Where Do I Start?

Your neighbor’s story of helping her son’s autism through diet sounds miraculous, and your cousin’s eczema disappeared virtually overnight when she changed her diet. But there’s no test that can precisely identify the foods that will help or harm a given individual.

How can concerned parents know when their children’s symptoms can be helped by overhauling their diet? Does your sister’s anecdotal success have any bearing on your child’s health? Is gluten always the bad guy? Maybe sugar is the root of all evil?

Tamar Feldman, RDN CDE, of Edison, New Jersey, specializes in gut health and hormonal balance, pursuing a functional medicine approach that has helped her get to the root of thousands of clients’ ills. She warns against defaulting to trendy fad diets.

In particular, she draws an important distinction between physiological concerns and behavioral ones. A stomachache might indicate a gluten intolerance, but it could also be celiac disease, lactose intolerance, or plain and unglorious constipation. A trained professional will make sure to rule out any serious medical diagnoses, and then use more precise diagnostic tools to zero in on the source of the issue.

“Taking shots in the dark ends up with parents, and more importantly kids, getting frustrated and ultimately burned out,” she says. “Don’t just try eliminating random foods to deal with your child’s gastric distress.”

On the other hand, there’s speculation and emerging research indicating that behavioral concerns such as ADHD and autoimmune conditions are often impacted by diet, and there are a number of well-known diets that purport to treat these. While the evidence for their efficacy is still mostly limited, the more well-researched options may be worth a try.  For example, kids with autism seem to thrive on diets free of gluten and casein  (a protein found in milk), and the Pagano diet is popular among psoriasis sufferers.

Unless the evidence for it is rock-solid, an MD likely won’t recommend, or even mention,  dietary changes, explains Tamar. For years, the specific carbohydrate diet (SCD), which treats Crohn’s disease by eliminating grains and curtailing sugars, didn’t have the backing of the medical establishment, but with time and additional study it has become much more acceptable to many physicians.  “Behavioral issues are still in that gray area,” says Tamar, where there is limited but growing evidence for the efficacy of certain diet plans.

Comprehensive guides to these diets are available in books and online, and for these, says Tamar, it generally isn’t necessary to work closely with a professional. Still, health professionals trained in understanding nutritional research can help laypeople weed through the research. They can also help families implement the dietary guidelines in a way that will set them up for success.

Gut Feelings

Shoshana’s second grader Dovy was an Active Kid. He didn’t have an official diagnosis, but his parents were constantly struggling to tame his explosive energy. Her curiosity was piqued when her friend told her about her nephew, who had gone off gluten for behavioral reasons. Another friend eliminated gluten from her daughter’s diet, and the little, petite princess grew several inches.

The gluten-free diet was buzzing at the periphery of her consciousness and came to the forefront when things came to an all-time low. Dovy was invited to a birthday party, where his less than decorous behavior involved flinging large objects at high speeds from second floor landings. At her wits’ end, Shoshana suddenly noticed all the cookies, muffins, and cupcakes in easy reach.

When it was time to leave, Dovi capped off the disastrous party with another major explosion, and Shoshana spontaneously announced that he was going gluten-free. “I’m not such a researcher,” she says. “I work on intuition. We hit rock bottom, and we just had to do something.”

She explained it to him in six-year-old terms: “Gluten is not a good friend; it tells you to do bad things. You need to tell it, ‘Now’s not a good time.’ ”

Shoshana’s gut reaction, says Avigail Gimpel, was right on target.

Avigail Gimpel, MS, of Gush Etzion, Israel, was a special educator before she was a mother, and she was always drawn to the kids with ADHD. Then she became a mother, and her kids were diagnosed with ADHD one after another. “The only reason they stopped getting diagnosed,” she says with a laugh, “is that I stopped taking them for evaluations.”

And that’s when her quest for answers became personal. The medical establishment told her there was something wrong with her kids — they were neurodivergent. But they actually looked pretty healthy to her, and overall, pretty awesome. Something wasn’t adding up, and Avigail dove headfirst into the study of ADHD to uncover it.

