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New Artificial Sweeter – OK for PKU?

FDA Approves New Artificial Sweetener

A new sugar substitute called advantame was approved on Monday by the U.S. Food and Drug Administration.  Advantame is chemically similar to aspartame (Equal), and certain people should avoid or limit their use of aspartame, the FDA noted.

These people have a genetic disorder called phenylketonuria (PKU), which makes it difficult for them to metabolize phenylalanine, a component of both aspartame and advantame. Food with aspartame must include label information warning people with PKU about the presence of phenylalanine.

The FDA evaluated whether advantame should also carry alerts for people with PKU. Because advantame is much sweeter than aspartame, only a small amount is needed to achieve the same level of sweetness.  As a result, foods that contain advantame do not need to include alerts for people with PKU, the FDA said.

Be sure to talk to your metabolic professional if they feel advantame is suitable for your diet.  Currently, the exact PHE content has not been reported.

SOURCE: U.S. Food and Drug Administration, news releases, May 19, 2014

At what age should I introduce solid foods?

At what age should I introduce solid foods?Feeding child

The American Academy of Pediatrics (AAP) currently recommends gradually introducing solid foods when a baby is about 6 months old.1

**Always consult your metabolic healthcare professional before introducing new foods or changing your child’s low protein diet.

How do I know if my baby is ready to eat solids?

The following tips may help2

  • Is your baby’s tongue-thrust reflex gone or diminished?
    This reflex prevents infants from choking on foreign objects, but also causes them to push food out of their mouths. Ask your pediatrician or metabolic dietitian.
  • Can your baby support his/her own head?
    To eat solid food, an infant needs good head and neck control and should be able to sit up unassisted in a high chair.
  • Is your baby interested in food?
    A 6-month-old baby who stares and grabs at your food at dinnertime is clearly ready for some variety.

What should I know about first foods?

Until now your baby is only used to liquids so it is essential that the first foods offered are a smooth, runny purée. First solids should be bland, easy to swallow and easy to digest. Your baby can progress to a thicker purée once they become used to the runny texture.

What types of food should I offer?

Check with your metabolic dietitian which foods are best for your baby.  Most parents begin with rice cereal mixed with formula and gradually introduce other foods. Homemade purées are inexpensive and easy to make. Fruit and vegetables can be cooked in a small amount of water until soft and then puréed using a hand blender or food processor. Ready-to-eat first foods and baby cereals are also available in the grocery store. Once you have introduced single purees to your baby you can try mixing different combinations for variety e.g. sweet potato and carrot, or apple and pear.

How much should I give my baby to eat?

At first, only offer very small amounts (about 1-2 teaspoons at a single meal). Gradually more food can be offered. When your baby is taking a reasonable amount of solids at a single meal (about 6-10 teaspoons) you can introduce solids at a second meal in the day and then at a third.

Suitable Low Protein Baby Foods2

6-8 Months Old

  • Apple sauce
  • Very small pieces of soft fruit
  • Some cereals
  • Soft cooked vegetables such as carrots or squash

9-12 Months Old

FRUITS

Fresh

  • Wash thoroughly.
  • Remove skins and seeds.
  • Cut into small, bite-size pieces or thin sticks (i.e. quarter grapes).
  • At one year, include unpeeled ripe fruits, berries, pears and nectarines.

Frozen/Canned

  • Look for fruits packed in their own juices.
  • Avoid fruits canned in heavy syrup.
  • Frozen fruits are soothing to teething gums.

Dried

  • Pitted or seedless prunes, apples, apricots, peaches, and dates.
  • Avoid raisins, which can cause choking.

Examples: Apple, Apricot, Avocado, Banana, Berry Grape, Kiwi, Mango, Melon, Nectarine, Orange, Papaya, Peach, Pear, Plum.

VEGETABLES2

Vegetables can be served hot or cold, but all will need to be cooked.

Fresh

  • Wash thoroughly.
  • Raw vegetables are difficult to chew, swallow, and digest.
  • Cook until tender and easily pierced with a fork.
  • Cut into small pieces, long thin strips, or grate.

