Metabolic Programming: What it is, and what it can do for your child

Feeding Your Child for Lifelong Health: Birth Through Age Six
by Susan B. Roberts, Ph.D., Melvin B. Heyman, M.D., Lisa Tracy

How the new science of "metabolic programming" can help you:

• Maximize your baby's IQ and development
• Prevent allergies and obesity
• Prevent or cure picky eating
• Teach your child to enjoy healthy foods
• Protect against family health problems
• AND make mealtimes a pleasure for you and your child!

In this groundbreaking book, two leading pediatric nutritionists-and experienced parents!-introduce exciting new research into "metabolic programming" and make it accessible and practical for every busy parent. They explain:

How the foods you choose can optimize your baby's future development, IQ bone strength, and immunity

The eight key nutrients to focus on

Scientifically based "smart strategies" for working with your child's inborn instincts to build healthy eating habits

Food solutions for common problems-including colic, constipation, poor sleep, and hyperactivity

How to prevent or deal with food allergies or obesity

Easy ways to adapt family meals for kids-with menus and portion sizes for every stage from birth through age six, plus essential tips for food safety

What's more, you can teach your child to enjoy these healthy foods and banish food battles and picky eating forever.

With her baby due in three weeks, a mother-to-be visited her local supermarket to buy some diapers and check out the baby food aisle. What an excitement - and a shock - it was. Those rows of jars, packets and cans made impending motherhood seem so real! But she had thought she was ready to feed her baby, and here was a whole world of new decisions to make. She wouldn't be using formula at first, but which of the 16 kinds (some costing three times as much as others) would be right for later? And would she need any of these other items? The pear juice in tiny bottles looked delicious, but wasn't her niece's tummy pain traced to an allergy to baby juice? Should fluoridated spring water go on the shopping list? And those jars of nutrient-packed spinach? Could she really get her baby to like something she hated? Should she even try?

This book began in that moment 6 years ago, when I was that excited and puzzled mother-to-be. As a nutrition researcher, I have spent 20 years studying the importance of healthy food at all stages of life. But it was only when I became a mother that I realized how much parents needed the information we were discovering. Studies from my own laboratory and others around the world had taught me that, contrary to the advice in the parenting books in my house, the foods my daughter would eat during the first months and years of life would have long-lasting, and in some cases permanent, effects. I knew that nutrition was not the whole story, of course. But it would make an important difference in virtually everything, from her mental and physical development to her vitality, personality, and health from childhood through old age. The way I behaved about her food would be critical, too, preventing difficult eating behavior in the short term and lifelong struggles with disorders such as obesity and anorexia. With this valuable knowledge as my guide, I began helping my daughter learn to enjoy the foods best for her development and health, a rewarding and joyful task that continues with her entry into kindergarten.

My first insight into the power of childhood food came some years ago when I worked with a research team in a village in West Africa. At first I was surprised to see no children who looked malnourished: They all seemed fine, and were extremely well behaved! It was only after I started studying them that I realized they were permanently stunted due to a lack of good food. Their quiet behavior stemmed not from superior discipline techniques (as I had first supposed) but from inadequate nutrition that left them without the vitality and exuberance of well-nourished children. Even worse, their lack of normal exploratory behavior was preventing them from learning all the things that children need to learn if they are not to be left behind in a fast-paced world.

Later, when my research moved to Cambridge University in England and subsequently to Tufts University in Boston, I realized that my observations in Africa were only the tip of the iceberg. Research from my laboratory and others was showing that even in affluent countries such as the United States, good childhood nutrition is not what many pediatricians and concerned parents currently think it is. Yet it can make the difference of a lifetime, conferring long-term, even permanent advantages in mental and physical development and health.

