FAACT's Roundtable

Ep. 254: Food Allergy Nutrition, Meal Substitutions, & Supplements

• Season 5 • Episode 254

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Making sure kids get the nutrition they need is always important—but for families managing food allergies, it can feel especially challenging when safe food options are limited. We’re joined by FAACT Medical Advisory Board Member, Owner of ALnourished, and Registered Dietitian, Alison Cassin, MS, RD, LD, to talk about how to meet essential nutritional needs, smart ways to swap ingredients, and when supplements may be helpful. Together, we’ll explore practical strategies for building a healthy, balanced life with food allergies.

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Caroline: Welcome to FAACT'S Roundtable, a podcast dedicated to navigating life with food allergies across the lifespan. Presented in a welcoming format with interviews and open discussions,

each episode will explore a specific topic, leaving you with the FAACTS to know or use.

Information presented via this podcast is educational and not intended to provide individual medical advice.

Please consult with your personal board certified allergist or healthcare providers for advice specific to your situation.

Hi everyone. I'm Caroline Moassessi and I am your host for the FAACT Roundtable podcast. I am a food allergy parent and advocate and the founder of the Grateful Foodie Blog.

And I am FAACT's Vice President of Community relations.

Before we start today, I just want to say thank you to DBV Technologies for being a kind and generous sponsor of FAACT's roundtable podcast.

Making sure kids get the nutrition they need is always important,

but for families managing food allergies, it can feel especially challenging when safe food options are limited.

Today we're joined by FAACT's Medical Advisory Board member, owner of Al Nourished and registered dietitian Alison Cassin to talk about how to meet essential nutritional needs,

smart ways to swap ingredients, and when supplements might be helpful. Together we'll explore practical strategies for building a healthy, balanced life with food allergies.

Welcome back, Alison, to FAACT's  Roundtable Podcast. We're very happy to have you here. This is such an important subject and I know you're going to bring us really great, practical, pragmatic solutions to everything.

Alison: Oh my gosh. Thank you so much. I'm pleased to be back. Thanks for the invitation. And I agree it's a very important topic.

Caroline: It really, really is. So to start, can you share your professional background and what led you to your current role in the food allergy community?

Alison: I'd be happy to. My professional background is a little bit varied. I took kind of a roundabout path to dietetics, especially food allergy dietetics.

I studied zoology as an undergraduate.

I really liked biology and I liked science. And after my undergraduate education, I found myself working in labs,

which was really interesting. I learned a lot, but I wanted to work with people more and I found that nutrition was a great way to meld my science background and my counseling skills that I think I have and wanted to utilize.

Went back to school. I got a master's degree in nutrition at the University of Cincinnati. I did a one year internship to become a registered dietitian.

And really I just landed in this great job working with individuals with food allergies and eosinophilic disorders at Cincinnati Children's hospital.

Really? I landed the job because I had a background in the food industry working in a lab at a flavoring company.

So with that background and my knowledge of food ingredients and food manufacturing processes, they thought that would be a great fit to work with people with food allergies. So here I am, I've been doing that.

I'm on year 14 and I'm really excited to continue to work with this population.

Caroline: You really did take a big path to get to us, didn't you?

Alison: Yeah, but I'm a second career dietitian, but I think think it worked out pretty well for me.

Caroline: That's fun. That's very fun.

So now let's just dive right into our topic. Can you walk us through the key nutritional needs children have at different ages? Just in general, what do kids need?

Alison: That's a great question. You know, when we think about kids nutrition, a lot changes as they grow.

Starting, you know, early in life. For infants, breast milk or formula gives them everything they need early on.

And then around six months of age, they're ready for solid foods. Which is my favorite part of pediatric nutrition is feeding babies real food.

That's the time that we usually introduce iron rich foods like iron enriched grains like oatmeal or, you know, wheat, cereal,

beans or pureed meats. They really need those good iron sources to support healthy brain growth and development.

Then as kids become toddlers and preschoolers, you know, they have big energy needs. They're little explorers, right? So, so they really do best with small, frequent meals because they fill up quickly.

If they're able to eat foods like milk and yogurt and cheese, those are great because they're really good calcium rich sources that also have some protein and some healthy fats.

This all helps to build strong bones.

They also need really good iron sources like fortified cereals or meats or sometimes even eggs, you know, if they tolerate them.

Because these little kids can be prone to developing anemia,

picky eating. I'm sure you've dealt with this. Raising kids is really common in the toddler and preschool age. So the key is to really keep offering a variety of foods without pressure.

Eventually we hope that they'll come around and accept a nice variety of nutritious foods.

So those are our infants and toddlers and then, you know, the older kids, this is what I'm dealing with in my household now.

You know, school age kids, they need steady fuel to stay focused and active during their school days and activities. So we talk about whole grains, fruits, vegetables always and lean proteins give Them energy for learning,

for playing.

And then these kids are also prone at this stage to constipation.

Fiber is really important really at all life stages. Right. But especially in our school age kids to help with digestion and help move things through their GI tract, You know, really, we encourage water also because juice and sugary drinks really aren't necessary at this life stage.

