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Today’s guest post is by registered dietitian, Sian Riley, founder of The Internet Dietitian.com. As well as having wide professional experience of advising people with food allergies and intolerances, Sian is also herself an “allergy mum” (with one of her children having a delayed milk allergy). Since my son’s peanut allergy diagnosis, I have often wondered what nutritional benefits nuts would have brought to his diet. What foods should he be eating in their place? Here Sian shares her tips for ensuring that your child’s nut allergy diagnosis doesn’t lead to a nutritionally compromised diet and that they still develop and enjoy a healthy relationship with food  – Louise

No nut nutrition

by Sian Riley (see Biography below)

A ‘nut allergy’ includes an allergy to tree nuts, peanuts (officially a legume, not a nut) or both. Doctors’ views differ as to whether it is necessary to avoid all nuts or just the specific ‘nut’ you are allergic to. Whichever nuts your doctor advises you to avoid, you must exclude them totally from your diet and this includes tiny amounts entering food through contamination during the manufacturing or cooking process.

Living with a nut allergy is extremely stressful and adjusting to a new nut free lifestyle can be a daunting and anxious time. Often the biggest challenge ‘nut free’ families face is the very real fear of this contamination exposing their family to nuts through processed foods and/or from eating out. The stress of preventing this accidental exposure can indirectly lead to a nutritionally compromised diet by fearing foods, leading to fussiness (particularly in children) and a limited diet.

Good nutrition isn’t just about eating the ‘right’ foods, there is also a huge social and emotional side to food that shouldn’t be ignored. Your family’s nutritional habits and attitudes are sown in these early years and affect how they eat for many years to come.

Here are my top tips for the nut free family and making sure your ‘No Nut Nutrition’ is safe, nutritious and enjoyable!

1. Read labels

There’s no avoiding this one! Reading labels to identify allergens will become a regular part of your shopping trips. Nuts and peanuts are each classed as one of the top allergens, so by law need to be included in the allergy labelling information on processed foods (until December 2014). Shopping may be time consuming in the early days, but it’ll soon get quicker as you become an expert in your family’s needs. Keep regularly double checking food labels though, as manufacturing processes and suppliers can change, resulting in a previously ‘safe’ food becoming at risk of contamination from the allergen. Using internet grocery shopping may help to make the process quicker, as labels can be scrutinised online. Supermarkets can also provide you with ‘free from’ information and advice – online or in store.

2. Focus on the positive

Creating a positive attitude to meal times and food will help to encourage a healthy relationship towards food for your whole family. Give as much focus to the foods your family can eat, as to food they’re allergic to – giving a balanced communication. Having ‘fun with food’ through cooking, baking and shopping will help build this healthy relationship. Growing fruit and veg in your garden is also a brilliant way for your family to learn about new foods whilst celebrating their horticultural success.

3. Variety

Variety is really important to ensure your family gets a full range of nutrients. See ‘The eatwell plate’ below. It’s easy for any family to get ‘stuck in a rut’ when it comes to meal options, but even more so for the family dealing with food allergies. Try to introduce a new recipe or meal once a week to extend your menu choice.

4. Support

It is crucial to get individual support and advice from your allergy specialist, GP, Health Visitor and Dietitian. They can advise you on local allergy groups and support you and your family in your unique situation. The internet also provides great support;  allowing sharing of your experiences and recipe ideas with other families in a similar situation. Get the most out of these websites by reading and contributing to online communities such as NutMums and Mumsnet.

5. Home cooking

Much of the risk of contamination comes from processed foods. Learning to cook from scratch will ensure your food is safe and you might even save some money in the process! It doesn’t have to be gourmet standard, start simple and have fun!

6. Empower and educate

An important stage in kids growing up is experiencing and developing their independence. This can be done as early as able – you know your own child. Educate the whole family about nut allergies and encourage the family to get involved in cooking and preparing meals. Give age appropriate jobs to the kids. Even the youngest can watch, stir and chop (with a butter knife). Getting creative in the kitchen will give them the opportunity to enjoy food, learn about good nutrition and understand where allergens can enter the cooking process. This will empower them to ask the right questions about food prepared for them and give them essential cooking skills for the future. You never know – they might become the next celebrity chef!