While my experience on three continents was teaching me about the importance of childhood nutrition, my partner in this book, pediatric gastroenterologist Mel Heyman, was having similar revelations in his nutrition clinic at the University of California at San Francisco. Mel had also observed that poor childhood nutrition was not confined to families struggling to make ends meet. Affluent, well-educated families were also vulnerable, even to problems such as the nutritional stunting I had seen in Africa. This was obviously not for lack of money or even for lack of concern, but sometimes because the families were eating extremely low-fat, whole-food diets that were healthy for the parents but contained the wrong nutrients to allow for normal childhood growth.

Raising our own children and spending time with other families, we also saw that knowing what to feed your child is not enough. How children are fed is as important as what goes on the table, because food counts only if it's eaten! Children can often seem difficult when it comes to food, but there are actually good reasons why they think and behave the way they do, reasons grounded in the normal psychology and biological programming of childhood. By learning how to work with, rather than against, our children's natural instincts, we can reduce feeding conflicts, while at the same time teaching a lifelong enjoyment of healthy foods.

Combining our insight into childhood psychology with the latest research on childhood nutrition, we saw we could point the way to a whole new approach to feeding children, one that would make parents' lives easier while ensuring that their children reach their full potential in development and health. This book was born out of our desire to share that knowledge with other parents and health professionals, and to give every child the benefits that an enjoyment of healthy foods can bring.

Six Myths About Feeding Children

Myth: Left to his own devices, your child will select a nutritionally balanced diet.

Reality: Parents need to help their children learn to enjoy foods that promote long-term development and health.

Myth: What is healthy for you is healthy for your child.

Reality: Children are not small adults when it comes to food. Although they can eat many of the same foods you do, the proportions need to be quite different to ensure that their very different nutritional needs are adequately met. Higher needs for fat and lower needs for fiber are just two of the many ways your child's nutritional requirements differ from yours.

Myth: Colic can't be treated by changing what your baby eats.

Reality: As many as 25 percent of colic cases can be improved or even cured by changing a baby's diet. This is true even for breast-fed babies, when it is the mother who makes the dietary changes.

Myth: Children need many more calories, pound for pound, than adults.

Reality: Children do need more calories than adults when their small size is taken into account, but actual calorie needs are much less than the current RDAs, which have recently been described as a "prescription for overfeeding".

Myth: If you delay weaning onto solid foods, you will prevent your child from becoming overweight.

Reality: Late weaning can actually compound a tendency to gain too much weight.

Myth: Vitamin supplements are not needed by children gaining weight normally.

Reality: Weight and height are only two indicators of healthy growth. More than 50 percent of American children under the age of 3 years do not get the RDAs for several essential nutrients without a daily multivitamin/mineral supplement.

METABOLIC PROGRAMMING: THE POWER OF CHILDHOOD FEEDING

Behind the big eyes that scan your face and the tiny hand that grasps your finger, an event known as metabolic programming is unfolding in your child. Metabolic programming is the new term being used to describe the fact that foods eaten in childhood can have lasting effects on the way your child's body grows and functions.

How do foods consumed early in life exert effects beyond the short time they are physically present in your child's body? Scientists believe that metabolic programming happens in part because growth and cell division in many parts of the body occur only in childhood. During this time individual cells are sensitive to the availability of nutrients, in other words, the body's basic building materials.

We now know that each organ, tissue, and nerve cell within the body develops in its own unique window of time, in response to a complex set of biological signals arising from the body's DNA. The nutrients physically present at this crucial time for cell division and growth determine how large or small each cell within the different body components ultimately becomes, and how efficiently and well it functions in the future. And because organ and tissue functions determine such essential body processes as hormone production and enzyme activity, alterations in normal development can have far-reaching effects. Once the cells' period of sensitivity to growth signals has passed, the function of each individual cell is largely fixed. In other words, it has been metabolically programmed by the food your baby, toddler, or preschooler was eating during that cell's growth spurt.

You can think of metabolic programming as being somewhat like the set of signals that control the switches on a railroad track. Sitting in a train in New York or San Francisco, you could go to many places. What determines which direction your train actually takes depends on the signals that set the switches on the track. If they're set right, you'll reach your destination. But if they are set wrong, especially near the start of your journey, you may end up in the wrong place or have to make a real effort to get back on the right track.

