Posts Tagged diet
In the middle of the night in Atlanta, I got a frantic call from my daughter in Chicago. “Daddy, I’m so sorry to wake you, but Michael just ate a little piece of cashew and now his face is swollen and he’s breaking out in a rash all over his body.” Once I realized that her voice wasn’t just part of some bad dream, I gave my doctor’s orders: “Give him Benadryl and take him to the emergency room immediately!”
As a board-certified allergist for 25 years, I recognized that my grandson was having a potentially serious allergic reaction and that his symptoms could get worse-much worse. Fortunately, by the time they arrived at the hospital, the swelling had subsided and his hives had resolved.
Even though my grandson’s diagnosis was easy to make, food allergies can be one of the most frustrating and complex allergy issues facing physicians, patients, and families. If you consider the unlimited number of foods and additives we consume today, the variable time between ingestion and allergic reaction, and the varied and often-subtle symptoms, it seems miraculous when an allergy-triggering food is actually identified.
Food Allergies In Children: A Disturbing Trend
Ask anyone who raised children 25 years ago if they ever heard of food allergies back then, and the likely answer will be no. Yet today, who doesn’t know a child-if not several kids-who have severe food allergies? Pediatricians and allergists are observing first-hand that food allergies in infants and children have increased to epidemic proportions over the last few decades. Studies have shown that in the under-18 age group, the prevalence of reported food allergies increased 18% between 1997 and 2007. Approximately 4% of Americans are estimated to have food allergies. That’s more than 12 million individuals. The prevalence of food allergies is even higher-6% to 8%-in infants and young children under three years old.
Any type of food can trigger an outbreak, yet the “Big 8″ account for more than 90% of all cases: milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat. Sesame is quickly becoming another common cause of allergies, especially in those with Mediterranean diets. The good news is that the incidence of documented food allergies decreases with age, probably due to the development of tolerance in children allergic to milk, wheat, soy, and eggs. Of the 2.5% of children allergic to milk, approximately 80% will “outgrow” their allergy by age five. Kids with peanut or tree nut allergies aren’t as lucky: Recent studies have shown that only about 10% to 20% of children will lose their allergy as they age.
Pediatric Food Allergies: Instantaneous Outbreak Of the two main types of allergies, the “immediate hypersensitivity reaction” gets the most hype, probably because you can see the symptoms (whether it’s hives or swelling) right away. The other kind is aptly named “delayed hypersensitivity reaction.” Otherwise known as IgE-mediated, the immediate allergic reaction is the best understood and the most easily diagnosed. Yet it can also be the most serious. When the proteins in an allergenic food come in contact with an IgE antibody (located in the skin, gut, and airways, or in the blood), a cascade of cellular events occurs resulting in the release of histamine and a multitude of other chemical mediators. The rapid release of the histamine and other chemicals is what causes the allergic reaction. The outbreak, which generally occurs within minutes of ingestion, can be relatively mild or severe. Moderate symptoms might include a rash, generalized itching and redness of the skin, facial or eyelid swelling, abdominal cramping, vomiting and/or diarrhea. These can be treated with a quick-acting antihistamine and tend to run their course over a few minutes to hours. The most severe reaction is called anaphylaxis, which can occur instantaneously or a few minutes after ingestion. As a general rule, the quicker the onset of symptoms, the more serious the reaction is likely to be. Symptoms of anaphylaxis might include those mentioned above, but can also rapidly progress to breathing difficulties and chest tightness (due to bronchial constriction and swelling of the airways), a drop in blood pressure leading to shock-and even death. Epinephrine (also known as adrenalin), which is available for self-injection in the form of an Epipen and other auto-injectors, must be given immediately and repeated if necessary. Foods that commonly cause severe reactions include peanuts, tree nuts, fish, sesame seeds, milk, and eggs. The most serious reaction I ever witnessed resulted from the ingestion of a single pine nut. That tiny seed (it’s not really a nut) transformed a healthy teenager into a critically ill patient within a matter of minutes. Fortunately, the patient recovered, but anaphylaxis can be fatal if not treated immediately and aggressively. If your child has ever had an immediate allergic reaction to a food, you should consult with a board-certified allergist. To identify or confirm the symptom-triggering food, the allergist will likely give a few tests, either through the skin or blood. From there, you and your allergist can come up with a plan to eliminate the food from your child’s diet and discuss prevention and management of future reactions. Read the rest of this entry »
I often hear from people who are very excited about beginning the Medifast diet and who want to lose weight as quickly as possible. Many are anxious to aggressively get started right away. To that end, many ask me about exercising when they first start the diet. They want to know if you’re restricted as to how much exercise you can do or if only certain types of activity are encouraged, at least in the beginning. I’ll share some of the Medifast exercise guidelines (as well as my own experiences and observations) in the following article.
Of course, you should address any questions about your health to your own doctor, but the Medifast guidelines on exercise suggest waiting a week or two before you start a rigorous exercise program if you are not currently exercising. The reason for this is to let your body adjust to it’s new calorie and carbohydrate level. If you are already on an exercise program, they suggest cutting down the intensity by half for a few weeks and drinking plenty of water when you work out. They also suggest (and this is just common sense) that you let your body set its own pace. In other words, if you feel tired, light headed or winded, you should rest or slow down before continuing on. You should not push yourself or your body beyond what is healthy or beneficial.
In a real world example, this would mean if you already bike two miles, you might cut that down to one mile and perhaps go at a slower pace until your body adjusts. Or if you currently push your body or muscles to failure, you don’t push nearly as hard during the first couple of weeks of dieting. And, if you haven’t yet started your exercise program, you may want to delay anything rigorous.
With that said, it’s been my experience and observation that gentle exercise like moderately walking or riding a bike is well tolerated by most. There’s no need to do tons of aerobic exercise when your body already has adjustments to make and is potentially working hard to get into ketosis (fat burning mode.) Also, from a psychological stand point, you don’t want to make the program too difficult right away. This truly is a long term process so there is no need to burn yourself out. I’ve found it’s best (especially initially) to try to incorporate exercise into your normal routine. Perhaps you try to work a little harder when playing or biking with your kids. But, there’s no need to hit the gym like a professional athlete when you’re adjusting to a new program, a new way of eating, and a new life style. It’s my opinion that changes are more likely to stick when they are gradual and feel easy and intuitive. Read the rest of this entry »