Sugar "allergy" and children's behavior.

Sixteen children whose behavior was said to become aggressive, overly active, loud, and noncompliant when ingesting sugar were tested. Sugar-free home diet was maintained and an "open" challenge to a large dose (3 g/kg) of candy bar sucrose was given. Subsequent behavior was noted by actometer, quantitative playroom observation using several standard behavioral tests, and ability to do maze drawings. No significant changes were found on the open challenge test. A slight change from baseline was noted in seven cases on three or four behavioral parameters. Five of these children agreed to a double-blind challenge test utilizing lemon-flavored slushes of sucrose, honey, tapioca starch, or aspartame, administered after a standard lunch free of sucrose. One child reacted to both sucrose and honey and another child reacted only to sucrose. These two children were challenged a second time. The child who reacted to honey again did so according to actometer readings, but this time not by Stony Brook test. To sugar, he reacted only at the 70-minute Stony Brook. The other child reacted to placebo instead of sucrose when rechallenged. The results indicate that high doses of sugar are not related to abnormal behavior. "Open" challenge was sufficient to rule out such a relationship in most instances. A repeated double-blind challenge confirmed the absence of a sugar effect in cases showing initial possibility of response.

Family-focused behavioral approach to weight control in children.

To treat the obese child or the child who is becoming obese appropriately, the clinician must determine if the adiposity is temporary or the beginning of a permanent trend that requires intervention. The concept of the "adiposity rebound" helps with this decision. The child's family is important and contributes to his or her body adiposity through both nature--an inherited metabolic tendency towards obesity--and nurture--the eating and activity environment and the family functioning. The activity level and energy intake, which although out of balance for the obese child, may not be low or excessive when compared to recommended amounts for children of that age or to that of peers. A child-family pattern can be defined in overweight children based on presence of a metabolic tendency, energy intake, activity level, and family functioning. In looking at the pattern rather than just the child's weight, the clinician can be much more effective with a weight control program, and with proper referral for changing family functioning prior to such a program if necessary.

Food allergies: immunological reactions to food.

Allergic reactions to food are mediated by the immune system, can be consistently reproduced, and cause a change in the target organ. An estimated 0.3% to 20% of infants are affected. The incidence decreases with age to about 1% to 3% in adults. Development of food allergies depends on heredity, intestinal permeability, immune responsiveness, and exposure to food. Common symptoms include gastrointestinal, skin, or respiratory disturbances that occur from seconds to several hours after food ingestion. Although the skin-prick test is the most reliable diagnostic test, positive results must be followed by a trial elimination diet and food challenge to determine whether symptoms appear after food ingestion. Food allergies are treated by the elimination of the offending foods from the diet. Breast feeding is usually recommended to reduce the incidence of allergic disease in infants. The dietitian's expertise is particularly valuable in assessing the nutritional status of the allergic person, assuring nutritional adequacy during treatment and maintenance, and participating in research to address the many unresolved issues surrounding food allergies.

Nutrition and the allergic athlete.

Nutritional management of the allergic athlete centers around providing a diet adequate to meet the increased needs of the athlete at the same time that it is modified by the exclusion of any problematic foods. The athlete has an increased need for water, total energy, carbohydrate, B vitamins, and perhaps protein, the last two of which are usually met when the diet fulfills the energy requirements of the athlete. Requirements for electrolytes are minimally increased, and the need for additional iron is unclear in light of "sports anemia." There is no evidence to support the use of vitamins C and E as ergogenic aids; however, the findings relating vitamin C to bronchospasm and bronchial hyperreactivity are interesting. Caffeine and bee pollen, often believed to increase performance, may be harmful for the allergic athlete. An approach for determining the problematic foods for the allergic athlete and necessary supplementation when they are avoided is given.