Transcript Pediatric Nutrition - drdavidsonintegrativemedicine.com

Pediatric Nutrition
Michael Davidson, Pharm.D., ACN
Integrative Pharmacist
Clinical Nutritionist
Phytotherapist
1
Disclaimer
• The information provided in this lecture should not be
construed as a claim or representation that any formula,
procedure, or product mentioned constitutes a specific cure,
palliative, or ameliorative for any condition.
• The material contained in this lecture has not been reviewed
by the FDA and is not for the diagnosis or treatment of any
disease.
• This lecture and the information it contains is for educational
purposes only; it is not a substitute for individualized
guidance from a qualified healthcare professional.
• Audiences are cautioned not to use any substance or product
mentioned herein without reviewing it with their qualified
healthcare professional to determine if it is appropriate for
them.
2
Are California Children Toxic?
3
Are California Children Toxic?
• In a recent study, the diets of California
children (ages two – seven) were analyzed to
determine the carcinogenic and other
deleterious health effects from exposure to
contaminants in food.
• Indeed, the main route of exposure to heavy
metals toxins, persistent organic pollutants
(POPs), and pesticides is likely to be food.
4
Are California Children Toxic?
• Because the body’s of children are still developing
and, they have greater intake of food and fluids
per unit of body weight compared to adults,
children are most vulnerable to these food-borne
contaminants and the diseases they cause.
• Cancer, asthma, lead poisoning, neurobehavioral
disorders (eg. Autism), learning and
developmental disabilities (eg. ADHD), and birth
defects are just some of the serious detriments
that have been linked to environmental toxin
exposures that are largely preventable.
5
Are California Children Toxic?
• The good news is that changing the diet can
change the level of exposure to these toxins.
• As one researcher explained, “A diet high in
fish and animal products, for example, results
in greater exposure to persistent pollutants
like DDT and dioxins and heavy metals than
does a plant-based diet because these
compounds bioaccumulate up the food
chain.”
6
Are California Children Toxic?
• Unfortunately, this sample of kids was not
eating foods from the bottom of the food
chain (plants).
• Cancer benchmark levels were exceeded by all
364 children in this study for arsenic, a banned
pesticide called dieldrin, a metabolite of DDT
called DDE, and dioxins.
7
Are California Children Toxic?
• Children exceeded safety levels for all toxins
by a greater margin than adults.
• Because all of these compounds are suspected
endocrine disruptors and thus may interfere
with normal child development, this is of
paramount concern for children.
• “Cancer risk ratios were exceeded by over a
factor of 100 for arsenic and dioxins.”
8
Are California Children Toxic?
• So which foods were the most contaminated?
• For preschoolers:
– #1 food source of arsenic was poultry (it was tuna for
their parents)
– #1 source for lead was dairy
– #1 source for mercury was seafood
– #1 source of the banned pesticides and dioxins was
dairy
• Men had higher levels of some of these
pollutants than women, as shown in a similar
study in Europe.
9
Are California Children Toxic?
• Interestingly, if you only looked at women who never
breastfed, their levels were on par with those of men,
and women who breastfed for over a year had the
lowest levels.
• As one researcher points out, “It is therefore likely that
the lactation-related reduction in blood pollutant levels
partly explains the lower body burdens among women
compared with men.”
• In other words, by excreting some of these toxins into
their milk (which we drink), cow’s can reduce their
levels. Unfortunately, human mothers can do the same
with their children.
10
Are California Children Toxic?
• Beyond being carcinogenic, theses pollutants
have a number of other detrimental health
effects.
• They can affect the immune system. One
researcher notes, “Studies clearly demonstrate
the ability of dioxins and related compounds to
have a long-lasting and deleterious impact on
immune function.”
• This translates into “increased incidences of
respiratory infections, ear infections, cough, and
sore throat.”
11
Are California Children Toxic?
• Studies indicate that the immunosuppressive
effects of these toxins may persist from
infancy into early childhood.
• These pollutants accumulate in animal fat.
• Therefore, the researchers concluded that a
plant-based diet and decreased meat, dairy,
and fish consumption will reduce exposure for
both children and adults.
12
Sources Cited for Above Slides
•
S B.Stolevik, U C Nygaard, E Namork, M Haugen, H M Meltzer, J Alexander, H K Knutsen, I Aaberge, K
Vainio, H van Loveren, M.Lovik, B Granum. Prenatal exposure to polychlorinated biphenyls and
dioxins from the maternal diet may be associated with immunosuppressive effects that persist into
early childhood. Food Chem Toxicol. 2013 51:165 – 172.
•
R Vogt, D Bennett, D Cassady, J Frost, B Ritz, I Hertz-Picciotto. Cancer and non-cancer health effects
from food contaminant exposures for children and adults in California: A risk assessment. Environ
Health. 2012 11:83.
•
B Winans, M C Humble, B P Lawrence. Environmental toxicants and the developing immune system:
A missing link in the global battle against infectious disease? Reprod Toxicol. 2011 31(3):327 – 336.
•
S B Stolevik, U C Nygaard, E Namork, M Haugen, H E Kvalem, H M Meltzer, J Alexander, J H M van
Delft, H van Loveren, M Lovik, B Granum. Prenatal exposure to polychlorinated biphenyls and
dioxins is associated with increased risk of wheeze and infections in infants. Food Chem Toxicol.
