Heartburn Meds Increase Bone Fracture Risk

A new warning from the FDA states that drugs called proton pump inhibitors increase the risk of wrist, spine and hip fractures.  These proton pump inhibitors are used to treat heart burn.  They prevent your stomach from producing the acid required to properly digest food.

Drugs cited by the FDA are Nexium, Dexilant, Prevacid, Prilosec, Zegerid, Protonix and Aciphex.  The FDA warns that use of these drugs for more than just one year or at high doses is enough to increase the risk of fracture.  The increased risk of fracture was seen in people 50 years old or older.

“A staggering 113.4 million prescriptions for proton pump inhibitors are filled each year, making this class of drugs, at $13.9 billion in sales, the third highest seller in the United States,” writes Mitchell H. Katz, M.D., of the San Francisco Department of Public Health in an editorial in Archives of Internal Medicine, May 10, 2010. He notes that while proton pump inhibitors are helpful in treating selected medical conditions, the huge numbers prescribed indicate that many–53-69%–are prescribed inappropriately.

This is a very dangerous situation.  Not only do huge numbers of people take these drugs, the vast majority are taking them unnecessarily or for conditions that do not respond to proton pump inhibitors!  This is particularly troublesome in light of the information from a study concluded last fall:

Treatment with the anti-heartburn drugs known as proton pump inhibitors (PPIs) for eight weeks induces acid-related symptoms like heartburn, acid regurgitation and dyspepsia once treatment is withdrawn in healthy individuals, according to a new study. More than 40 percent of healthy volunteers, who had never been bothered by heartburn, acid regurgitation or dyspepsia, developed such symptoms in the weeks after cessation of PPIs.

If these drugs are being prescribed for people incorrectly or for people who don’t need them, there is a very real chance a physician could create the very problem he is supposedly treating.  In people who do not have peptic disease “rebound hypersecretion” occurs.  To explain, within two weeks of stopping the PPI your stomach begins to actually over produce acid.  This is all induced by taking a pill that is supposed to reduce acid production.

The researchers in the above study concluded:

“If rebound acid hypersecretion induces acid-related symptoms, this might lead to PPI dependency. Our results justify the speculation that PPI dependency could be one of the explanations for the rapidly and continuously increasing use of PPIs.”

An extremely convenient way to get people hooked on your product don’t you think?  I wouldn’t put it passed the pharmaceutical industry to design a product that would cause total and lifetime dependency on it.

Unfortunately, these drugs are treated by most physicians as if they are harmless.  They are intended to be used for no more than 14 days at a time.  However, I have many patients that come to me who have been on them for years. When they voice their concerns to their physicians they are reassured that what they are doing is safe and not to worry about the long term effects of these drugs.  It’s outrageous.

What Really Causes Heartburn?

The problem with PPIs is that they reduce stomach acid when the problem for most people who experience reflux is not over production of acid at all.  It’s actually under production of stomach acid!  This lack of stomach acid leads to improper digestion of food which can be irritating to the stomach.  It also allows a very specific bacteria to grow called H. pylori.  This bacteria is responsible for producing ulcers and possibly increasing the symptoms you are trying to prevent.  There are actually over 16,000 articles supporting the fact that suppressing stomach acid does not treat the problem.

Natural Ways to Treat Your Heartburn

The first and potentially most important way is to lose weight. People who are overweight are much more likely to suffer from heartburn.  Often times losing weight solves the problem without any other interventions.

Try a little sodium bicarbonate. Sodium bicarbonate, or baking soda, is a great way to relieve the symptoms.  One half to one teaspoon of baking soda mixed with water and swallowed often relieves the symptoms immediately.

Find out if you have a hiatal hernia. A hiatal hernia is when the stomach begins to slip up passed the diaphragm.  When this happens is allows stomach acid to reach the esophagus causing irritation.  There are simple manual maneuvers that can reduce this hernia without surgery.  It is very effective if applied correctly.

Change your diet! If you want heartburn, eat lots of processed food and sugar.  By eliminating these things from your diet you can significantly improve your symptoms.

Eliminate any food triggers you have identified. Occasionally foods will trigger symptoms like this.  If this is the case there is no need to take a PPI.  Simply eliminate these foods from your diet and you’ve solved your problem.

The increased risk of fracture is serious.  Often times a hip fracture is fatal in the elderly.  Keeping your body healthy from multiple aspects is important for reducing your risk of heartburn and dependency on PPIs.  If you follow the steps outlined above you should be able to significantly reduce your symptoms in a very short period of time.

Solving Childhood Obesity Part IV – Food Marketing

The marketers that come up with advertising campaigns for the food industry are pure genius.  They can take a food that is completely unhealthy and spin the commercial so that it appears as if the food is as good (if not better) than any health food available.  My rant on Tostitos is a good example. (Click here to read the post.) Some excerpts and statistics from this blog were taken directly from the Let’s Move Report to the President available at www.letsmove.gov.

Honey Nut And Chocolate Cheerios are Health Foods!