So water and you know, if they tolerate it,

low fat milk are the best drinks for them.

And then. I know, Caroline, we've talked a lot in the past about teenagers and their growth needs.

Teenage adolescence is a period of rapid growth.

These teens really need extra protein for their muscles. They need calcium and vitamin D for their bones, because this is a really again, rapid period of growth. Bone accrual. They need iron for energy, especially for our adolescent girls if they start their periods.

So since teens are really like, you know, growing and developing not only physically but also developmentally, you know, they're making more of their own choices. It really helps to encourage balanced meals and healthy snacks at that stage, you know, over chips or soda,

which of course they're going to eat and drink. But encouraging balance is really important at that phase. So anyway, I've talked a lot, but the biggest message for parents is variety,

colorful plates, keeping meal time positive with low pressure,

with the hope that these habits kids are working on now will lay a nice foundation for lifelong health.

Caroline: I think that is so true because when I even look at my food habits now, or my children who are now adults,

it is so fascinating to see their go to foods are a lot of the foods that we introduced or meals that we created when they were younger. So that's such a really interesting concept to really think about not only meeting their needs at the different ages and stages, but you're really setting the tone for later in life.

Alison: Oh, for sure. And I know we'll talk about supplements later, but certain nutritional deficiencies, we can supplement those or fix those pretty easily. But a general, healthy, positive relationship with food is a lot harder to fix later in life.

So if we can encourage that early,

that's the best for all kids.

Caroline: That's a really good point.

Now that we understand the ages and stages much better,

let's talk about situations where safe meals might be hard to find. Like you're traveling or you went to a party and you gotta sneak out now and get food, or there's just something different going on.

What strategies or substances institutions do you recommend to help families create quick, nutritious and allergy friendly meals?

Alison: Yeah, this is such an Important question. You know, families managing food allergies, you know, are facing real challenges when they're away from home because options can be limited.

So you know, when I talk with these families, we focus on a few things, on planning ahead,

kind of knowing what your safe substitutions are and how with all that in mind to, to keep nutrition in balance. And I'll kind of talk about those in some detail.

So planning ahead, you know, any food allergy parent, of course, already knows how to plan ahead and that's because it makes a huge difference.

You know, if you know you'll be in a place where allergy safe meals might be limited, bringing a small safety kit or snacks can be a lifesaver.

So of course I'm a dietitian. I'm always going to talk about fruits, veggie sticks, things like that. But also some things that have some oats, fat and protein to help tide over your appetite, like a seed based granola bar or a single serve hummus pack if you tolerate sesame.

Those snacks are portable, they're filling and they can give you some peace of mind and at least until you can get to a place where you can consume a safe meal.

So planning ahead is important.

Second, substitutions.

That knowledge of substitutions can really help you make a meal work even when the choices are limited.

So here's an example. If you have to avoid dairy, many places nowadays have plant based milks as an alternative, like oat or soy milk or even soy or oat based cheeses.

It's a pizza joint, for example.

These can replace cow's milk based products in a pinch.

If nuts are off limits, for example, sunflower seed butter or pumpkin seed butter can be a stand in and also a healthy snack. Again, that's satiating,

you know, eliminates a strong appetite to help hide you over to the next meal.

So those can help give you some meal balance without feeling restrictive. Third, if you're really stuck, think about building a plate from the safest, simplest components that you have available.

What does that mean? Cooked simply without a lot of added ingredients are going to have a higher probability of being allergen safe. So a plain grilled meat or poached fish, steak, steamed vegetables, baked potato, they're not fun or exciting, but they can give you a solid meal without sauces,

without extras that may contain allergens.

So sometimes stripping a dish back to its most basic parts can be the safest, but still also most nutritious choice.

So I always remind families, focus on what you can eat, not just what you can't have a short list of. Go to safe foods that you can pack and enjoy.

Rotate those, and it can reduce some stress when you're traveling or out and about and make meals feel a little more normal. So plan ahead,

lean on your safe substitutions and keep meals simple when needed to highlight variety that you can have.

Caroline: That's really good advice about breaking it down simple, because I think sometimes we forget that and we just go simple. And actually, from one of our previous podcasts, he took some of your tips back to my family, my children, about hitting the grocery store, and that's exactly what they do.

They get a baked potato because they can do that in a microwave dorm or in a hotel. They can get a package of the frozen veggies that you can steam in the bag now.

Alison: Perfect.

Caroline: And they can grab that and then they'll buy a lunch meat that's safe.

They're not so excited about making chicken in the microwave, but they've done eggs in the microwave before,

and they'll grab the lunch meat. And if they can find their safe bread. And then a wild but. But they learned just hitting the grocery store and just, it's simple.

And it's not, you know, a culinary grand moment,

but it's a perfect substitution.

And it works.

Alison: It does. It does.

You know, I even do that if I'm traveling for an extended period of time, and I'm lucky enough that I don't have food allergies, but I still don't want to eat at a restaurant three meals a day for five days a week.