The conventional view of ADHD, she says, is that it’s a genetic, neurological condition, and there’s not much you can do to change it. But she learned that the research backing that claim is weak, and that the individual has far more power over his condition than the prevailing narrative indicates. In the course of her studies, she uncovered the tremendous importance of diet.

While she started at the surface level and worked her way inward, following the behavioral clues led her to the same conclusions as Tamar and other functional medicine practitioners — that despite the gaps remaining in the research, gut health is critical in the management of ADHD.

Today, Avigail researches ADHD and coaches hundreds of families in managing the condition. In her book, HyperHealing (Gatekeeper Press, 2021), she elaborates on the importance of diet, though she’s quick to qualify that it’s not the only factor that contributes to challenging behaviors.

Some of the symptoms that could point to a compromised gut include frequent need for antibiotics (the kid who always has an ear infection or strep), sensory issues, autoimmune conditions like allergies and eczema, constant runny nose, and frequent high fevers.

“We have to be nuanced,” notes Avigail. “We have to see symptoms that make me think it’s worth turning the parents’ and child’s lives upside down.”

Restricting kids’ diet is a major, complicated undertaking, so don’t beat yourself up if it seems impossibly difficult to tell your generally healthy kid that he can’t have ice cream ever again. Drastic steps always need to be weighed against the difficulty involved.

First Steps

Like Aidy’s two-week trial period, many practitioners advise a limited test run before overhauling a child’s diet in earnest.

If Avigail sees enough symptoms that point to a need for gut healing, she’ll suggest a 30-day trial period to a parent. “I’ll never tell a parent, ‘This is your new lifestyle.’ It’s too daunting.”

While years of internal damage can’t be undone overnight, she says a month of overhauled diet should be enough to get a sense of whether diet is at the root of the presenting symptoms. If by week three or four there’s no noticeable difference, there’s a good chance this approach is not the right one.

Tamar is more conservative. Although positive change can sometimes be discernible as early as week three or four, she says most conditions will visibly improve only after eight to twelve weeks on a new diet.

Though a 30-day challenge might sound like an easy enough, bite-size trial, it’s not that simple. You need to prepare foods that your kids will eat, and you need to wean them off the habit of receiving treats as rewards — something they may not be accustomed to. If kids are faced with rabbit food instead of their favorite snacks, and exercise feels like an army boot camp drill, they’re not going to comply cheerfully.

Avigail recommends starting by replacing snacks and treats with better options, such as high-quality chocolate and dye-free lollipops. “We’re not taking happiness and joy from the child’s life,” she reminds parents.

Tamar says the most frequent obstacle her clients face is a lack of creative thinking. With many of their favorite foods off-limits, they’re stymied — what’s left to eat?

To overcome this hurdle, she brainstorms a list of snack and meal options. “Once you have ideas and alternatives, it’s not as hard to comply. The challenge is to not make the kid feel restricted.”

Once you’ve laid the groundwork and equipped the pantry with supplies, you can start the 30-day challenge.

On Day 1, Avigail recommends that parents list and rate the severity of all their child’s symptoms. If he can spend four minutes doing homework, and that increases to seven minutes at the end of 30 days, that’s a victory. But you might not realize it if you didn’t carefully track the symptoms.

Are parents signing up for a lifetime of complicated restrictions?

“Most of the time, as the body resets the gut microbiome and heals, we can start talking about adding restricted foods back in,” says Tamar. Unless there’s a specific medical condition, like diabetes or celiac disease, a generally healthy body can tolerate a fairly wide range of foods without breaking down again.

But even while on a stricter diet, maintaining a sense of proportion is important. It’s not a catastrophe if they have soda at a kiddush, says Avigail. Our bodies are resilient. “During a 30-day challenge, we want to be as clean as possible. Then, if it works, we want to continue, but not in a hysterical way.”

Educated Consumers

Education is key in sustaining dietary changes. Avigail shows her kids how food coloring is made from petroleum (yes, really. I didn’t believe it either, but look it up). “Pictures of the gut are interesting!” she insists.