I recently saw another good example.  This was a Honey Nut Cheerios commercial.  It started about by talking about cholesterol and how high levels of the stuff can be bad for you.  Then it mentions how whole grains can improve cholesterol numbers.  I have issues with that statement as well but that’s a whole different post.  The commercial continues and states that Honey Nut Cheerios is made from whole grains and in a “study” was shown to reduce cholesterol.  We are of course provided no information on this so called study, but it sounds official so it’s included in the commercial.  They also put a big read heart on the box to suggest that eating Honey Nut Cheerios is heart healthy.  At the end of the commercial they also introduce Chocolate Cheerios and it too has a big red heart on the box!  It’s heart healthy too!  The problem?  Honey Nut Cheerios and Chocolate Cheerios are not heart healthy!  In fact, they are the opposite.  They are loaded with sugar and are not a good way for children to start the day.

Both Honey Nut Cheerios and Chocolate Cheerios provides a child with the equivalent of more than 4 teaspoons of sugar to start the day.  That’s equal to half a soda for breakfast.  Would you let your child drink half a soda for breakfast?  Probably not.  But wait, Cheerios does provide vitamins and minerals, right?  Yes, they do but what if Coca Cola decided to fortify its soda with vitamins and minerals?  Does it make soda healthy?  Certainly not.  I have provided the nutrition information and packaging of both Cheerios below for your viewing pleasure.

As you can see, both boxes have the big red heart on them.  The marketers know that the vast majority of people that see this box with assume that means Cheerios is healthy and that’s a major problem because it’s cereals like this that are contributing to childhood obesity is a big way.

The Marketing Billions

Food marketing to children and adolescents is a big business. The Federal Trade Commission (FTC) estimates
that, in 2006, food, beverage, and quick-serve restaurant companies spent more than $1.6 billion to promote their products to young people. Children and adolescents are an important demographic for marketers for several reasons: (1) they are customers themselves; (2) they influence purchases made by parents and caregivers; and (3) they are the future adult market.  The last reason is of particular importance to marketers.  Just like the cigarette companies of the 50’s and 60’s, the food industry knows that if it can get you hooked on their products as a child, you are unlikely to change as an adult.  Habits are hard to break.

Food and beverage companies utilize a full range of marketing techniques including print, internet advertising (such as advergames), product packaging, in-school marketing, cross-promotions, prizes and contests, and the use of popular licensed characters that appeal to children and adolescents.

Marketing Works (Unfortunately)

Research conducted by the Sesame Street Workshop in 2005 found a strong influence of popular licensed characters on preschoolers’ food preferences. When preschoolers were asked if they would rather eat broccoli or a Hershey’s chocolate bar, 78% of the children chose the chocolate bar and only 22% chose broccoli. When an Elmo sticker was placed on the broccoli, however, 50% of the children chose broccoli.  This shows that children are extremely impressionable and will likely always want to eat the foods that have the marketing behind them.  Unfortunately, this is almost always foods that are nutrient empty.

Can Big Business Police Itself?

The food industry claims it is concerned with the health of children.  In 2006 the Council of Better Business Bureaus established the Children’s Food and Beverage Advertising Initiative (CFBAI).  CFBAI was intended to change the ratio of food and beverage advertising messages directed to children under the age of 12 to encourage healthier eating and lifestyles. It has 16 current member companies – Burger King, Cadbury Adams, Campbell Soup, Coca-Cola, ConAgra Foods, Dannon, General Mills, Hershey, Kellogg, Kraft, Mars, McDonald’s, Nestle, PepsiCo, Post Foods, and Unilever.

These companies are doing this on a voluntary basis and have set guidelines for themselves:

1. 100% of child-directed television, print, radio, and internet advertising must promote “healthier dietary choices” or “better-for-you” products.
2. Products depicted in child-directed interactive games must be “better-for-you” foods or the games must incorporate healthy lifestyle messages.
3. Companies must reduce their use of third-party licensed characters in advertising that does not promote healthy dietary choices or healthy lifestyles.
4. Companies must not pay for or actively seek placement of their products in entertainment directed at children.
5. Companies must not advertise food or beverage products in elementary schools.

While these guidelines sound noble, it’s like asking the wolves to guard the sheep. A recent examination of the CFBAI has showed that it really is nothing more than a thinly veiled attempt to appease the public while continuing to do what they have always done.

The Federal Trade Commission’s 2008 report on the CFBAI noted that the participating companies’ nutritional standards, as well as their definitions of “child-directed,” vary by company. Within certain guidelines, each company developed its own nutritional standards for what constitutes a “better for you” food or a “healthy dietary choice.” Moreover, the FTC criticized the program for applying these standards only to certain forms of advertising.

A recent study analyzed the effectiveness of the CFBAI and found that it had not substantially shifted advertising for children toward healthier products. Using one measure of nutritional quality, the study determined that, in 2009, advertisements for healthy products accounted for a very small fraction of all advertising by participating companies, while most advertising promoted foods of low nutritional value. The study also found that companies participating in the CFBAI nearly doubled the use of licensed characters over the past four years, increasing from use in 8.8% of advertisements in 2005 to 15.2% in 2009. Roughly half of all advertisements with these characters are for foods in the lowest nutritional category.

This clearly shows that while the guidelines have been set, they are not abiding by them at all.  And why would they?  There is no actual power in this CFBAI.  It’s a voluntary group that is regulating itself.  The food industry is not going to do anything that may cost them any profit.  The sad fact is though that it is costing the youth of America their health.

The Solution

There has got to be tighter regulation on what is termed health food.  Just because it contains whole grains does not make it a health food.  Industry wide changes need to be made.  Official guidelines need to be set that categorize foods into good and bad (easier said than done, I might add) and these big companies need to be forced to adhere to them.  The consequences of not doing so need to be severe as well.