2011 49(8):1843 – 1848.
•
Bjermo H, Darnerud PO, Lignell S, Pearson M, Rantakokko P, Nälsén C, Enghardt Barbieri H, Kiviranta
H, Lindroos AK, Glynn A. Fish intake and breastfeeding time are associated with serum
concentrations of organochlorines in a Swedish population. Environ Int. 2013 Jan;51:88-96.
13
Drink H20
14
Drink H20
• Essential to life
• In a US study, nearly 2/3's of the kids tested were
likely to be dehydrated as indicated by a high
urine concentration. Why?
• They weren't drinking enough water.
• Studies show that most (75%) school-aged
children do not drink water from the time they
wake up to when they go to school.
• Don’t they drink something during breakfast?
15
Drink H20
• The wrong beverages might actually dehydrate
the body.
• Cells can shrink and become dehydrated from the
high levels of sodium, sugars, and amino acids in
milk and juice, for instance.
• Even mild dehydration can impair a child’s ability
to perform on cognitive tests in school.
• Studies showed that giving these children water
resulted in better performance on school tests
compared to children that were not offered
water.
16
Sources Cited for Above Slides
•
J. D. Stookey, B. Brass, A. Holliday, A. Arieff. What is the cell hydration status of healthy children in the USA?
Preliminary data on urine osmolality and water intake. Public Health Nutr 2012 15(11):2148 - 2156
•
V. M. Sharma, K. Sridharan, G. Pichan, M. R. Panwar. Influence of heat-stress induced dehydration on mental
functions. Ergonomics 1986 29(6):791 - 799
•
M. S. Ganio, L. E. Armstrong, D. J. Casa, B. P. McDermott, E. C. Lee, L. M. Yamamoto, S. Marzano, R. M. Lopez, L.
Jimenez, L. Le Bellego, E. Chevillotte, H. R. Lieberman. Mild dehydration impairs cognitive performance and mood
of men. Br. J. Nutr. 2011 106(10):1535 - 1543
•
C. J. Edmonds, D. Burford. Should children drink more water?: The effects of drinking water on cognition in
children. Appetite 2009 52(3):776 - 779
•
C. J. Edmonds, B. Jeffes. Does having a drink help you think? 6-7-Year-old children show improvements in cognitive
performance from baseline to test after having a drink of water. Appetite 2009 53(3):469 - 472
•
R. Fadda, G. Rapinett, D. Grathwohl, M. Parisi, R. Fanari, C. M. Cal`o, J. Schmitt. Effects of drinking supplementary
water at school on cognitive performance in children. Appetite 2012 59(3):730 - 737
•
M. Sécher, P. Ritz. Hydration and cognitive performance. J Nutr Health Aging 2012 16(4):325 - 329
•
J. E. Holdsworth. The importance of human hydration: perceptions among healthcare professionals across Europe.
British Nutrition Foundation Nutrition Bulletin, 37, 1624 2012 37(NA):16-24
17
Chemical Food Additives and
ADHD
18
Color Additives and ADHD
• a study of 5000 10th graders found soft drink
consumption to be significantly correlated to
hyperactivity.
• Is this any surprise?
• Preservatives like sodium benzoate commonly
found in soft drinks have been associated with
hyperactivity.
• The huge amounts of high fructose corn syrup
don’t help much either.
19
Color Additives and ADHD
• According to the FDA, “Without color additives,
colas wouldn’t be brown, margarine wouldn’t be
yellow and mint ice cream wouldn’t be green.”
The horror!
• Compared to 50 years ago, we are currently
consuming five times more food dyes in our daily
diet due to the consumption of much more
processed foods.
• In the United States, fifteen million pounds of
food dyes are used every year in foods, drugs,
and cosmetics.
20
Color Additives and ADHD
• Imagine a box of Kraft mac and cheese. One of
the food colors in it is Yellow #5. If instead of
Yellow #5, the ingredient read: Trisodium 1-(4sulfonatophenyl)-4-(4-sulfonatophenylazo)-5(pyrazolone-3-carboxylate) on the label, would
this sound as harmless? Would consumers be
as likely to buy it?
21
Color Additives and ADHD
• A randomized, double-blind, placebo-controlled trial in one
of the most prestigious medical journals, showed that
artificial colors increased “inattentiveness, impulsivity, and
hyperactivity among young children.”
• So what did regulatory bodies do in response to this
evidence?
• The British government mandated that food manufacturers
remove most of the artificial food colors from products. The
whole European Union decreed that a warning label
stating: “may have an adverse effect on activity and
attention in children.” must be placed on the product if
manufacturers keep using these dyes.
22
Color Additives and ADHD
• Although many international food companies
have removed them from their products in
Europe, they continue to use them in the same
products here in the U.S., where there are no
comparable regulations.
• To determine which artificial food colors may be
damaging your child’s brain, some researchers
recently suggested purchasing bottles of food
dyes for experimental reasons…
23
Chemical Food Additives and ADHD
• Artificial Dyes/Colors (synthesized from petroleum and
may be contaminated with toxic byproducts that
include lead, mercury and arsenic).
• Artificial Flavors
• Artificial Sweeteners (eg. Aspartame, sucrolose, etc.)
• Preservatives (especially BHA, BHT and TBHQ)
• Feingold Diet (www.feingold.org)
• Neuroprotective Compounds (Omega-3s, turmeric,
green tea, etc.)
