A five- to ten-day course of antibiotics can impact the gut bacteria anywhere from six months to a year.1,2 I recommend my patients take a probiotic while they are taking an antibiotic to support the gut environment. Probiotics can also help prevent antibiotic-associated diarrhea and the yeast-driven diaper rash or vaginal irritation that can sometimes accompany a round of antibiotics.3 We need more research in this area, but this is how I advise my patients currently.
HOW TO TAKE A PROBIOTIC WHEN TAKING AN ANTIBIOTIC
Take the probiotic 1 to 2 hours before or after taking the antibiotic. Please modify if the antibiotic has to be taken 3 or 4 times a day. Continue the probiotic for at least two months after you stop the antibiotic.
Research is rapidly changing Discuss with your doctor
FOODS THAT SUPPORT THE HEALTH AND DIVERSITY OF THE MICROBIOME
Foods That Contain Probiotics
Fermented foods, not pickled foods. Fermented foods contain beneficial bacteria and yeast. Fermentation takes time whereas pickling uses vinegar.
Pickles (be sure they don’t contain high-fructose corn syrup or vinegar)
Sauerkraut
Kimchi
Kombucha
Tempeh, natto, and miso (soy based)
Yogurt (non-dairy for those who are sensitive or allergic to dairy)
Often with my patients, the family is just beginning to make major shifts in diet and lifestyle. If the probiotic- and prebiotic-rich foods aren’t commonplace, we use a probiotic supplement while we begin incorporating some of these foods into the diet.
Proceed with caution
Fermented foods and some probiotics can increase histamine levels in the body for some people, making symptoms (such as bloating, gas, loose stools, and/or eczema) worse or even creating new symptoms.
Foods containing prebiotics
(food for the beneficial gut bacteria)
Bananas
Onion
Garlic
Chicory root
Dandelion greens
Jerusalem artichokes
Leeks
Asparagus
Apples
Jicama root
Chia seed
Flaxseed
Hemp seed
Vegetables, especially homegrown in the soil or purchased from a farmer (the soil is teeming with microorganisms that support our gut health)
Activities that support the microbiome
Playing outside in the dirt
Gardening
Being around animals
Spending time on a farm
Walking outside in the woods
MINI CLEANSE
Sugar4 grams = 1 tsp
To figure out how many teaspoons of sugar are in a particular food, look at the number of grams of sugar and divide that by 4 (24 grams of sugar / 4 = 6 teaspoons).
American Heart Association (AHA) Guidelines on Daily Sugar Intake4
AGE 2 TO 18 YEARS ADULT WOMEN ADULT MEN
Recommended Upper Limit of Teaspoons daily 4 to 6 (16 to 24 grams) 6 9
The Actual Average Daily Intake in Teaspoons5 12 to 34 (teenagers have the highest intake)
Sugar Content of Common Beverages Kids Drink
TWELVE-OUNCE BEVERAGE SUGAR (GRAMS) NUMBER OF TEASPOONS
Can of soda 39 9¾
Orange juice 28 7
Cow’s milk 19½ 4¾
Vitamin Water (ten ounces) 16 4
Soy milk 14 3½
Almond milk, unsweetened < 1 < 1
Notice how much sugar your child has ingested after eating a bowl of cereal with milk and a glass of orange juice in the morning.
Oils to Avoid and Their Healthy Replacements
OILS TO AVOID OILS BEST FOR LOW OR NO HEAT COOKING OILS SAFE FOR HIGH HEAT COOKING
Canola oil
Grapeseed oil
Rice bran oil
“Vegetable” oil
Safflower oil
Soybean oil
Corn oil
Cottonseed oil Olive oil
Coconut oil
Butter Avocado oil
Ghee (clarified butter)
High-Fiber Foods
VEGETABLES FRUITS SEEDS NUTS LEGUMES
Asparagus
Broccoli
Brussels sprouts
Cauliflower
Eggplant
Onion
Sweet potato
Sugar beets
Turnips Apples
Avocado
Berries
Grapefruit
Oranges
Pears
Prunes Chia
Flaxseed
Psyllium seed
husk Almonds (soaking before eating makes them easier to digest) Beans
Lentils
Peas
Daily Fruit and Vegetable Recommendations
AGE FRUIT CUPS PER DAY VEGETABLES CUPS PER DAY
2 to 3 years 1 1
4 to 8 years 1 to 1½ 1½
9 to 13 years (male) 1½ 2½
9 to 13 years (female) 1½ 2
14 to 18 years (male) 2 3
14 to 18 years (female) 1½ 2½
Source: https://www.myplate.gov/eat-healthy/fruitshttps://www.myplate.gov/eat-healthy/fruits
Some helpful comparisons
2 medium carrots = 1 cup
3 medium stalks of celery = 1 cup
1 medium cucumber = 1½ cups
1 medium pepper chopped = ½ cup
1 small apple (tennis ball size) = 1 cup
Removing Dairy/Gluten
Dietary Reference Intakes for Calcium from the Institute of Medicine
Calcium expressed in milligrams per unit specified
0 to 6 months 200 mg/day
6 to 12 months 260 mg/day
1 to 3 years 700 mg/day
4 to 8 years 1,000 mg/day
9 to 18 years 1,300 mg/day
19 to 50 years 1,000 mg/day
51 to 70 years (F) 1,200 mg/day
51 to 70 years (M) 1,000 mg/day
71+ years 1,200 mg/day
Calcium Content of Various Foods
Calcium expressed in milligrams per unit specified
Non-dairy Milks (Calcium per 1 Cup)
Many of these milks are fortified with calcium in the manufacturing process and may vary from product to product. If you make them at home, please be aware that the calcium content may be lower.