Like those signals, metabolic programming gives your child's body directions for his future. We now know that first foods can have permanent effects on growth, strength, the immune system, and intelligence, with long-term consequences for many other aspects of health and even personality. Through metabolic programming, our children's whole lives are influenced by what they eat in their early years.

We also know, of course, that metabolic programming doesn't tell the whole story, and that genetic makeup and family circumstances are tremendously important, too. Understanding metabolic programming and using it to advantage certainly doesn't guarantee that our children will grow up to be athletes, opera singers, or doctors, or that they'll live to be 122. What it does enable us to do is help them realize their own best potential in development and health.

Is working with your child's metabolic programming something you have to start right from day one, or forfeit its benefits? In most cases, the answer is an emphatic no. Raising a healthy child involves trial and error for all parents, ourselves included, and we have time to make mistakes and recover from them. Health benefits, in particular, are cumulative, and the child who starts to eat well only when he is 5 will still be much healthier in the long run than the one who doesn't begin until his teen or adult years.

At the same time, certain ages present a special window of opportunity for specific metabolic programming. Height, for example, is metabolically programmed primarily during the first five years of life. When it comes to intellectual development and IQ, your child's brain is growing especially fast during the first year, and this is when food can make the difference of a lifetime. For the immune system, a major window of opportunity is during the first few months.

Although metabolic programming affects virtually all aspects of our children's lives, there are five major areas where you can expect food to have an especially big impact:

1. Promoting Healthy Weight Gain and Preventing Obesity

More people are overweight in the United States now than at any previous time in history: well over half of all adults, and now about 10 percent of preschoolers, double the number 20 years ago. At the same time, research is showing a link between excess weight gain in childhood and remaining overweight throughout adult life. Helping your child avoid becoming overweight is a good example of how you can influence metabolic programming to prevent future problems. Fortunately, new strategies suggested by the latest research make this easier than ever before.

But while we want to help our children avoid excess weight gain, it is also important to prevent inadequate weight gain. This form of malnutrition in childhood, often termed "failure to thrive", surprisingly does not occur only in families below the poverty level. About 15 percent of American children seen by pediatricians for poor weight gain suffer from accidental malnutrition. Often this is simply due to a misunderstanding on the part of affluent, health -conscious parents about what foods constitute a healthy diet for a baby or child. Paradoxically, children who gain too little weight in early childhood are at greater risk of becoming overweight adults. This seems to be because the caloric deficit metabolically programs their bodies to be more efficient in storing calories.

2. Avoiding Allergies and Childhood Diabetes

Protecting your baby's immune system by avoiding high-risk foods during the vulnerable first 12 months of life is a simple step that pays big dividends. Most childhood food allergies arise when the immature infant digestive system allows partially digested food proteins to get into the blood stream. These protein particles in turn activate the immature immune system, programming it to overreact in the future to foods and non-foods such as pollen or dust An overactivated immune system may also destroy the insulin-producing cells in the pancreas, leading to an increased risk of childhood diabetes.

Allergies often run in families and may not be totally preventable. But with what we now know about the role of nutrition, a lot can be done to minimize the risks. Breast-feeding, the use of a new generation of hypoallergenic formulas, and a modified program for introducing solid foods are just three of the ways parents can help lower the risk of allergies by at least 50 percent in a susceptible son or daughter.

3. Optimizing Bone Strength and Height

"Drink your milk so you'll grow up tall" was the standard advice for many decades, but recent research has shown that calcium actually doesn't influence height: Height is largely in the genes. And the nutrients that influence it the most are calories and zinc, not calcium!

