Tylenol and ADHD - What is the evidence?

Acetaminophen and Pregnancy - Does it Cause Problems or not?

There were some headlines recently about a study that was publicized as Acetaminophen use during pregnancy could lead to behavioral problems in children.

The actual study looked at 65,000 children in Denmark (where all medical information is captured in a government database). Taking children with ADHD (Attention Deficit Hyperactivity Disorder) diagnosis or medication prescriptions, they looked back at the use of Acetaminophen during these pregnancies. They found that women with reported use of acetaminophen showed a slightly increased risk; and those who had used it for more than 19 weeks total had an over 80% increased risk. However the absolute number of cases was relatively small.

But this does not necessarily show cause and effect. First, Acetaminophen is an over the counter drug, so its use may have been under-reported. Even more interesting would be why these women took the drug for 19 weeks or more during the pregnancy. Perhaps the factors that required its use; or some genetic predisposition associated were the cause.

Even the study author and journal editorialists conclude that it is too early to assign cause and effect and more studies are needed. Unfortunately many lay publications conveniently omit this.

I would not stop the use of acetaminophen in pregnancy for appropriate symptoms. Like all drugs during pregnancy, it should only be used if absolutely necessary.

New Polio-Like Virus in California - Cause for Concern

New Polio-Like Virus in California - Cause for Concern

Many of you may have heard about a new condition in California, that has affected up to 25 children in the past 18 months. It leaves the child with total paralysis of one arm or leg, and has had some breathing issues in a few children.

At present this seems very rare. During the polio epidemics there were thousands of cases in an 18 month period.

Physicians are researching the cause. A few of the children have been found to have a polio like virus called enterovirus-68. But most do not seem to have it. This virus is a suspect because it has caused rare paralysis in the past in children in Asia and Australia. Another possibility being looked into is an auto-immune process; where the body reacts to a common viral illness and produces antibodies that cross react with itself. This may be much harder to detect and treat.

There does not seem to be any association with any vaccines, and no direct relationship to polio virus. The cases found so far are separated enough by location and time that the CDC does not believe this is an epidemic. It remains a rare phenomenon.

Paralysis from Polio was an uncommon side effect of the virus; perhaps affecting one in a thousand children. However the infection was so prevalent and contagious that enough children got sick to create the epidemic. For example if in a big city like New York, 20,000 children were infected, then 2,000 would have paralysis; a huge number.

Currently researchers are working diligently to discover the cause. I believe they will find it. At present there is no need for any panic.

Supplements - stop poisoning yourselves!

Selenium, Vitamin E and Prostate cancer

Once again, supplement use comes under attack. I still recommend a balanced diet and avoidance of dietary supplements; the majority of which are unproven.

However, researchers are continuing to review and mostly disprove their benefits.

Selenium, a necessary minor element in the diet had been touted as prevention for prostate cancer; as has Vitamin E which also has many other purported benefits.

Now a study has been published which not only shows that these products do not prevent prostate cancer, but apparently increases the risk of aggressive cancers!! This is in doses above normal requirements; which of course we all get in a balanced diet.

In a brief review of web sites I found many claims that selenium protects the prostate! And the claims for Vitamin E are almost endless! Although low dose vitamin E seems to delay Alzheimer's in a recent study, higher doses have been associated with increased mortality.

The bottom line is that we should not be trying to extract the supposed active ingredient from healthy foods (unless you plan to try and make money out of selling supplements!). Just eat right and stay healthy!!

FODMAPS and Irritable Bowel

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Have you heard of FODMAPS? They are Fermentable, Oligo-, Di-, Monosaccharides, And Polyols). FODMAPs are poorly absorbed, short-chain carbohydrates that include fructose, lactose, fructans (found in wheat), galactans, and polyol sweeteners.

Confused? I'm sure. Here is a good spot to check out which foods are high in FODMAPS:

Standford FODMAP diet

or FODMAP diets information

This is a list from Stanford. There are many other sources available through a Google search. These foods, which include high fructose corn syrup (very commonly found in processed foods) 

Researchers in a crossover study found an almost 50% decrease in symptoms of irritable bowel in patients on this low FODMAP diet. It is also low in gluten.