24
Sources Cited for Above Slides
•
R. B. Kanarek. Artificial food dyes and attention deficit hyperactivity disorder. Nutr. Rev. 2011 69(7):385 - 391.
•
L. J. Stevens, T. Kuczek, J. R. Burgess, E. Hurt, L. E. Arnold. Dietary sensitivities and ADHD symptoms: Thirty-five years of
research. Clin Pediatr (Phila) 2011 50(4):279 - 293.
•
B. Weiss. Synthetic food colors and neurobehavioral hazards: The view from environmental health research. Environ. Health
Perspect. 2012 120(1):1 - 5.
•
W.-T. Wu, Y.-J. Lin, S.-H. Liou, C.-Y. Yang, K.-F. Cheng, P.-J. Tsai, T.-N. Wu. Brain cancer associated with environmental lead
exposure: Evidence from implementation of a National Petrol-Lead Phase-Out Program (PLPOP) in Taiwan between 1979
and 2007. Environ Int 2012 40:97 - 101.
•
H. W. Mielke, S. Zahran. The urban rise and fall of air lead (Pb) and the latent surge and retreat of societal violence. Environ
Int 2012 43:48 - 55.
•
S. Kobylewski, M. F. Jacobson. Food Dyes A Rainbow of Risks. Center for Science in the Public Interest.
•
B. Weiss. Artificial food color additives and child behavior: Weiss responds. Environ. Health Perspect. 2012 120(1):a17
•
International Food Information Council (IFIC). 2010. Food Ingredients and Colors. Foundation US Food and Drug
Administration (FDA).
•
T. J. Sobotka. 2010. Overview and Evaluation of Proposed Association Between Artificial Food Colors and Attention Deficit
Hyperactivity Disorders (ADHD) and Problem Behaviors in Children. Interim Toxicology Review.
25
Exercise to Alleviate Symptoms
of ADHD
26
Exercise to Alleviate Symptoms of
ADHD
• In the US alone, 20 million prescriptions for
stimulants (like Ritalin) are written for kids
with attention deficit hyperactivity disorder by
doctors every year.
• More than any other drug class, this number
of scripts increases; 800,000 added every year
to that 20 million.
• That’s a lot of amphetamines for a lot of kids.
27
Exercise to Alleviate Symptoms of
ADHD
• Stimulants are thought to act by raising levels of
neurotransmitters like dopamine and norepinephrine
levels in the brain.
• How else can we increase dopamine and
norepinephrine levels?
• Exercise. Dopamine and Norepinephrine levels rise
within minutes of starting physical activity.
• Whereas the stimulants may take an hour to work;
physical activity works almost immediately.
• Both acute and chronic physical activity can alleviate
ADHD symptoms, according to the latest review of
evidence.
28
Exercise to Alleviate Symptoms of
ADHD
• The drugs produce unwanted adverse drug reactions,
toxicities, and drug induced nutrient depletion and
have the potential for abuse.
• With no side-effects, exercise has been shown to be
effective in controlling ADHD symptoms.
• Actually exercise dose have side effects-- good ones.
The authors of the review conclude, “it should be
noted that a major difference in the two treatment
modalities is that medications have a defined effect on
ADHD symptoms alone, whereas exercise produces
physical, mental, and emotional advantages that are
far-reaching.”
29
Sources Cited for Above Slides
• G. Chai, L. Governale, A. W. McMahon, J. P. Trinidad, J. Staffa, D.
Murphy. Trends of outpatient prescription drug utilization in US
children, 2002-2010. Pediatrics 2012 130(1):23 - 31
• J. I. Gapin, J. D. Labban, J. L. Etnier. The effects of physical activity on
attention deficit hyperactivity disorder symptoms: The evidence.
Prev Med. 2011 52 (Suppl 1):S70 - S74
• G. R. Van Loon, L. Schwartz, M. J. Sole. Plasma dopamine responses
to standing and exercise in man. Life Sci. 1979 24(24):2273 - 2277
• Thomas L. Lenz. A Pharmacological/Physiological Comparison
between ADHD Medications and Exercise. Am. J. Lifestyle Med.
2012 6(4):306 - 308
30
Fruits and Veggies to Prevent
Asthma and Allergies
31
Fruits and Veggies to Prevent Asthma
and Allergies
• The prevalence of asthma is growing around
the world; it is the most common chronic
disease in children.
• The most comprehensive study of this kind
ever undertaken, an international study of
asthma and allergies in childhood, studying
more than a million children in nearly a
hundred countries.
32
Fruits and Veggies to Prevent Asthma
and Allergies
• Increased consumption of plants in
adolescents was associated with consistent
decreases in symptoms of wheezing (current
and severe), allergic rhinoconjunctivitis and
atopic eczema.
• Allergies decreased with increasing intake of
calories and protein from plant sources.
33
Fruits and Veggies to Prevent Asthma
and Allergies
• In general, decreased consumption of fresh fruits,
green vegetables, and other dietary sources of
antioxidants was associated with an increase in asthma
prevalence.
• Eggs and soda have been associated with increased risk
of respiratory symptoms and asthma in schoolchildren,
whereas consumptions of fruits were associated with
reduced risk of respiratory symptoms.
• In only 8 weeks, removing eggs and dairy from the diet
may improve lung function in asthmatic children.