Calcium is, of course, vitally important for bone and tooth strength. Less than 50 percent of American children consume as much as they need. The metabolic signals for absorption of calcium begin at birth and continue through adolescence. Once we become adults, bone and tooth strength is largely fixed, and the best we can hope for is to hold on to what we developed as children. For a lifetime of strong bones, and for preventing eventual osteoporosis and tooth loss, your baby needs an adequate calcium intake now and throughout childhood.

4. Boosting Intelligence

During the first three years of life, and especially during the period from birth to age one, your child's brain is developing rapidly and can be influenced to a remarkable extent by what he eats. The mineral iron is essential to optimal brain development and future intelligence. Iron is a vital component of the red blood cells that transport oxygen to the brain. It also has additional diverse roles around the body, including helping control synthesis of the myelin sheath that surrounds brain cells and is essential for normal brain activity. Even a briefly inadequate supply of iron, as when mild anemia develops, has been shown to have permanent effects on IQ, motor development, attention span, and behavior. Yet according to a recent survey, a shocking one in seven American children is clinically iron-deficient.

Another critical nutrient for brain power is fat, because the brain is 60 percent fat by weight. For your new baby's brain cells to grow, divide, and develop into the billions of interconnected cells he will need in the future, he needs to consume about 50 percent of his calories as fat, about twice the amount that is healthy for you. One of the reasons that breast milk is widely accepted as the best food for young babies is that it supplies exactly the right amount and kinds of fat for optimal growth of the brain and nervous system.

This crucial connection is especially clear in research on premature infants. Children who as preemies were fed their mothers' milk for just the first three weeks of life showed an eight-point advantage in IQ scores in tests at age 7 over those who had been fed formula. New research is showing that babies born at term may receive comparable benefits. A recent study of teenagers born at the normal time and breast-fed in the first months of life showed higher IQ, better school grades, and only half the risk of leaving school early compared to teenagers fed formula after birth. This finding was true not only in a straight comparison of the two groups, but also after statistically adjusting the results for factors such as maternal smoking and family income.

5. Preventing Childhood Cancers

This is a difficult topic for parents even to think about. Yet one recent study reported that children who eat a low-risk diet, one with plenty of fruits and vegetables and few or no high nitrite foods, have only one-seventh to one-tenth the incidence of brain cancer and one-third the incidence of leukemia seen in other children.

Cancers start when the DNA in a single cell gets irreparably damaged and causes uncontrolled cell division and growth. And although DNA damage is caused by a number of environmental factors, of which food is only one, it is possible to substantially reduce our children's risk of cancer by controlling the types of foods they eat.

One way to help is to minimize children's consumption of nitrite-containing foods including hot dogs, ham, bacon, and sausages. The body can convert harmless nitrites into potent carcinogens called nitrosamines and nitrosamides, which increase the risk of DNA damage.

Ensuring that children get plenty of the antioxidant vitamins A, C, and E is another way to help. These vitamins, found in fruits and vegetables, and, in the case of vitamin E, nuts, seeds, and oils, literally soak up the dangerous free radicals (products of normal metabolism) that attack DNA. It's important not to rely on supplements alone for antioxidants, because plant-based foods also contain thousands of other anticancer substances called phytochemicals.

how you feed your child is Just as important as what YoU feed

Feeding your child healthy foods doesn't have to be the daunting task it is often made out to be. In fact, much of the conventional wisdom on how to get the right foods into children is positively counterproductive. Your child is equipped with an incredible set of innate instincts and behaviors that can become your best helpers in the feeding process. Your newborn's instinct to suck, and his instinct to put everything in his mouth at about six months, when he begins to need solid food, are just two examples of how your child starts life ready to help with the important job of getting himself fed.

This is not to say that your child's instincts will automatically make him eat the right foods no matter what. Far from it! We have to channel our children's instincts, particularly when it comes to the foods we want them to enjoy in the future. This is necessary because we live in a world surrounded by a vast array of highly refined commercial foods for which evolution didn't prepare us. It's also necessary because medical and technological advances now allow us to live far longer than the 40-year life expectancy of our ancestors. Almost any food will allow us to survive for 40 years. But for double that life span, a much better diet is needed.