I think we should avoid processed foods in general; but if you have issues with irritable bowel this is definitely worth a try!

2014 Immunization Schedules

2014 Immunization Schedules

Paste this into your browser:

http://www.cdc.gov/vaccines/schedules/easy-to-read/index.html

Sleep, Mood and TV

Sleep, Mood and TV

In a couple of studies that recently were published, researchers examined the effects of additional sleep and TV watching.

Teenagers habitually stay up late and have trouble getting up in the morning. By allowing just 25 minutes of extra sleep, researchers found that bedtime did not change, and students averaged 29 minutes of extra sleep. Daytime sleepiness, depressive symptoms, and caffeine use were significantly reduced. Chronic sleep deficit in adolescents has been associated with crashes related to drowsy driving; obesity; cardiovascular disease; and impaired mood, attention, memory, and executive function. Inadequate sleep has also been associated with worse academic performance and decreased motivation to learn.

Perhaps this will translate into changes in our school systems to allow teens to get more sleep.

Our circadian (sleep/wake) rhythms are affected by light and darkness; the photosensitive receptors are much more sensitive to blue and white light than other colors. In a study on hamsters, researchers found that nighttime exposure to blue and white light, in levels similar to TV and computer monitors, caused increased “depressive” symptoms in these animals. Can this affect humans? Perhaps; and patients with a history of depression should probably avoid excessive nighttime TV and computer exposure. 

Raw Milk, Sugar Sweetened Soda, Gut Microbiome and probiotics - More interesting news

Food Diet and Health

·         Raw milk – why you should avoid it!

·         Sugar sweetened soda – cancer causing?

·         Bacteria in the Intestine – Gut microbiome – autism and other diseases

·         Probiotics and gastroenteritis

Raw Milk

            There has been a movement toward “raw milk”; meaning non pasteurized milk directly from the cow. While very fresh milk contains very little bacteria, few of us can get ½ hour fresh milk. As well, there are certain diseases, such as listerosis, which can have minimal effects on cattle, but can be transmitted to humans with possibly fatal effects. Pasteurization was a major health advance in preventing disease. Now a study has been published confirming the association, especially in  pregnant women, with listerosis and more serious illnesses. Raw milk has absolutely no nutritional advantage over pasteurized milk and should be avoided.

Sugar Sweetened Soda

            A single soda can have from 14 to 20 packets of sugar in it. Aside from obesity, diabetes, tooth decay and other expected health risks, researchers have discovered that, even after adjustment for weight, there was a 78% increased incidence of endometrial cancer in women who were in the top 25% of the sugar drinkers. Neither fruit juice nor diet drinks increased the risk.

Gut Microbiome

            Recent studies have suggested that the bacteria growing in your intestines can have both good and bad effects on your health. Antibiotics and certain foods can change the type of bacteria. There have been associations with cancer and heart disease. Now a Caltech team studied a mouse model of autism, and discovered that the autistic mice had a distinct group of bacteria in their intestines. These produced an chemical that seemed to induce autistic symptoms in other mice. As well, using probiotics to change the bacteria could actually reverse the symptoms in these mice. This could have major implications for human disease if true.

            In another study, researchers found that diet had a dramatic effect on the bacteria in the intestine. The mix in patients on animal meat diets was quite different form those on vegetarian diets. This might have major implications in disease.

Probiotics

            Much has been published about pro-biotics and there are many claims about them. They seem to help adults with gastroenteritis, and may help improve  the intestinal bacteria (gut microbiome). In a recent study, nearly 600 term infants less than 1 week old were randomized to receive a probiotic, Lactobacillus reuteri or placebo daily. After 3 months, parents in the treatment group reported significantly better outcomes for mean daily infant crying time, regurgitation episodes and evacuations. In addition, the treatment group had fewer emergency department visits, fewer days of parental work lost, and less use of products to control GI symptoms -- translating to a mean savings of US$119 per patient (after accounting for the cost of the L. reuteri). Perhaps we will be recommending these in the future!

Supplements and Vitamins - DANGEROUS MEDICINE

Supplements and Vitamins

·         Are Supplements Needed?

·         Baby Vitamins – are they dosed improperly?