34
Fruits and Veggies to Prevent Asthma
and Allergies
• High vegetable intake has been found protective
in children, reducing the odds of allergic asthma
in half. And fruit showed a consistent protective
association for current and severe wheeze and
runny nose in adolescents, and for current and
severe asthma, allergies, and eczema in children.
• The best approach is a combination of eating less
processed animal foods and more plant foods.
35
Fruits and Veggies to Prevent Asthma
and Allergies
• Those with the lowest intake of vitamin C from
plants foods may have seven times the risk of
airway hyper-reactivity, while those with the
lowest intake of saturated fats had a 10-fold
protection.
• A scientist explains, “The protective effect of
plant-based food may also be mediated through
effects on intestinal microflora."
• The intestinal micorobiota (gut flora) may affect
immune system development and competency in
early childhood.
36
Fruits and Veggies to Prevent Asthma
and Allergies
• Lactobacilli, the beneficial microorganisms
that may be obtained from fermented foods
and fruits and vegetables, are found less
frequently in children with allergies.
• Kids raised on primarily organic vegetarian
diets may have a lower prevalence of allergic
reactions due, in part, to these lactobacilli
probiotics that may also help with childhood
asthma.
37
Fruits and Veggies to Prevent Asthma
and Allergies
• Probiotics may even have immune enhancing
effects in adulthood, as indicated in two studies.
Participants given probiotics for a few weeks had
a boosted white cell and natural killed cell activity
(important immune cells), even a few weeks after
the probiotics were stopped.
• Other randomized double-blind placebo
controlled studies also showed that those taking
probiotics may have significantly fewer colds,
fewer sick days, and a lower risk of upper
respiratory tract infections.
38
Fruits and Veggies to Prevent Asthma
and Allergies
• However, evidence suggests that prebiotics
(the foods required to keep the probiotic
bacteria alive, such as fiber) may be even
more important.
• Raw fruits and vegetables may have both pre
and probiotics with may contribute to their
immune enhancing effects.
• Value of Probiotic Supplements (quality,
viability, effectiveness)
39
Sources Cited for Above Slides
•
E von Muthius. The burden of childhood asthma. Arch Dis Child. 2000 82(2):112--5.
•
J Mallol, J Crane, E von Muthius, J Odhiamo, U Keil, A Stewart, ISAAC Phase Three Study Group. The International Study of Asthma and Allergies in
Childhood (ISAAC) Phase Three: A Global Synthesis. Allegrol Immunopathy (Madr.). 2013 41(2):73--85.
•
JO Warner. Worldwide variations in the prevalence of atopic symptoms: what does it all mean? Thorax 1999 54(2):S46--51.
•
Asher MI, Stewart AW, Mallol J, Montefort S, Lai CK, Aït-Khaled N, Odhiambo J; ISAAC Phase One Study Group. Which population level environmental
factors are associated with asthma, rhinoconjunctivitis and eczema? Review of the ecological analyses of ISAAC Phase One. Respir Res. 2010(11):8.
•
C Bime, CY Wei, J Holbrook, LJ Smith, RA Wise. Association of dietary soy genistein intake with lung function and asthma control: a post-hoc analysis
of patients enrolled in a prospective multicentre clinical trial. Prim Care Respir J. 2012 21(4):398--404.
•
JL Protudjer, GP Sevenhuysen, CD Ramsey, AL Kozyrskyj, AB Becker. Low vegetable intake is associated with allergic asthma and moderate-to-severe
airway hyperresponsiveness. Pediatr Pulmonol. 2012 47(12):1159--69.
•
Agrawal S, Pearce N, Ebrahim S. Prevalence and risk factors for self-reported asthma in an adult Indian population: a cross-sectional survey. Int J
Tuberc Lung Dis. 2013 17(2):275--82.
•
HJ Tsai, AC Tsai. The association of diet with respiratory symptoms and asthma in schoolchildren in Taipei, Taiwan. J Asthma. 2007 44(8):599--603.
40
Sources Cited for Above Slides
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NA Yusoff, SM Hampton, JW Dickerson, JB Morgan. The effects of exclusion of dietary egg and milk in the management of asthmatic children: a pilot
study. J R Soc Promot Health. 2004 124(2):74--80.
•
A Seaton, DJ Godden, K Brown. Increase in asthma: a more toxic environment or a more susceptible population? Thorax. 1994 49(2):171--4.
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A Seaton, G Devereux. Diet, infection and wheezy illness: lessons from adults. Pediatr Allergy Immunol. 2000 (11)13:37--40.
•
B Björkstén.Effects of intestinal microflora and the environment on the development of asthma and allergy. Springer Semin Immunopathol. 2004
25(3-4):257--70.
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Björkstén B, Naaber P, Sepp E, Mikelsaar M. The intestinal microflora in allergic Estonian and Swedish 2-year-old children. Clin Exp Allergy. 1999
29(3):342-6.
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Vitali B, Minervini G, Rizzello CG, Spisni E, Maccaferri S, Brigidi P, Gobbetti M, Di Cagno R. Novel probiotic candidates for humans isolated from raw
fruits and vegetables. Food Microbiol. 2012 31(1):116-25.
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Chen YS, Jan RL, Lin YL, Chen HH, Wang JY. Randomized placebo-controlled trial of lactobacillus on asthmatic children with allergic rhinitis. Pediatr
Pulmonol. 2010 45(11):1111-20.