Canned or Jarred

  • Be careful of the amount of sodium, choose low sodium if possible.
  • Rinse the can or jar before opening.
  • Can be served directly from the can, cut to appropriate size.

Frozen

  • Must be cooked until tender and cut to appropriate size.

**Be sure to discuss PHE or protein tracking an your child’s daily allowance prior to proving any new foods.

References:
1. American Academy of Pediatrics Web Site. Web. 03 Mar. 2010. http://www.aap.org/
2. Eat Right Stay Bright. Guide for Hyperphenylalanemia. L Bernstein and C Freehauf. Chapter 1. Pages 56-58

Eating Out on a Low Protein Diet

Although it can be easier to prepare low protein meals at home, this can restrict your work and social activities. Fortunately, many eating places are beginning to realize that an increasing number of people follow “special diets”.

Many of the larger restaurant chains state that they will try and cater for customers on a special diet whenever possible. To get further information from a particular company contact their Customer Service helpline or check their website.

RESTAURANT TIPS

  • Try and give advanced notice to the restaurant whenever possible
  • When explaining your diet, try not to get caught up in a long list of “I can’t have” foods
  • Offer a few ideas of possible dishes you can eat and recipes if necessary
  • Ask if you can bring in your own low protein products such as pasta or pizza bases if this is suitable

EATING ON THE GO
1. Cafes/sandwich shops

Small cafes that make things up from scratch can prove useful (especially if they get to know you!).  Ask if nutritional information is available to find out ingredients /protein content of items.

Possible snack ideas

-Salad
-Fruit
-Tomatoes on toast*
-Chips*
-Jacket potato* and butter

2. Fast food outlets

Some larger, well known fast food chains, provide nutritional content leaflets  for customers in the shop or online access nutrition information.

Possible snack ideas

-Salad (if available)
-Chips*
-Onion rings*
-Hash browns*
– Most veggie burgers are NOT suitable, as they are high in protein.

3. Cafeterias at work or school

Some cafeterias can be quite flexible so it is worth asking if they can cook or re-heat some of your low protein foods. If the cafeteria food choices are limited it may be easier to take a packed lunch in.

Possible snack ideas

-Salad/vegetables
-Fruit
-Baked Potato (avoid mashed potato as it is likely to contain milk)
 *Weigh out as usual

Note: Each condition may vary in tolerance for specific foods that contain protein, even if low in protein. Always speak with your metabolic dietitian or healthcare provider before adding new foods or changing your metabolic diet in any way.

5-A-Day the Low Protein Way

For those following a low protein diet for a medical reason, FRUITS and VEGETABLES are a very important part of the diet. The good news is fruits and veggies are good for you and it is recommended to have a least 5 servings a day. The best of all they are typically naturally low in protein and a good source of vitamins and antioxidants. Antioxidants are chemical compounds (natural) found in food that keep cells within your body strong and work to fight off illness.

Here are some quick tips for eating 5 A Day the Low Protein Way

  • Included a tossed green salad as part of your dinner and lunch
  • Keep celery and carrot sticks pre-cut so they are available for a quick snack
  • Add fresh berries to your low protein cereal (Shop Loprofin Low Protein Cereal Now)
  • Roast vegetables in advance for quick eating and reheating during the week
  • Don’t leave home without it! It = An apple!
  • Enjoy canned fruit cocktal (packed in juice) as an evening snack or when summer fruit is out of season
  • Try something tropical like guava, pineapple, mango or papaya diced on a salad
  • Add fruit to your formula and blend for a PKU formula (or any other metabolic condition) smoothie
  • Freeze grapes for a cold, bite size treat

Posted by: Sandy Simons, MA, RD, CHES

Sandy is a Registered Dietitian and Certified Health Education Specialist. She received her graduate training at Columbia University’s Teacher College in New York. She has been working on the industry side of metabolic nutrition for the past 11 years and is often seen at patient events around the country.