Foods to Avoid Down Syndrome (Advise from a Pediatrician) Your doctor may suggest eliminating certain foods from your pregnant woman’s diet. If your future mother is having a Down syndrome baby, your doctor may ask you to remove tuna and other fish rich in methylmercury from her menu. They also recommend avoiding organ meats, as well as herring, mackerel, shellfish, and eggs contaminated by the bacteria Salmonella.
Down syndrome is a genetic disorder which causes both intellectual and physical delays. In the last ten years, scientists have made huge breakthroughs in understanding what causes this disorder, its symptoms and its effects on chromosomes. A lot of credit goes to the thousands of studies that are being conducted every year to study Down syndrome and the proteins associated with it.
What is Down Syndrome?
Down Syndrome is a genetic disorder, the cause of which is not yet known. It is estimated that in Ireland approximately 1 in 546 children are born with Down Syndrome.
What Effect Does it Have?
The range of abilities of children and adults with Down Syndrome is very wide. It is difficult to predict at birth the degree of disability a child may have. With appropriate support and encouragement each person with Down Syndrome can reach their individual potential.
Children with Down Syndrome have a different growth pattern to that of the general population, their average height is shorter, their head circumference is smaller and their growth rate is slower between ages of 3 – 36 months.
It is essential that growth in children with Down Syndrome is carefully monitored. Height and weight should be plotted using the growth charts specifically designed for children with Down Syndrome from birth to 18 years.
Infants and children with Down Syndrome can have feeding and drinking difficulties. A smaller oral cavity and low muscle tone in the facial muscles can be contributing factors. In addition, the tongue may appear larger due to a high arched palate, a smaller oral cavity and reduced muscle tone in the tongue. Teeth tend to appear at a later stage. Many children are mouth breathers due to smaller nasal passages, and may have difficulties coordinating sucking, swallowing and breathing whilst feeding. All of these factors can impact on how a child develops efficient oral and feeding skills.
Mothers of infants with Down Syndrome may have no difficulty breast feeding, whereas other mothers may choose to bottle feed their child. Some infants have no difficulty with the introduction of solid foods and follow the normal weaning process successfully. Sometimes parents prefer to delay the weaning process, depending on their child’s feeding skills.
Infants who have increased oral sensitivity often have difficulty accepting new tastes and textures – intervention by a Speech and Language Therapist at an early stage will encourage oral motor and feeding skills. Some infants with Down Syndrome may require the support of a Paediatric Dietitian for feeding difficulties, poor weight gain, weaning advice, and oral sensitivity.
Excessive weight gain is a problem for many older children and adults with Down Syndrome. Adolescents with Down Syndrome do not have the same growth spurt as adolescents in the general population. Adolescents and adults with Down Syndrome tend to be shorter than their peers, and have a lower resting metabolic rate of 10-15% than the general population which further predisposes to weight gain.
It is common for someone with Down syndrome to be diagnosed with Type 1 Diabetes at a young age. Caretakers of people with Down syndrome should look for these symptoms of diabetes:
- Increased thirst
- Frequent urination
- Unexpected weight loss
- Fatigue or extreme tiredness
Type 1 diabetes is treated with diet and medication to get blood sugar to a normal level. Diabetes education classes are the best way to teach caregivers and people with Down syndrome about diabetes management.
People with Down syndrome are more likely to develop Celiac disease than the general population in the United States, with the incidence estimated at 7% to 16%. Celiac disease is an autoimmune disorder that is characterized by sensitivity to gluten which is found in wheat, barley, and rye. When a person with celiac disease ingests gluten, an immune response is triggered that that damages the lining of the small intestines. Treatment for celiac disease is a lifelong, gluten-free diet.
People with Down syndrome are at an increased risk of constipation due to low muscle tone and a sedentary lifestyle. Below are ways to prevent or treat constipation.
- Drink fluids throughout the day, preferably water: 6-8 eight-ounce glasses per day
- Increase the amount of dietary fiber consumed each day. Be sure to drink extra water when eating more food with dietary fiber. Examples include:
- raw fruits and vegetables. Leave skin on as it is a great source of fiber.
- dried fruits such as raisins, prunes, and figs.
