Brain Power with Dr. Eko

Ep. 20 | Pediatric Headaches and Neurological Health: Strategies and Diets with Dr. Fernandes

• Dr. Hokehe Eko • Season 1 • Episode 20

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Unlock the secrets to safeguarding your child's neurological health with the brilliant Dr. Fernandes, a pediatric neurologist who brings the latest insights on the concerning rise in pediatric headaches since the dawn of the pandemic. It's more than just an episode; it's a journey into the complexities of a child's brain, where Dr. Fernandes unravels the impact of disrupted routines, excessive screen time, and the pivotal role of diet and sleep. As parents grapple with these challenges, our conversation steers toward practical advice on how to adapt and foster a healthier lifestyle for our youngest generation. Furthermore, we navigate through the intricacies of managing conditions like autism and seizures, emphasizing the importance of early diagnosis and strategies to improve medication adherence.

Prepare to be enlightened by the therapeutic potential of low glycemic index diets and various ketogenic diets, which serve as more than just meal plans but as a beacon of hope for children dealing with epilepsy and migraines. Dr. Fernandes and I dissect the importance of complex carbohydrates, the risks of processed sugars, and the tailored applications of each diet type. We stress the cruciality of professional guidance before embracing these specialized diets, ensuring your child's unique health needs are met safely. Concluding our dialog, the spotlight turns to sleep – the cornerstone of brain health in children – and the responsibility that falls on you, the parents, to arm yourselves with knowledge and advocacy when it comes to your child's healthcare journey. This episode is an invaluable resource for any parent seeking to champion their child's neurological well-being.

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Dr. Hokehe Eko:

Hello everyone, welcome to another episode of Brain Power with Dr. Eko. I have an amazing guest today, Dr. Fernandes. She's a pediatric neurologist and she is simply amazing. So, without further ado, welcome to the podcast, Dr. Fernandes.

Dr. Cecilia Fernandes:

Thank you, Dr. Eko. Thank you so much. It's such a pleasure to be here.

Dr. Hokehe Eko:

Thank you. So please tell our listeners all about the amazing work that you do.

Dr. Cecilia Fernandes:

Yeah, I'm just going to introduce what I do, because a lot of times when you say pediatric neurologist, people are like what is that? Did someone say urology? So it's by instinct I like to get into. You know what I do, what I do. So we are child brain doctors and most people don't understand that children can actually have a lot of brain developmental issues and the very common things I see are seizures, headaches. These days, headaches more than seizures. Actually, seizures used to be a big part of my clinic but since the pandemic I've seen such a huge rise in the number of headaches and in all age groups, starting with small toddlers all the way up to, you know, teenagers and older. So I think that's a big part of what I do. Other than that, of course, developmental issues, like developmental disease, you know, co-concurrent autism. So we see a lot of children with autism and seizures. So it's a very interesting place with a lot of multitude of things we do and I love what I do isn't that the key?

Dr. Hokehe Eko:

you better love what you do for sure, because if you, you want to find something that you can do, that doesn't feel like work, and so that way you're giving your very best right. So I want to talk about something you said real quick. You said that since the pandemic, you've seen headaches, the rise of headaches in younger and younger children. So is there any research around why that's happening and, if yes, what is it and what can parents do to help their kids?

Dr. Cecilia Fernandes:

Yeah, so that's very interesting that you asked. I think most of the research leads us to one spot where you know they were basically disconnected from their routine. So a lot of times when you are disrupted from your routine, you don't get enough sleep, you're not eating the right things, you're snacking throughout the day. So you know that forms the foundation of everything to do with brain health, which is diet, sleep. And then throw into that, you know, the fact that they were on screens throughout the day.

Dr. Cecilia Fernandes:

Parents had to keep them on screens, even to keep them occupied, because they couldn't leave the house, not having that social structure, not being able to play outside. So all of those things are contribution to you know, what we are probably seeing right. So, in addition to, of course, some of them have had COVID and they've had the infection, so there's some kind of, you know, inflammatory component to it as well. But I think a large part of it is really disruption of routine which leads to where we are, and so you know parents can really help by getting their child back into a routine. Routine really helps children when they know, you know what time they have to eat, what time they have to sleep and sort of getting them back in that routine is the first step to it and decrease screen time.

