiome piece needs to be looked at.
            
I know like constipation, or intermittent diarrhea constipation is a big one, and parents are often surprised. They come in to meet with me as a psychologist and in the course of doing an intake and them doing the paperwork and me interviewing them, I’m asking things about their child’s bowel habits and things like that, and they are looking at me a little bit confused like, “Why are you asking about this?” It’s like because your child’s ability to poop regularly or not it tells us a lot about what’s going on there.

So what are some of those common more physiological symptoms that can indicate maybe they’re role for nutrition there that needs to be uncovered that parents should look into more.

Judy:   
Well if you … Just broadly, if you are given a kind of sideways glance from your school staff that maybe your child needs medication, which they are not legally supposed to say, but I have met many parents have been told that and they don’t know that that’s not cool. To tell you to get your child medicated. Then right away that’s cause to say, “Well wait a minute,” and even if you’ve gone to your pediatrician and, “Oh, his growth is fine. He’s happy.” Well, why don’t we look and find out first, because if you are using nutrition support strategy it’s going to make your child healthier overall.

Nicole:
Right.

Judy:  
If it doesn’t completely resolve the, quote, behavior you are going to probably see a medication tolerated better. I often see that as well and I also want to make that clear. It’s not like you need to chose medicine. What can also work really well is a combination and usually what I see is kids either need a different medicine or a different choice will be made that will work much better with the nutrition support around it, or they need a lower dose than they’ve had.          
  
So it’s not one of the other, but in terms of clinical science, there are all kinds of things. I mean I’m often hearing, “Oh, the GI doctor said my child is just withholding stool.” I just don’t buy it. Who wants to do that? If it’s been painful to defecate and you are really little, your first instinct is to avoid it. So make it comfortable, and that can improve and I have seen that happen as well.
           
But gosh, not sleeping well or let’s say, for example, your child can’t fall asleep easily, or if you wake up and they just completely rearranged the bed and they are upside down and inside out. That’s a very common side of weak iron status.

Nicole:    
Yeah.

Judy:  
So gosh, there’s all kinds of clinical signs. Children are like little canaries in the coal mine. I certainly look at lab data, but for assessing a child nutritionally you have to look at clinical science symptoms. You have to read a food diary. You have to because it’s not about seeing is mom doing a good job for you? We are all trying to do a good job. It’s not about that. It’s about what does that child’s body feel like eating. Is he a picky eater? And what happens when they eat this particular food? That’s a diagnostic for me. That food diary and everyone hates doing them, but I have a form and I make people fill it out.

Nicole:                  
Oh, I do too.

Judy:                  
Yeah, and it really helps me understand what’s going on.

Nicole:                  
Yeah.

Judy:                  
And in fact, that’s another one. It’s common for kids to struggle to eat during the day. So they won’t have enough food, and that alone will affect behavior. Just having a small calorie deficit, not for you or me, we are different we are not growing, but for children just that. I’ve seen just correcting food intake alone.

One child, in particular, was ten and was doing a lot of wetting at school and couldn’t write, lots of dysgraphia, but the very first thing we did was work the school IP team to make sure he ate during the day. Just that and he stopped wetting his pants and he started writing much more clearly. He also began initiating tasks himself.

You know it’s not glamorous, it’s very simple, and nobody wants to think that they are overlooking that, but it’s easy to overlook that.

Nicole:                  
Mm-hmm (affirmative). It is and that’s overlooked a ton. You know, and I think that what you just said a moment ago about kids having different needs because they’re growing and we aren’t, I find that a lot of times as adults, we look at things like food intake and eating products with a lens of ourselves or as adults, and we’re done growing. We only grow out from here, right?

And we forget that kids, especially at different phases in their growth and development, need a tremendous amount of resources via food and nutrition in order to support their physical growth, their neurological growth; not just how they’re functioning well, but also the fact that they’re growing and what an impact that can have. And I think that food diary is so important because often, parents will say, “Oh, yeah, well he eats fine,” and you look at that and you’re going, “Whoa. We’ve got way too little or not consistent enough or way too many of the same kinds of things,” and what we see in those patterns is that how they’re eating and what they’re eating is not conducive for a child to be able to optimally grow and develop.

