CHAPTER 3
Beginning Your Journey:
What to Leave Behind and What to Take with You
“The doctor of the future will give no medicine, but will interest … patients in the care of the human frame, in diet, and in the cause and prevention of disease.”
—Thomas Edison
THE HEALTHFUL RECOMMENDATIONS IN THIS CHAPTER apply to all individuals and particularly to those with ADHD, autism, and similar disorders. This is the core diet for those with ADHD or autism.
Beyond the challenges of developmental delays and disorders of sensory, language, processing, and motor functions, many children with ADHD, and more so autism, have additional burdens to their already overchallenged systems. Environmental deterioration exposes them to indoor and outdoor manufactured, nutrient-depleting chemicals; pesticides; and toxic metals; in addition to inhalant allergens and rapidly expanding electromagnetic fields and radiofrequency radiation. Through food, children take in a wide range of artificial additives, endure food reactions and frequent infections, and have restricted appetites and poor nutrition. For children who are biochemically less resilient, any one of these issues may be tolerated, however the total load and complexity have become overwhelming.
Any effort to reduce the burden on children’s systems can help them improve. Any positive change is helpful. A healthier environment and diet along with optimum nutritional status are cornerstones, not options. This holds true for all adults and children, especially those with ADHD and autism.
Environmental Considerations: Outdoors and Indoors
In the last 100 to 200 years, we have created and allowed an exponentially increasing number of manufactured chemicals into our indoor and outdoor environments and the addition of artificial additives and contaminants into the food supply. Regulation by the 1976 Toxic Substances Control Act (TSCA) has been disastrous for the environment. Currently, there are more than 90,000 manufactured chemicals, 62,000 of which were grandfathered in without testing. There are 700 new chemicals per year and testing is voluntary. If tested, the results must still be revealed. Over 16,000 are permitted to be kept secret from the public. The EPA acknowledges that only 200 manufactured chemicals have been tested for safety. The bottom line is that for more than 99% of environmental chemicals, there is a scarcity of research, woefully inadequate testing, and lenient, inadequate regulations. Grassroots efforts to improve this act continue.
As of June 2016, the TSCA has been amended to mandate EPA evaluation of existing chemicals and increase public transparency. As of 2019, there are EPA strategies to prevent pollution, and there is greater transparency in tracking active new chemical cases.
Indoor pollution sources that release gases or particles into the air are the primary cause of indoor air quality problems. Inadequate ventilation can increase indoor pollutant levels by not bringing in enough outdoor air to dilute emissions from indoor sources and by not carrying indoor air pollutants out of the area.
Note that when these manufactured chemicals, toxicants, and naturally occurring toxins (such as lead, arsenic, cadmium, mercury, and aluminum) come into our bodies, the impact can be devastating.
TOXINS ARE NUTRIENT ANTAGONISTS AND DEPLETE HEALTHY NUTRIENTS, which are “spent” trying to rid the body of these culprits. For those with autism and, to a lesser degree, those with ADHD, it is not uncommon to find defects in glutathione and other detoxification “disposal” systems. The challenges are far beyond the diet’s ability to compensate.
Even if some of the 90,000 manufactured chemicals are banned, and there is a reversal of the TSCA section that permits 16,000 to be kept secret, we will not eliminate those already present long-term in our environment and deep within our bodies. We will pass them on to the next generations.
How Problematic Is the Environmental Toxic Load?
Beyond exposure to natural toxins, the toxic load now includes manufactured chemical components in plastics, pesticides, fire retardants, nonstick cookware, herbicides, artificial turf, building products, cosmetics, personal care products, household cleaning agents, disinfectants, air fresheners, fabric softeners, dental implants and restorative materials, and more.
They can cause behavioral, cognitive, and learning problems and respiratory conditions, and also increase cancer risk, immune dysfunction, and, as endocrine disrupters, they negatively affect hormone metabolism, reproduction, and fetal development. In the cord blood of newborn babies, there are more than 200 industrial pollutants, some of which are known carcinogens and endocrine disrupting hormonal agents. This has been termed “born pre-polluted.”
Important and increasing is our exposure to electromagnetic fields (EMFs) and radiofrequency radiation (RFRs) from our technological devices, appliances, and meters, which are now ubiquitous in our indoor and outdoor environments. The deleterious effects on the nervous system are well known. There is increasing concern about the safety of these lifetime exposures and the lack of regulations regarding human exposures.
The evidence of harm is already known; action is what is needed.
Excellent Nutrition Is Not Optional … It Is Vital
In the 1960s, nutritionist Adelle Davis wisely said “you are what you eat.” We have modified that to “you are what you eat, digest, absorb, transport, uptake, and utilize based upon your healthy or unhealthy exposures and your own unique genes and biochemistry.”
To have excellent nutrition, it’s important to understand what nutrition is. Your diet is what you eat. Nutrition is what the cells derive from what you eat. When you consume poor-quality food, your nutritional status will be poor. However, a healthy diet may still result in poor nutrition if there are problems in one or more of the following: food digestion, nutrient absorption, transportation to the tissues, uptake and utilization of nutrients by the tissues as impacted by helpful nutrients, and/or interfering substances, such as environmental and dietary toxins, herbs, and medications (e.g., antacids, diuretics).
In the past 100 to 150 years and with the evolution of the “modern” diet, healthy fats were replaced with damaging commercially hydrogenated fats (trans-fatty acids) and artificial fats (Olestra). Meanwhile, genetically modified foods, imitation foods, refined foods, and copious amounts of artificial additives, sweeteners, coloring, flavoring, preservatives, and sugars have become part of the modern diet. In addition to chemicals in cookware, many food containers have harmful chemicals that can seep into the food. There are more than 3,000 FDA additives included in food in the US, which includes the GRAS (Generally Recognized As Safe) list. Our advice: go organic.
Health Enemies: Leave These Behind
1. SAY NO TO NATURAL TOXINS AND ARTIFICIAL INGREDIENTS, INCLUDING ARTIFICIAL FOOD ADDITIVES, PRESERVATIVES, SWEETENERS, TASTE ENHANCERS, ARTIFICIAL FLAVORING AND COLORING AGENTS, EXCITOTOXINS, GMO FOODS, TRANS-FATTY ACIDS, AND COMMERCIALLY PROCESSED FOODS.
The FDA oversight and regulation of food additives, which are so abundant in non-organic, processed foods, is not consistent with the increasing scientific findings about the detrimental health impact of singular and combined chemical additives in our foods. Even if a single additive has a mild negative effect, there are combinations of mild-effect additives that can have potent synergistic negative effects. When consuming many processed foods, consumers have no way of knowing what those combinations do to their immunity, brain health, neurological system, hormonal functions, and more.