- high fiber grains/cereal products: bran, whole-wheat flour, whole cornmeal, wheat bran cereals (All Bran, Bran Buds, Bran Chex), bran flakes (Raisin Bran), Grape-Nuts, Shredded Wheat, Fiber One.
- Eat small frequent meals during the day.
- If the problem persists, consult with the registered dietitian nutritionist or physician about taking a fiber supplement such as Miralax or Benefiber.
Studies have shown that 13-55 percent of people with Down syndrome will develop thyroid issues at some point in their life. They may be at higher risk for being diagnosed with Hashimoto’s Thyroiditis, usually causing hypothyroidism, Graves’ Disease, usually causing hyperthyroidism, or Thyroid dysgenesis, which is hypothyroidism found at birth. Symptoms of a thyroid issue can be seen at birth or later in life. Signs of hyperthyroidism (an overactive thyroid) include changes in sleep habits, changes in energy, feeling hot, or unexpected weight loss. Signs of hypothyroidism (an underactive thyroid) are lack of energy, fatigue, feeling cold, or unexpected weight gain. Recognizing these symptoms may be difficult to identify, but especially difficult in a child with Down syndrome. Bring up any concerns with a physician. Treatment for these conditions is a spectrum. Many nutrients are needed in optimizing thyroid function, however, iodine, vitamin D, selenium, and B12 are among the most beneficial.
Gastroesophageal Reflux Disease (GERD)
GERD is a condition where stomach contents reflux back into the esophagus causing several uncomfortable symptoms including heartburn, sore throat, regurgitation, chest pain, and difficulty swallowing. GERD is a concern for children and adults with Down syndrome and can interfere with nutrient intake. The following suggestions may be helpful in minimizing GERD symptoms:
- Eat small, frequent meals
- Wait at least an hour after a meal to exercise
- Do not lie flat after a meal
- Drink before or after meals, not during
- Talk to your health provider about medication
- Avoid spicy foods, citrus, caffeine, chocolate, or dairy
- Losing weight
About 40-50 percent of babies born with Down syndrome have a heart defect. Depending on the severity of the defect, a newborn may require nutrition support or a feeding tube if surgery is required. Throughout childhood and into adulthood, it is important to maintain a heart healthy diet full of fruits, vegetables, fiber, and water while limiting processed foods, sweets, and sugary beverages. Adults with Down syndrome are at risk for developing cardiovascular disease that can be prevented with diet. Learn more about a heart healthy diet from the American Heart Association.
Finding an Optimum Diet for people with Down syndrome
When it comes to addressing diet, a one-size fits all approach is inadequate to address a complex condition like Down Syndrome because of the diversity of factors involved.
As a Naturopath, treating a person with Down Syndrome can feel like pulling apart the pieces of a puzzle and reorganising them in a pattern which is healthier for them. The puzzle is so complex that moving one piece won’t always be enough to balance them. The pieces have to be addressed and reorganised in relation to each other.
We have to look at health with a wide lens. Multiple factors affect us from within and without including our environment and its toxins, stress, infectious agents we are exposed to and underlying genetic susceptibility. Acting more powerfully than ever before, this combination of risk factors makes it vital we address all contributing factors to a health issue – we no longer have the luxury of limiting our treatment to a single factor.
Nutrigenomics: Treating the individual
“Nutrigenomics is a science focused on the interaction between nutrition and genes, especially with regard to prevention or treatment.”
Through this new science we can begin to understand the underlying expression of genes which are risk factors for conditions such as Down Syndrome.
The optimum dietary approach for a person with Down Syndrome includes a personalised program based on biochemical test results, and follow-up testing undertaken to assess biochemical status and to monitor progress. Simple solutions to dietary treatment are behind us.
A new vista to personalised medicine is now open through the ongoing research of the human genome. By treating each person as unique we can properly address the symptoms associated with Down Syndrome and other complex conditions.
Laying the right groundwork
It is essential to lay the right nutritional groundwork through diet, prior to introducing nutrients via supplements. The basic principle of Naturopathy is to give the body the right environment to support its innate intelligence to facilitate healing. Foundational to this is diet.
It is common sense that if a child follows a program perfectly while living in a toxic environment and eating junk food he isn’t going to progress as easily as if he were avoiding all harmful synthetic food additives and eating healthy whole foods like fruits and vegetables.