Another big part of the problem is the lack of education in the general public.  I see these ads and brush them off as ridiculous.  I can do this because I’ve had years of nutritional training.  While it does not take years to train someone how to eat and evaluate food properly, the food industry knows that most people don’t know the difference between good and bad foods.  They also know that people trust what they see on television.  If they are told that Chocolate Cheerios are heart healthy then it  must be true.

Education is the only real solution to this problem.  Children need to be taught from a young age what foods are good for you and what foods should be viewed as treats and eaten sparingly.  My advice to my patients is always the same – if it comes in a box and is processed, don’t eat it. Those are the most likely culprits to destroy your health.  Shop around the edges of the grocery store.  Skip those middle aisles with all the cookies, snacks and cereals.  Most of the cereals on the market today are no better than a box of cookies anyway.  If you do this, you’ll live a healthier and happier life.

Solving Childhood Obesity – Part III – Screen Time

In this third installment of how to solve childhood obesity we will be talking about the problem of ‘screen time.’  Screen time is the amount of time that a child spends in front of a television, computer or other similar device.  Thus far in this series we have talked about how breastfeeding and chemical exposure is related to obesity.  These ideas are not my own.  They are from the Let’s Move Campaign spearheaded by Michele Obama.  I am simply discussing them here.

In my practice I see many children with a wide variety of conditions.  Most of these conditions respond favorably to reducing screen time.  A child who is watching television or playing video games is not active.  This reduction in activity level not only leads to obesity but complicates ADHD and other learning disorders.

The American Academy of Pediatrics (AAP) recommends that children two years old and under should not be exposed to television, and children over age two should limit daily media exposure to only 1-2 hours of quality programming.  In contrast to these recommendations, one study found that 43% of children under age two watch television daily, and 26% have a television in their room!

Children this young are not opting to watch television.  Their parents are using it as a cheap babysitter unfortunately.  It may be easy to sit your child in front of the TV and let them ‘entertain themselves’ but it is not healthy.  Children that young need to be up and about learning and exploring the world.  Not only is it important for maintaining a healthy weight, it’s how their brain develops.  The input from the muscles and joints provides enormous amounts of information to the brain.  The brain uses this information to develop.  If a child is seated and is not active a large portion of this input is lost.

Secondly, Physical activity assists children in obtaining and improving fine and gross motor skill development, coordination, balance and control, hand-eye coordination, strength, dexterity, and flexibility—all of which are necessary for children to reach developmental milestones.

Thirdly, allowing a child to watch too much TV or play too many video games sets up bad habits.  Habits that we form when we are young are hard to break.  Just like eating poorly as a child leads to poor eating habits as an adult, watching too much TV as a child leads to the same as an adult.

Preschool aged children are also watching more television than recommended.  Ninety percent of children ages 4-6 use screen media for an average of two hours per day. Over 40% of children in this age group have a television in their bedroom, a third have a portable DVD player, and a third have a portable handheld video game player.

The choices for children are just about endless.  The list below is just a sample of the devices that children have access to these days.

• Television
• DVD/Blu-Ray player
• Computer
• iPhone
• iPod
• iPad
• Nintendo DS
• PSP
• Wii
• Playstation 3
• XBox 360

Not only do they have all the above options, but the gaming systems come with hundreds of games that could keep a child entertained for a life time.  This list above doesn’t mention cellular phones (except the iPhone) either.  I’ve seen children as young as 8 with cell phones.  Who are they calling?

Also the online world has changed how children are entertained as well.  Kids go home, get online and chat with their friends instead of actually getting outside and moving.

It’s one thing to talk about all these forms of entertainment, but do they actually lead to obesity.  The research says they do.  Studies show an association between television viewing and risk of being overweight in preschool children, independent of socio-demographic factors. Specifically, for each additional hour of television viewing, the odds ratio of children having a BMI greater than the 85th percentile was 1.06.   Having a television in the bedroom had a stronger association, with an odds ratio of 1.31. One study noted that preschool children who watched television for more than two hours a day were more likely to be overweight than children who watched television two hours or less daily.

Television viewing is also linked to dietary intake. Another study found that television exposure was correlated with fast-food consumption in preschool children, even after adjusting for a variety of socio-demographic and socio-environmental factors.

So how do we solve the problem?  I often tell the parents of my young patients that their child needs to be limited to no more than 2 hours of total screen time per day.  If the child wants to get up and watch 1 hour of cartoons before school, they only have one hour for the rest of the day.  Also, they are not permitted to watch television during meals.  That should be for family time.  When children get home from school they should get outside and enjoy an activity that makes them move.  Ride a bike, play a sport or get involved with an after school program.  Kids that come home and plop down in front of the television are much less likely to be healthy.  Do your kids a favor and get them moving!

Pesticides and your child’s health

I am going to take a one day break from my series on solving childhood obesity to mention this study that I just read about.  The study shows that children exposed to small amounts of pesticides have a significantly higher risk of developing ADHD.

In my last blog I spoke about controlling chemical exposures to limit obesity in children.  This study reveals yet another reason you should be wary of what goes in your child’s mouth.  The study looked at pesticides that are used on fruits and vegetables to improve the yield of a crop.  Sure, the pesticides work because they stop insect infestation but at what cost.

The pesticides are in a class of compounds called organophosphates.  These organophosphates are neurotoxins (toxic to the nervous system).  They act by inactivating an enzyme called acetylcholinesterase (A-see-tal-kole-in-es-ter-ace).  By inactivating this enzyme in an insect they die.  The problem?  Humans also need this enzyme to function.