Oat 350
Hemp 300
Quinoa 300
Rice 290
Tree Nut Milks
Almond 480
Coconut 460
Cashew 47
Walnut 24
(coconut is actually a fruit, but the FDA labels it as a tree nut)
Legume Milk
Legumes can irritate the lining of the GI tract for some kids. These may not be good options for kids with significant GI issues or eczema.
Pea 440
Soy 300
Vegetables (calcium per 1 cup cooked unless otherwise specified)
Collard greens 265
Turnip greens 200
Mustard greens 165
Bok choy 160
Beet greens 160
Turnip greens 105
Swiss chard 100
Rhubarb 100
Broccoli rabe 100
Kale 95
Winter squash 90
Sweet potato 90
Butternut squash 85
Okra (raw) 80
Broccoli microgreens (raw) 60 to 100
Broccoli 60
Brussels sprouts 55
Acorn squash (raw) 45
Watercress 40
Carrots (raw) 40
Asparagus 30
Cauliflower (raw) 25
Red bell pepper (raw) 10
Spinach 250
(Only a small percentage of the calcium in spinach is absorbed.)
Fruit
Olives (1 cup) 100 to 190
Orange Juice (calcium-fortified) 290
Orange (1 larg
e) 75
Blackberries 40
Raspberries 30
Avocado (1 cup pureed) 30
Kiwi (1 large) 30
Fig (1 large) 30
Strawberries 25
Prunes (5) 20
Blueberries 10
Legumes (calcium per 1 cup canned)
Tofu 870
Black-eyed peas 370
Mung beans 270
Kidney beans 260
Soybeans 200
White beans 190
Chickpeas 210
Black beans 100
Edamame 100
Hummus 90
Snap peas (raw) 80
Green beans (cooked) 55
Lentils 40
Peas (1 cup cooked) 40
Peanuts (¼ cup) 35
Peanut butter (2 tablespoons) 15
Tree nuts (calcium per ¼ cup)
Almonds 95
Pistachio 50
Cashews 20
Walnuts 20
Seeds (calcium per 1 tablespoon)
Sesame 90
Tahini 65
Chia 60
Flax 25
Hemp 15
Sweetener
Blackstrap molasses (1 tablespoon) 145
Plants/herbs
Stinging nettle (1 cup cooked) 450
Artichoke (1 large) 70
Parsley (1 cup) 80
Gluten-free grains/flours (calcium per 1 cup)
Be sure the packaging says gluten-free.
Some grains can bother individuals with celiac disease or a gluten sensitivity. Be sure to pay attention to any GI upset, skin rash, or irritability if you decide to use any of these flours.
Teff 120
Amaranth 115
Steel cut oats 50
Buckwheat 30
Quinoa 30
Sorghum 30
White rice 15
Animal products
Fish (canned with bones, calcium per 1 ounce)
Sardines 110
Salmon 80
Cooked animal products (calcium per 3 ounces)
Oysters 100
Shrimp 70
Herring 65
Mackerel 65
Mussels 30
Egg (1 large) 25
Beef 15
Pork 15
Lamb 15
Salmon 10
Chicken 15
Bone broth (1 cup) 10 to 70
Animal milks (calcium per 1 cup)
Goat’s milk 330 (contains A2 beta-casein and very low amounts of A1 beta-casein)
Sheep’s milk 475 (contains A2 beta-casein and almost no A1 beta-casein)
Cow’s Milk Foods—Calcium Content for Comparison
Milk (1 cup) 300 (contains A1 beta-casein—can cause GI distress)6
Greek yogurt (3/4 cup) 190
Cheese (1 ounce) 200
SUPPLEMENT DOSING GUIDE
Please refer to my website sheilakilbane.com for an up-to-date list of the supplements I recommend, including dosing by age.
When possible, dosing is based upon the RDA or the AI. The RDA (recommended dietary allowance) is based upon scientific evidence and defined as the average daily dietary nutrient intake level sufficient to meet the needs of 98 percent of healthy individuals. AI (adequate intake) is established when evidence is insufficient to develop the RDA and it is set at a level assumed to ensure nutritional adequacy. You’ll notice the omega-3 fat dosing is based upon the AI.
Probiotic
Probiotics should not be given to anyone who is immunocompromised or who has venous access with a central line (an access port for those getting chemotherapy or long-term antibiotic infusions).