·         Testosterone Supplements – more dangers

·         Liver damage – sometimes fatal – from supplements

·         Regulation (or lack of) OTC supplements

Are Supplements or Vitamins Needed – The evidence is no

            There have been many health claims about vitamins and supplements (more later on that). However, except for few exceptions (such as Vitamin E for Alzheimer’s and Vitamin D) most studies have shown no benefit; and in fact possible dangers from taking these.  In three studies in several thousand patients there was no benefit in cardiovascular or cognitive functions in those taking multivitamins and supplements. As well, patients taking carotene actually had an increased death rate from lung cancer! The recommendation was: “Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided.”

Baby Vitamins – too much

            Many people give their babies vitamins or supplements. In a proper pediatric diet this is usually unnecessary. And it appears that even the available vitamins contain far more than the current recommendations. Over 200 labels of supplements for children under 4 were reviewed and they all contained much more than the daily allowance, sometimes by a factor of 10. In adults it has been shown that certain vitamins are actually dangerous; we do not know what the effect could be on children. I would not use these unless specifically recommended by your doctor.

Testosterone Supplements – heart attack risks

            As the marketing blitz for Low-T continues, we are seeing more side effects of the unnecessary use of testosterone. Most experts do not recommend taking testosterone unless the level is below 200 or 300. However many “clinics” treat at levels up to 500 (which is normal). Aside from the risk of prostate cancer, in a recent review of senior (65 and over) patients given supplements, there was a three times increased risk of a heart attack in the first 90 days. The perceived benefits are not worth the risk.

“Herbal” Supplements – fatal dangers and lack of regulation

            Supplements, whether for body-building, weight loss, menopause, etc have almost no regulation. They often contain dangerous and even life threatening ingredients, as well as unlisted chemicals or even medications! For example an ”herbal” supplement advertised as an alternative to Viagra was found to contain real Viagra! Many body building supplements were found to contain steroids.Of the over 50,000 supplements sold in the United States, less than 1% have been examined for their ingredients. An estimated of 20% of hospital admissions for liver failure come from these. I actually had one patient who required a liver transplant after using a special “tea”. In an investigation by USA Today, the industry was found to to have many criminals actually marketing products.

http://www.usatoday.com/story/news/nation/2013/12/19/dietary-supplements-executives-criminal-records-spiked/4114451/

http://www.nytimes.com/2013/12/22/us/spike-in-harm-to-liver-is-tied-to-dietary-aids.html?_r=1&

Focus on Alzheimer's Disease

+ Vitamin E may prevent deterioration of Alzheimers
+ DDT metabolite implicated in Alzheimers
+ Efficacy of Brain Exercises
+ Tai Chi and Alzheimers

Vitamin E
In 2005 a study came out that showed that taking excess of 400U of Vitamin E was associated with an increased risk of death. This, however, has been contradicted by recent studies, where 4000 U seemed to be safe. They also found that patients with existing Alzheimer's disease actually had a slight slow down in their disease when they took Vitamin E at 4000 Units daily. Since there do not seem to be any adverse effects, I would recommend using this in Alzheimer's patients. However there is no proof that it can be preventative, and it is probably not a god idea to use Vitamin n E for that reason.
Other vitamin and mineral supplements have been studied and do not seem to be of any benefit (more on this in a post to come soon).

DDT Metabolites
As mentioned in thee previous post, a higher level of DDT metabolites was found in Alzheimer's patients. Stay organic!

Cognitive Training
Several studies have confirmed the "use it or loose it" philosophy of cognition. The more you "exercise" your brain, the less deterioration. Now a study has shown that a 5-6 week course consisting of a total of 10 hours of training (including memory, speed of reasoning, and processing resulted in improved thinking and decreased deterioration that actually lasted 10 years AFTER the training. Unfortunately there was no effect on memory; but these subjects had significant improvement in activities of every day living.

Tai Chi
Interestingly, Tai Chi also seemed to have lasting effects on improved thought processing and activities of daily living. This relatively simple activity that even moderately physically impaired  patients can participate in is worthwhile.

In summary, use your brain, exercise and eat well. Do Tai Chi if you can, and if you have developed Alzheimer's take 4000U of vitamin E daily.