Fix Fat Kids - drink water, avoid calories and stay away from fructose!!

Childhood Obesity has many causes, but one of the factors we can actually change is the diet.

Water

Sugar (or corn syrup) flavored drinks are unnecessary and have very high levels of useless calories. Researchers wondered if offering water to overweight children would actually lead to weight loss.

This study in New York was performed in schools that already had removed sugar sweetened drinks from the cafeterias. The study involved 483 public schools that installed “water jets” (large, fast-dispensing, electrically-cooled, water jugs costing about $1000 each) in cafeterias from 2008 to 2013 and 744 schools that did not.

They found small but significant decreases in obesity in the schools offered water; one of the reasons could have been that students in schools with water jets bought about 14 fewer half-pints of fat-free chocolate milk per student per year - a savings of money as well!

Schwartz AE et al., JAMA Pediatr 2016 Jan 19

Fats

In another study researchers looked at whether (in adults) calorie equal low fat or low carb diets were more effective. Interestingly low fat diets led to greater fat loss (not weight loss). However the difference was small. So it is not as critical you avoid carbs to lose weight; as long as you avoid excess calories!

Fructose

fructose is a natural sugar found in many fruits and vegetables. It is also the main sugar found in high-fructose corn syrup; an inexpensive sweetener very often substituted for raw sugar in processed foods. Many pundits have claimed that this is unhealthy. A recent study confirms this.

Forty-three obese U.S. children (age, 8-18 years) with high sugar intake followed a diet for 9 days that replaced added sugar with starch. The goal was to reduce total sugar intake to 10% of daily calories, and fructose intake to 4%, while maintaining baseline caloric intake and weight. All food was provided by the researchers.

After 10 days there was an average weight loss of over 2 pounds (even though they ate the same amount of calories!), as well as decreases in blood pressure, fasting sugar, and cholesterol.

These sugars are bad for you and should be avoided!!

http://onlinelibrary.wiley.com/doi/10.1002/oby.21371/epdf

With common sense we can stop this epidemic!

Video Games and IQ

Most children love to play video games - almost to the extend of addiction. There have been some arguments that this can lead to improved computer literacy. However many studies that I have previously mentioned clearly show that we should be limiting screen time to children.

Now a study reviewed video games. More hours of video gaming were associated with lower verbal IQ as well as some distinct changes in brain chemistry that are sometimes found in autism spectrum disorders. In fact, the authors support the evaluation of autism spectrum and depressive disorders in children who choose video gaming over other age-appropriate behaviors (e.g., socializing).

I would discourage video games before teenage years (when you probably can't control it!).

Takeuchi H et al., Mol Psychiatry 2016 Jan 5

Is Vitamin D dangerous

There has been much publicity about our "low" vitamin D levels and how important it is to test and supplement it. However there is little or no actual evidence that low vitamin D levels are dangerous. In fact, the US Public Health Task Force; whose job is to review the literature, recently (in November) stated:

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults.

http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/vitamin-d-deficiency-screening

A recent study in JAMA (JAMA Intern Med. Published online January 04, 2016 doi:10.1001/jamainternmed.2015.7148) examined supplementation of low vitamin D levels in older adults (over 70). They were hoping to find that these would have a lower risk of falls and fractures. However, they found that the group supplemented had 2-3 times the number of falls!

Low Vitamin D has been defined as below 20; and very low below 7-10. In children with growing bones, extremely low Vitamin D can lead to rickets; this is still extremely rare. But there is little evidence that slightly low levels are dangerous in adults/

A small supplement of Vitamin D is probably safe; recommendations of up to 1-2 thousand s units per day are reasonable and unlikely to be dangerous. Like many other things, moderation is the safer way to go!

Germs in Your Intestine - Something New in Medicine!

One of the biggest new stories in medicine is the relationship between the gut bacteria, also known as the microbiotome, and your health.

In previous posts I have mentioned how changes in these germs can increase risk for:

• Obesity
• Asthma
• Diabetes
• Ulcerative Colitis and Inflammatory Bowel Disease
• Melanoma

Now more provocative information has been published.

Microbiotome can affect your response to Cancer Chemotherapy:

In an immune therapy for Melanoma, researchers found that only in the presence of a certain gut bacteria would the therapy be able to cure the cancer!