•
Alm JS, Swartz J, Björkstén B, Engstrand L, Engström J, Kühn I, Lilja G, Möllby R, Norin E, Pershagen G, Reinders C, Wreiber K, Scheynius A. An
anthroposophic lifestyle and intestinal microflora in infancy. Pediatr Allergy Immunol. 2002 13(6):402-11.
•
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Asthma. 1985;22(1):45-55.
41
Chronic Constipation and Dairy
Products
42
Chronic Constipation and Dairy
Products
• Chronic constipation is a common problem in
children.
• The usual treatment prescribed is fiber
supplements and laxatives.
• If that fails, more potent and higher doses of
laxatives are used, but that still may not work
• Years go by and many kids are still suffering; it
may even extend into adulthood.
43
Chronic Constipation and Dairy
Products
• Although a link between dairy product
consumption and chronic constipation in children
was suggested as early as the 1950’s, there was
still a widely-held mistaken belief that most
chronic constipation in infants and young children
was psychosomatic (it was all in their head), that
they had some GI disorder or were anal retentive.
• So what happened when researchers tried
removing cow milk protein from the diet of
infants who presented with chronic idiopathic
constipation (of unknown cause).
44
Chronic Constipation and Dairy
Products
• Within just three days, 21 of the 27 children
were cured of their constipation. When a diet
free from cow milk was used, symptoms
completely regressed.
• What’s more is that reintroduction of cow milk
to the diet resulted in a clinical relapse in 2
subsequent cow milk challenges. (The
constipation reappeared within 24 to 48 hours
both times following cow milk reintroduction).
45
Chronic Constipation and Dairy
Products
• After about a month on the cow milk free diet,
not only did their constipation resolve but
they were also seemingly cured of their
eczema and wheezing!
• The researchers concluded that many cases of
chronic constipation in young children may be
due to an underlying cow’s milk protein
allergy.
46
Chronic Constipation and Dairy
Products
• A subsequent larger, higher quality study in the New
England Journal of Medicine that looked at cow’s milk
versus soy milk confirmed these findings.
• Children suffering from chronic constipation that did
not respond to treatment with laxatives many of who
had anal fissures (a tear in the anus) and inflammation
and swelling. The ressearchers gave them either cow’s
milk or soy milk for two weeks and then switched it
around.
• Constipation resolved while the kids were avoiding
cow’s milk in 2/3 of the children; the anal fissures and
pain were cured.
47
Chronic Constipation and Dairy
Products
• None of the children receiving cow’s milk had any
improvement.
• In the cured children, the relation with cow’s milk
protein hypersensitivity was confirmed in all
cases by a double-blind challenge with cow’s
milk.
• All those lesions, including the most severe anal
fissures, disappeared on a cow’s milk-free diet
and reappeared within days after the
reintroduction of cow’s milk back into the diet.
48
Chronic Constipation and Dairy
Products
• The results of that study may explain the 8-fold risk of
developing anal fissures in children drinking more than
a cup of milk a day.
• Cow’s milk may also contribute to recurrent diaper rash
in infants.
• In adults too, removing milk from the diet may help
cure anal fissures, reintroducing cow milk brought their
pain from 0 back up to 8 or 9 (on a scale of 1 to 10).
• Whereas the previous studies only removed cow milk,
there was a more recent study that removed all dairy
sources and achieved a 100% cure rate.
49
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•
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•
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50
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G Iaconoa, S Bonventreb, C Scalicia, E Maresic, L D Primad, M Soresid, G D Gesu, D Notod, A Carrocciod. Food
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Feb;18(2):143-50.
•
M Abdel-Aziz El-Hodhod, A M Hamdy, M T El-Deeb, M O Elmaraghy. Cow’s Milk Allergy Is a Major Contributor in
Recurrent Perianal Dermatitis of Infants. ISRN Pediatr. 2012;2012:408769.
•
A Carroccio, P Mansueto, G Morfi, A D Alcamo, V D Paola, G Iacono, M Soresi, G Scerrino, Emiliano Maresi,
Gaspare Gulotta, G Rini , S Bonventre. Oligo-Antigenic Diet in the Treatment of Chronic Anal Fissures. Evidence for
a Relationship Between Food Hypersensitivity and Anal Fissures. Am J Gastroenterol. 2013 May;108(5):825-32.
•
S M Dehghani, B Ahmadpour, M Haghighat, S Kashef, M H Imanieh, M Soleimani. The Role of Cow's Milk Allergy in
Pediatric Chronic Constipation: A Randomized Clinical Trial. Iran J Pediatr. 2012 Dec;22(4):468-74.
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Paediatr Child Health. 2003 Jul;39(5):329-31.
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Mar;146(3):359-63.
•
G lacono, MD, A Carroccio, F Cavataio, G Montalto, M D Cantarero, A Notarbartolo. Chronic constipation as a
symptom of cow milk allergy. J Pediatr. 1995 Jan;126(1):34-9.
51
Dairy and Disease
• Constipation is by far not the only problem dairy causes in
children, casomorphins (opioite-like peptides produced by
cow’s milk) from the cow’s milk protein beta-casein may
contribute to the cause of such conditions as: autism, crib
death, type I diabetes, postpartum psychosis, circulatory
disorders, and food allergies.
• Delayed psychomotor development and muscle spasticity
was associated with elevated levels of bovine casomorphin
found in cow’s milk based formula-fed infants.