Dr. Hokehe Eko:

Oh yes, believe it or not, the screen doesn't teach your kids. You teach your kids, and your kids learn from using their senses right, Not from watching TV.

Dr. Cecilia Fernandes:

That is true, yeah.

Dr. Hokehe Eko:

And something else I wanted to ask about that you mentioned. You said you see a lot of kids with seizures and with autism, and I know that particular combination can be really severe and really give parents a lot of concern. So let's talk some more about that.

Dr. Cecilia Fernandes:

Yeah. So firstly, it's very important for parents whose children have autism to be able to one accept the diagnosis so that the child can get the right care. And I see a lot of parents because, you know, when the pediatrician has made the diagnosis of autism, oftentimes they have questions and they're like we want to see the brain doctor and so when they come to us you know we don't have anything else to offer because ideally it's based off of symptom science that this diagnosis of autism is. And once you know a child has a diagnosis of autism, it's really not a disease but it's really a type of behavior. You know they are just different in their type of behavior so you have to handle them in a specific way. So we recommend, you know, getting them into behavioral therapy sooner. So having a diagnosis helps with that. Now, 30% of our children with autism have seizure disorder, epilepsy.

Dr. Cecilia Fernandes:

And so it's very, very common that we have an overlap and in our children with seizures, now obviously they have difficulty taking their seizure medicines. So, you know, parents have to find different loopholes, mixing those medicines with, like you know, liquids that they like. I even had a parent like put it in a fruit loop, like their medicine in a fruit loop, and make them eat.

Dr. Cecilia Fernandes:

So it's very, very challenging, I would say, to have the combination, and so, when we have epilepsy, I think it's very important for parents to know that there are different modalities of treatment. So most of us neurologists will touch upon that. One of them is medications, one of them, you know, ketogenic diet, and then, of course, the more advanced treatments are surgery and devices.

Dr. Hokehe Eko:

Right, that's how it is Okay. So usually by the time we see the kids, the kids are already on medication for seizures and the parents are asking so what else can I do with my child? Or I've heard about the ketogenic diet and I've heard that it helps my child. So how exactly am I going to start a ketogenic diet in a child that's a picky eater and also has autism? So you may or may not be able to communicate why you're changing the diet, and if their diet is already restricted, then that's a whole nother barrier, right? So walk us through what you would say to a parent like that.

Dr. Cecilia Fernandes:

Yeah, so I think here it is based on how severe the autism is. If you have a child who's a high functioning autism, you can actually work with them some, but if you have a child who is more in the moderate or severe category, then it becomes pretty challenging because you have to know what your child likes to eat. Most children with autism are eaters, so it becomes a little difficult. Now, ketogenic diet typically has different types of variations. You would say so you have your classic ketogenic diet, which is where you take up to 90-95% of your diet. You take up to 90-95% of your diet is just fats. Okay, now if your child loves butter, loves cream cheese, loves heavy cream, bacon so if your child likes all this, then you're in a good spot. It's a win-win, because all that is fatty, you know heavy fatty foods.

Dr. Cecilia Fernandes:

Another option is you know, those children who are drinking milk or who are younger. We do have diet formulations so that can be introduced. But otherwise having a nutritionist really helps because they can help to match with your kids' diet some. If that doesn't work, then you have other variations where you have low glycemic index, you know treatment or LGIT diet, or you have the modified Atkins, and that is just a variation of the amount of carbohydrate. So, like I said, you know where ketogenic, classic ketogenic diet is like 90% fat, then you have just 4% of carbohydrates and rest is all protein. The other diets you can allow a little more carbohydrates, so your amount is a little more, but you're still maintaining low glucoses. What I would recommend is working with a provider, not trying to do this on your own but, working with a provider or a nutritionist to help you, because this will then move you forward.