7. Be prepared

Being prepared and organised will optimise your families nutrition and safe avoidance of nuts. If you’re travelling abroad, consider getting a translation card from Allergy UK in your chosen language. Discuss your family’s allergies with parents before a party or play date and consider taking along some ‘safe’ food options. Contact restaurants beforehand if possible and don’t be afraid to ask lots of questions until you feel reassured about eating there.

8. Guilt

Parenthood and guilt come hand in hand, but more so for the family facing the day to day anxiety of a nut allergy. Even doing your best, there will be situations out of your control. Take time out to look after yourself and manage this additional stress and hard work in your life. Talk to family and friends and help them to understand the extra strain an allergy adds to daily life.

The Nutrition bit!

Although nuts have a lot of nutritional goodness (see my previous blog post if so desired!), a varied and balanced nut free diet should provide all the important vitamins and minerals.

Here are some of the important nutrients related to nuts, and some nut free alternatives.

Nutrient Why is it needed? Nut free alternatives
Vitamin E Protects our cells from damage Avocado, vegetable oils &
margarines
Omega 3 fatty acids Essential for cell membranes Oily fish, seeds such as linseed
/flaxseed and their oils
Selenium Protects our cells from damage Bread, meat, fish, eggs, milk
Iron Transport of oxygen around our body Dark meat, green leafy veg, eggs,
dried apricots
Zinc Supports our immune system Meat, dairy, fish, shellfish, fruit
and veg
Niacin Essential for making our DNA Meat, fish, wholegrain cereals
Magnesium Vital for growth and repair Green veg, wholegrain cereals
 

The Eatwell Plate

The eatwell plate is a great model for the whole family (over 2 years of age) to follow, particularly when following a ‘free from’ diet. It will help you and your family get the balance right over the whole day and includes all meals, drinks and snacks.

The-eatwell-plate3

  • Green – Fruit and Veg

Fruit and veg should make up 1/3 of your ‘plate’ and include the recommended 5 or more portions per day. Fruit and veg provide important goodness such as fibre and a host of vitamins and minerals. Aim for a ‘rainbow plate’ – lots of different colours to give a variety of nutrients.

Choose fresh, frozen or tinned and select unprocessed where possible to avoid contamination and the all important label reading.

Peanuts are classed as a legume, as are peas. There may be some cross reactivity, so it’s important to discuss with your doctor if you can include other legumes in your ‘nut free’ diet.

  • Yellow – Starchy carbohydrates

Again, starchy carbohydrates make up a 1/3 of your ‘plate’. Important source of Fibre and B vitamins. Rice, potatoes, bread, oats, cous cous, quinoa and pasta are all nut free, however label reading will still be required to check for ‘may contain’ warnings. Choose wholegrain where possible for Fibre and maximum nutrition.

Breakfast cereals are a really important source of nutrition as well as being the 1st crucial meal of the day. Close inspection of the label is required, as sometimes nuts are added. Nut free alternatives such as Porridge Oats, Readybrek and plain Weetabixs are good options to ‘break-the-fast’. Check out Nutmums ‘nut free food’ list for more options.

  • Pink – Protein

Protein is essential for growth and repair and should be included at each meal. Meat, fish and seafood are all good protein sources. Aim to have fish twice a week, with one of those being Omega 3 containing oily fish (such as Salmon, Sardines, Mackerel). Vegetarian protein sources include eggs, quorn, beans, lentils and soya. All these protein sources are nut free – again, read the labels for ‘may contain’ warnings, particularly if any ‘extras’ might have been added during the manufacturing process.

Beans, soya and lentils are classed as legumes, as are peanuts – so as above, discuss with your doctor any possible cross reactivity with these foods.

  • Blue – Dairy

A good source of Calcium and important for healthy bones and teeth. Aim for 3 portions a day of  milk, yoghurt and cheese. Choose lower fat versions where possible and if appropriate. Double check the label of other dairy products for potential allergens and be aware that nut milks are becoming increasingly popular and may be used in home cooking and baking.

  • Purple bit at the bottom – Foods and drinks high in fat and sugar

These foods should be limited, but the odd treat is fine and helps to maintain ‘normality’ in your family’s diet. The ‘everything in moderation’ rule applies here! Again careful label reading is required……but you already knew that!

