Sugar-free or full-of-sugar for kids?

I had a question come to me today about giving kids sugar free foods and wanted to share it and my response with you all.
Q: I never know whether to by sugar free items for my kids or get the real thing. For example, popsicles. Real ones with 6-10grams of sugar in it or sugar free with aspartame, and phenylketonurics w/ phenylalanine. Obviously, sugar free sounds better, but I feel those can have mystery ingredients!!! Please help!!!
A: Great question...unfortunately, there is not a whole lot of "evidence-based" research on the topic as artificial sugars are relatively new in the food industry and their effects are likely more long-term and related to the amount consumed. 

However, I do have some knowledge on the topic...so here goes! Aspartame should be avoided completely in kids with a genetic disorder called PKU (phenylketonuria) because they lack the enzyme that comletely breaks the chemical down and the toxins produced will kill them. This disorder is tested for at birth (or shortly after) as these kids will die if they are exposed to food containing phenalynine, which are plentiful in our modern food supply. By the sounds of it, you probably don't need to worry about PKU as you would know if they had it by now.

As for non-PKU kids, I would say you want to limit the amount of artificial sugars, preservatives, hormones, etc, in their foods as we aren't sure what the long term effects are. That's not to say that sugar is great for them either, but if given enough play time to run around every day (approx 1 hour at least), your kids should be able to burn off the calories they consume. Some people blame neurologic problems, cancer, migraines and food allergies on artificial food ingredients, although there is little to no concrete evidence to back up the claims. (This doesn't mean they aren't true, though. We just haven't proven it yet. We have, however, pretty much dispelled the myth that aspartame causes cancer when consumed at normal doses (as opposed to the enormous doses the lab rats recieved in the intial studies)).

That being said, my advice is to limit the bad stuff (ie, artificial sugars, hormones, preservatives, coloring, etc), stick to the basics (eat lots of fruits and veggies & limit soda and even juices, instead give milk and water) and keep up about an hour of exercise per day (for everyone!) and your kids should grow up to be healthy and strong. You can try more natural sweeteners like agave nectar and substitute carob for chocolate if you're concerned about sugars.

A baby aspirin a day helps keep the doctor away!

     This is well known when it comes to heart health. But did you know that this same medication can protect you from developing colon cancer? And it only takes a small dose (approx 75 mg) per day to do so! A moderately-sized study (approx 2200 patients in both the treatment and control groups) published in a recent volume of Gut found a significant difference in the incidence of colon cancer between people who take a baby aspirin every day and controls (who do not take the aspirin). And the effect was noted at 5 years...meaning that you don't have to take the medication for that long (5 yrs is a relatively short amount of time in the prevention world) to notice a difference in colon cancer rates.
      This type of "prevention" is known as chemo-prevention, in that a drug (chemical, hence chemo-) can be taken to prevent a specific illness (hence -prevention). A well-known example of chemo-prevention is tamoxifen, which is used to prevent breast cancer. I point this out as we will be seeing more and more of this type of prevention in the future.
     As for this study, more research needs to be done (a randomized, controlled trial) to evaluate if these findings are long-lasting and robust. My advice, though, is to take the baby aspirin (they are accessible, cheap, relatively low risk and  good for your heart!) unless you've had a GI bleed or hemorrhagic stroke - then stick to an apple a day and consult your doctor!

Mediterrenean diet may decrease risk of developing melanoma

Thanks to Dr.Weil.com for this info:

Not only do Mediterreneans and others who follow a traditional Mediterranean diet have lower rates of heart disease and cancer, but they also have extremely low rates of melanoma. Some attribute this risk to their flavorful, anti-inflammatory diet consisting of colorful fruits and vegetables, nuts, legumes, olive oil, yogurt and fresh fish. New research from Israel suggests that the Mediterranean diet actually does protect against this potentially deadly form of skin cancer.

"Investigators gave one group of study volunteers a daily drink that was high in antioxidants; a second group drank beverages such as sodas instead. After two weeks - and five to six hours per day in the sun - blood tests showed that the volunteers who drank the antioxidant mix had 50 percent fewer oxidation products in their blood than the soda drinkers. In addition, drinking the antioxidant cocktail also delayed a tell-tale skin change - one that indicates the beginning of the tissue and DNA damage that can lead to skin cancer."