The baseline nutrition most of us get everyday comes from food, and for our children we want that food to be the highest quality. Lets consider the optimum environment and diet for sensitive children like those with Down Syndrome.
An Optimum Environment should include fresh, oxygen-rich air and exercise, natural products, air and water purifiers, toxin-free paint, steam cleaning, natural supplements, glass and stainless steel containers, natural cleaning and personal care products, and natural cosmetics.
An Optimum Diet should include pure water, an organic plant-based whole-food diet, moderate in protein, low in saturated fat and fructose, alkalising and toxin free. Foods should be rotated every four days to avoid intolerances.
Foods to eliminate
1. Synthetic food additives, sweeteners, pesticides, antibiotics and hormones should be significantly reduced or eliminated entirely, if possible.
2. Children with neurological conditions like Down Syndrome must eliminate excitotoxins – foods and substances which cause overstimulation of the nerves and nerve damage. The most common examples of excitotoxins are MSG and artificial sweeteners.
3. Specific natural substances found in certain foods tend to increase neurological inflammation and should be avoided or limited in the diet. Calcium intake should be limited to moderate amounts due to its inflammatory effect on the brain when combined with glutamate – an excitotoxin.
Some foods are problematic until the gut is in better balance. A leaky gut allows foods to pass into the blood stream, where they act as foreign substances and stimulate an allergic reaction (IgG). The most common allergens which should initially be avoided are dairy, gluten, chocolate and bananas. If you suspect your child has multiple allergies to foods you could try an Elimination Diet or get an IgG Food Sensitivity Profile done. As your child’s gut health improves, these foods cease to be a problem. You can track improvement via an Intestinal Permeability Test. When sensitivity testing reveals a positive IgE reaction this indicates a true food allergy and these foods must be avoided.
Optimising digestive and immune function will decrease some food allergies. Some will remain, requiring you to move forward avoiding specific foods and ingredients. Always be cautious. If you are concerned about your child’s reaction to a food, simply avoid it.
Balancing GABA and Glutamate
Children with Down Syndrome are born with an excess of the inhibitory neurotransmitter GABA. However they also experience a high rate of Oxidative Stress that damages neurones and exposes them to the harmful effects of excess Glutamate, released from damaged neurones. Optimising the health of neurones in Down Syndrome means moderating the effects of excess glutamate.
The following neurotransmitters are pulled into the cells by glutamate and should be avoided if Glutamate levels are high:
Aspartate, Aspartame, Aspartic acid, Glutamate. Glutamic acid, Glutamine, Monosodium glutamate (MSG), Cysteine, Homocysteine.
Research shows that excess Glutamate can elevate eosinophils causing an inflammatory reaction, increase or cause irregularities in blood pressure and affect areas of the brain involved in speech and language.
A Urinary Amino Acids Test can identify elevated levels of glutamate, glutamine, glutamic acid, aspartate and/OR aspartic acid.
Child with Down syndrome are born with triplicated CBS (Cystathionine Beta Synthase) activity and it is important to limit their intake of sulphur-containing foods. Depending on the severity of the CBS over-expression, excess sulphur can trigger chronic stress.
Normally, sulphur is bound to amino acids (such as homocysteine, methionine, SAMe, SAH, or cysteine), and can’t create systemic havoc. However, with increased CBS activity, sulphur groups are instead released into the system as toxic sulphites.
If your child has CBS upregulations, avoid foods and nutrients with high sulfur content: Broccoli, Brussel Sprouts, Cabbage, Eggs, Epsom Salt Baths, Garlic, Glucosamine sulfate, Milk thistle, Nuts, Onions, Radish.
A Urinary Amino Acids Test can identify an over expressed CBS enzyme via elevations of Taurine, Ammonia, Citrulline, Methionine, Phenylalanine.
Healthy Eating Tips for Children with Down Syndrome
Obesity in children and adolescents is a growing health crisis. More than 15 percent of American children are overweight, which puts them at risk for numerous health problems.
Children with Down syndrome are no exception. In fact, they are even more likely to be overweight than their peers without Down syndrome. Research has shown that as many as 50 percent of children with Down syndrome between the ages of 1 month and 18 years are overweight. While the exact reason for this is unknown, there are a variety of contributing factors, including:
- Lower basal metabolic rate. Studies have shown that people with Down syndrome burn fewer calories while resting than individuals without Down syndrome.