To teach our children to enjoy healthy foods, we need to understand why they think and behave about food the way they do: Why do they instinctively avoid foods they know we want them to like? Why at age 2 are they are instinctively cautious about vegetables, and how can we work around this innate behavior? Why do they pick up the bad habits of their peers from about age 3 on, and how can we prevent this? Once you understand why children think about food the way they do, you can use "smart strategies" to actually mold your child's food preferences and eating habits. These strategies work because they tap into the way children instinctively learn. You and your child become collaborators in healthy eating.

Programming your child's future food preferences

Eating is one of life's great pleasures, and is something we should all be able to enjoy. When you introduce your child to healthy foods in the right ways, she learns to actually enjoy the foods that are best for her development and long-term good health.

Why should the foods your child enjoys now determine her future preferences? One reason lies in the way childhood memories are formed. Up to the age of about two and a half or three years, children do not form conscious memories, but instead are busy using their daily experiences to create the instinctive emotions, and likes and dislikes that will become intuitive feelings in the future. So if your young child learns to enjoy vegetables for dinner every night and fresh fruit for dessert, she incorporates these healthy foods into her developing subconscious blueprint for what a proper meal should be. Not only does it taste good to her, it feels right, too. It nourishes her soul while feeding her small but growing body.

Many of us have unhealthy internal blueprints for what foods make us feel whole and content, and they dominate our lives more than we would like. When we crave the pies our mother made for us or overindulge in chocolate and cookies when we are stressed, we are living through the subconscious feelings about foods that were built up during our early years.

Your child doesn't have to develop these associations. With your help she need never learn to crave the items you want her to avoid. Instead, she'll have the kind of blueprint that makes her enjoy eating the foods that put her on the right track for a long and healthy life.

HOW this book CAN HELP

Our book is designed in four parts to help you make the best possible feeding team with your child. In Part 1 you'll learn how science is redefining our knowledge of childhood food and feeding: the what, how, and why of nourishing your son or daughter. We urge to read Part 1 even if you sometimes skip the theory section of books, because it has information you will find nowhere else. If you are pregnant or recently had your baby, you may want to read Part 2 next, which will walk you through the essentials of breast milk and formula, and what to do if your baby was born early. If your child is older, Part 3 will take you through all the food transitions from 4 months to 6 years and will explain how to prevent and treat common food-related problems as they arise. Part 4 is devoted to concerns such as food-related allergies, weight gain, hyperactivity, and sleeping disorders.

Have confidence that you can do a great job. Your baby comes equipped not only to survive but to thrive with your help. The master plan for this seemingly enormous task is unfolding in every cell of her body. You're her guide and caregiver, and you too can learn everything you need to know. Our role is simply to help you do it in the best and easiest way possible.

Excerpted from Feeding Your Child for Lifelong Health by Susan B. Roberst, Ph.D. and Melvin R. Heyman, M.D. with Lisa Tracy Copyright © 1999 by Susan Roberts. Excerpted by permission of Bantam, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

About the Author

Susan B. Roberts, Ph.D., is Chief of the Energy Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging and Professor of Nutrition and Associate Professor of Psychiatry at Tufts University. She is an internationally recognized expert on infant and adult nutrition, with research publications on topics including infant nutrient requirements, infant and adult obesity, breast-feeding, nutritional needs of premature infants, and nutrition and aging.

Melvin B. Heyman, M.D., M.P.H., is Professor of Pediatrics and Chief of the Division of Pediatric Gastroenterology, Hepatology and Nutrition at the University of California in San Francisco, where he directs an active clinical program. He also directs a research and training program focusing on nutritional treatment of acute and chronic diseases, childhood nutritional requirements, and food allergies.

Lisa Tracy is an editor with The Philadelphia Inquirer and the author of two previous nutrition books.