Although the number of subjects in the study was small, it's a pretty interesting study. Just imagine what a typical Mediterrenean diet (or anti-inflammatory diet, which I recommend) can do for your internal organs given such findings in skin! For more information on Dr. Weil's Anti-Inflammatory Diet (based on the typical Mediterrenean diet), click here (redirects to Dr. Weil's webpage).

Lately...

Hey everyone,

Hope you are all well. I am enjoying the beautiful cooler weather (in the 70s and super sunny, no humidity...girl can get used to that!) and spending more time in DC this weekend. Things are definitely picking up at work...I've even stayed late a couple days this week to finish up assignments I couldn't finish during the day. Hence, I haven't had as much time for blogging, etc.

On Monday, I met with staff members of Texas Congressmen and women - Senator John Cornyn, Rep. John Culberson and Rep. Ron Paul (Galveston County) - to discuss increasing financial aid to preventive medicine residencies. That was interesting and I think our points were well taken. I don't think it will make too much of an impact, however, on what happens in the legislature, but you never know. On Wed, I joined a national conference call put on by the CDC on the Flu virus, which was interesting and yesterday, I went and heard a briefing on children's health insurance coverage put on by the Human and Health Services (HHS) Department. The head of the Department, Secretary Kathleen Sebelius (more powerful than the Surgeon General), spoke along with the Secretary of Education, Arnold Duncan, the President of the American Academy of Pediatrics and the President of the United Way. The room was filled with people involved in health care reform and children's health advocacy (as well as press and a plethora of photographers). It was very exciting to see what is being done all over the country to ensure that America's children get the health coverage they deserve!

This week, I also began working on a project with the former director of Preventive Medicine residencies at Emery, Dr. Erica Frank. She now works in Canada and I will be working with her to finish up internet-based Adolescent Medicine, Preventive Medicine and eventually, Cancer Prevention, curricula to be used by health care professionals all over the world to improve upon their credentials. After completion of the internet course, people qualify for a certificate in a particular area. This is a pretty big deal, especially for people in rural areas who have limited access to educational resources, and I look forward to working with Dr. Frank to increase the knowledge base of health care professionals everywhere.

In other news, I have officially applied for a 3-4 year cancer prevention fellowship at the National Cancer Institute (NCI) here in the DC area to start next August. NCI is the largest branch of the NIH, with millions of research dollars funneled through it yearly...so it would be an excellent opportunity for me in that it will allow me to explore the research world for a while. Will let you know what happens with it as things progress :)

I've also added www.drashleymaltz.com to my list of websites/blogs and hope you will use this website as an access point through which to follow me.

Have an incredible and restful Labor Day weekend and I hope to talk with you all soon! Don't forget to email me with questions or recommendations...I'm all ears!

Until next time,
Ashley

Workplace wellness programs SAVE moulah!

Here's my write-up for the American College of Prev Med weekly newsletter...

A new longitudinal study of workplace wellness plans, overseen by Principal Investigator, Dr. Dee Edington at the University of Michigan, found significant cost-savings with the programs. The study, which analyzed expenses and savings of a utility company in the Midwest over nine years, estimated savings of $12.1 million in association with the company’s participation with the wellness program as opposed to the $7.3 million it spent on the program. Indirect costs, such as those for recruitment and for changing food menus, as well as all pharmacy and medical costs were assessed. Cost-savings were further demonstrated using very conservative figures. This study illustrates the importance of wellness plans in the workplace as a cost-savings tool. Of note, Dr. Edington was the ACPM’s KBS Guest Lecturer in 2009.
View a write-up of the article at http://www.ns.umich.edu/htdocs/releases/story.php?id=7928

For the love of chocolate...

A recent study done by Harvard Medical School, Harvard School of Public Health and Sweden's Institute of Environmental Medicine found some disappointing findings in regards to women's chocolate intake and heart health. The article, published in Circulation, found that only a MODERATE amount of dark chocolate would improve woman's odds of not developing heart failure (HF) as opposed to a larger amount.The researchers found a rate ratio (odds ratio) of HF was 26% lower among those who consumed 1-3 servings of chocolate per month and 32% lower among those who consumed 1-2 servings of chocolate per week, but the rate of HF was similar among women with no regular chocolate intake and those who consumed chocolate 3-6 servings per week and those who consumed one or more servings per day. The horror!!!!!!!!!!!

