CRUSH CHATS TO Paediatric Dietetian Kath Megaw
Author of the new cookbook Real Food – Healthy, Happy Children
Kath Megaw holds four medical qualifications including a paediatric dietetic qualification from the prestigious Johns Hopkins University in Baltimore, USA. She has been published in the Epilepsia journal on the use of the paediatric ketogenic diet in third-world settings and frequently speaks to groups of both professionals and parents on infant and childhood nutrition. She also speaks on television and radio. She is the co-author of Feeding Sense (Metz Press, 2012), has been in private practice for the past 15 years and is the founder of Nutripaeds, a paediatric dietetic practice. She is married with three children (aged 9, 12 and 16).
It was around 2002 that I started using the ketogenic diet for children with epilepsy. The ketogenic diet is very high fat and extremely strict on carb intake. What I noticed is that even though this diet was the complete opposite of what we were supposed to be recommending to children who didn’t have neurological conditions – in other words, the low fat, high carb diet – the children on the keto diet lost weight and their immunity improved.
In the early 2000s — around 2003/4 — I started working more extensively with the keto diet. I was looking at international research too. On a high fat diet, the triglyceride levels of these children were not increasing. This was not what I had been taught to expect. We were also finding that we could normalise a child’s cholesterol if we replaced the wrong fats with the right fats.
These findings contradicted what I had learned at varsity. I was taught that from two-years old a child’s fat intake should be limited. That was the mindset. As nutritionists, we were taught to provide for the child’s calorific needs by putting in a lot of carbs. But the volume of carbs needed to be high to do this. And actually children don’t eat a whole lot. They get bored. Plus, many children are picky eaters. Fat is a much more concentrated form of energy. Children can eat it in smaller volumes and get the same calories. So I started drifting away from the accepted nutritional advice. I started doubting that what I’d learnt was gospel. It was strange. I was thinking, surely the profs would have kept up with the research and known better? I felt like I was going behind the backs of my professional gurus advocating full fat milk to all my patients. I felt bad doing it — but at the same time I couldn’t not do it.
My turn-around moment was in 2012, when I went to a ketogenic conference in Chicago. The conference looked at diabetic diets, oncology, cancer … It went beyond epilepsy. I went to a lecture by Gary Taubes, and was lucky enough to have lunch with him afterwards. I chatted to him about what I had noticed. He convinced me that it made sense to apply the principles of the ketogenic diet beyond children with “special needs” like those with epilepsy. All over the world, nutritionists had started restructuring diets along keto lines for children with diabetes, ADHD and weight problems. It was clear to me that keto was no longer just a diet with applications for children with neurological problems. It was also beneficial for children with lifestyle-related issues. It was like a coming-out moment for me. I thought, “actually this makes a lot of sense”. It gave me permission to come back and change my diet sheets. My carb diet sheets now excluded refined grains and become restricted to carbs “of the earth”, like sweet potatoes and butternut.
In the past I had dreaded my weight loss patients because we weren’t seeing results. The diets were not sustainable. Now the children were finding the diets tasty and enjoyable. And long term we were seeing great results. A year down the line the weight would still be off and the child would still be enjoying the food.
WHAT I DID AT HOME
I made changes at home too. After the revelation of Chicago, I immediately went home and decreased our bread intake. I started including protein and fat at breakfast time, and I made double suppers so the children could have meat and veg for lunch. On Sundays I cookedtwo chickens and the children and I would debone them and portion them for fridge snacks.
I noticed that the children stopped being so driven about their lunchboxes. Because we were cutting down on starch at breakfast, they sometimes didn’t open their boxes until second break. Their blood sugar was sustained a lot longer through the day. When myteenaged son came home he was no longer desperate to eat. He would put his bag downfirst, have a chat. There was a calmness to their appetites.I also noticed they were not as tired. My teenager was able to study a bit later in the evenings. He actually noticed that too, and now during exam time he eats less carbs and more veg and protein.
Our suppers are always protein- and veg-based. My boys eat vegetables to fill their plates. That’s been very rewarding. We are not excessive with protein. My children don’t have more than one egg a day each. Sometimes my older son will have chicken from the fridge if he’s not full after supper. The one thing I didn’t do gradually was fruit juice. I just stopped buying it. My youngest was four-and-a-half at the time. He was in the habit then of filling up on the empty calories of juice. He gave me some resistance in the beginning. But on the whole it was amazing. We all went on this big water drive, and we’ve never gone back.
The other thing my little boy struggled with at that time was biscuits. I used to buy them for tea dates so they were in the cupboard and he begged for them every day. Eventually I hit on the idea of treat boxes. I would put a handful of healthy and nonhealthy treats in the children’s boxes twice a week. I included things I knew they liked: biltong, a mini Bar One, pretzels, dried fruit and popcorn … I said it was up to them when they had their treats. It had to let some stuff go with that. They were allowed to have a treat before breakfast if they wanted to. It gave them autonomy. But that was logical to me. I didn’t want to control their treats because when they stepped out of my house I wanted them to know how to moderate for themselves by listening to their bodies.
The treat boxes actually bore more fruit than I expected them to. It stopped the nagging and negotiating at home – and the supermarket aisle disaster! I was happy to shop with them again. Also, my little boys learnt the days of the week through his treat box. He learnt the concept of time and the concept of pacing himself. My children even gave me treats from their boxes to carry over to the next box if they had had a treat outside the house.
It wasn’t a huge struggle making the shift away from carbs and sugar, and processed food in general. We transitioned gradually — it took us a good year. I couldn’t have done it overnight. I spent a lot of time explaining things to my children and engaging with them. And sometimes I would revert. One day I brought home sausage rolls. My children couldn’t understand what I was doing. They didn’t want pies. They liked them once, now they wouldn’t think of eating them. Suddenly I realized I had their buy-in. It’s much easier now. And it’s not because I am standing there with a whip.
Occasionally we have carbs when we’re out, or when we braai. If your diet is healthy, you can afford to have a potato or some rice now and then. We don’t usually have sweet things during the week but we go out for a treat sometimes at the weekend if we feel like it, or I make them a pudding on a weekend night. It’s important to have a bit of flexibility.
Read our Q&A with Kath HERE.
Real Food – Healthy, Happy Children, published by Quivertree, will be available in August 2015.