In the human brain the neurotransmitter acetylcholine (A-see-tal-kole-een) is used for many things.  It is essential for learning and memory.  Acetylcholinesterase is also present in the brain.  It is designed to breakdown excess acetycholine.  By inactivating this key enzyme you may have too much neurotransmitter causing detrimental side effects.

This recent study isn’t the first to link organophosphates to ADHD, but it is the first to look at exposure to the general population.  Other studies have looked at farming communities and workers.

Researchers measured the levels of pesticide byproducts in the urine of 1,139 children from across the United States. Children with above-average levels of one common byproduct had roughly twice the odds of getting a diagnosis of ADHD, according to the study, which appears in the journal Pediatrics.

Where is the exposure coming from?  The EPA has banned most organophosphates from general lawn and garden use so the exposure is likely our fruit and vegetable supply.  That’s a scary thought because these are supposed to be our healthiest options.

Detectable levels of pesticides are present in a large number of fruits and vegetables sold in the U.S., according to a 2008 report from the U.S. Department of Agriculture cited in the study. In a representative sample of produce tested by the agency, 28 percent of frozen blueberries, 20 percent of celery, and 25 percent of strawberries contained traces of one type of organophosphate. Other types of organophosphates were found in 27 percent of green beans, 17 percent of peaches, and 8 percent of broccoli.

Nearly 95% of the children studied had detectable levels of organophosphate metabolites in their urine.  The children with the most had the highest rates of ADHD.

I always encourage my patients to eat organic or at the very least buy local.  Organic is best because it ensures that there is very little, if any, pesticide residue on your fruit or vegetable.  Buying local is also good because studies have shown that local produce also has less pesticide on it.

In my practice I see children with ADHD very frequently and our first step is always to clean up the diet and go as organic as possible.  In general parents are receptive to this which is good.  Most of the time, however, they get very little support from their family doctor or their child’s pediatrician.  In general I find, pediatricians don’t believe diet or chemical exposure has anything to do with ADHD.  It’s nice to finally have a study that will be published in their own trade journal that proves it does matter what a child eats.

The authors of the study suggest washing and peeling fruits and vegetables before you eat them.  I agree with the washing advice but don’t suggest you peel anything.  The skins of fruits and veggies is where some of the best nutrients are.  They are important to consume.  My advice is to buy organic and still wash the fruit or vegetable.  This will significantly reduce your risk of consuming organophosphates.

Solving Childhood Obesity – Part II – Chemical Exposures

In my last blog I spoke about the importance of breastfeeding a child in regards to reducing childhood obesity in this country.  That was the first part in a series of blogs I am writing to help get the word out about the new Let’s Move campaign.  I usually don’t see eye to eye with these kinds of campaigns but after reading the White House Task Force on Childhood Obesity Report to the President I was pleasantly surprised with many of the ideas put forth.  They are very much in line with my philosophy on health care.  In this second part in my series we will be talking about chemical exposures and how it relates to obesity.

Chemicals and Obesity

The evolution of our children...

Chemicals are all around us.  They make our lives easier in some ways (think gasoline) but they also take a toll on human physiology.  Chemicals may mimic human hormones and cause problems in that way.  Chemicals that do this are known as endocrine disrupting chemicals (EDCs).

These EDCs can cause problems in several ways.  They may promote obesity by increasing the number of fat cells, changing the amount of calories burned at rest, altering energy balance, and altering the body’s mechanisms for appetite and satiety.  Some also mimic human sex hormones such as estrogen which also alters metabolism.

Fetal and newborn exposure to these chemicals can cause more weight gain per unit of food gained and less weight expenditure per unit of exercise.  Over time this results in significant weight gain and all of the conditions associated with being overweight significantly increase.  The results these EDCs have on the fetus or young child appear to be permanent and persist well into adulthood.  According to scientists these chemicals change genetic expression and permanently alter metabolism.

Where are we getting these exposures?

Unfortunately, there are many sources of these chemicals.  Below I have listed some very common ones.

DDT – DDT is a chemical that was originally used as a pesticide to control mosquito populations.  It was synthesized during World War II as an alternative to an effective natural pesticide that was exported to the US from Japan.  It was studied very little but approved for civilian use after the war.  As early as 1946, the harmful effects of DDT on bird, beneficial insects, fish, and marine invertebrates were seen in the environment.  DDT has been found in the tissues of animals world wide and has even been found in the polar ice caps and the Himalayas.  This illustrates that it has spread to areas of the world where it was never directly applied.  DDT interferes with reproductive abilities suggesting that it alters human sex hormones and may play into obesity in that capacity.

Polychlorinated Biphenyls (PCBs) –  PCBs are a class of chlorinated compounds used as industrial coolants and lubricants.  The health effects of PCB exposure have been known since the 1930’s and were seen in the workers who made the product.  Unlike DDT this chemical was not supposed to be applied directly to the environment.  Companies, however, were not responsible in the disposal of it.  Between 1952 and 1977, the New York GE plant had dumped more than 500,000 pounds of PCB waste into the Hudson River.  Again, toxic effects were seen very early on in workers producing the chemical but Monsanto (the largest producer of PCBs) downplayed health issues stemming from it in order to continue making money from its production.  Recent studies show the endocrine interference of PCBs is related to the liver and thyroid and increases childhood obesity in children exposed prenatally.  Additionally, it may increase the risk of developing diabetes.