This deeply saddens me, as I have been convinced that dark chocolate (more than 60% cocoa) in any amount would improve my health...despite the saturated fat and calories it brings with it. Oh well...another delectable treat bites the dust in my eyes.

(Ok, so I'm being a bit sarcastic...never truly believed a large amount of chocolate in any form is beneficial...I just dreamt it was!)

http://circheartfailure.ahajournals.org/cgi/rapidpdf/CIRCHEARTFAILURE.110.944025v1.pdf

Medicare to cover smoking cessation (quitting) as part of the Affordable Care Act (ACA)

Article from MedPage Today, courtesy of my friend, Dr. Mike Green. This is good news as smoking cessation can be quite costly., according to my patients. Patches, gum and medications are NOT generic...and must be used either daily or weekly. So...here's to a good thing from health care reform! In addition, evidence-based screening techniques will be completely covered by insurance (ie, colonoscopies, mammograms, etc). That is a win-win situation! 


See below for more on smoking cessation coverage...

WASHINGTON - Good news for seniors who want to quit smoking --
Medicare will now cover tobacco cessation counseling -- the Department
of Health and Human Services announced.

The new coverage was mandated by the Affordable Care Act (ACA), which
contains a number of measures that focus on preventing diseases before
they occur, such as paying for cancer screenings, and annual no-cost
wellness checkups.

"For too long, many tobacco users with Medicare coverage were denied
access to evidence-based tobacco cessation counseling," HHS Secretary
Kathleen Sebelius said in a statement announcing the new benefit.
"Most Medicare beneficiaries want to quit their tobacco use. Now,
older adults and other Medicare beneficiaries can get the help they
need to successfully overcome tobacco dependence."

Of the 46 million Americans who smoke, about 4.5 million are Medicare
beneficiaries over age 65, and another million receive Medicare
benefits because of a disability, according to HHS.

Previously, Medicare only covered smoking cessation counseling if a
recipient had already been diagnosed with a tobacco-related disease or
showed symptoms of such a disease.

All Medicare beneficiaries already have access to smoking-cessation
prescription medication through Medicare's prescription drug program,
Part D.

Under the new coverage -- which applies to Medicare Part A and Part B
-- any Medicare beneficiary who smokes will be able to receive
counseling from a "qualified physician or other Medicare-recognized
practitioner" who can help them quit smoking.

The benefit will cover up to two separate tobacco cessation attempts
per year -- and each stint in stop-smoking counseling can include up
to four sessions.

"Giving older Americans and persons with disabilities who rely on
Medicare the coverage they need for counseling treatments that can aid
them in quitting will have a positive impact on their health and
quality of life," said CMS Administrator Don Berwick, MD, in a
prepared statement. "As a result, all Medicare beneficiaries now have
more help to avoid the painful -- and often deadly -- consequences of
tobacco use."

HHS will issue guidance in the next few months on a Medicaid provision
in the ACA that requires states to help pregnant women quit smoking.

What is Preventive Medicine??

From the American College of Preventive Medicine website (because, who am I to reinvent the wheel??):

Physicians who are board certified in Preventive Medicine hold a variety of positions from chief medical officers of private corporations, to directors of state/local health departments, to policy makers within governmental organizations, to program developers for multi-national NGOs, to many other positions. Career paths include managed care, public health, occupational medicine, aerospace medicine, clinical medicine, informatics, policy development, academic medicine, international medicine, and research. These positions are located in all levels of government, educational institutions, organized medical care programs in industry, as well as voluntary health agencies and professional health organizations. Preventive Medicine physicians operate in a variety of settings, but common to these settings is an approach to health that looks at systemic and population-based interventions to improve the health of individuals.

For more info, check out https://www.theabpm.org/  (American Board of Preventive Medicine) or http://acpm.org/index.htm (American College of Preventive Medicine...where I'm currently working).

Low-fat vs Low-carb diet??

That is the million dollar question. As described in a recent study in The Annals of Internal Medicine (August 3rd edition) by Foster, et al., people on both diets in combination with a comprehensive lifestyle modification program lost weight, however, they differed in measures of cholesterol and triglycerides.

