Part I: Milk, Eggs, Fish, and Shellfish

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FOMO, or the fear of missing out, is a source of anxiety for many. For some, it means missing out on social engagements with friends. For others (likely many of our Allergy Amulet followers), it means missing out on certain foods. If you’re in the latter category, this post is for you.

There are many reasons people avoid certain foods: elimination diets, food allergies, or food intolerances, to name a few. In these cases, you’re not only removing the food from your diet, you’re also removing important nutrients (especially if we are talking about growing children!). As a pediatric dietitian, my job is to identify the foods that need to be eliminated, and then figure out how to ensure those lost nutrients remain in my client's diet.

This two-part series will focus on the nutrient implications of eliminating one or more of the top eight most common food allergens from your diet. Whether because of a food allergy or intolerance, or for diet or religious reasons, we’ve got you covered. This first part will focus on milk, eggs, fish, and shellfish. Next month, we’ll cover wheat, soy, peanuts, and tree nuts. Let’s get started.

Personally, I find it helpful to first look at each food and its corresponding nutrients side by side. This approach can make it less intimidating to then find other food sources for those lost nutrients.

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As you can see, some of the foods listed above have overlapping nutrients, vitamins, and minerals. For example, if you are eliminating eggs from your diet, you can find substitutes for protein and vitamin B12 in fish and shellfish.

Where can you find these nutrients and how do they affect your health? Let’s take a closer look.

Protein: Is my child getting enough protein? This question comes up frequently in my practice. First, it’s important to keep in mind that the majority of Americans eat plenty of protein! To see how much daily protein you should be consuming, these Dietary Reference Intake standards provide helpful guidelines. On average, a child should consume approximately .8 - 1.2 gram/kg of protein per day, depending on their age. For example, a 4-year-old child who weighs 35 pounds would need about 16 grams of protein per day. For perspective, a glass of soy milk at breakfast and a turkey sandwich at lunch would be about 24 grams.  

Of course, protein doesn’t just come from animals. There are many plant-based sources that can help you meet your daily protein needs. Most non-dairy milks and yogurts are rich in plant-based protein, for example, as well as beans, legumes, seeds, and nuts.

Has anyone noticed the ever-growing number of milk substitutes hitting grocery aisles? I certainly have! If you’re wondering which one might be best for you, the below table shows common milk substitutes and their approximate nutritional values.

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Calcium: Most parents worry about protein, but I find I’m more focused on calcium intake - especially for those that don’t eat dairy! Calcium is important because it helps maintain the strength of our bones and teeth. It also supports our body structure and helps our muscles, heart, and nervous system function properly. Calcium can be found in vegetables like bok choy, broccoli, Chinese cabbage and collards, beans (black, garbanzo, pinto), and almonds. Several milk substitutes and some orange juices and cereals are also fortified with calcium. Calcium needs range from 700mg - 1300mg/day, depending on a person’s age.

Vitamin D: Vitamin D also plays a role in bone health and the absorption of calcium. Your vitamin D intake depends mostly on sunlight exposure. That said, if you’re not getting much sunlight (read: grey winter weather), it helps to supplement your diet with this important nutrient. You may also routinely have your blood checked to determine whether you’re deficient in this vitamin, as you may need more than the recommended daily dose. If you can’t eat dairy or eggs (a major source of vitamin D), you should look to foods enriched with vitamin D as substitutes.

B Vitamins (B12, B2/Riboflavin, and B5/Pantothenic acid): B vitamins are important multitaskers. They are involved in everything from cognitive function and mood, to energy production and heart health.

B12: The best sources of vitamin B12 are eggs, milk, meat, fish, and poultry. I most often worry about B12 intake in my patients that are vegetarian or vegan. If you fall in either of those camps, plant-based milk substitutes and fortified beverages are great ways to help you meet your daily B12 needs while avoiding animal products.

B2/Riboflavin: Foods high in riboflavin include eggs, dairy, lean meats, green vegetables, and fortified grains (think cereals and breads).

B5/Pantothenic acid: Vitamin B5 (pantothenic acid in scientific terms) plays an important role in turning carbohydrates, fats, and proteins into energy. It removes strain, or stress on the body. Good sources of B5 include mushrooms, cheese, fish, avocados, eggs, lean meats, sunflower seeds, and sweet potatoes.

Expert tip: focus on the foods that you CAN eat. If certain foods are off limits, create a list of the foods you can safely eat, and separate them into different categories (see below).

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Ultimately, the more variety in your diet, the more likely you are to meet your nutritional needs. Plus, it makes eating that much more interesting! Nobody should have FOMO when it comes to food—even if cutting out certain foods is a necessary part of your diet. The solution, in my opinion, is expanding your palate.

 

Tara McCarthy is a Registered Dietitian Nutritionist who has a passion for pediatrics. She has worked at Boston Children’s Hospital for over 15 years as well as a private practice, and specializes in nutrition for children with special dietary needs such as food allergies, celiac disease, FPIES, EoE, allergic colitis, and sucrose isomaltose deficiency. 

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