Dr. Cecilia Fernandes:

If you're looking at it as a treatment for seizures, don't look at just diet as the sole and just stop all the medicines. That doesn't help either. It has to be a balance. Everything in medicine is about a balance, so we do want side effects, but we want benefits also, right that's what I would say absolutely and when.

Dr. Hokehe Eko:

When you say work with the provider, so for me, I'm an integrated pediatrician and I do testing to see what's really going on with the child. So so instead of just blindly in the dark taking things out of the diet or adding things in, you want to work with somebody who can figure out is your child sensitive to something that even could be the trigger for the seizures? And if that's the case, you want to take that out while we craft a personalized diet plan for your child. So I'm glad you said that, because you definitely don't want to stop the meds. You want to do both at the same time and then work with your doctors to see if maybe the meds can be decreased, especially if there are side effects.

Dr. Cecilia Fernandes:

Yeah, I think you bring up a very important point you know with especially children who have chronic illnesses like epilepsy. When we talk about medications, when we talk about that, you know, always most of us providers are open to discussion before we move forward. You know, and if you don't feel comfortable, you don't trust your physician. You can always change and find somebody that you feel you know can trust you, that you feel you know can trust you. But definitely having a discussion with your provider because our knowledge base, where we are coming from and wanting to provide this, is only for the family. You know we're not doing this for ourselves, we're really doing it for the family.

Dr. Cecilia Fernandes:

So I'm glad you brought that up.

Dr. Hokehe Eko:

Yeah, yes, definitely. So you mentioned low glycemic, and somebody might say what in the world is that? So can you explain what goes low glycemic index, what? What kinds of foods fall into that category?

Dr. Cecilia Fernandes:

yeah, yeah, yeah. So I think it's very. It's also coming up as a you know more of a fad now, a lot of people doing this sort of low glycemic. So there are foods which don't spike your glucose throughout, you know, and they are more complex carbohydrates, really easy things that we eat, things that is in everybody's diet, mostly starting with oatmeal in the morning, doing you know sort of rice or wheat in the afternoon.

Dr. Cecilia Fernandes:

But again, this is not we are not talking about ketogenic, but we're not talking about aspect of things, because there you're going to cut down a lot on the carbohydrates and you're going to keep really fatty diet but at the same time, bearing in mind that these you're not giving intermittent bursts of sugar to increase the amount of sugar in the bloodstream, right?

Dr. Cecilia Fernandes:

So you're maintaining a certain amount of glucose in the bloodstream and that is essentially that idea of low glycemic index. Where it gets messed up for a lot of us is we end up eating so much of processed sugar if you look at all the cereals on the store in the store, full of processed sugar and you're creating a huge spike in the baby's blood, right, or the child's blood, so spike of glucose. So it's very important for us to be mindful, to start getting into that habit of reading the labels, checking the amount of sugars there are. I just started doing that a few years ago and I'm so surprised I'm yet to find a good granola with low amount of sugar. Hey, you can make it yourself.

Dr. Hokehe Eko:

I know, I have started doing that. I know Me too. Same thing happens to me. I said I read the names, I was like, wait did I just see fructose at the top and then corn syrup. So now they're splitting instead of high fructose corn syrup. Now everybody says, don't do it. So now you see fructose and then corn syrup in the other end.

Dr. Cecilia Fernandes:

You're like, oh wait yeah, these are all those marketing strategies, and and and. When you start getting educated about this which is, you know, the goal of much of what we do in terms of your podcast as well, I feel like so phenomenal where you've been giving these to, it's all really good.

Dr. Hokehe Eko:

So you mentioned that there are several kinds of ketogenic diet, right, depending on the child. How do you which diet goes with which child? Yeah, I know we can be here for another hour discussing how we determine that, but just as a broad overview, what parents here are curious about. Okay, so now you just mentioned three things. How do we determine which one is which? And again, as I'm asking that question, I'm reminding parents remember she said you need to work with somebody who knows what they're actually doing. But just so that you can have a discussion with your provider, go ahead yeah, so there.

