Food Additives and Children's Health

The American Academy of Pediatrics released a policy on food additives and children. It is definitely worth looking at!

Here are some of the additives with the most evidence for concern:

• Bisphenols: Used in plastic containers and the lining of metal cans, bisphenols (such as BPA) can disrupt endocrine function, potentially reducing fertility and changing the timing of puberty.

• Phthalates: Found in plastic food wrap as well as in plastic tubes used during food manufacturing, phthalates have been tied to endocrine disruption (including testicular toxicity), cardiotoxic effects, and oxidative stress.

• Nitrates and nitrites: Added directly to foods (usually processed meats) as a preservative or to enhance color, these compounds have been linked to cancer and thyroid dysfunction.

To help reduce exposure, the AAP recommends that families to eat more fresh or frozen (rather than canned) fruits and vegetables, and to avoid processed meats. In addition, plastic shouldn't be put in microwaves or dishwashers, as heat can cause chemicals to leak into food.

The full list of chemicals of concern — and more recommendations for clinicians — are available at the link below.

http://pediatrics.aappublications.org/content/142/2/e20181408

Are Cheerios Poisonous?

The active ingredient of Roundup (A Monsanto Product) was recently implicated in a court case as a possible cause of cancer. This glyphosate is sprayed on many oat crops to kill the plant and dry out the oats for harvest.

It appears that most Oat cereals and snacks, including Cheerios and Quaker Oats have levels considered by the World Health Organization as possibly carcinogenic.

I would rethink eating these products, especially for children!

https://www.ewg.org/childrenshealth/glyphosateincereal/#.W3WU8M5KiM9

Organic Foods Prevent Cancer

I have always recommended organic foods, which are free from toxic pesticides (hopefully) and other chemicals. It seems logical that these will be healthier.

Well, in a recent study of over 70,000 French patients over 5 years they found a 24% lower incidence of cancer - a highly significant number.

JAMA Intern Med. Published online October 22, 2018.

So if you are in a position to eat organic, it is prudent to do so!

Internet Supplements - Alternate facts?

It is unbelievable how often people tell me they are taking natural supplements or herbal drugs because they are natural; yet these same people have an aversion to prescription medicine.

The FDA regulates prescription drugs; there is no regulation of supplements. In a recent review from the FDA’s Tainted Supplements database, they found that a total of 776 dietary supplements, produced by 146 different companies, were identified as containing unlisted pharmaceutical ingredients. Most of these products were marketed for sexual enhancement, weight loss or muscle building, and most commonly contained Viagra (sildenafil), sibutramine (Meridia; removed from the US market in 2010 because it caused heart valve deterioration)), and anabolic steroids. And this list is likely incomplete as it is a post marketing survey!

Some supplement manufacturers voluntarily submit their products to USP or other independent institutions for verification. USP, for instance, will allow its seal to be displayed on the labels of products it verifies are made using Good Manufacturing Practices and contain the labeled ingredients in the correct doses without unlabeled additives or harmful levels of contaminants. A USP seal does not indicate that a product has any medical benefit, but it’s a good indication that what’s on the label is what’s in the container. These are the only ones you should use!

You can review the list here

https://www.accessdata.fda.gov/scripts/sda/sdNavigation.cfm?sd=tainted_supplements_cder

How to Stay Young

There are many studies on how we can maintain fitness and maintain cognitive thinking as we age. A few recent ones are below.

Fall Prevention and Tai Chi

As we age, the risk of falling and fracturing a hip or other bone increases. An injury like that often results in significant deterioration of health. In a recent study (median age 78), JAMA Intern Med 2018 Sep 10, regular Tai Chi resulted in an almost 70% decrease in falls and injuries. It was more effective than balance exercises or strengthening. Maybe insurance will cover it!

Supplements - Omega-3 and Aspirin

In a previous post I reported a study about aspirin not really helping prevent disease. Now a new one suggests that Omega-3, also touted as an important supplement, probably does not help either. In reviewing 79 studies, researchers found Omega 3s had little to no effect on mortality or adverse cardiovascular event. Perhaps it is time to reassess supplements and just get onto a healthy diet with plenty of fresh fruits and vegetables!