The Environmental Working Group (ewg.org) provides information important to consumers with regard to scientific concerns on the safety of already approved and new food additives. Use EWG’s Food Scores to find foods without the problematic additives. See the following for more information:
EWG’s Food Scores at www.ewg.org/foodscores/
EWG’s Dirty Dozen Guide to Food Additives at www.ewg.org/research/ewg-s-dirty-dozen-guide-food-additives
Generally Recognized as Safe?
The FDA classifies approximately 3,000 additives as Generally Recognized as Safe (GRAS), though studies can indicate otherwise. Beyond this are more questionable GRAS additives that come into contact with food through food containers and packaging. For new ingredients, the law recommends safety evaluation through the FDA approval process. In 1997, the FDA established a voluntary system for manufacturers, which allows them to establish their own GRAS determination, sharing the information with the FDA. Because it is voluntary, many additives are being used in foods and are not known to the FDA.
The Following GRAS Items Are of Significant Health Concern:
Genetically modified organisms (GMOs) are living organisms whose genetic material has been artificially manipulated in a laboratory through genetic engineering creating combinations of plant, animal, bacteria, and virus genes that do not occur in nature or through traditional crossbreeding methods. More than 80% of all GMO crops worldwide have been engineered for herbicide tolerance (pesticide “ready”). GMO crops have caused the emergence of “super weeds” and “superbugs” that can only be killed with evermore toxic poisons. According to animal studies and human observation, GMO exposures can have a negative effect on digestion, immunity, food tolerances, reproduction, and development. They do not increase crop yield and can cross-pollinate in crops, contaminating them long-term, harming the land and sea ecosystems. When the US failed to require GMO labeling, the Non-GMO project was created to give consumers the informed choices they deserve. See the following for more information:
EWG’s 2014 Shopper’s Guide to Avoiding GMO Food at www.ewg.org/shoppers-guide-to-avoiding-gmos
The Non-GMO Project at www.nongmoproject.org
The following are examples of more of the GRAS items that are of significant health concern based on current scientific data: aluminum (a known neurotoxin); artificial colors (behavioral and attention problems); artificial sweeteners (weight gain and diabetes risk); Bisphenol A/BPA (hormonal effects); BHA and BHT (potential carcinogens); nitrates and nitrites (cancer causing); natural flavors (permitted to contain numerous synthetic chemicals); GMO foods (endocrine disruption, herbicide tolerance, and immune dysregulation); sulfites (allergenic); animal growth promoting hormones, antibiotics, and steroids; and “excitotoxins” including MSG (monosodium glutamate), which causes problems in development, behavior and neurological function.
Abundant in processed foods, there are more than 70 types of dietary excitotoxin sources which include artificial additives, preservatives, artificial sweeteners, taste enhancers, and artificial flavoring and coloring agents. Glutamate (and glutamic acid), especially MSG, are the most notable excitotoxins; however, there are others such as aspartame, aspartate, cysteine, and casein. They are able to cross the blood-brain barrier and affect brain function by overstimulating the natural body neurotransmitter known as glutamate, which is balanced by the naturally occurring, calming neurotransmitter, GABA (gamma–aminobutyric acid). Glutamate and GABA occupy the two ends of a teeter-totter that is thrown out of balance by excessive glutamate overexciting the neurons, thereby reducing the calming neurotransmitter, GABA.
2. SAY NO TO DRINKING WATER CONTAMINANTS.
The contamination of tap water is a concern in almost every community. Most of the problems are from pesticides, manufactured environmental chemicals, and toxic metals.
CONTAMINANTS that increase risks for cancer, fetal development, and cognition problems include: solvents, arsenic, herbicides, chromium-6 (not nutritional chromium), copper from copper plumbing, lead, manganese (excessive), nitrates (fertilizer), nitrosamines from the use of chloramine disinfectants, perchlorate, and radiological contaminants that leach into water from minerals and mining.
The EPA reports that more than 1,000 communities have water tainted with lead, which impairs cognition in children and increases cardiovascular risk in adults.
SULFURYL FLUORIDE (pesticide) increases fluoride exposure exponentially, adding significantly to total fluoride exposure.
DISINFECTION BYPRODUCTS (DBPS). There are more than 600 byproducts in chlorinated drinking water, the main groups of which are potentially harmful to fetal development and can increase cancer risk: trihalomethanes (THMs), haloacetic acids (HAAs), chlorate, and bromate. For more information, read www.ewg.org/tapwater/reviewed-disinfection-byproducts.php#
FLUORIDE has been added to public water supplies in order to reduce dental decay. The CDC, National Research Council of the National Academy of Medicine (formerly the Institute of Medicine), the American Public Health Association, and the US Department of Health and Human Services have been concerned about the lack of safety testing of SILICOFLUORIDE (SIF) used in 92% of the public water supplies. Fluoride has been identified as a chemical of significant concern with regard to health issues, including recent research (2019, JAMA Pediatrics) validating previous findings that higher water fluoride levels correspond to lower IQ scores, most strongly in boys. The US Department of Health and Human Services already proposed lowering fluoride in public water supplies. This has been accomplished in many communities attempting to reduce harm from excess fluoride exposure.
There are a variety of filter options that vary significantly in terms of cost. For more information, check with the Environmental Working Group’s Tap Water Database: www.ewg.org/tapwater
3. SAY NO TO SUGARS AND SUGAR-RAISING FOODS.
Understanding the Glycemic Impact on ADHD and Autism
Glycemic means “sugar raising.” The glycemic index (GI) is a measure of how a food triggers a rise in blood glucose. The range is zero (fats, oils, cheese, and seafood) to 100 (glucose). Glycemic foods include all sugars, caffeine, refined carbohydrates (including breads, pasta, crackers, pretzels, bagels, and white rice), sweets, caffeine, sodas (diet and regular), fruit juices, juice drinks, dried fruits, potatoes, and corn.
When a glycemic food is consumed alone, the sugar enters the bloodstream quickly, raising blood glucose. The more of the glycemic food consumed, the higher and faster the glucose rises. This triggers an excess release of insulin, which drives the glucose into the cells and converts some of it to fat (triglycerides, which store as “belly fat”). Also, as the glucose drops, there is “brain fog,” irritability, hunger headaches, visual disturbances, fatigue, muscle weakness, and/or cravings for a “quick fix”—more of the sugar sources.