Dr. Cecilia Fernandes:

So when you have epilepsy, ideally the classic ketogenic diet is what you need, because classic ketogenic diet is a treatment. You're basically forcing the body to think it is in starvation okay, and when your body goes into starvation it conserves all that energy and it reduces that hyper excitability which is happening in right. So basically, how I like to tell families is you're moving your fuel for your brain from being glucose to being ketones, or ketones are a byproduct of fat for everybody to understand. So basically you're moving that fuel. You know, like in your, in your car, your petrol diesel, so you change the fuel. So it's just like you change the fuel of your brain to ketones.

Dr. Cecilia Fernandes:

So children with seizures, typically, a good, strong, ketogenic diet would be very, very helpful. Now there you have to be monitored, you have to be admitted. It's good to have your epilepsy doctor, neurology, your integrative medicine doctor. You know everybody working together, your nutritionist, so sort of everybody needs to work together. We check labs very often and not everybody meets criteria to start ketogenic diet because there are some bodies which don't have the right chemicals to break down fat. So in those bodies they cannot be put through a ketogenic diet. Their body is going to start breaking down. So we have to be very careful with the type of children that start diet.

Dr. Cecilia Fernandes:

Then the other aspect is the low glycemic index or modified Atkins diet. Now, that can be. You can work with your nutritionist and your primary care provider to actually implement that. You don't need lab work for that. You don't need to follow labs for that as such in terms of monitoring. But classic ketogenic diet definitely so. Classic ketogenic is for epilepsy. The others are helpful in children who have migraines and you're trying to move towards you know more of a headache management. Then you could use a gluten-free diet you can use, you know, anti-inflammatory diet, which is like Mediterranean Indian food. You know African food has a lot of anti-inflammatory components to it and lastly, you know modified diet.

Dr. Hokehe Eko:

Okay, wonderful. Thank you for explaining that for parents so they have some idea when they're having the discussion with their providers. Because it's good for us, it's good for parents to be informed about the discussions, and I always tell parents if you don't understand, ask them to explain it to you. Don't just accept whatever they say if you don't understand what they're saying. So, and don't be afraid to do that, because you're your child's first and best advocate.

Dr. Hokehe Eko:

So, speak up and ask when you have to go see, like the neurologist or any specialist you're seeing, especially if your child has both seizures and autism together. So thank you for all that you've shared. Do you have any last tips on any last brain health tips for our kids?

Dr. Cecilia Fernandes:

Sure, sure yeah. So, I think you know, with children definitely sleep. I would say sleep is so, so important. So you know, if parents can work with their children on making sure that they get at least eight to nine hours of rest, it really helps the brain with development. It helps the brain with just clearing all that debris and it prevents future diseases like Alzheimer's disease, parkinson's. We're seeing a lot of correlation with lack of sleep. So sleep for both parents and their children is very important.

Dr. Hokehe Eko:

Yes, I like that. You made that last point, that you're saying there's a correlation between lack of sleep and Alzheimer's, and parents we may think, okay, we're young, alzheimer's is down the road, but there's so much evidence to show that it actually starts in our early like, with the habits we have and they're not sleeping and all of that, and I know that's a whole nother topic.

Dr. Cecilia Fernandes:

But yes, stay tuned for that prevention is better than cure, correct? Yeah?

Dr. Hokehe Eko:

no, so parents, don't put it off. It's important for you to do what you need to do to enhance your sleep as well as your child. So thank you. You so much again, Dr. Fernandes, and before we go, can you tell the listeners where they can find you?

Dr. Cecilia Fernandes:

Yeah, so please do share my link. I'm ceci_fern on Instagram. I practice in Atrium Health in Charlotte, North Carolina, so you can find me there and I'm happy to take care of your kid.

Dr. Hokehe Eko:

Yes, wonderful. Yes, please go see her if you're in the state of North Carolina, in Charlotte. So thank you again, and please share this episode with any members of family of your family or friends that need to hear about this. So have an amazing day. Until the next episode, take care.