Your Intellect - Use it or Lose It

This makes sense, and, in a recent study in Hong Kong of over 15,000 individuals over the age of 70, intellectual activities (e.g., reading, playing games such as Mahjong) resulted in significantly less dementia. The question as th whether the fact that these people were already engaged in these activities contributed was not answered. So if you don't use your brain then start, if if you do; don't stop!

5 Factors to Stay healthy

Finally, in a 30 year study Circulation. 2018; CIRCULATIONAHA.117.032047, researchers looked at what factors contributed to healthy aging. The five main factors were healthy diet, never smoking, moderate-to-vigorous physical activity (at least 30 min/day), moderate alcohol consumption, and healthy weight. Those with all 5 factors had an average increased life span of 13 years at age 50!

Screen Time and Healthy Children

There have been many recommendations about restricting screen time in children. Unfortunately every time I am in a restaurant it seems that every child is on a screen; even toddlers.

But the studies are out there. In one study Pediatr Res 2018 Jun 13, increased screen time was associated with significant behavioral problems as compared with minimal (less than an hour a day).

U.S. children aged 8 to 18 years spend, on average, over 7 hours each day in front of screens for recreational purposes, according to estimates reported in a new advisory on sedentary behavior and childhood obesity from the American Heart Association. They have found that this is associated with significant obesity and diabetes.

In another study, JAMA. 2018;320(3):255-263, 2600 teens in Los Angeles were studied, comparing their use of video games and chatting. Those with higher use had a significant increased risk of being diagnosed with ADD or ADHD.

Other studies have shown that keeping screen time to less than an hour a day improves intellect, creativity and intelligence.

Devices are useful but are not replacements for imagination, creativity and reading. Keep your children away from devices!

Your Diet - News on Dairy, Chocolate, Meats and others

Dairy and Heart Disease

Dairy foods have cholesterol, and many have suggested this fat may increase our risks. In a recent study of over 130,000 patients (Lancet 2018 Sep 11) researchers actually found a lower risk of heart disease in people who had more dairy (milk and yogurt especially). This was an association, but it is likely you don't have to worry about dairy and heart disease.

Dark Chocolate and Vison

Most of us love chocolate. In a recent study of 30 patients (not sure why this was done) ophthalmologists compared a dark chocolate diet with milk chocolate and found that, in a small group, eating dark chocolate improved high contrast visual acuity. I am not sure about what this means except that I am going to get a piece of dark chocolate right now!

Brave Sour Lemons?

In another study (again not sure why it was done) Obrist M. Sci Rep 2018 Jun 7, researchers compared risky behavior in patients given a sour solution to drink versus controls. They were also given other solutions, such as sweet and salty. They found that the sour food made the patients braver. So if you are about to go into an anxiety provoking situation, get those sourballs!

Cured Meats and Mania

Meats are cured with nitrates, which may have adverse health effects. To see if nitrates could contribute to bipolar disease, researchers fed these to mice and patients. Mol Psychiatry 2018 Jul 18. They found a definite increase in hyperactivity and mania with the cured meats. They also speculate that this may be related to changes in the intestinal microbiome.

Is Aspirin Losing its Mojo?

Taking a baby aspirin a day was often touted as a way to prevent heart disease and cancer - and many people have been doing that. This was based on some older studies showing there were benefits after a heart attack. Also there was some evidence it may lower your risk of colon cancer. So what happened?

In a recent study (Lancet 2018 Aug 26) sponsored by Bayer, the makers of aspirins, researchers followed over 12,000 patients over 55 who had no history of heart disease. Half the group took low dose aspirin and the other half a placebo.

The results showed that there was no difference in cardiovascular disease in the two groups, but a slight increase in the risk of bleeding in the aspirin group.

In another study (N Engl J Med 2018 Aug 26) aspirin was slightly preventative in diabetic patients, but the risk of bleeding countered this benefit.

So the conclusion is that baby aspirin may not really help you much. There may be some benefit; perhaps in colon cancer or in some subgroups. Taking one is a personal decision and not really, now, a medical recommendation.