Anthony L. Komaroff, MD Reviewing Snyder A et al., Science 2015 Nov 27; 350:1031

Also, stool transplants (frozen capsules of stool bacteria) has become the most effective treatment for a potentially fatal colon infection (Clostridium).

The medical has been responding to this news - antibiotic use has decreased by about 25% between 2000 and 2011 in the US,

Thomas Glück, MD Reviewing Frenk SM et al., J Antimicrob Chemother 2015 Oct 12

Look for more news as we learn more about the unique relationship between gut microbiotome and disease. One day forms or probiotics will become adjunctive or primary treatment for many diseases!

Too Many C-Sections

Many people think that the US is doing too many Cesarean sections; for many reasons including malpractice concerns, convenience, and financial gain.

But is this reality? What is the appropriate rate?

When looking at smaller numbers we realize that every delivery is different. However, in a recent study, researchers looked at cesarean delivery rates and morbidity and mortality data from 194 World Health Organization member nations from 2005 to 2012. They found that rates of about 19% were associated with the lowest maternal and neonatal mortality. This is counter to the 15% rate many have suggested as ideal.

So how are we doing? Very poorly. In 2013, the CDC reports that 32.3% of all births were by C-section. In Puerto Rico it was 49%; Louisiana, Florida and New Jersey were close at 38%. The best states were Utah, Idaho, Hawaii and Alaska at rates of 22-25%.

In Canada, the rate was 17% in 1995, but has now climbed to 27%.

So yes, we are doing too many C-sections. If you can. check out your doctors record and willingness to allow labor to proceed when the mother and child are not in danger. Not only are many C-section unnecessary, but they are actually harmful to the mother and child!

JAMA, December 1, 2015, Vol 314, No. 21

http://jama.jamanetwork.com/article.aspx?articleid=2473490

"Idiocracy" and The Idiot Box

In 2006 Mike Judge wrote and directed a movie, "Idiocracy" based on a concept that 500 years in the future humanity would have evolved downward towards lower intelligence.

In a recent study, Steven Dubovsky, MD Reviewing Hoang TD et al., JAMA Psychiatry 2015 Dec 2, the researchers discovered that we are dumbing ourselves through our lifestyle.

They reviewed self reports on TV watching and exercise of over 5,000 adults who had been followed for 25 years. After adjusting for factors such as illness and smoking, they found a long-term pattern of low physical activity was associated with significantly slower processing speed. Watching television for >3 hours/day had significant associations with slower processing speed and poorer executive function. Participants with the lowest level of physical activity and the most television watching had the slowest processing speed and worst executive function.

This study began in early adulthood; one can only guess about what effect it is having on our children!

Perhaps less intelligent people watch more TV and exercise less because they are less intelligent. But would you take that chance with your kids?

Screen time should be restricted in children (and adults), and regular exercise strongly encouraged. Next time you go out to dinner count how many people are not on a device - it will be easier than those with their faces in their phones. Perhaps if we don't change soon Mr. Judge's prophesy will become reality!

Environment Health and Good Germs

More studies are beginning to show that our bodies are actually in quite a delicate balance with our environment; and this can easily be destabilized by medical intervention.

We already know that changes in the bacteria, or germs, that grow in our intestines can lead to obesity and autoimmune diseases. As well, there is a severe intestinal infection, known as Clostridia, which results from antibiotic treatment, is best treated by changing the bacteria in our gut (using a "stool transplant" in a frozen prepackaged capsule).

In a recent study, researchers found that children at high risk for asthma (defined as wheezing and positive skin prick tests at age 1 year) had received more courses of antibiotics during their first year of life, were more often born by caesarian section and were more often exclusively formula fed. They found that certain bacteria were less likely to be found in their intestines.

Sci Transl Med 2015 Sep 30; 7:307fs39

In a second, JAMA Pediatr 2015 Nov 9, researchers gave probiotics during the first month of life to a group of infants who had a genetic marker associated with type 1 diabetes. They found that there was a 40% decrease in development of diabetes in these children during the 10 year followup.

The environmental influences of intestinal bacteria are related to breast feeding, as well as normal behavior where children "taste" everything. We have discovered that exposure of babies to "dirt" or things they normally pick up is a normal adaption that actually prevents autoimmune diseases and allergies.

We need to, within reason, allow our babies to be "dirty", try and breast feed for at least 6 months (a year is preferred), and avoid antibiotics unless absolutely necessary. This includes eating foods or meats that have been treated with antibiotics.