Bisphenol A (BPA) – I have previously written a blog about BPA. If you’re interested please read that as well.  BPA is a chemical that is used in plastic water bottles, the lining of cans, baby bottles, plastic food containers and dental materials.  It has been shown through many studies that even in low levels of exposure it increases the risk of diabetes, breast and prostate cancers, causes decreased sperm count, reproductive problems, early puberty, obesity, and neurological problems.  Fortunately, most responsible companies have stopped using it in their products but the total load of BPA in our environment is likely to remain very high because the breakdown of the products that contain it will continue for hundreds of years.

Phthalates – These are found in some soft toys, flooring, medical equipment, cosmetics and air fresheners.  The main area of concern for phthalates is the disruption of the male reproductive system.  Again, it likely alters sex hormones with can adversely affect metabolism.  Europe and California have banned its use in toys.

So What Can You Do To Protect Yourself  And Your Child?

1. My advice to patients is always to live as naturally as possible.  Eat foods that are fresh so you can avoid the packaging that contains many of these chemicals.
2. Don’t use artificial air fresheners.  They do make phthalate free air fresheners these days.
3. Buy your baby’s toys from companies that are ecofriendly.  Those companies won’t use any of these chemicals.
4. If you reheat your food or food for your children don’t do it in a plastic container.  Buy glass containers to store your food and use them to reheat your food.  Heating plastics increase the speed some of these chemicals break down.
5. Use a glass baby bottle.
6. Avoid generic fish oil.  They have been shown to have high levels of PCBs in them.  Always get your fish oil from a health professional.  (Check out our blog on PCB contamination of fish oil)

It isn’t possible to avoid all exposure.  After all DDT, while not used anymore, can be found even in the farthest reaches of the world.  The goal is to keep exposure to a minimum and keep your body as healthy as possible so it is adequately equipped to fight back.  That means eating healthy, exercising and avoiding unnecessary chemicals like cigarette smoke.  You should also take supplements known to have powerful antioxidant effects.  If you do this, you are providing as much protection as possible.

Solving Childhood Obesity – Part I

Recently released this month was an interesting piece on childhood obesity.  It is part of the Let’s Move campaign that is headed by First Lady Michelle Obama.  The report entitled Solving the Problem of Childhood Obesity within a Generation is full of good information (full report available at www.letsmove.gov).  I am usually skeptical of such reports because they seem to just recycle to same old information that has gotten us into the problem in the first place.  This report seems to be different.  Over the next couple of weeks, I am going to try and break down most of the recommendations that were put forth in this new report. Some of the recommendations I find very refreshing.  They are often things chiropractors, naturopaths and nutritionists have been recommending for years.  I’m glad to see traditional medicine catching up.

I have spoken many times on this blog about childhood obesity and what a large problem it is in the US.  The numbers are staggering.

• One in every three children (31.7%) ages 2-19 is overweight or obese.
• Obesity is estimated to cause 112,000 deaths per year in the United States, and one third of all children born in the year 2000 are expected to develop diabetes during their lifetime.
• The current generation may even be on track to have a shorter lifespan than their parents.

Also, this takes a massive toll on our health care system.  As health care costs continue to rise many economists say that they could eventually bankrupt the country.  Each year, obese adults incur an estimated $1,429 more in medical expenses than their normal-weight peers.  Overall from 1998 to 2008 medical costs related directly to obesity in adults increased by almost four fold from $40 billion to over $147 billion.  Childhood obesity now contributes to $3 billion in medical costs.

Unfortunately the trends of obesity are continuing to rise and have risen substantially in the last 30-40 years.  In particular, the levels of obesity have increased significantly since 1980.  Obesity has more than doubled among adults (rising from 15% to 34%), and more than tripled among children and adolescents (rising from 5% to 17%) since 1980.

While most people know that being overweight increases the likelihood of heart disease, there are other problems associated with it as well.  Obesity increases the risk of cancer, diabetes, arthritis, depression and osteoporosis to name a few.  Quality of life is also affected.  Children who are obese report a lower health-related quality of life (a measure of their physical, emotional, educational, and social well-being). One study actually found that children who are obese have similar quality of life as children with cancer!

So the question is how do we solve the problem?  The first part of the solution might surprise you.

Breastfeeding

Children who are breastfed are at reduced risk of obesity.77 Studies have found that the likelihood of obesity is 22% lower among children who were breastfed. This effect was noted all the way into adolescence suggesting that breastfeeding your child has very long lasting effects.  Other studies have shown that for every month a child is breastfed up to 9 months, a 4% reduction in the risk of being obese is observed.

In my practice I recommend that my patients breastfeed up to 12 months if possible.  Routinely I hear from expectant or new mothers that their doctors ‘recommend’ breast feeding but that they won’t lose out on anything if they choose formula.  This may stem from the years when women were being told that breast milk was no match in terms of nutrients to what could be concocted in a lab.  It is clear now that breastfeeding is an important part of the early life of a child.

Even though the research clearly points out that breastfeeding is critical most children (67%) do not breastfeed after three months.  The protection offered by breast milk is from several factors.   First, synthetic formulas contain twice as much protein as breast milk.  This stimulates insulin to be secreted in amounts that are too high.  This leads to excess fat storage.