And finally, whilst you’re reading all those labels – check the salt content! Too much salt in the diet can cause health problems later in life. Adults should be having less than 6g (1tsp) per day, half that for children 4-6 years old.  Reduce your family’s salt intake by using herbs and spices instead, and don’t add salt at the table or in your cooking.

Please share your tips and personal experience in ‘No Nut Nutrition’ below.

Biography

SIAN RILEYSian Riley is a registered Dietitian and a busy mum to 3 young children.

With particular interests in food intolerances, allergies and family nutrition, she has recently founded a business ‘The Internet Dietitian.com’ – providing ‘made to measure’ nutritional advice via e-mail consultations.

“Food to live, food for life”

Please have a look at her website for further information and blog posts.

www.theinternetdietitian.com

 

Internet Dietitian

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The resurgence of rickets has recently made news in the UK, with a six-year-old boy from Lutterworth, Leicestershire being diagnosed with the bone-softening condition after his mother (quite understandably, given today’s advice for parents on skin cancer prevention) applied SPF 50 sun tan lotion each time he played outside in the sun.

When we attended D’s 2 1/2 year check with the health visitor, I was advised to start giving both him and his little sister Vitamin D drops. Apparently, a Vitamin D supplement is now recommended, for the prevention of rickets, for all UK children (who aren’t on formula milk) living north of Birmingham. However, I was warned to discuss D’s peanut allergy with the pharmacist before purchasing, as some brands of vitamin drops contain peanut oil.

Several google searches and three chemists later, I began to wonder whether “Vitamin D drops” for children actually existed. So I instead decided to plump for a children’s multi-vitamin that contained the recommended amounts of Vitamin D.

The pharmacist advised me that Abidec Multivitamin drops were out, as they contain peanut oil. For more information, see the Netdoctor site, which states that:

“Abidec multivitamin drops [are] …. not to be used in … Children with an allergy to peanuts or soya (Abidec drops contain arachis oil).”

However, she recommended Wellkid Baby & Infant liquid as a safe alternative.

Update (5 July 2013)

Wellkid Baby & Infant Liquid

I decided to double check with Vitabiotics (who manufacture Wellkid Baby & Infant Liquid) whether the product was peanut-free. They confirmed that:

“Wellkid Baby & Infant Liquid is free from peanuts and other nut components. However, the product is produced at a site that may handle nut ingredients.”

Abidec Multivitamin Syrup

Following publication of this post, I am very grateful to a reader who contacted me in respect of Abidec Multivitamin SYRUP (as distinct from the multivitamin drops). Abidec’s website states that the syrup is for children aged 1-5, whereas the drops are for children aged birth-12.

She noted that although (as at 5 July 2013) the Boots website lists the syrup ingredients as:

“Purified water, glycerol, fish oil powder, sodium citrate, thickener: Xanthan gum, vitamin c (ascorbic acid), lemon flavouring, citric acid, sodium chloride, preservative: potassium sorbate, vitamin E (d alpha Tocopheryl acetate, sunflower seed oil), Niacin, Pathothenic Acid, vitamin B6, vitamin A (dl alpha tocopherol, vitamin A palmitate), Thiamin (Vitamin B1), vitamin D (dl alpha tocopherol, vitamin D, medium chain triglycerides).
Gluten, yeast & wheat free.”

The “precautions” section for the syrup also states “Contains peanuts”.

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As we approach the first anniversary of my toddler son’s anaphylactic reaction to a peanut cookie, I thought it would be a good time to take stock and think about all the things we’ve had to learn since his allergy diagnosis. If you are reading this as the parent of a young child recently diagnosed with a life threatening peanut or nut allergy, I hope you find this useful. Continue Reading

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Before my son’s anaphylactic reaction to peanuts, I knew that:

  • Some people are allergic to peanuts and nuts.
  • A thing called “anaphylactic shock” existed and that it was life threatening.
  • My son (D) had eczema.
  • D probably had asthma too.
  • I had mild asthma (although I no longer had an inhaler).
  • Things like asthma, eczema and hay fever are all linked.

What I hadn’t done was to join all the dots, to realise that D’s eczema and suspected asthma put him at higher risk of food allergies (and therefore at a higher risk of a life threatening allergic reaction to peanuts) Continue Reading