Judy:                  
Right. I think we’re past parents being afraid of fats. I mean, I’ve been at this long enough.

Nicole:                  
Right.

Judy:                  

But that was the story a couple of decades ago, and you know, I think finally parents understand their kids need a lot of fat. Right now, we’re kind of in a carb fear mode. I have a lot of parents who want to use diets that deeply restrict carbohydrates, so carbohydrates are essential for kids.

Nicole:                  

Mm-hmm (affirmative).

Judy:                  

You can use what I like to call clean carbs that aren’t sugary and processed. There are all kinds of ways to do that, but carbohydrate in a child’s diet protects protein and fat, what they’re eating, to use it for structure and function. If you’re not giving your child enough carbs and they start using their dietary proteins for energy. It’s a very wasteful process to extract energy from protein.

Nicole:                  

Mm-hmm (affirmative).

Judy:                  

It’s harder on your organs. If you are trying to use, say, a ketogenic diet, which has a lot of interesting benefits, and of course have been around for almost a century.

Nicole:                  

Right.

Judy:                  

I have used those in children with seizure disorders. There is going to be stunting, and I know there are some data questioning that now. I don’t see any of it very convincing so far.

Nicole:                  

Mm-hmm (affirmative).

Judy:                  

Those do have an impact on children that will change things like their growth pattern. It will change how their bones are mineralized. It may create more fractures in children. So, you know, please don’t enter these things lightly. Carbohydrates do help children on their weight trajectories. It helps just like it does, like you said, if you and I went nuts there. We would just go sideways.
               
It helps the whole growth pattern function as it should, and even when kids are very restricted with what they can eat, there are still ways to work that so that they can grow and feel good and function pretty well.

Nicole:                  

And I think …

Judy:                  

And I was gonna say it is essential to put first.

Nicole:                  

Right. Right, and I think that really goes back to something that you said at the beginning of our conversation about it’s great for parents to access information online and elsewhere about nutrition and diets and all of that, but when your kid’s really having significant challenges, you really do need to be working with a professional who can guide that process because I think what you’re saying here, and I see this too, is some families, with the best of intentions or maybe having worked with other practitioners who don’t understand nutrition as fully, they’ve tried their kids on a lot of restrictive diets.

Judy:                  

Mm-hmm (affirmative).


Nicole:                  

You know, I call it sort of the “let’s just throw everything at the wall and see what sticks,” right?

Judy:                  

Mm-hmm (affirmative).

Nicole:                 

Let’s do a full-on elimination diet for months and months and months at a time or let’s do SCD or GAPS or something like that. And while there’s nothing inherently wrong with any of those plans, when they are improperly applied, what I see is that we get a host of other issues then and we get kids who are not getting enough and are not growing well, and ultimately, you’re not getting the results that you want.            

So I know that obviously, you are training in a lot of specialized diets so what do you recommend for people that are feeling like, “Well I’ve read about all these diets, maybe one of these is good for my kid.” How do you suggest that parents really think about that or approach that? What do you feel like are some things that are worthwhile for parents to try themselves as far as shifting to a more conducive diet versus things that really should have a professional level intervention?

Judy:                  

Yeah, great question. I think what’s really easy for parents to do is shift away from processed stuff and try to … If you have time to learn to cook. Get in your kitchen, start making some things for your family and kids that are whole foods.

Another important one is get away from glyphosate, get away from GMO foods, get away from pesticides because there’s enough data now that even the American Data of Pediatrics, which is uber conservative and not cutting edge in any way when it comes to therapeutic nutrition with our children, even they have published an article saying that they found a lot more of that in kids with ADHD than kids without ADHD. So get off that stuff. That means committing to organic foods, and whatever of that you can afford, buy it because it’s important.
             
I think what young parents now don’t know, can’t know is that when I was a little kid very little of that stuff was in the food supply. We didn’t have GMO foods. Yes, we had pesticides, but a lot more of what we ate was more whole.

Nicole:                  

Yeah.

Judy:                  

And we didn’t grow up ingesting all of this stuff. So 1990 was kind of the dark turn if you will. That’s when GMO … That decade is when GMO foods really exploded and they were in infant formulas, and then, of course, vaccine schedules changed. One of the vaccines change, one of the vaccines that were given right at birth was genetically modified also. It really changed the playing field for children and what was going on in their immune systems, and their gut, and the gut immune interface.
       