Most children with ADHD or autism eat sugar-raising, low-protein, and low-fiber diets. They crave “white foods,” refined grains and processed carbohydrates—pasta, breads, crackers, pretzels, bagels, and sugars. They also crave sugary sweets, sodas, and juices. Besides wearing out the body’s ability to handle sugar and setting up children for early diabetes, glycemic foods have a serious negative effect on mood stability, focus, and attention. Because children with ADHD or autism already suffer from these problems, it is important to not reward good behavior and attention with sugar treats and candies. Many parents describe “hangry” (a combination of hungry and angry) behaviors in their children from the blood glucose drop after a high glycemic meal or snack or when not eating sufficient protein, good fats, and fiber to keep blood sugar regulated between meals.
The key is to slow down the entry and quick rise of glucose by including healthy fats, proteins (nuts, seeds, beans, meats, poultry, seafood, tolerated milk products), and fiber (vegetables, beans/legumes, nuts, seeds, limited grains, and some fruits). These choices will blunt the glucose-raising effect of food that is more glycemic. When hungry, there is a tendency to consume more of the first food served. Avoid serving breads or any glycemic food first. Instead, serve the healthy, low glycemic foods first.
HIGH FRUCTOSE CORN SYRUP (HFCS), manufactured primarily from genetically modified corn, has replaced sugar in most processed foods and drinks. It is high in fructose (42 to 50%). It has double the sucrose (sugar) effect and increases weight gain, diabetes risk, triglyceride, LDL, high blood pressure, and risk for kidney damage. The high content of fructose can increase pancreatic cancer risk. Reports indicate the presence of mercury in 50% of the HFCS.
SUGAR BLUES: white table sugar (cane sugar), sugar in the raw, brown sugar, and corn syrupIn 1820, in the US, sugar consumption was less than 10 pounds (4.5 kg) per year per person. By 1900, it was 50 pounds (23 kg) per year. In 2000, it was 100 pounds (45.5 kg) per year. Currently, the average US sugar consumption is 130 to 170 pounds (59 to 77 kg) per year. Sugar increases blood glucose, which increases risk for diabetes, which has increased 90% in the last decade. For more information, see Sugar Consumption in the US Diet between 1822 and 2005: http://onlinestatbook.com/2/case_studies/sugar.html
AGAVE SYRUP is high in fructose, which increases diabetes risk more than pure glucose and also increases nonalcoholic fatty acid liver disease.
SUGAR DRINKS AND JUNK ELECTROLYTE DRINKS: Juice drinks are juices with sugar and/or HFCS added. These are highly glycemic and must be avoided. The most popular electrolyte drink is primarily sugar in various forms with artificial coloring. For a better electrolyte drink, consider organic coconut water plain or with some organic fruit juice added. Organic vegetable juices are nutrient dense. Drink water and organic vegetable juice.
SODAS (DIET AND REGULAR): Sodas, both diet and regular, are a problem, and not just because they take the place of drinking more water and nutritional beverages. They provide a combination of artificial coloring and flavoring in addition to artificial sweeteners. They are high in phosphorus, a nutrient abundant in any diet. Excess phosphorus via sodas can bind with minerals, making them unavailable for use by the body. Phosphorus depletes calcium, magnesium, zinc, and vitamins C and B. Sodas are the opposite of electrolyte drinks; they are electrolyte thieves. They take nutrients out of the nutrient stores. The body cannot easily compensate for the depletion.
Both diet and regular sodas significantly increase risk for obesity, diabetes, and metabolic syndrome, and confer a 48% increased risk for cardiovascular disease including strokes. Diet sodas are worse because they contain artificial sweeteners. Human and animal studies have demonstrated that artificial sweeteners slow metabolism down and impair regulation of calorie intake—leading to overeating and the long-term health consequences of overeating. All sodas and artificial sweeteners must be avoided.
Children with ADHD or autism characteristically have low levels of minerals and vitamins. Especially in autism, the nutrient deficiencies are significant, and the nutrient needs are well above what is standard due to metabolic inefficiencies. What these children do not need is a drink that deprives them further and increases their risk for mood swings, diabetes, obesity, and behavior problems.
REFINED GRAINS: Because a product says “whole grain” does not mean that it is nutrient-dense and fiber-rich. All grain products come from “whole grains,” including refined white breads, so don’t be fooled. Grains that are less glycemic include barley, bulgur, and rye (if gluten is tolerated), gluten-free oats (steel cut), oat bran, wild rice, and pseudo-grains such as quinoa, buckwheat, and amaranth. The more refined the grain, the higher the glycemic (sugar-raising) effect. This includes bagels, white breads, pretzels, pizza dough, and brown and white rice.
Unless a bread is high in fiber or includes nuts and vegetables, the glycemic effect can be almost as high as that of sugar. Almost all cold cereals are glycemic; we like to think of them as “desserts,” and not necessarily healthy. So just as you would not start dinner with dessert, we suggest starting breakfast with good protein, healthy fat, and good fiber. If transitioning from a typical high sugar, non-organic cold cereal to a healthier version, after the healthier foods are consumed, offer a small serving of the organic, low glycemic cold cereal. This will blunt the blood sugar raising effect of the glycemic cereal alone.
CAFFEINE: The quick wake-up jolt from caffeine (no matter the source) is ultimately glycemic. Caffeine stimulates the adrenals to put out adrenaline, the hormone responsible for the “fight or flight” response that occurs under stress and dangers. Adrenaline directs the liver to break down glycogen and release glucose into the bloodstream, which initiates the glycemic response. Children with ADHD or autism are more sensitive to the effects of caffeine and more at risk for excitability and anxiety.
4. SAY NO TO PROBLEM FATS.
PARTIALLY HYDROGENATED OILS/TRANS-FATTY ACIDS: When healthy oils are hydrogenated to become unhealthy mutant, plastic, saturated fatty acids, it is analogous to good Dr. Jekyll becoming evil Mr. Hyde. Hydrogenation is the industrial processing of vegetable oils (corn, sunflower, safflower, canola, peanut, cottonseed, or soy) to form unhealthy, highly saturated, trans-fatty acids. The process involves bubbling hydrogen through the oil at high temperatures using toxic metal catalysts such as nickel and cadmium. Partially hydrogenated oils (PHOs) contain the unnatural, harmful “trans-fatty acids,” which are far worse than any naturally occurring saturated fatty acid. In fact, trans-fatty acids from commercial hydrogenation do not occur in nature at all and do not belong in the human body.