• Thus delayed psychomotor development and diseases such
as autism may be partly caused by the inability of some
infants to adequately eliminate bovine casomorphin.
52
Sources Cited for Above Slide
• Sun Z, Zhang Z, Wang X, Cade R, Elmir Z, Fregly M. Relation of betacasomorphin to apnea in sudden infant death syndrome. Peptides.
2003 Jun;24(6):937-43.
• Fiedorowicz E, Jarmołowska B, Iwan M, Kostyra E, Obuchowicz R,
Obuchowicz M. The influence of μ-opioid receptor agonist and
antagonist peptides on peripheral blood mononuclear cells
(PBMCs). Peptides. 2011 Apr;32(4):707-12.
• Kost NV, Sokolov OY, Kurasova OB, Dmitriev AD, Tarakanova JN,
Gabaeva MV, Zolotarev YA, Dadayan AK, Grachev SA, Korneeva EV,
Mikheeva IG, Zozulya AA. Beta-casomorphins-7 in infants on
different type of feeding and different levels of psychomotor
development. Peptides. 2009 Oct;30(10):1854-60.
53
Diet and Puberty
54
Diet and Puberty
• Hormone-related cancers, a shorter lifespan,
metabolic syndrome, and cardiovascular
disease all have a common risk factor. Can you
guess what it is?
• A number of diseases in adulthood (including
the above mentioned) are linked to an earlier
onset of puberty.
55
Diet and Puberty
• Animal protein consumption has been the most
consistent link between diet and premature
puberty. Each gram of daily animal protein
consumption—that's the weight of a paperclip—
is linked with a 17% increase in the risk of girls
starting their periods earlier than age 12.
• Only a century ago, girls were beginning their
periods at around age 16, which may help explain
why breast cancer is now such an epidemic.
56
Diet and Puberty
• "children with higher intakes of vegetable
proteins start puberty 7 months later than
average, and children eating more animal protein
start puberty 7 months earlier than average.
• Soy is protective. "Girls with the highest levels of
dietary isoflavone intake—the phytonutrients in
soy foods--may experience their onset of breast
development approximately 7–8 months later
than girls with the lowest levels of intake."
• Recommend organic (non-GMO) soy products,
especially fermented soy foods.
57
Diet and Puberty
• What effect would delaying puberty have on the
risk of diseases in adulthood?
• "Delays in the timing of puberty in response to
beneficial dietary habits (higher intakes of
vegetable protein and soy, and lower intakes of
animal protein) may be of substantial public
health relevance:”
• reduced risk of breast cancer and lower total
mortality is associated with a later menarche
(onset of puberty).
58
Sources Cited for Above Slides
•
G. Cheng, A. E. Buyken, L. Shi, N. Karaolis-Danckert, A. Kroke, S. A. Wudy, G. H. Degen, T. Remer. Beyond
overweight: Nutrition as an important lifestyle factor influencing timing of puberty. Nutr. Rev. 2012 70(3):133 - 152
•
I. S. Rogers, K. Northstone, D. B. Dunger, A. R. Cooper, A. R. Ness, P. M. Emmett. Diet throughout childhood and
age at menarche in a contemporary cohort of British girls. Public Health Nutr 2010 13(12):2052 - 2063
•
M. Heys, C. Jiang, K. K. Cheng, W. Zhang, T. H. Lam, G. M. Leung, C. M. Schooling. Does childhood meat eating
contribute to sex differences in risk factors for ischaemic heart disease in a developing population? J Epidemiol
Community Health 2011 65(6):522 - 528
•
A. Thankamony, K. K. Ong, M. L. Ahmed, A. R. Ness, J. M. P. Holly, D. B. Dunger. Higher levels of IGF-I and adrenal
androgens at age 8 years are associated with earlier age at menarche in girls. J. Clin. Endocrinol. Metab. 2012
97(5):E786 - 90
•
E. D. Hond, W. Dhooge, L. Bruckers, G. Schoeters, V. Nelen, E. van de Mieroop, G. Koppen, M. Bilau, C. Schroijen, H.
Keune, W. Baeyens, N. van Larebeke. Internal exposure to pollutants and sexual maturation in Flemish
adolescents. J Expo Sci Environ Epidemiol 2011 21(3):224 - 233
•
A. Chen, E. Chung, E. A. DeFranco, S. M. Pinney, K. N. Dietrich. Serum PBDEs and age at menarche in adolescent
girls: Analysis of the National Health and Nutrition Examination Survey 2003-2004. Environ. Res. 2011 111(6):831 837
59
Gargling to Prevent the Common
Cold
60
Gargling to Prevent the Common Cold
• Gargling is one of the best things to do to
treat a sore throat.
• Does it work to prevent the common cold?
• In Japan, to prevent URIs, like the common
cold, gargling has been strongly recommended
(though like many virtually cost-free, simple
and effective modalities it’s not yet popular in
the Western world).
61
Gargling to Prevent the Common Cold
• In a randomized controlled study in 2005. "They found
a significant drop in the incidence of the common cold,
but not the flu, suggesting that simple plain water
gargling is effective to prevent respiratory infections
among healthy people. This virtually cost-free modality
would appreciably benefit people both physically and
economically around the world.”
• Nearly 20,000 preschoolers were followed for 20 days
in another study. Children in the exposure group were
instructed to gargle at least once a day.