In addition to nutritional specifics, Avigail emphasizes the importance of trying to give over healthy attitudes to kids, like the importance of respecting their bodies. “Your body is not just the thing that carries your brain around,” she says.

Aidy printed out the US Department of Agriculture’s MyPlate graphic, which she shares with her children to illustrate the healthy balance they should be striving for.

“I have some very sensory, picky kids who will throw up if I offer them a pepper,” she says. “My kids are not pleasant to feed vegetables to. No one is going, ‘Yum, salad.’ ” She shows them the MyPlate graphic and prompts them: What’s on your plate? What else do you need? The visual cue is a great reminder to them that they should be balancing their diets, and though they don’t always do it, they reach for the veggies surprisingly often.

Shoshana emphasizes that people need different things, in an effort to preempt resentment from the dietary challenged children toward the ones who can eat what they choose. A frequent theme in her home is that fair doesn’t mean identical, it means giving each kid what he needs. One might need avocado smeared on everything to gain weight, while another needs portion control; each gets what’s right for them.

Just Try It

As each parent shared her family’s tale of adventure into new, uncharted nutritional waters, my skepticism grew. I just couldn’t imagine imposing this kind of new regime on my family.

When questioned, each mother in turn conceded that cutting out large, tasty food groups only works if your kids are on board. In most cases, their kids were basically compliant because they saw and felt the positive changes in their own lives. All agreed that a child old enough to be out in the world will only comply if he understands and experiences the benefits, and if he is a reasonably flexible eater.

Even with picky eaters, though, all is not lost.

Aidy, mom to several finicky eaters, jokes that “Mommy’s job is to make supper, your job is to say, ‘Ew!’ ” But on a more serious note, she says that in her work as an occupational therapist with many sensory-defensive kids, she sees that parents often unintentionally reinforce picky eating.

She often meets mothers who say things like, “Oh, he won’t taste cantaloupe, don’t even try.” But when they give up and stop offering unwelcome foods, the antipathy is reinforced and eventually the child can’t even bear to be at the same table as the unwanted food.

Aidy encourages mothers to have their kids try, or at least tolerate, new foods. Your new mantra can be, “You don’t have to eat it, but you have to leave it on your plate.”

Still, says Tamar, “If your kid is behavioral and has major sensory or food issues, you may not be able to force the magic.”

Perfect Is the Enemy of Good

Leah Keller* turned to dietary healing after several years of traditional treatment took their toll on her child. Diagnosed with chronic Lyme disease, her daughter spent the better part of three years on and off various antibiotics. When one set of symptoms improved, something else would worsen, or they’d taper off a medication only to suffer a severe relapse.

Then the stomachaches began. Chani would cry and scream every time she used the bathroom, necessitating another string of visits to specialists.

Along the way, Mrs. Keller learned a lot. One pattern that caught her eye was that cereal and milk triggered Chani’s episodes, so dairy was the first to go.

Around the same time, Chani began to awaken with frightening night terrors, and Mr. Keller was the one to notice that those were linked to days when she had eaten challah.

Once she began to pay attention to what was in the food they were eating, Mrs. Keller began to notice the effects of different foods on her entire family. Her kids, she saw, reacted to food coloring, and Leah was validated when she saw it was right there in black and white on the package of sour lassos she once brought home. The health warning mandated in the candy’s European country of origin said: “This product contains synthetic food dyes known to cause inattention and hyperactivity in children.”

Still, with all her firsthand knowledge of  the toxic effects of sugar and gluten on her kids, Leah acknowledges that their diets are far from perfect.

“I should send homemade lunch to school every day, but I have a life, I can’t do it,” she says. “Though if it would be deadly, I’m sure I would find a way to do it.”

Like mothers everywhere, she finds herself making constant cost-benefit analyses and weighing tradeoffs. In her house white flour is a no-no. In an ideal world, her kids would be gluten-free, but since it’s so hard to manage, she uses spelt whenever she can, and whole wheat in a pinch.