Commercial trans-fatty acids from commercial hydrogenation are found in numerous processed foods. They are nutritionally inferior, have absolutely no health benefit, and are severely detrimental to health in ways that affect all people. They are antagonists to omega-3 fatty acids.
So how bad can trans-fatty acids be, and why are they important when it comes to children with ADHD or autism? In the body, trans-fatty acids look like and take the place of the natural and essential fatty acids within the cell membrane. They are similar to a key that looks like your door key, fits in the lock, and becomes stuck, blocking the right key from fitting in. Trans-fatty acids become part of the cell membranes, hardening them. This interferes with the ability to transport nutrients into the cell and remove metabolic waste (garbage) from the cells. Mitochondrial function is impeded, resulting in increased cell death in hippocampus brain cells. Children with ADHD or autism already have problems with cell function and toxic accumulation without adding trans-fatty acids from partially hydrogenated oils to the diet.
Trans-fatty acids interfere with cell function, reproduction (male and female), fetal development, brain structure and development, breast milk quality, immunity, and metabolic enzymes. They increase the risk for poor-quality lipids, diabetes, obesity, inflammation, immune disorders, cancers, and autism.
Studies in pregnant women indicate increased risk for autism in children whose mothers consumed PHO trans-fatty acids. Trans-fatty acid levels in the cord blood matched serum levels in the mothers. Breast-fed infants’ intake of trans-fatty acids is directly affected by the mother’s dietary intake of trans-fatty acids. Based on the importance of omega-3 fatty acids in neural development, it is understandable that trans-fatty acid consumption could affect developmental issues including autism. When it comes to spreads, butter is better, but not for those with casein/milk problems. The alternative is ghee, which is clarified butter, also called drawn butter.
DEEP FAT FRIED FOODS are high in calories and lack nutrient density (empty calories). The most common oils for deep frying are canola, cottonseed, and soybean. The high temperature cooking increases the rancidity of the oil. Some of the oils contain a possible carcinogen, acrylamide, which is a byproduct of deep fat frying. Roasting and stir frying are healthier options.
CANOLA OIL: The canola plant was bred from the rapeseed plant, which has large amounts of erucic acid, known to contribute to health problems including cardiovascular diseases. In 1995, Monsanto produced a genetically modified version of canola (named for Canada—oil). Canola oil is partially hydrogenated, and currently over 90% of canola oil comes from genetically modified canola.
GMO SOY OIL AND CORN OIL, like canola oil, are not the best choices. More than 90% of soy crops and corn crops are genetically modified and engineered to survive being doused with large amounts of herbicides. If soy is the only option as a milk substitute, it must be 100% organic (USDA Organic).
PALM KERNEL OIL: Derived from the seed of the palm fruit, this oil is less beneficial and less nutritional as compared to the unrefined palm fruit oil (red palm oil).
5. SAY NO TO NON-ORGANIC DELI MEATS, PROCESSED FOODS, AND CONTAMINATED SEAFOOD.
NON-ORGANIC DELI MEATS are preserved with nitrites, which, in significant enough amounts, can deactivate hemoglobin, impeding the carrying of oxygen by red blood cells. Nitrites also can convert to nitrosamines, which are carcinogenic.
PROCESSED FOODS are calorie high, nutrient low, fiber low foods that increase blood glucose levels and the risk for obesity, diabetes, immune disorders, and developmental delays. They are usually high in artificial ingredients, preservatives, glutamates, and excitotoxins.
CONTAMINATED SEAFOOD: Seafood is abundant in healthy nutrients, especially protein, zinc, omega-3 fatty acids, and iodine. Seafood is generally much easier to digest than animal protein (meats, poultry). Some of the concerns lie in environmental issues, such as inadequate conservation efforts to avoid depletion of certain species of fish and the increasing contamination from industrial pollutants. The species most likely to have higher levels of toxins and pesticides include the large steak fish that feed on smaller fish and bottom-feeders. The toxins move up the food chain, becoming more concentrated and detrimental. Farming techniques contribute to the toxic content of farm-raised fish, depending on what they are fed. The location of the seafood determines the type and level of toxins present. Currently in the United States, there is no USDA organic certification for seafood or aquaculture production. Problems associated with contaminated seafood:
• Chemicals and contaminants: mercury, polychlorinated biphenyls (PCBs), chlordane, dioxins, DDT, cadmium
• Toxins are higher in the organs and fatty tissues (shellfish “mustard” or “tamale”).
• Government monitoring is poor. There is no USDA organic certification for seafood.
• The more contaminants, the higher the risk.
• Fetuses, young children, and those with immune problems are at increased risk for cancers, neurological problems, learning disorders, cognitive decline, and developmental delays.
SEAFOOD TO AVOID (The highest risk is during pregnancy and to fetuses, infants, children, and those with immune disorders.) |
|
Mercury (found in big, old fish) |
High in PCBs (polychlorinated biphenyls) |
Blue fish Halibut Kingfish Lobster Mackerel (King) Mahi Marlin Sea bass Shark Swordfish Tilefish Tuna (Bigeye) Tuna (canned light and albacore) |
Catfish Carp Lake trout Muskellunge Northern pike Shark Striped bass Walleyes |
Higher in Other Contaminants |
|
Carp Flounder Grouper Orange roughy Shellfish |
Farm-raised fish—raised in crowded pens Catfish with processed feed The mustard in blue crabs or tamale in lobsters Raw fish (sushi, sashimi)—risk of parasite exposure |
Resource for seafood safety: Calculate your safe intake of seafood using EWG’s Seafood Calculator https://www.ewg.org/research/ewg-s-consumer-guide-seafood/seafood-calculator# |
|
6. SAY NO TO ANY FOOD OR BEVERAGE THAT CAUSES A NEGATIVE REACTION.
Make certain the reaction is due to the food or beverage and not to artificial additives, preservatives, coloring, and flavoring. If a food or beverage causes a reaction (for example hyperactivity, aggression, or irritability), make sure that food is organic and does not have artificial additives before eliminating the food. For example, if your child is reacting to a fruit punch that has red dye, switch to an organic fruit juice that does not have additives and observe the reaction. If the reaction persists in an organic juice, then that fruit and its juice may be the problem.
We have described the negative effects from numerous single environmental and dietary culprits discussed in this chapter. As exposure to combinations of these culprits increases, the effects are not additive, they are compounded exponentially, and the consequences gravely endanger health at every stage from conception to death. All of these are considered health, neurological, and behavioral risk factors to humans, and especially to the more susceptible individuals with immune, metabolic, or developmental issues.