Influencing Doctors

I'm not surprised when I read this recent study that shows that physicians are affected by pharmaceutical marketing. While in practice I often saw doctors prescribing extremely expensive new drugs which had much less expensive generic alternatives (which patients frequently requested). And politicians seem no different.

I was fortunate enough to go to McGill University medical school, where, even in the 1970s, we were not allowed to accept gifts from drug companies, and required to use generic, and not brand drug names.

In this study, Hadland SE et al. JAMA Intern Med 2018 May 14, researchers identified nearly 370,000 physicians who prescribed opioids in 2015. Of these, 7% received roughly US$9 million (≈$350 per physician) in nonresearch payments related to opioid products during 2014. About 2% of physicians received payments received $1000 or more. Total U.S. opioid prescriptions decreased slightly overall from 2014 to 2015 but increased among physicians who received payments; those who received payments wrote about 9% more opioid prescriptions than those who did not.

Drug companies were undoubtedly aware that they were contributing to their profits at the expense of the opioid epidemic in the US population.

Marijuana - More News and Not Innocuous

Now that cannibis is becoming legal in many states, it is important to become aware of its limitations and side effects.

Although it has many proven uses, including pain management, anxiety and even epilepsy, sellers have been marketing it as a miracle drug for all diseases. It is not.

PREGNANCY

Marijuana should NOT be used in pregnancy. It does not treat the first trimester nausea. Studies have shown that THC (the active ingredient) can stimulate changes in brain cells, especially developing cells, that are similar to those found in schizophrenia and autism (Guennewig B et al. Transl Psychiatry 2018 Apr 25). Unfortunately, women of childbearing age, who know to avoid alcohol, might consider THC a safe alternative for recreational use.

BREAST FEEDING

THC is excreted in breast milk after ingestion (Baker T et al. Obstet Gynecol 2018 May ). Since it can affect developing brain cells in babies it should not be used while breast feeding.

COGNITIVE EFFECT - Still called DOPE

There was probably a reason marijuana was called "dope". In a recent study, Scott JC et al. JAMA Psychiatry 2018 Apr 18, researchers found that Marijuana use was associated with decrements in cognitive function — learning, speed of information processing, delayed memory, attention, and various facets of executive function. Fortunately these were back to normal after 72 hours of abstinence.

FALSE MEMORIES?

I am surprised this has not yet been tweeted by certain politicians as an explanation of why states with legalization voted in certain ways! This study, Doss MK et al. Biol Psychiatry 2018 May 9, examined memories of words and pictures. Two days after shown these, the group given THC had false recognition of words and pictures that had not been presented.

Marijuana has some therapeutic uses, but the side effects should be understood. It is not innocuous, and like alcohol, its recreational uses can result in cognitive effects.

Are Prostate Digital Exams Obsolete

It has been medical practice, much to the chagrin of men and their doctors, that a digital rectal exam be performed annually to examine the prostate. I always suspected the utility of this exam; I performed thousands yet never discovered any pathology.

Now a new study examined many previous studies and found that in 9000 screening there was no significant benefit.

It is probably unnecessary. Good news!

Ann Fam Med March/April 2018 vol. 16 no. 2 149-154

Blue Blocking Glasses and Manic activity

It seems that seasonality and light conditions can affect bipolar-disorder. There is more depression when the days are shorter.

It seems that the manic component of bipolar disorder (even mild) can be affected by light. The brain senses light and darkness exclusively by light in the blue spectrum. Using blue blocker lenses (orange lenses) we can "fool" the brain and melatonin systems into "thinking" it is totally dark.

In a small study (Henriksen TE et al. Bipolar Disord 2016 May. ) researchers found that manic activity decreased significantly when users wore these glasses, and increased again when they were not used.

This could lead to another treatment for manic disorder. I also wonder if it might have some uses in jet lag or sleep disorders?

Caffeine in Pregnancy and Obesity

To try and determine how to prevent obesity in children researchers have been looking at the diet of pregnant women.

Norwegian researchers studied over 50,000 mother-child pairs. The mothers completed food-frequency questionnaires during pregnancy, from which caffeine intake was estimated, and the children's height and weight were measured several times until age 8 years.