- Hypothyroidism. Individuals with Down syndrome have a higher likelihood of having thyroid disorders that can cause weight gain.
- Hypotonia (poor muscle tone) and heart defects. These may cause a delay in achievement of motor milestones and limited physical activity. Later there may be medically imposed limitations on sports activities or organized play, which reduces opportunities to burn calories.
- Short stature. Children with Down syndrome are shorter in stature than their peers without Down syndrome, and because of this they need less food intake. Consumption of even a small amount of excess calories can result in weight gain.
Ironically, many children with Down syndrome have difficulty putting on weight as infants. Problems with sucking and swallowing related to hypotonia or weakness due to heart problems often reduce food intake. Later, tongue thrust problems and delay in tooth eruption may slow the progression of diet from milk to solid foods.
While it’s not inevitable that children with Down syndrome will become obese, learning the proper prevention skills may pose a challenge for parents who spent months trying to help their child gain weight, says Catherine Conway, MS, RD, CDN, CDE, chief of nutritional services at YAI/National Institute for People with Disabilities in New York. It’s also a challenge for the child who must be careful about food selections. “In the world we’re in, they want to eat like everyone else,” Conway says.
What can you do to help your child with Down syndrome maintain a healthy weight? Here are some ideas:
Young children can learn good eating habits when they’re served a variety of healthy foods at each meal and at snack time. Be sure to include these important basics in your child’s diet: lean meats or meat substitutes such as tofu or peanut butter, fruits and vegetables in a variety of colors, whole grain breads, cereals and pastas and milk or milk products such as yogurt and cheese. Children with Down syndrome, like all children, will choose the appropriate amounts and types of food throughout the day if they are given good selections. To offset any lack in vitamins and minerals, most health experts suggest a daily multivitamin.
Involve your child in meal planning and preparation, advises Conway. Children who help with their own meals and snacks not only learn about healthy foods but also have an opportunity to practice fine motor skills, color recognition and counting. Even very young children can help stir the muffin batter or pick up vegetables to top a salad.
Don’t underestimate the value of a family meal, either, says Joan Medlen, RD, LD, who has a private practice in Oregon and is the mother of a child with Down syndrome. “The family meal is a tremendous teaching time,” Medlen says. “It’s a time to come together around a well-planned meal [and] to learn about food.”
Your own eating habits are important, too; parents are essential models of good eating behaviors. Even if you love potato chips and soda, keep these things out of the house. Limit high calorie, less nutritious foods such as cakes, pies and candy to special occasions. If you want to serve dessert, serve something nutritious, yet appealing to children. “Make pretty fruit cups,” suggests Conway.
Rather than limiting food intake, which may cause a nutritional deficiency in children under age 18, children with Down syndrome can maintain a healthy weight by increasing their physical activity, says Medlen. This can involve small, simple daily changes such as having your child walk with you to a nearby destination, rather than riding in the car, or taking the stairs rather than the elevator. Try to find and plan family activities that involve movement, such as biking, hiking or playing tag or catch.
Weight Management for Adults with Down Syndrome
Individuals with Down syndrome have a higher likelihood of being obese than their typically developing peers. Sometimes it is the result of hypothyroidism, a condition in which the thyroid doesn’t produce enough of certain hormones. If there are new symptoms of hypothyroidism, such as increased sleepiness, confusion, or mood changes, the individual’s primary care doctor should consider ordering a blood test to check thyroid function. It has also been suggested that people with Down syndrome may have a lower level of metabolism, i.e., their bodies may burn fewer calories and store more.
More generally, though, weight management issues in individuals with Down syndrome are often due to the intake of too many calories in relation to the level of physical activity. Strategies for treating and preventing obesity involve:
- Eating smaller portion sizes
- Using healthy ingredients that increase bulk (like fiber, fruits, and vegetables)
- Increasing water intake
- Eating fewer snacks between meals
- Empowering adults to monitor their own weight
- Involving supervisors at work and school on the treatment plan
- Preparing meals at home
- Not using food as a reward
- Introducing a daily exercise routine that is appropriate to the person’s interests and skills.