Many families observe significant improvements in behavior and learning by making adjustments to diet (including going organic), household environment, and toxic outdoor environmental exposures. If the total load of culprits remains in the diet and environment, success with an elimination diet or diets may be blunted. Having said this, we believe that any effort you make is a positive step.
Healthy Foods for Your Journey
The right diet depends upon genetics, family history, ethnicity, culture, age, gender, stage of life, health status, lifestyle, stress, food reactions, and food aversions. A healthy diet is an organic, nutrient-dense diet appropriate to the uniqueness of the individual’s digestion, biochemistry, and nutrient needs.
1. DON’T TRY TO FOOL MOTHER NATURE—GO ORGANIC.
This is not fluff or a trendy concept. The US Department of Agriculture (USDA) Organic seal is a certification that mandates specific standards. Organic foods may not be irradiated or produced with genetically modified organisms (GMOs). All organic farmers and processors are required to meet the standards of the USDA and the National Organic Standards Board (NOSB). Organic foods are grown without relying on synthetic chemical pesticides. Techniques must help protect the air, soil, water, and food supply from potentially toxic chemicals and other pollutants. Organic farming conserves natural resources by recycling natural materials, protecting ecosystems, and preventing contamination of crops, soil, and water by plant and animal pathogenic organisms, heavy metals, or toxic residues.
The definitions are strict and easy to understand:
100% ORGANIC: This means that 100% of all the ingredients are organic, and animals are fed 100% organic feed. Labeling may include the USDA ORGANIC SEAL and/or 100% ORGANIC claim. Labeling must identify organic ingredients.
Organic meat regulations require that animals are raised in living conditions accommodating their natural behaviors (e.g., pastured), fed 100% organic feed and forage, and not administered antibiotics or hormones.
ORGANIC: This means that 95% are organic ingredients, free of synthetic additives like pesticides, chemical fertilizers, and dyes, and must not be processed using industrial solvents, irradiation, or genetic engineering. The remaining 5% may only be foods with additives on an approved list. Labeling may include the USDA ORGANIC SEAL and/or ORGANIC claim. Labeling must identify organic ingredients.
MADE WITH ORGANIC: This means that the product does not qualify for the USDA Organic seal. It indicates that the product contains 70% or more organic ingredients, and the remaining 30% of the ingredients are produced without using prohibited practices (e.g., genetic engineering) but can include substances that would not otherwise be allowed in 100% organic products.
As a rule, we recommend using organic foods whenever possible, primarily because it avoids so many of the aggravating effects from artificial additives. Some children with ADHD and many children with autism already have inefficiencies in metabolizing and eliminating their own toxins, placing a burden on their systems. Ingesting harmful pesticides, additives, contaminants, and toxins can increase that burden. USDA organic products are therefore safer to consume. When buying organic produce is not possible, focus on the less contaminated “clean 15” foods and wash them thoroughly. (See here.)
2. BE IN CONTROL OF YOUR BLOOD SUGAR (GLUCOSE) LEVELS.
Guidelines for Maintaining a Stable Blood Sugar (Glucose):
Never consume a glycemic (sugar-raising) food on an empty stomach: sugars, sweets, sodas, caffeine, fruit juices, and refined grains (bread, pasta, crackers, pretzels, bagels, most cold cereals, and white rice).
Good protein, fats, and fiber help keep blood glucose stable. They also reduce the problems with glycemic foods.
The first food or beverage of the day sets the glucose standard for the day. It must be low in sugars and refined carbohydrates. This helps maintain healthy glucose levels throughout the day.
Consume healthy, organic sources appropriate to the diet:
• PROTEIN: seafood; pastured poultry, meat, and eggs; and legumes, beans, nuts and seeds If tolerated/allowed: pastured source organic cheese, Greek yogurt, and cottage cheese (included in some elimination diets)
• FATS AND OILS: coconut, butter, lard, seafood, fish oils, algae, and oils of olives, almonds, avocados, pumpkin seeds, walnuts, macadamias, flaxseeds, perilla, peanuts, and vegetable oils
• FIBER FOODS: beans, nuts, seeds, grains, non-starchy vegetables, and low glycemic fruits (cherries, grapefruit, prunes, apples, pears, strawberries, and peaches)
• NATURAL SWEETENER OPTIONS (USE SPARINGLY): organic stevia, coconut sugar, raw honey, maple syrup (grade B), blackstrap molasses, banana purée, real fruit jam/spread, and Sucanat
3. JACK SPRAT WAS WRONG: GOOD FATS TO THE RESCUE.
A common diet myth is that animal fats are all saturated and vegetable fats are all unsaturated. Dietary fats and oils are combinations of saturated and unsaturated fatty acids, both of which occur naturally in animal and plant sources. Cholesterol is found only in animal food sources. Fat is important in energy production, providing part of the structure of the cell membranes; absorption and carrier of fat soluble vitamins A, D, E, and K; and functioning as a precursor source to the essential omega-6 (linoleic acid LA) and omega-3 (linolenic acid ALA) fatty acids.
Polyunsaturated Fatty Acids
POLYUNSATURATED FATTY ACIDS include the best- known essential fatty acids, omega-6 and omega-3.
OMEGA-3 AS ALPHA-LINOLENIC ACID (ALA) is a precursor to the omega-3 EPA and DHA. ALA is found in plant sources only, such as flaxseeds, walnuts, pumpkin seeds, and hemp and perilla seed oils.
OMEGA-6, LINOLEIC ACID (LA), is found in vegetables, nuts, seeds, and their oils and is more abundant in the Western diet.
OMEGA-3 EPA AND DHA sources include seafood, fish oils, and algae. EPA and DHA are critical to brain structure and function, vision, cognition, skin health, immunity, hormones, reproduction, development, and more. Not all people thoroughly convert the precursor plant source omega-3s to EPA and DHA.
RATIO OMEGA-6 TO OMEGA-3. The ratio of 1 to 1 is ideal with a healthy range up to 4 to 1. Omega-6 and omega-3 fatty acids are both important in human health. In Western cultures, the ratio of omega-6 to omega-3 fatty acids is skewed toward omega-6, which can promote inflammation. Based on inadequate intakes or individual biochemical uniqueness, those with ADHD or autism tend to have higher needs for omega-3 fatty acids. This can be determined by dietary history and documented via testing.