Second, the biological response to breast milk differs from that of formula. When feeding a baby, the mother’s milk prompts the baby’s liver to release a protein that helps regulate metabolism.  This is not produced with formula.  Also,  giving formula is associated with unfavorable concentrations of leptin, a hormone that inhibits appetite and controls body fatness.

So why don’t more women breast feed? It is a complicated answer that has physical, social and cultural factors.  However, in this country we don’t make it easy for new mothers.  In the hospital a newborn is often taken from their mother and necessarily given formula.  This makes it difficult for the baby and the mother to learn how to properly breastfeed.  Part of the solution is to designate hospitals as “baby friendly” as determined by an independent group appointed by the government.  A hospital is given this baby friendly designation if they meet certain criteria for breastfeeding.  Currently, only 3% of births occur in baby friendly hospitals.

My advice to patients is always to breastfeed.  Do everything you can to make sure it happens.  If any doctor tells you that formula is ‘just as good’ as breast milk, find another doctor.  If you cannot breastfeed directly, try and pump your breast milk.  The advantages of breast milk over formula are huge.  After all a million years or so of evolution can’t be wrong.  In my next blog we will talk about chemical exposure and screen time and how it relates to childhood obesity.  I hope you’ll continue to read.

Baby Bottles and BPA – You need to know the facts…

Bisphenol A of BPA is a chemical that is used in plastics and in the lining of cans.  It is what is known as a xeno-estrogen.  That means that it mimics the human hormone estrogen.  It is so widely used that virtually all Americans have likely been exposed.  In fact, one study found that BPA could be detected in the urine of 95% of adults. (Environmental Health Perspectives Volume 113, Number 4, April 2005.)

The U.S. Department of Health and Human Services released a report in September 2008 concluding that there was cause for “some concern for effects on the brain, behavior and prostate gland in fetuses, infants and children at current human exposures.”

Other studies have linked BPA to a host of cancers, early onset puberty, obesity and type II diabetes.  Current research suggests that it can be harmful in extremely low quantities – parts per trillion – yet most people are exposed to levels 10 to 100 times greater than that. This is another example of an chemical that has made its way into our lives and continues to be there despite good evidence that it is dangerous.

But how exactly does it get from the plastic to us?  It’s called leaching.  As the plastic begins to break down, the BPA leaches out of the plastic and we ingest the chemical.  This process is sped up greatly by heating.  So as you wash that baby bottle in hot water you are actually speeding up the degradation of the plastic and increasing the leaching of BPA.  A good rule of thumb is that the hotter the wash or the older the bottle the more BPA will leach.

The problem is that the group of people that is probably most at risk are infants and small children which is precisely the people who will be feeding out of a bottle.  Small children are most at risk because their bodies are growing rapidly.  Rapidly growing cells are always more susceptible to damage from toxins than mature cells that have finished growing.  This is true of any chemical, not just BPA.  BPA alters the way genes are activated in the cells of rats.  These cells, according to scientists, are very similar to human cells.  When these cells are exposed to amounts of BPA that a baby would receive from a plastic bottle they divide quicker and eventually cause cancer.

So what can you do?  Below is a link to a great website that has tips on what you can do to avoid BPA exposure.  Fortunately, most responsible companies have moved away from using it in their products, but that doesn’t change what is already on the shelf.

Tips to Avoid BPA – Click Here

I believe this is a major problem and BPA should be eliminated from all materials that are to be used in any form of human consumption.  The research is there and it’s clear that there is at least something to be concerned about.  My patients often ask me about this and the best way to avoid exposure for your baby is to breast feed.  If you do need a bottle from time to time, buy glass bottles or buy a BPA free bottle – they are available.

Toxins causing ‘grievous harm,’ cancer panel says

Widespread exposure to environmental toxins poses a serious threat to Americans, causing “grievous harm” that government agencies have not adequately addressed, according to a strongly worded report released today by the President’s Cancer Panel, a body of experts that reports directly to President Obama.

The American Cancer Society estimates that about 6% of cancer deaths — nearly 34,000 a year — are caused by environmental pollutants.

That number could be much higher, the new report says. Although the report doesn’t give a figure, it says the government has “grossly underestimated” the problem because of a lack of research. Much of the suffering faced by people diagnosed with toxin-related cancer “could have been prevented through appropriate national action,” according to the 240-page report.

The report urges the Obama administration to act, even if the evidence linking cancer and chemicals isn’t definitive. Nearly 80,000 chemicals are used in the country today, many of which are unstudied and “largely unregulated,” the report says.

Children appear to be especially vulnerable, the report says.

The report was produced by cancer specialists LaSalle Lefall and Margaret Kripke, both of whom were appointed by President Bush and who heard from dozens of experts over the past two years. The panel’s third position is vacant.

Reaction to the report was mixed.

Jeanne Rizzo, president of the Breast Cancer Fund, an environmental advocacy group, said the report was “a watershed that could transform federal policy not just on cancer, but on chemicals.”

The American Cancer Society’s Michael Thun called the report “unbalanced” because he said it implied pollution is a major cause of cancer and dismissed prevention efforts. The report “restates hypotheses as if they were established facts,” Thun said in a statement. “It reflects one side of a scientific debate that has continued for almost 30 years.” Thun said he hopes the report won’t confuse Americans about the clearest ways to prevent cancer, such as through healthier living. The American Cancer Society says smoking alone causes far more deaths — more than 168,000 every year.

via Toxins causing ‘grievous harm,’ cancer panel says – USATODAY.com.