If I'm traveling for work, I like to hit up the grocery store, too, just to have some normal food. When I'm traveling,

I do the same.

Caroline: Exact thing for our conferences or just traveling with the family. I get my veggies, I get my yogurt, and the baked potato, the sweet potato. It's real, it's fun. It was.

Alison: I'm hungry. I was hungry during our conferences.

Caroline: I love it. All right, so now let's turn our attention over to supplements. And how can a parent know if it's time to consider supplements to help support their child's growth and overall nutrition?

So, like, for example, when my son was really,

he couldn't have dairy, he couldn't have egg, he couldn't have nuts, he couldn't have seeds. So there were a lot of food groups that just were not in there. So at what point do you start discussing supplements and then who do you discuss that with?

Alison: That's a great question. You know, the first thing to know is that most kids with food allergies don't automatically need a supplement. You know, if they're eating a variety of whole foods as a foundation of their diet,

they might not need additional supplementation.

But you know, as you touched on, if a child is avoiding multiple foods and especially major food groups, then a supplement might be needed if you can't achieve adequate intake of certain nutrients from your diet alone.

So for example, if a child, as you mentioned, has a dairy or milk allergy, they're missing a key source of calcium and vitamin D.

Now,

you can get calcium and vitamin D from plant based milks that are on the market now, but not all are fortified equally.

So they may or may not have enough.

And also a lot of kids don't drink enough volume of say, a plant based milk or plant based beverage to meet their calcium and vitamin D needs. So in those cases, a calcium or vitamin D supplement might be appropriate.

You know, for kids who are avoiding multiple food groups like milk, eggs, nuts, soy, those nutrient gaps can add up really quickly, especially protein.

So healthy fat might need to be supplemented. And certain vitamins like riboflavin or zinc are often commonly deficient in kids with multiple food allergies.

We also, you know, in addition to considering what the child's avoiding, we also want to think about their age. As I said before, toddlers, young kids, they're going through rapid growth.

They might have small appetites.

If their safe food list is short or only comprised of kind of like crunchy, snacky foods that aren't nutrient dense, they might need a multivitamin. And they might specifically need a multivitamin that has iron in it,

which is important to look out for when you're looking at multivitamin composition.

Those older kids, the teens, the athletes that we talk about a lot, they might need some extra energy or protein if they're nutritional needs or calorie needs are outpacing what they're able to safely consume from their diet.

So maybe something like a plant based meal replacement, say if they have a milk allergy or something similar to that might be beneficial for them. The emphasis that I want to make is not guessing.

You know, before you start a supplement,

check with your pediatrician or a dietitian who specializes in managing food allergies.

These people can assess growth patterns. They might be able to check labs if your child needs them or if there are concerns for true deficiency.

They can assess your child's usual intake to figure out if there are any gaps that might require a daily multivitamin or specific nutrient supplementation like calcium or iron or even as I mentioned before, kind of like a medical nutrition shake that can fill in calorie protein and other vitamin mineral gaps.

Supplements are just that. They're a supplement. They shouldn't replace. Nice, well rounded healthy diet. Think of them as a tool to kind of fill in the cracks while you're expanding safe food choices.

But talk with your pediatrician, talk with a registered dietitian who has knowledge and food allergy and they can help point you in the right direction.

Caroline: Thank you for that clarity because it feels overwhelming because you see ads constantly telling you to have this protein powder and this and that and that. And so I'm so glad you said you it's to fill in the cracks where sometimes I feel all this marketing that I've been seeing recently is not even addressing that we're filling in the gaps.

But you must have this. It's just so overwhelming and especially when we're dealing with special diets. So I really appreciate that clarity.

Alison: Thank you for sure. And to touch on a keyword you used there,

Marketing the supplement industry is a huge business and there's a lot of money to be made. And being made,

along with the potential for toxicity of over consumption of certain vitamins and minerals is also the potential for allergen contamination in some of these products because they're not regulated by the FDA.

And allergens are not required to be declared in these products because they're not regulated by the FDA.

So that's another consideration in addition to their nutritional composition.

Caroline: That is a really good point. Thank you for bringing this up. So before we say goodbye today because this went really fast, but it was packed with great information. So thank you.

Is there anything else you want listeners to hear from you?

Alison: I would say if you are a parent of a child with a food allergy, you are probably doing better than you think in terms of feeding them and raising them with a healthy relationship with food.

You are well meaning to seek out advice from your pediatrician or registered dietitian, which I always recommend.

But I find myself providing a lot of reassurance to families and which I'm always happy to do. So I think a lot of parents are doing better than they think.

And if you're listening to the podcast, you're probably a step ahead.

Caroline: That's wonderful advice. Thank you. Well, thank you so much for your time. We know you're super busy, you have a family and a practice and all this great work that you do.

So thank you so much for spending time with us today to help educate the community.

Alison: Sure thing. Always my pleasure.

Caroline: Thank you.

Before we say goodbye today,

I just want to take a moment to say thank you to DBV Technologies one more time for being a kind and generous sponsor of FAACT's Roundtable Podcast.

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