She teaches her children, likewise, not to let the perfect be the enemy of the good. “In each situation, make the best choices,” she tells them. If there’s a whole wheat option, choose that over white flour. For herself, too, forgetting to defrost supper doesn’t mean she needs to default to nutritionally empty foods; she reminds herself to make the best choice from the available options, like offering scrambling eggs instead of instant noodle soups.

At the same time, she tries not to make too much of an issue out of healthy eating. After Purim, she’ll buy her kids’ nosh from them, but she also doesn’t make a fuss if they prefer to eat it. “My kids definitely eat what they shouldn’t, but generally, they’re learning to make better choices,” she says.

While she’s careful not to demonize any foods, she does point out the connection between what her kids consume and the symptoms they experience. For example, one of her children can experience anxiety after eating white flour, sometimes even a couple of days later, so she’ll point that out to him, creating an awareness for the future.

Despite the clear benefits her family experienced, Aidy also finds the diet too exhausting to keep perfectly. Their whole environment is at odds with sugar-free eating. “Every Shabbos in shul, the kids have free access to the candy bag,” she points out. “A kid can eat a lot of candy in ten minutes.” Her son has told her that he’d love to take fruits to school, but it’s too embarrassing to be the only one.

All the mothers interviewed agreed that it’s far harder to implement healthy diets outside the home, and they choose to pick their battles. Preparing in advance, whether that means brown-bagging lunch instead of the school’s options, or asking Bubby to have a couple of dishes that work for their kids, isn’t always practical. Instead of trying to control their kids, Aidy and the others focus on educating them to make better choices when they can, and they do their best not to turn food into a battleground or mark their child as different.

For example, instead of aiming for a total sugar-free diet, Aidy aims to keep the sugar in check. She’s currently teaching her son the benefits of saving his nosh and eating it in moderation.

As part of a school-incentive program, he receives a Slurpee every night. He drinks just a little, putting the rest away for a different time. Though the Stein freezer is packed with rock-hard Slurpees, Aidy says it’s a great learning experience. He enjoys the feeling of ownership, but he also gets to flex his self-control muscles and regulate his own sugar intake.

Aidy tries to add healthy fats to Chaim’s diet and encourage physical activity, especially on days that she knows will be sugar-challenged, like when he has a birthday or siyum. In general, she says, she’s learned to focus less on taking away, and more on adding other healthy habits.

A Lonely Road

Mothers of children whose diagnoses aren’t clear-cut often face a lot of judgment.  While today her mother respects her kids’ diets, shares Leah, for years she would provide her kids with foods they weren’t supposed to have.

“My daughter happens to have a nut allergy. That, everyone recognizes, because the effect is immediate.” But family members are skeptical and disbelieving that the same child’s milk sensitivity causes inflammation.

“It’s exhausting, lonely, and difficult,” Leah says. It’s not just the food prep; it’s the entire package. “Your kid having issues not recognized by the world — trying to find the answer yourself is a very lonely journey. That’s my sacrifice for my child.

“Did it take a toll? Yes. Do people understand? No. Can I talk freely? No.  Do they think I’m crazy? Yes. They think I’m extreme, a health freak, I’m imagining things. It’s very isolating.”

New Horizons

When Leah first started reading labels, the learning curve was tough. “In the beginning, I felt like a baalas teshuvah who just started keeping kosher,” she remembers. She had to carefully read ingredient panels and learn which products would work for her family. Today, though, it’s become second nature, and more clean products become available every day.

Pesach, with its own attendant food restrictions, is actually a great time to experiment with eliminating problem foods. Many more gluten-free products are available this time of year, and people have cleaned out their pantries and gotten used to eating more real, minimally processed food.

Whether or not we have children with medical or behavioral challenges, whether our go-to meals for the final week before Yom Tov included fermented tofu or noodle soups, Pesach is a time of year when we make conscious choices about what we’re putting into our mouths. It’s a period featuring a heightened consciousness of how we’re nourished by the foods we eat, spiritually and physically, and offers an opportunity to reflect on whether our relationships with food are in line with our values and serve our families’ unique dynamics. Choose life.