Dr. Court’s Comments

I think it’s great that this kind of information is finally starting to get out there.  I routinely recommend that my patients do a bio-detoxification for the reasons mentioned above.

Most of the chemicals that are in our lives have not been studied and no one knows the long term effects of these things.  For every chemical that may be harmless there are likely more that cause cancer.

And what about the chemicals that don’t cause cancer?  What about the chemicals that just affect physiology?  Some cause chronic pain, sensory perception issues, trouble breathing, head aches, joint pain, auto-immune disorders and the list goes on and on.

The fact that these chemicals are all around us makes them very dangerous.  You can’t get away from them.  They get into our soil, water and air.  You eat them, you drink them, and you breath them in.  Over time, some of these chemicals are dangerous and can cause cancer in susceptible individuals.  The problem is there is no way to tell who those susceptible people are.

Also, think about the list of people who don’t get cancer but are destined for a lifetime of suffering with some mystery condition that cannot be figured out because of some chemical exposure.  I routinely see patients who have these mystery conditions and I can almost always attribute it to some environmental exposure.

So the questions is, what can you do to protect yourself?  I always recommend that my patients do a bio-detoxification at least once per year.  Through that program you are able to cleanse you body of many built up toxins.  If you do this regularly, you have less of a chance of these chemicals adversely affecting you.

Secondly, eat a healthy diet.  These chemicals cause cancer by causing free radical damage that alters your DNA.  Free radicals are countered by a diet high in antioxidants.  A diet full of healthy protein, fruits, veggies and nuts will supply you with ample free radical scavenging antioxidants.

Thirdly, take supplements to boost your immunity and antioxidant capacity.  Things like vitamin D, vitamin C, curcumin, and green tea extract have known protective benefits.

Lastly, avoid using necessary chemicals in your life.  Here in the Northeast spring is in full bloom, but that also means the bugs and weeds are out too.  Instead of using the chemical weed and bug killers that are available, use a natural product.  I’ve used both natural weed and bug killer in the past two weeks and they worked great.  The ingredients were nothing more than peppermint, rosemary and thyme oil with a small amount of alcohol in it.

It’s no secret that we are surrounded by chemicals in our daily lives.  We start by getting up in the morning and driving to work in a car fueled by chemicals, printing our daily reports with chemicals and end our day by sitting down and watching our new fancy TVs that are filled with chemicals.  To assume they have no effect is naive.  They not only can cause cancer but also cause other long term health issues.  Do what you can to protect yourself and your family.

Why Salads Cost More than Big Macs

One of the major issues facing health care today is the cost which Americans must pay in order to obtain basic care.  Then the care they receive does nothing to address the problem they actually have.  For example, if a person walks into their doctor’s office with high cholesterol, they are almost always giving a statin medication to artificially lower their cholesterol.  The reason their cholesterol is high is not because of a statin deficiency.  It’s because of poor diet and lack of exercise.  Those causes, sadly, are hardly ever addressed.

The cost of this type of health care, according to some experts, is going to bankrupt this country if things are not changed and changed soon.  I have written many times about prevention and how that is the true key to reducing overall health costs in this country.  I absolutely believe that is true.  However, what if our government spent money a little differently in the mean time to reduce the cost of healthy foods?  Maybe that would put a dent in our rising obesity epidemic?

I can’t tell you how many people tell me that it’s just too darn expensive to eat healthy.  While I believe some people like to use that as a convenient excuse not to eat correctly, I believe most people have a hard time affording some healthy foods.  Just the other day I was at a local farmer’s market and one 3 oz. bag of shelled walnuts was $6!  A $6 snack? And a small one at that!

Often times fruit, vegetables, nuts and seeds are among the most expensive items at the grocery store.  The cheap stuff includes low grades or less desirable cuts of  meat, dairy and all grain products.  Want to know why?  Below is a graphic of what our government chooses to subsidize and in what percentage of the whole. (Original article can be found here.)

Subsidized America

Of course lobbying plays a major role in what gets subsidized, but that doesn’t change the above graphic.  You’ll notice that vegetables, fruits, nuts and legumes are subsidized the least while the meat, dairy and grain industry make out like bandits.

Meat is an essential part of our diets.  We need animal protein.  It is the only complete source of protein.  It also contains healthy fats that are vital to survival.  When consumed properly is the absence of abundant carbohydrate, it is perfectly healthy.  Do not let mainstream medicine talk you into being a vegetarian.  Eliminating meat is a big mistake. That being said, their piece of the pie should not be so significantly higher than the other important part of our diet – fruits, veggies and nuts and seeds.

The grain industry gets the second largest chunk.  The current government recommendations on the right in the diagram above more than make up for the lack of subsidy.  Our government recommends that everyone eat 11 servings of grains per day.  And where has this gotten us?  It has lead us straight into an obesity epidemic.  It’s the carbohydrate consumption that is out of control in this country.  If people were eating too much high quality meat, I doubt we’d see the problems we are seeing today.

McDonald’s, whose product’s success relies mostly of meat and refined grain, are okay with the current subsidization I am sure.  Let’s face it, when you buy a Big Mac for $.99 you aren’t buying it for the iceberg lettuce or the soft tomato they put on it.

At the very top of the subsidy pyramid are vegetables, fruits, nuts and legumes.  They account for just 2.28% of government subsidy.  They get less money than sugar and alcohol do.  See a problem with that?  However, does this translate to higher prices you ask?  Check out the diagram below.