Monounsaturated Fatty Acids
OLEIC ACID is an OMEGA-9 monounsaturated fatty acid, found in olive oils, avocados and avocado oil, macadamia nuts and macadamia oil, and peanuts and peanut oils. Oleic acid is also abundant in animal fats such as lard and tallow.
Saturated Fatty Acids
SATURATED FATTY ACIDS are found in coconut oil and red palm oil, poultry, meats, seafood, milk fats, and butter. The short-chain fatty acids are found in butter, coconut oil, and palm oil and have lower melting points than longer-chain saturated fatty acids. Medium-chain saturated fatty acids are found in foods as medium-chain triglycerides (MCT) and are used in special medical formulas for those who cannot absorb the longer-chain fatty acids. These are especially important in infant formulas where they duplicate the medium-chain saturated fatty acids found in human milk. The longer-chain saturated fatty acids are the most common fatty acid found in foods. The long-chain fatty acids are important in membranes, especially in the brain.
Coconut Oil and Unrefined Red Palm Oil
are not the enemies. These healthy natural fats and oils were abandoned with the saturated-fat scare and replaced with partially hydrogenated oils, which consist of highly damaging trans-fatty acids, more harmful to human health than any naturally occurring fatty acid. The lauric acid found in coconut oil and mother’s milk has antifungal and antimicrobial properties and is especially beneficial to infants and children. Tropical oils have been demonstrated to raise good cholesterol (HDL) levels.
Good News about Cholesterol!
Cholesterol is found only in animal sources: meats, poultry, animal milk fats, egg yolks, seafood, lard, tallow, and butter. One pervasive myth is that if high cholesterol is bad, the lower the cholesterol, the better. This is not true. Without cholesterol, the body cannot function. Cholesterol is so important to human health that the liver makes approximately 1,000 milligrams per day. Scientific studies have documented that dietary cholesterol has little effect on blood cholesterol levels. The body regulates the amount of cholesterol so that when more is consumed, the body makes less, and when less is consumed, the body makes more.
Why would the body make a substance purported to be so dangerous? Why would mother’s milk be so rich in cholesterol? Cholesterol is vital to the structure of all cells. It is a major precursor of reproductive and natural steroid hormones, vitamin D, and digestive bile acids. It forms the “bricks” of the cell membranes and the covering of nerves. In fact, 25% of total body cholesterol is in the brain, critical to brain structure and function. It is important in the serotonin neurotransmitter receptor in the brain, which affects mood, social behavior, sleep, memory, and appetite. Cholesterol maintains the health of the intestinal wall, preventing leaky membranes.
Cholesterol does not attach to or attack healthy vessels. When there is injury to vessels, the body sends out more cholesterol as a repair substance or band aid for the injury. The cholesterol becomes part of the injured area of the vessel. So yes, the elevated cholesterol in the blood is associated with heart disease—but it is not the direct cause. The cholesterol plaques that form within the wall are part of the problem. The causes of vessel injury are the main source of the problem, and they include genetics, aging, high blood pressure, high blood glucose, inflammation, infections, viruses, stress hormones, deep-fried foods, hydrogenated oils, oxidized fats, lack of antioxidants, excess free radicals, lack of B vitamins, elevated C-reactive protein (CRP), methylation defects, and elevated homocysteine.
The previous and outdated limit on cholesterol intake at 300 milligrams per day was based on the faulty premise that consuming cholesterol is harmful to health. Studies show that at four times the so-called “limit,” there is little impact on blood cholesterol. Cholesterol is an important nutrient for the body and is regulated by the body. If intake is low, the liver makes more, and if intake is high, the liver makes less. The Institute of Medicine has declared that cholesterol is no longer a nutrient of concern.
The Good Egg
Eggs, another item wrongly maligned over time, are not the enemy either, as confirmed by numerous current scientific studies. The egg is a high-protein, nutrient-rich food so beneficial to health that it is considered one of the leading nutrient-dense foods. The white includes amino acids; however, it is the yolk that is loaded with vitamins, minerals, anti- oxidants, and choline, a brain nutrient. Healthy choices include pastured sources and omega-3 enriched eggs. Because cholesterol production is regulated by the liver, egg intake contributes little to total blood cholesterol levels. In fact, egg intake is associated with increased good HDL cholesterol levels and improved cholesterol ratios.
As long as there are not allergies, eggs are, indeed, incredible. They are an excellent way of increasing good-quality protein.
Low Cholesterol Levels and Autism
Studies have found that a subset of children with autism spectrum disorders have a cholesterol level that is too low. Some of these children have low cholesterol as part of a defined genetic disorder, Smith-Lemli-Opitz Syndrome (SLOS), while others have low cholesterol that is not due to an apparent genetic disorder. In SLOS, there is a deficiency of 7-dehydrocholesterol reductase, the enzyme responsible for the final step in making cholesterol. The severity of the symptoms in this syndrome appear to correlate with the degree of deficiency in cholesterol. The cause of low cholesterol in autism is not yet known.
The use of high doses of cholesterol supplementation in individuals with SLOS and autistic symptoms can result in a decrease in autistic behaviors, irritability, hyperactivity, aggression, self-injury, temper outbursts, and improvements in physical growth, language, sleep, and social interactions. It is possible that increasing cholesterol in individuals with autism who do not have SLOS may also be helpful.
4. FISH FACTS
Seafood is abundant in healthy nutrients, especially protein, zinc, omega-3 fatty acids, and iodine. Seafood is generally much easier to digest than animal protein (meats, poultry).
Nonpolluted Seafood—Recirculating Aquaculture System (RAS) Technologies
These are gigantic land-based, closed-containment, eco-friendly aquariums. The water is 99% recycled and filtered to remove residual waste, which can be used as fertilizer. Currently, RAS facilities are commercially producing food-size Atlantic salmon, rainbow trout, sturgeon and their caviar, pike, perch, catfish, barramundi, tilapia, and other species. This allows for more variety in fish choices without the usual toxins.
For more information, see Fish 2.0: http://fish20.org/images/Fish2.0MarketReport_Aquaculture.pdf
See also the Aquaculture Research at the Conservation Fund Freshwater Institute www.conservationfund.org/our-work/freshwater-institute/our-projects
Suggestions:
Choose seafood from RAS land-based, closed-containment, eco-friendly sources that avoid contamination. Note that open containment exposes seafood to toxins. If you’re not sure of the source, ask.
If seafood from RAS sources is not available, follow these recommendations:
• Avoid farm-raised fish.
• Eat seafood caught away from major cities.
• Avoid fish sticks; (less healthy fish are used in processed fish production.)