A Word of Warning

While elimination diets might sound like the answer you’ve been looking for, anything too restrictive is likely to backfire, says Dina Cohen, MS RDN CEDRD-S, who offers nutritional counseling at her Lakewood, New Jersey, practice, Eat Well Soon.

“Kids have to learn to make choices in the world that they’re in,” she says. “I’ve seen kids go to extremes to get the foods their parents don’t let them have. While every parent wants the best for her child, we need to be mindful of what that child is up against.  It’s very hard for kids not to eat what everyone around them is eating. When a special diet is medically necessary, there’s no choice. But when there’s a gray area, I advise giving it serious thought, because the more you make food into a thing, the more it becomes a thing, and you might end up seeing the opposite of what you want.”

Dina cautions against incentivizing food choices. While it might work in the short run, turning food into a moral issue sets children up for a lifetime of fraught associations with food. “When she gets older, she’ll associate the brownie with guilt,” says Dina. “She’ll say, ‘Ma gave me a prize for not eating it; now I’m eating it, I’m a bad person.’ It messes with their heads.”

Instead, parents might bolster their kids’ morale in more general ways, like taking them on a trip in recognition of the challenges they’re facing, instead of tying rewards to specific foods or choices.

We’ve all met that kid who is desperately trying to beg, cajole, or trade his asparagus sticks for the snacks his parents don’t let him take to school.

Don’t be that asparagus mom.

Advice from the Trenches

Mishpacha’s Rorie Weisberg, INHC, who revitalized her family’s diet, offers these tried-and-true tips.

• Keep offering. As moms, we don’t give up in frustration when our kids don’t say “please” or “thank you” after we’ve been teaching it for a while, we continue to model and encourage. Healthy eating is no different.
• Season things well. Have good dressings.
• Don’t hide the vegetables as if they’re contraband. But at the same time, don’t bring the cauliflower farfel to the table and say, “Guess what this is made from!” Make it as much of a non-issue as possible.
• Be patient! When a child eats a lot of sugar, her taste buds are hijacked, and the savory foods and herbs you love actually taste terrible to her. By cutting down sugars and subbing healthier ingredients, over time taste buds can change.

Starting Small

We asked the experts to suggest three introductory improvements they’d recommend to someone who wants to upgrade her family’s lifestyle, but isn’t prepared to commit to drastic measures.

Rorie:

1. Make water or seltzer your main drink. The average American consumes way more than the AHA recommended 24 to 36 grams of sugar a day, often by drinking. Drinks with chemical sugars aren’t an improvement.
2. Swap out refined inflammatory fats like canola, vegetable, cottonseed oils, and margarine with unrefined healthy fats like extra-virgin olive oil, avocado oil, and extra-virgin coconut oil.
3. Reduce sweeteners in baking and cooking. If a recipe calls for one cup of sugar, use just three-quarters. Make cooked foods savory rather than sweet more often, and choose natural sweeteners like fruit, dates, silan, raw honey, or coconut or date sugar.

Tamar:

1. Increase anti-inflammatory healing foods by aiming for two servings of fruit daily, and a vegetable portion each with lunch and dinner. Prioritize brightly colored produce.
2. Reduce gut-damaging chemicals and processed sugars by cutting back on sugared drinks and processed deli meats.
3. Increase fiber by aiming to make at least half to two-thirds of daily grain intake whole grains, and eating both beans and nuts at least a few times per week.

Avigail:

1. Eliminate sugar until a certain time of day, such as two p.m. This can easily cut half of your daily sugar consumption, without a feeling of deprivation.
2. Have cut-up fruit or vegetables on the table when kids come home, or a bowl of fruit on the table all the time so kids can access them with little effort.
3. Spend quality time with kids outdoors, running, climbing, getting dirty, and seeding your gut with the wonderful bacteria nature has to offer.

(Originally featured in Family First, Issue 839)