The cost of fresh fruit and vegetables has clearly gone up while most other foods have remained the same or decreased.

This illustrates very well just how much subsidizing food products can have an effect on price.  While fruits and vegetables have increased in price, soda has plummeted.  This is a major issue, especially considering that soda is a major contributor to preventable disease in the United States.

With this knowledge it is easy to see that a salad could easily cost just as much if not more than a whole meal at McDonald’s.  The soda, burger and bun all get larger subsidies than the salad that you didn’t buy.

Health care cost are at an all time high and the complexities of the problem are astounding.  I think the above is also a large part of the problem.  While senators and congressmen are elected to impart the will of the people, they rarely do.  In order to get elected it takes a lot of money.  Big business has a lot of money.  Put 2 and 2 together.  Special interest groups control political action (or lack thereof) and people suffer with expensive salads and cheap Big Macs.

My advice?  While good food might be more expensive to eat, it’s worth it in the end.  You might get away with eating a poor diet for years and years while your young, but it catches up with us as we age.  Don’t short change yourself in terms of your diet.  It only ends up costing you more in the end.

The Fabric of America

The largest health concern in America today is the number of people who are overweight or obese.  It accounts for just about every preventable disease we know about.

Being overweight or obese increases one’s risk for heart attack, stroke, diabetes, osteoporosis, cancer and all the way down to acid reflux.  One major problem is our diets.  If you’ve read my blog before you know we’ve discussed that in detail.  The other major problem is our level of exercise.

Exercise is critically important because it increases our metabolism, burns stored body fat, reduces bad cholesterol and increases good cholesterol, improves mood and increases the efficiency of our hearts.  Despite all of this information most people still do not exercise!  Only 31% of Americans get enough exercise for it to be considered beneficial (i.e. playing a half hour of tennis a week is not enough).  And a full 40% do not exercise at all!  These numbers are quite staggering.

Currently the guidelines state that one should get 2 1/2 hours per week of moderately intense exercise or 1 1/4 hours of very intense exercise for it to be beneficial.  Moderately intense exercise would include brisk walking and intense would include jogging or swimming.  I’m not sure I agree with their classifications, but that’s for another blog.  It isn’t particularly important for this article anyway.

Part of the problem with Americans exercising (or not as is the case most of the time) is that it is not part of the fabric of our society.  It isn’t in our faces.  Unfortunately the things that are in our faces are things like fast food ads, pharmaceutical ads and snack food ads.  These things have become part of the fabric of American society.  The big corporations that profit from these sorts of things are extremely good at what they do.  They market to you in a way that makes it seem like there is no greater thing in the world than their product. They try to make you feel that if you don’t have it, use it or take it you are going to be left out.  It appeals to us in a way that is very primal.  It appeals to us on a subconscious level in that being alone or singled out is dangerous for survival.  Of course we know cognitively that if we don’t eat McDonald’s we are not going to be left alone to die in the woods, but there’s still something about being part of the group that we just can’t quite put our finger on.

What is this was exercise?  That if you didn’t exercise you would be one of the few who didn’t?  You wouldn’t want to be left alone so you’d start exercising.  These things are not marketed because you generally can’t make money by telling people to get outside and walk.  A new program, however, is putting a foot forward to try and get people out and moving to make America healthier.

The program is called the U.S. National Physical Activity Plan.  Among groups involved are the Centers for Disease Control and Prevention, the American College of Sports Medicine, the American Heart Association and the American Cancer Society.  Now I have my gripes with each one of these groups for some of their positions and lack of action on certain subjects, but  this is a step in the right direction.  Their ideas include:

• Make sure roadway spending includes money for “complete streets,” accommodating cars, bikes and pedestrians.
• Have doctors assess patients’ physical activity levels at appointments and discuss ways they can meet the activity guidelines.
• Encourage early childhood education programs to have little ones as physically active as possible.
• Provide access to and opportunities for physical activity before and after school.
• Encourage school officials to find ways for children to walk and bike safely to school.
• Provide tax breaks for building owners or employers who provide amenities in workplaces that support active commuting, such as showers in buildings, secure bicycle parking, free bicycles or transit subsidies.
• Increase funding and resources for parks, recreation, fitness and sports programs and facilities in areas of high need.

These ideas are good because they force people to start thinking about their physical activity levels.  It does so by making it “in your face.”  Think about it – if everywhere you went you saw bike paths, walking paths, parks and other outdoor recreational facilities, wouldn’t it make you think about getting outside and getting moving?  I think so.

Of particular importance is having doctors asses their patients’ physical fitness and activity levels and educating children from a young age about physical fitness.  Most doctors have a lot left to be desired in terms of assessing their patients’ physical fitness and recommending changes.  Routinely my patients tell me that their primary care doctors have only brushed over needing to exercise more.  Probably because they are not adequately trained to do so.  More appropriate resources are people actually trained in fitness and exercise.

Educating young people is the most important.  If we can educate young people we can “get ’em for life.”  A person that forms a habit young, good or bad, generally keeps it for the rest of their life.  I think getting young people involved in sports and fitness would significantly change the metabolic landscape of the country.

A healthy diet and exercise are two important factors that are missing from most Americans’ lives.  Getting exercise to become part of the fabric of society would be key to getting people to accept and understand the benefits that it offers.