When purchasing fish, notice the following:
• Flesh should look moist and shiny.
• Gills should be red; eyes should be bright, not dull.
• Buy the whole fish and ask to have it filleted.
Preparing:
Store in the refrigerator; cook and eat or freeze immediately.
Keep mussels, clams, oysters, and shellfish alive. If they are dead, do not cook or eat them.
Remove the skin. Trim off the dark meat and fat. Cook fish so that the fat drips away.
Broil, bake, or grill and avoid the drippings. Poaching removes some contaminants.
SAFER SEAFOOD CHOICES |
The safest sources are seafood from RAS (Recirculating Aquaculture System) technologies. If not available, choose from these safer choices: Anchovy Atlantic Croaker Atlantic Mackerel Black Sea Bass Blue Crab (Atlantic) Burbot Butterfish Catfish Clam Cod Crawfish Croaker Haddock Hake Herring Lobster Mackerel (Atlantic) Monkfish Mullet Oysters Pacific Club Mackerel Perch Pike Pollock Porgie Rockfish Sablefish Salmon (wild) Sardine Scallop Sculpin Shad Shrimp Skate Smelt Snapper Sole Squid Tilapia Trout (rainbow) Tuna (canned light has less mercury than albacore, which is highest) Whitefish |
Resource for seafood safety:
• Calculate your safe intake of seafood using EWG’s Seafood Calculator https://www.ewg.org/research/ewg-s-consumer-guide-seafood/seafood-calculator#
• EWG’s Consumer Guide to Seafood at https://www.ewg.org/research/ewg-s-consumer-guide-seafood/why-eat-seafood-and-how-much#
5. FERMENTED FOODS—FRIENDS OF THE GUT MICROBIOTA
Fermentation of foods is one of the oldest forms of food preservation. The fermentation process results in the production of probiotics, nutrients, and enzymes. Probiotics support healthy microbiota. There are 10 trillion human cells and 100 trillion microbe cells, which renders us 1 part human and 10 part microbes. They are responsible for more than 70% of our entire immune system, and they produce short-chain fatty acids that, in balance with each other, are necessary for a healthy gut. The gut flora participate in improving digestion and nutrient absorption, neurotransmitter production, reducing inflammation, improving resistance, and reducing eczema, allergies, and asthma. Those in Western cultures have about 25% of the diversity of microbiota species, rendering us vulnerable to a wide range of problems with digestion and immunity. Prebiotics are indigestible carbohydrates that are “food” for probiotics. Prebiotic foods include Jerusalem artichokes, chicory root, dandelion greens, garlic, onions, leeks, asparagus, bananas, flaxseeds, seaweed, and more. Fermented foods are important and provide more diversity to the gut microbiota than you would have by merely supplementing with probiotics and prebiotics.
DAIRY FERMENTATION (Note that cow milk sources are avoided in milk/casein-free diets.)
• YOGURT can be made using a dairy or nondairy milk and milk or non-milk starter. The process is easy using a yogurt maker.
• KEFIR is usually made from milk with kefir powder or grains as a starter.
• CULTURED BUTTERMILK
• CHEESE
• SOUR CREAM
VINEGARS have a starter (mother) that is a slimy film-like substance made of cellulose and acetic acid bacteria.
• APPLE CIDER VINEGAR is the most common of the fruit vinegars.
• WHITE VINEGAR is made from a vodka-like spirit distilled from grain, and the final product is comprised of acetic acid (5 to 10%) and water.
• WINE VINEGAR and GRAPE VINEGAR are made from a two-fold fermentation of grape juice.
• KOMBUCHA VINEGAR is made from kombucha.
YOUNG GREEN COCONUT KEFIR* is made with the liquid of the young coconut (coconut water) and the starter.
VEGETABLE FERMENTATION occurs when the natural bacteria in the vegetables break down the vegetables into forms easier to digest and more nutritious than the raw vegetable. The following are the most popular vegetables to ferment: sauerkraut, pickles, kimchi (from cabbage and other vegetables), daikon radishes, turnips, and parsnips.
KOMBUCHA is a tangy fermented beverage of black tea and sugar (cane, fruit, and honey) and a slimy disc-shaped layer starter culture known as SCOBY (Symbiotic Colony of Bacteria and Yeast), mother or mushroom. The SCOBY metabolizes sugar and caffeine to create probiotics, vitamins, and enzymes.
MISO can be made from soybean or brown rice.
TEMPEH is made from cooked and slightly fermented soybeans and formed into a patty.
* Young Green Coconut Kefir can be purchased at www.bodyecology.com/articles/coconutkefir.php.
See the probiotic discussion on the previous page and the Fermented Beverages sidebar for more in-depth information.
6. USE SALT, NOT SODIUM PRESERVATIVES.
A subset of children with ADHD or autism have constant physiologic challenges due in part to genetic predispositions, inefficiencies in energy metabolism (mitochondria), nutritional deficiencies, inability to rid toxins, and poor diet, including glycemic (high sugar) diets and low protein intake. They can experience a cluster of symptoms, including generalized physical weakness, low muscle tone, cold extremities, lower body temperatures, digestive symptoms, and extremely pale skin. There are often cravings for sweet foods and salty foods. Commonly, there is lower blood pressure, poor balance, and dizziness upon standing up too quickly. The symptoms can be signs of an imbalance in the autonomic nervous system, termed dysautonomia, which can also include inefficient adrenal function (not adrenal disease). Adrenals respond well to good protein intake, excellent glucose control, and optimum salt intake. Remember, the body regulates sodium levels, absorbing and retaining more when needed and less when not. For these children, salt is important. Parents often notice improved alertness and less fatigue and pallor after salt consumption, improved protein intake, and reduction of sugars.
Chloride is necessary for cell function, balance, and distribution of body fluids, and a necessary part of digestive acid (hydrochloric acid). It is depleted through sweat, vomit, and diarrhea.
The sodium preservatives (nitrites, benzoates, and MSG) are generally not well handled by children with ADHD and even less well by those on the autism spectrum. MSG-glutamate is an excitotoxin.
Do not restrict salt for your child, unless your health care provider has instructed you to do so because of specific medical conditions. Allow salt intake to be determined by taste. If your child has the symptoms described shown here, observe to see if there is improvement in your child after salt consumption.
AVOID
Environmental indoor and outdoor toxins: pesticides, glyphosate, artificial turf, and VOC chemicals in paints, building products, and furnishings; nonstick cookware; harmful ingredients in cleaning products, fabric softeners, air fresheners, personal care products (cosmetics, shampoos, fragrances, and oral care); and electromagnetic fields (EMFs) and radio frequency radiation (RFR).