HKHM Plantadophilus
AGE START OF BREAKFAST START OF DINNER
Infants Only under the guidance of a doctor
1 year + 1 capsule 1 capsule
You can open up the capsule and mix it with soft food, and it tastes surprisingly good!
For a list of foods that contain prebiotics and probiotics, see the Gut Health section of the Appendix.
Digestive Enzymes
Pick one form which will work best for your child: powder, chewable, or capsule.
HKHM Digest Powder (contains flax)
AGE START OF BREAKFAST START OF DINNER
Infants Only under the guidance of a doctor
1 to 2 years half a scoop half a scoop
3 years + 1 scoop 1 scoop
Take at the start of breakfast and dinner along with the probiotic. May mix in soft food or liquid.
HKHM Kids Digest Chewable (contains flax)
AGE START OF BREAKFAST START OF DINNER
2 to 3 years 1 chewable 1 chewable
4 years + 2 chewable 2 chewable
HKHM Digest capsules
AGE START OF BREAKFAST START OF DINNER
3 to 5 years ½ capsule ½ capsule
6 years + 1 capsule 1 capsule
Enzyme That Helps Break Down Gluten
Dipeptidyl Peptidase IV (DPP-IV) enzyme: For those with celiac disease or a gluten sensitivity who are off gluten but continue to have symptoms.
HKHM CARBO-G
AGE START OF BREAKFAST START OF DINNER
3 to 5 years ½ capsule ½ capsule
6 years + 1 capsule 1 capsule
NATURAL WAYS TO IMPROVE DIGESTION
Do more of the activities that support digestion and fewer of the ones that compromise our digestion:
Be in a relaxed state when you are getting ready to eat.
Chew your food thoroughly.
Eat mindfully and slowly.
Eat with people you love.
Enhance your toolbox of ways to handle stress.
Eat foods that support the microbiome.
Cut out the processed, packaged, high-sugar foods.
Be sure you are having at least 1 daily, easy, formed bowel movement.
Omega-3 fats
The Current Recommended Adequate Intakes (AI) of Omega-3s for Kids
AGE DOSE
0 to 12 months 500
1 to 3 years 700
4 to 8 years 900
9 to 13 years (male) 1,200
9 to 13 years (female) 1,000
14 to 18 years (male) 1,600
14 to 18 years (female) 1,100
Refer to my website sheilakilbane.com/book
for up-to-date and specific supplement suggestions
Omega-3 Foods
Coldwater fish: salmon, mackerel, herring, trout, char, sockeye, sardines
Flaxseeds, flax oil
Chia seeds
Hemp seeds
Walnuts
Almonds
(specify the meats)
Berries: blackberries, blueberries, strawberries
Brussels sprouts and other green leafy vegetables
Eggs (free range)
Vitamin D
Remember: Vitamin D is a fat-soluble vitamin which means you can overdose on it. Please follow the recommended guidelines unless advised by your doctor.
Vitamin D Recommendations of The American Academy of Pediatrics (AAP) and The Institute of Medicine7
AGE DOSAGE
0 to 1 year 400 IUs/day
2 to 70 years 600 IUs/day
71 years + 800 IUs/day
Breastfeeding infants should be supplemented daily. Formula-fed babies who are not drinking one quart (thirty-two ounces) daily should be supplemented. Thirty-two ounces of formula contains 400 IU vitamin D.
Adequate vitamin D is extremely important for a developing baby. Studies show that less than 30 percent of US infants are getting adequate amounts, and breastfed babies were more likely to fall short of the guidelines than formula-fed babies.8
I typically give kids two years and older 1,000 IUs/day, but I also follow their levels via bloodwork. I try to keep my patient’s levels between 40 and 60 ng/mL (100 to 150 nmol/L). This should only be done in conjunction with your child’s doctor.
Refer to my website sheilakilbane.com/book
for up-to-date and speci
fic supplement suggestions
How Do We Get vitamin D Naturally?
We synthesize vitamin D through the absorption of sunlight from our skin. The amount of vitamin D we synthesize from the sun varies greatly and depends upon age, where you are in the world, the time of year, and skin pigmentation. Darker skin requires longer sun exposure. The time needed can range from ten minutes for a fair-skinned individual to sixty minutes for more pigmented skin. Sunscreen prevents the skin from synthesizing vitamin D.
A small number of foods contain vitamin D naturally.
Foods that Naturally Contain vitamin D
VITAMIN D9 IU PER OUNCE
Blue fish 280
Cod 104
Grey sole 56
Salmon, Farm 240
Salmon, Wild 988
Trout, Farm 388
Ahi Tuna—Yellowfin 404
Vitamin D content varies from fish to fish and depending upon its source (farm raised have lower amounts than wild caught).
Foods Fortified with vitamin D
(which means it doesn’t occur naturally in that food)
Pasteurized milk, 100 IUs per 8 ounces
Orange juice, 100 IUs per 8 ounces
You’d have to drink more than 32 ounces daily of juice or milk to provide your body with the recommended amount of 600 IUs. I don’t recommend anyone drink that much milk or juice in one day!
Whole-Food Supplement Options or Multivitamin Mineral Options (Pick One)