62
Gargling to Prevent the Common Cold
• Whereas gargling with tap water reduced the
chance of a fever by about a third, gargling
with saline water or green tea lowered this
risk even further by half (saline water) and
two thirds (green tea) respectively.
• The researchers concluded that “Gargling
might be effective in preventing febrile
diseases in children.”
63
Sources Cited for Above Slides
•
K. Satomura, T. Kitamura, T. Kawamura, T. Shimbo, M. Watanabe, M. Kamei, Y. Takano, A. Tamakoshi.
Prevention of upper respiratory tract infections by gargling: A randomized trial. Am J Prev Med
2005 29(4):302 - 307
•
M. Sakai, T. Shimbo, K. Omata, Y. Takahashi, K. Satomura, T. Kitamura, T. Kawamura, H. Baba, M.
Yoshihara, H. Itoh. Cost-effectiveness of gargling for the prevention of upper respiratory tract
infections. BMC Health Serv Res 2008 8(NA):258
•
T. Kitamura, K. Satomura, T. Kawamura, S. Yamada, K. Takashima, N. Suganuma, H. Namai, Y.
Komura. Can we prevent influenza-like illnesses by gargling? Intern. Med. 2007 46(18):1623 - 1624
•
T. Noda, T. Ojima, S. Hayasaka, C. Murata, A. Hagihara. Gargling for oral hygiene and the
development of fever in childhood: A population study in Japan. J Epidemiol 2012 22(1):45 - 49
•
K. Sato, T. Ohmori, K. Shiratori, K. Yamazaki, E. Yamada, H. Kimura, K. Takano. Povidone iodineinduced overt hypothyroidism in a patient with prolonged habitual gargling: Urinary excretion of
iodine after gargling in normal subjects. Intern. Med. 2007 46(7):391 - 395
•
Fendrick AM, Monto AS, Nightengale B, Sarnes M. The economic burden of non-influenza-related
viral respiratory tract infection in the United States. Arch Intern Med. 2003 Feb 24;163(4):487-94.
64
Fever and Ionic Calcium
65
Fever and Ionic Calcium
• Parent’s often panic at the thought of seizures
called febrile convulsions that can sometimes
occur with sudden high fever in children.
• Research has shown us that, in-fact, febrile
convulsions in children are actually
hypocalcemic tetany (muscle twitches
resulting from low intracellular calcium levels).
• These convulsions do not injure the CNS or
lead to epilepsy
66
Fever and Ionic Calcium
• Fever is the body’s natural attempt to eliminate
infection and can occur due to insufficient blood
calcium levels in the presence of infection
• (One of the mechanisms whereby) fever, results
in enhanced immune activity is by increasing the
temperature of muscles adjacent to bones,
thereby leaching small amounts of ionic calcium
from the bones so that it may be used by the
body to activate immune cells (in the
complement cascade)
67
Fever and Ionic Calcium
• However, might it not better to get calcium
from the diet rather than from your own
bones?
• Something as simple as getting enough
calcium from the diet may help to prevent
fever and febrile seizures
68
Fever and Ionic Calcium
• So what foods are good sources of calcium?
• If a dairy product came to mind, think again.
• The pasteurization process alters the availability
of calcium in dairy products; thus they may not
be a good source of absorbable calcium.
• The main reason not to rely on dairy for calcium
however, is due to its overall overwhelmingly
detrimental effects on health as previously
discussed.
69
Sources Cited for Above Slides
• Pediatrics (66:1009-10012, December 1981).
• Decava, Judith, “Symptoms of disease or
symptoms of repair” Biochemical Research
and Clinical Nutrition, Vol. 1 No. 9, 1990.)
70
Good Sources of Calcium
Dietary Sources:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Spinach
Turnip Greens
Kale
Arugula
Broccoli
Okra
Acorn Squash
Collards
White beans
Black-eyed peas
Green peas
Almonds
Dried figs
Sesame seeds
Supplement Sources (roughly in
order of bioavailability):
• Calcium lactate
• Calcium mallate
• Calcium citrate
71
“Eat your Broccoli!”
72
“Eat your Broccoli!”
• When kids were given a choice between
broccoli or a chocolate bar, which do you think
they picked?
• 78% picked the chocolate bar
• But what if an Elmo sticker was placed on the
broccoli?
• Placing an Elmo sticker on the broccoli
changed this ratio to 50/50
73
“Eat your Broccoli!”
• This experiment was repeated successfully with a
picture of SpongeBob saying, “Got beans?”,
resulting in 37% more boys and 17% more girls
choosing green beans.
• If you’re going to give your kids cookies (you
shouldn’t), studies show that just by cutting them
in half, you can reduce your child’s total intake by
about a quarter.
• So how should vegetables be cut to maximize
consumption?
74
“Eat your Broccoli!”
• One study showed that “Shape was very
influential; children clearly preferred having
their vegetables cut.” The shape most liked
were stars.
• What about size? Would whole slices or
miniature sticks be preferred?
• Ordinary slices were preferred to the
miniature sticks.
75
“Eat your Broccoli!”
• Simply giving vegetables more appealing names
dramatically increases intake.
• In a study done with elementary school children names
like “X-Ray vision carrots, Power Punch Broccoli, Silly
Dilly Green Beans, and Tiny Tasty Tree Tops”
substantially increased consumption of these
vegetables (eg. more than twice as many broccoli and
almost 3 times as many green beans were eaten).