BMJ Open. http://bmjopen.bmj.com/content/8/3/e018895

They found that drinking 2 cups of coffee a day caused a 17% increased risk for the child being overweight at age 3 years, and very high intake (3 cups a day or more) conferred a 44% increased risk. This persisted.

It seems to be a good idea to limit coffee during pregnancy to one cup a day. 

Melatonin and Aggressive behavior?

Melatonin, a hormone released at night, is frequently used as a supplement to help with sleep and even migraine. It may also have effects on emotions and thinking.

Researchers in China examined how a 5 mg nighttime dose would affect 40 twenty-one year old volunteers.

They discovered that the nights they took melatonin, they were about 40% more likely to react aggressively to an experimental situation. In young healthy men, melatonin increased reactive aggression, which occurs when strong emotions are provoked. Whether this effect occurs in real-life circumstances is unknown.

However if someone you know appears to be a little more aggressive than usual it is worth asking about melatonin

Liu J et al. Psychopharmacology (Berl) 2017 Jul 21.

Skipping Breakfast - Bad for you or a sign of an unhealthy lifestyle?

Researchers in Spain studied 4000 men with cardiovascular risk factors. They found that those that skipped breakfast were almost twice as likely to have significant arteriosclerosis or blocked arteries than a similar group who did not. Both groups had the same measurable risk factors, such as smoking and cholesterol.

This was an association, not a definite cause. They speculated that although this may contribute in some currently unknown way, it is also possible that skipping breakfast is associated with other unhealthy lifestyles.

Still probably a good idea to eat breakfast!

http://www.onlinejacc.org/content/70/15

Polluting Developing Brains — EPA Failure on Chlorpyrifos

Our current EPA is intent on removing protections to our population so that business can thrive irresponsibly.

These policies seem aimed at hurting those in this country who can least afford it. When the government pulled back the Medicaid expansion, medical care for that section of our population suffered and recent studies confirmed that the poorest states, mostly in the South, have the sickest population.

Now the EPA has reversed a previous ruling on a widely used insecticide.

In 2016, just before the election, the EPA mandated a phasing out of the use of chlorpyrifos, based on evidence that it has been damaging our childrens' developing brains. Just as the EPA was poised to act, however, the plan was scrapped in March 2017 by incoming EPA Administrator Scott Pruitt, who overrode the recommendation of agency scientists to ban all commercial use of chlorpyrifos.

Organophosphate insecticides, like this one, were first introduced as nerve-gas agents during World War II, organophosphate chemicals were later repurposed by chemical companies as insecticides and other pesticides.

The adverse effects of this chemical will most strongly affect farm workers, their children, and anyone who cannot afford to buy organic foods. It is still widely used on fruits and vegetables, including apples, almonds, and dozens of other crops (see map in linked article).

By ignoring science and good sense, this government seems to be intent on creating a class separation in our society, pushing us to become more like many countries in South America with severe social issues related to a very rich class and a very poor class. For those of us who can, buy organic food!

Journal Article

http://www.nejm.org/doi/full/10.1056/NEJMp1716809?query=pfwNGTp&jwd=000005007879&jspc=GP

Breast Implants and cancer

Some years ago there were several lawsuits about breast implants and fibromyalgia. Even though this association has been disproven, it received enough publicity to frighten many people - and enrich many attorneys!

But it seems that certain kinds of implants, in rare instances, can cause a very rare and dangerous cancer. I'm not sure why this has not received the notice it should.

The FDA has received 414 reports of anaplastic large-cell lymphoma associated with breast implants, according to the latest numbers from the agency, which cover reports through September 2017. This was seen both with silicone and saline implants, but 90% of those were "textured".

So we really should be discouraging use of textured implants.

FDA Report

Germs are Eevrywhere - So What?

Update! The world is not sterile. We see many news reports about germs being everywhere (for example

Rossen Reports

Or this article about germs in your rubber duckie

Rubber Duckie

What is missing from all these articles is the fact that no one has ever shown there is a danger from these bugs. And maybe this improves our natural immunity. We are, after all, loaded with bacteria, mostly helpful.

So really, do you need to sterilize the airplane seat, tray, armrests, lightswitch (wings?). I don't think so.

Here is a blog from Dr Paul Sax, a Harvard physician:

Paul Sax Blog