Artificial: additives, preservatives, sweeteners, taste enhancers, flavoring, coloring; and excitotoxins, GMOs, MSG, amines; and growth promoters in meat and milk products
Contaminated drinking water: pesticides, agricultural runoff, industrial chemicals, nitrates, toxic metals, and byproducts of chlorination. Also, avoid use of plastic water bottles and food containers.
Sugars and sugar-raising foods: high fructose corn syrup, sugars, agave syrup, sugar drinks, junk electrolyte drinks, all sodas (diet and regular), refined grains, and caffeine.
Problem fats: trans-fatty acids, deep-fried foods, canola oil, palm kernel oil, and GMO soy and corn oils.
Non-organic deli meats, processed foods, and contaminated seafood.
Any food or beverage that causes a negative reaction.
INCLUDE
Organic foods: USDA Organic seal, Non-GMO Project Verification, pastured animals, poultry, eggs, and milk products. Clean, contaminant-free drinking water.
Blood sugar control: The first food or drink of the day sets the glucose standard for the day; it must be stabilizing and include low glycemic foods. Have protein, fiber, and good fat at meals and snacks.
Protein: seafood, poultry, meat, eggs, tolerated milk products, legumes, beans, nuts, and seeds
Fats and oils: coconut, butter, lard, seafood, fish oils, algae, and oils of olives, avocados, nuts
Fiber foods: non-starchy vegetables, legumes, beans, nuts, seeds, and low glycemic fruits
Natural sweetener options: organic stevia, coconut sugar, raw honey, maple syrup (grade B), blackstrap molasses, banana purée, real fruit jam/spread, sucanat, splash of organic fruit juice
Healthy fats:
• Omega-3: (essential) seafood sources, algae, legumes, beans, nuts, seeds, and fish oils
• Omega-6: vegetables, nuts, seeds and their oils
• Omega-9: plant source oils (olive, avocado, macadamia, peanut) and some animal sources
• Saturated fatty acids: found in plants and animals
• Cholesterol: healing substance produced by the body and found only in fats from animals and seafood
• Eggs: nutrient-dense natural food: high protein (white), nutrients and choline (yolk)
Seafood: Select the least toxic sources, and, ideally, seafood from RAS (Recirculating Aquaculture System) technologies that are land-based, closed-containment, eco-friendly aquariums producing healthy, nontoxic fish
Fermented foods:
• Probiotics from milk products, vinegars, coconut kefir, vegetables, kombucha, miso, and tempeh
• Prebiotic fuel for microbiota growth: Jerusalem artichokes, dandelion greens, garlic, onions, leeks, asparagus
Salt (not sodium preservatives): Salt is a nutrient, regulated by homeostasis and especially beneficial to those who experience generalized weakness, dizziness, salt cravings, poor endurance, and/or low blood pressure
DIETARY GUIDELINES – THE BASICS – HEALTHY FOOD CHOICES FROM 3 CATEGORIES |
The following charts give basic information applicable to all of the diets. All of the diets will include proteins, fats, and carbohydrates. The specific foods to include will differ among the various elimination diets. |
PROTEIN |
FAT |
CARBOHYDRATE |
Animal Source Seafood Meats Poultry Eggs Milk products Plant Source Fiber sources Beans/Legumes Nuts Seeds |
Saturated Fatty Acids Unsaturated Fatty Acids Monounsaturated Omega-9 Polyunsaturated Omega-6 Essential Omega-3 Essential |
Fiber sources Vegetables Fruits Grains Beans Nuts Seeds |
Dietary Guidelines by Age
The following chart provides the general recommended intake by age. These guidelines are relevant to most individuals and not necessarily specific to ADHD and autism only. In the various elimination diets, there will be food restrictions. It is still important to maintain a healthy balance with any of the diets.
Daily Intake |
Age 2 to 3 |
Age 4 to 6 |
Age 7 to 11 |
Calories |
1,000–1,400 |
1,200–1,800 |
1,200–2,000 |
Protein Grams |
20-25 |
25-35 |
35-45 |
Veggies Cups |
1 |
1.5-2 |
2 |
Fruit Cups |
1 |
1-1.5 |
1.5-2 |
Grains* Ounces |
0-3 |
0-4 |
0-5 |
Fiber Grams |
5 |
15-19 |
15-20 |
Water Ounces |
30-35 |
40-45 |
45-60 |
Daily Intake |
Age 12 to 17 |
Adult Female |
Adult Male |
Calories |
1,600–2,400 |
2,000–2,400 |
2,400–3,000 |
Protein Grams |
45-60 |
60-75 |
75-90 |
Veggies Cups |
2-3 |
3-3.5 |
3-3.5 |
Fruit Cups |
2-2.5 |
2-2.5 |
2-2.5 |
Grains* Ounces |
0-6 |
0-7 |
0-8 |
Fiber Grams |
20-25 |
25-30 |
30-35 |
Water Ounces |
55-60 |
60-70 |
70-90 |
*Grains - 1 ounce equivalents = 1/2 cup cooked rice, cereal, pasta 1 slice bread or 1 small muffin 1 cup cold cereal flakes (organic)
Serving Size
The protein serving sizes are provided to help readers understand how much protein is in a given amount of food. The serving size equivalents provide a visual means of estimating food amounts.
PROTEIN SERVING SIZE
Each person’s animal-protein serving size is equal to his or her own palm (minus fingers and thumb).
The following amounts of protein foods contain approximately 7 to 8 grams.
1 ounce (30 g) meat, fish, or poultry
1 extra large egg or 2 small eggs
1/2 cup (90 g) baked beans, (50 g) cooked dried peas, (100 g) cooked lentils
2 tablespoons (32 g) nut butter
1/3 cup (1.5 ounces, or 42 g) nuts/seeds
1 cup (235 ml) milk
1/2 cup (115 g) Greek yogurt or cottage cheese
VEGETABLE, FRUIT, AND GRAIN SERVING SIZES |
|
|
1 cup = 1 baseball |
|
medium = 1 baseball |
|
1/2 cup = 1/2 baseball |
|
1 medium = computer mouse |
SERVING SIZE EQUIVALENTS |
|
|
table tennis ball |
|
golf ball |
|
baseball |
|
tennis ball |
|
deck of cards |
|
1 adult palm |
|
1 child palm |
|
tip of thumb |
|
whole thumb |