• Giving vegetables more appealing names creates a
lasting impact with the selection of vegetables in the
treatment school going up by 99% over the course of 2
months (while declining by 16% in the control school).
76
“Eat your Broccoli!”
• If your kids won’t even eat “tiny tasty tree
tops”, another strategy would be to dip the
veggies in organic peanut butter.
• As one study showed, “Pairing vegetables with
peanut butter may successfully increase
intake, even in vegetable-resistant children.”
• Salad dressing might help as well, although its
probably far less nutritious
77
“Eat your Broccoli!”
• If that doesn’t work, you can try incorporating
vegetables into familiar dishes without telling your kids
• In one study, “broccoli, cauliflower, tomatoes, squash,
and zucchini were covertly added to familiar entrees so
that the appearance, flavor, and texture of the original
recipes were maintained,” such as pureeing vegetables
and adding them into a sauce.
• Families didn’t notice.
• Secretly adding vegetables to foods can “have a
beneficial effect on children’s vegetable intake, but it
should not be the only way that vegetables are served
to children.”
78
“Eat your Broccoli!”
• Although repeated exposure to a vegetable
can increase appetite for it, secretly adding
vegetables to foods may not get your kids to
start eating them voluntarily.
• Therefore, it’s important to expose kids to
whole vegetables.
79
“Eat your Broccoli!”
• If all else fails, you can use their favorite
activity against them.
• Video Games!
• “The Quest to Lava Mountain,” is a video
game in which you can harvest kale and glean
“knowledge about the health benefits of
eating healthy foods such as fruits, vegetables,
and whole-grain foods” and the deleterious
health effects of consuming junk-food.
80
“Eat your Broccoli!”
• Video games aside, another study looked at
different parenting styles with regard to
increasing children’s fruit and vegetable
intake.
• Do you think putting pressure on kids to
increase intake was successful?
• What was the most important factor with
regard to increasing consumption?
81
“Eat your Broccoli!”
• The most important predictor of the children’s
fruit and vegetable consumption was…
• The parent’s own intake
• The researchers concluded that in order to
increase children’s fruit and vegetable
consumption, parents should first improve
their own diet.
82
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•
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increase children's vegetable intake and reduce energy intake. Am. J. Clin. Nutr. 2011 94(3):735 - 741.
•
A. D. Blatt, L. S. Roe, B. J. Rolls. Hidden vegetables: An effective strategy to reduce energy intake and increase
vegetable intake in adults. Am. J. Clin. Nutr. 2011 93(4):756 - 763.
•
C. A. Johnston, J. L. Palcic, C. Tyler, S. Stansberry, R. S. Reeves, J. P. Foreyt. Increasing vegetable intake in MexicanAmerican youth: A randomized controlled trial. J Am Diet Assoc 2011 111(5):716 - 720.
•
A. Olsen, C. Ritz, L. Kramer, P. Moller. Serving styles of raw snack vegetables. What do children want? Appetite
2012 59(2):556 - 562.
•
N. Beasley, S. Sharma, R. Shegog, R. Huber, P. Abernathy, C. Smith, D. Hoelscher. The quest to Lava Mountain: Using
video games for dietary change in children. J Acad Nutr Diet 2012 112(9):1334 - 1336.
•
D. Marchiori, L. Waroquier, O. Klein. 'Split them!' smaller item sizes of cookies lead to a decrease in energy intake
in children. J Nutr Educ Behav. 2012 May-Jun;44(3):251-5.
•
C. Vereecken, A. Rovner, L. Maes. Associations of parenting styles, parental feeding practices and child
characteristics with young children's fruit and vegetable consumption. Appetite 2010 55(3):589 - 596.
•
B. Wansink, D. R. Just, C. R. Payne, M. Z. Klinger. Attractive names sustain increased vegetable intake in schools.
Prev Med 2012 55(4):330 - 332.
83
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J. O. Fisher, J. A. Mennella, S. O. Hughes, Y. Liu, P. M. Mendoza, H. Patrick. Offering dip promotes intake of a moderately-liked raw vegetable among
preschoolers with genetic sensitivity to bitterness. J Acad Nutr Diet 2012 112(2):235 - 245.
•
J. S. Litt, M.-J. Soobader, M. S. Turbin, J. W. Hale, M. Buchenau, J. A. Marshall. The influence of social involvement, neighborhood aesthetics, and
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L. Suriano. Veggiecation: A Culinary Nutrition Education Program About Vegetables.
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B. Wansink, K. van Ittersum, J. E. Painter. How descriptive food names bias sensory perceptions in restaurants. Food Qual Prefer. 2005 16(5):393-400.
•
B. Wansink. Changing Eating Habits on the Home Front: Lost Lessons from World War II Research. J Public Policy Mark. 2002 21(1):90-99.
•
B. Wansink, S.-B. Park. Sensory suggestiveness and labelling: Do soy labels bias taste? J Sens Stud. 2002 17(5):483 - 491
•
S. Finz. Big food fight on Bay Area's school menus / Santa Clara's strict proposal highlights a healthy debate. SFGate. Published 4:00 a.m., Monday,
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90
Acknowledgements
• A big thank you to Dr. Michael Greger for the
content and sources of many of the slides
presented.
91
Thank you!
Questions?
92