So you right now can get away from that. That’s a choice that you can make. As far as discerning what other specific nutrition support your child needs, it’s really hard to know unless someone assesses it for you. So I would almost say work on … That’s the most important thing. Work on whole foods in your home and really also important, don’t pathologize this.
                
My goal is always toward getting kids to eat as much … Rather than restricting, getting kids to expand what they can comfortably and safely eat. I’m not about avoiding, avoiding, avoiding. I mean yeah you are going to be avoiding some foods.

Pretty much every child in my caseload has had to have a dietary restriction. They can’t eat gluten or they can’t eat eggs, or whatever for a variety of reasons, but at the end of the day I want parents and families to remember that food is joyful. Food is love. Make it that in your home. Make it that. Don’t talk about how food is bad for you. Just bring in the good stuff and enjoy that. Don’t even mention the other stuff.

That’s also really important. Especially for little kids. They don’t need to know this stuff. They need to see you being happy and joyful and bringing good things to the table and enjoying it.

Nicole:                  

I love that approach and that philosophy about it, because I think especially for parents who have been at this a while, or have been doing a lot of dietary interventions, it can become such a chore and such a stressor and so much about the withholding. Just all of that and I love what you are saying about, let’s focus on what we are going to put in, let’s focus on making food a joyful more relaxed. Like this doesn’t have to be a medicalized process.               

Even for kids who do have significant medical issues related to that we can still have a mindset around this and an approach to it that’s a lot healthier, not only physically but mentally and emotionally and relationally too.

Judy:                  

Right, yeah and I’m going to just jump off to this other tangent that we mentioned earlier too real quick. About kids who are so severely affected that they are hospitalized or what not. Yes, I want to make sure that I answer that. Nutrition is not too weak to redirect that. I’ve worked with kids who are hospitalized for suicide attempts and actually not that this is necessarily my goal. My goal is to make them happy and feel good, but they are off medication and different. Completely different.              

One child, and I think you and I have talked about this guy before, who was in so much pain that he broke helmets. He had to wear a helmet to protect his head because he would bang it because he had so much gastrointestinal intestinal pain he really couldn’t care. He had a good GI doctor and an incredible effort from his mom and a very thorough intervention just found a couple little things that we could change to correct that gut dysbiosis and that kids life changed. He went from being bedridden to going to school, jumping on his trampoline, getting a little job. I mean this is life changing. This really is.

Nicole:                 

Yeah, and as you said earlier whether it’s using nutritional interventions in isolation, or in combination with medication what I find too is that sometimes kids have been on a lot of medication and maybe there is a small dose of a medication that’s beneficial for them, but that’s going to work better in combination with good growth patterns, with the right kind of diet, with the right kind of targeted nutrients, or whatever it is that they may need when we optimize the nutrition piece of things the medical interventions, including medications can work even better and I think that’s important for people to realize.

Judy:                 

Right, yep.

Nicole:                  

Yeah. Well, this is awesome. We could go on talking for hours because there are so many things to talk about, but this is really great and gives people, I think some helpful starting points for thinking about maybe in a new way some of the things that they’ve noticed with their kids or what might be going in beneath the surface of their behavioral challenges in what they are dealing with. So I appreciate you sharing that.

I want to make sure that people know where they can find you. How can they access more information from you? You’ve got several books, you’ve got a website. So what are the best ways for people to find you online or get more info from you?

Judy:                  

Thank you. Probably the quickest and easiest thing is to go to my website which is nutritioncare.net and you can reach me through that, you can get yourself on the calendar if you want. There’s a link right there to put yourself in there if you like. There are links to books, and there’s a deep blog there with lots of topics. So that’s a great way to find me. Nutritioncare.net.

Nicole:                  

It’s an amazing website. I send people there so frequently. You’ve got so many great blog articles on so many topics, and then your books are also wonderful and I know your books can be found on Amazon as well as an easy way for people to access on your books. So lots of great resources that you make available to people. So thank you so much for taking the time to share your expertise today and for being on the show. I appreciate it.

Judy:                  

Oh my pleasure, Nicole. Anytime.