The low-fat group had a significantly greater decrease in LDL cholesterol (bad, damaging cholesterol) level than the low-carb group at 3 and 6 months, but the difference did not persist beyond 6 months. Early decreases in triglyceride level (another type of fat in the blood, want them to be as low as possible) and increases in HDL cholesterol (good, protective cholesterol) level were significantly greater in the low-carb group than in the low-fat group, but only the difference in HDL level remained significant at 2 years. Blood pressure fell with weight loss in both diet groups but did not differ significantly between the groups at any time point. Early decreases in triglyceride level and increases in HDL cholesterol level were significantly greater in the low-carb group than in the low-fat group, but only the difference in HDL level remained significant at 2 years.

The take-home point...either weight-loss plan is good, as long as you committ to it in a safe way (no more than 2-3 pounds per week). An interesting point that these authors found was a significant increase in "adverse symptoms" and a higher drop-out rate (42% vs 32%)  in the low-carb group in comparison to the low-fat group. This is likely due to the "low" blood sugar feeling people not eating carbs can get. In fact, when you stop eating carbs alltogether (ie, the Atkins Diet), your body starts producing another type of fuel called ketones. Ketones aren't necessarily bad for your body, however, they are not the preferred type of fuel for your brain..it MUCH prefers sugar (ie, glucose)! So, some people don't tolerate the diet well, but most people I know, have no problems with it. It is, very difficult to live without carbs in this increasingly carb-friendly world.

Now that's food for thought...

Exercise as medicine...a tool for personal well-being

We all know exercise is good for us. But the science of exercise is finally getting the recognition it deserves. The benefits are far-reaching! Not only is exercise great for weight loss, it also decreases blood pressure, increases glucose tolerance in the body (how well your body uses the sugars in your blood), increases joint motion, can decrease risk of cancer and can be used as treatment for depression (see below). That being said, doctors are forlorn on how to prescribe such an intervention, besides telling patients to go to the gym 3-4 times a week. I attended a lecture on prescribing exercise (writing out specific recommendations for patients) 2 years ago at the annual American College of Preventive Medicine conference in LA and was blown away.

Check out http://www.exerciseismedicine.org/ for more info!



Also read about yoga as a treatment for mild to moderate depression... 

Direct from Dr. Andy Weil's website:

Daily aerobic exercise is a reliable and effective treatment for mild to moderate depression, but new research suggests that yoga may work even better. A study from Boston University School of Medicine showed that practicing yoga increased levels of GABA (gamma-aminobutyric) in the brain. Low levels of GABA, a neurotransmitter, are associated with depression and anxiety disorders. Investigators followed two randomized groups of healthy volunteers for 12 weeks. One group performed an hour of yoga three times a week, while the other group walked for an hour three times a week. Before and after the last session, the researchers compared the GABA levels of each of the volunteers using magnetic resonance spectroscopic imaging. They found increased GABA levels and decreased anxiety among the participants in the yoga group, who also reported a significantly greater decrease in anxiety and more improved mood over the course of the study than did the volunteers in the walking group. The study was published online by the Journal of Alternative and Complementary Medicine.

Urge the House to pass the Child Nutrition Act!! Important!!!

Schools are back in session, but the House of Representatives must still pass the Child Nutrition Act to give our kids healthier options at school. Urge your Rep. to prioritize the health of our kids- http://bit.ly/acBU4Z

Direct from the CDC website...

Eggs are making headlines around the world these days...mainly for their delicious taste and versatility (the egg-white omelette with various veggies is my personal favorite!) and occasionally for their excessive cholesterol content. But now, also for the an outbreak of Salmonella cases traced back to 2 U.S. farms.  

Check out how to reduce your risk of getting Salmonella from those delicious oval edibles...straight from the horse's mouth...

http://cdc.gov/Features/SalmonellaEggs/

Oh, the incredible, edible egg! How I still love thee (and plan to eat you when I feel like it) : )

Green Leafy Vegetables Actually Lower Diabetes Risk! Amazing!

Increased consumption of leafy green vegetables is associated with lower risk for developing type 2 diabetes, a British Medical Journal meta-analysis finds. (A meta-analysis surveys studies that have already been done and compiles their results in a systematic way). Researchers examined data from six prospective cohort studies (studies with compared likely compared 2 groups of people, matched in age, race, gender, etc) that measured individual consumption of fruits and vegetables. The studies also assessed the development of diabetes over a median of 13 years. Intake of fruit or vegetables, either alone or combined, was not associated with lower risk. In the four studies that specifically measured the intake of leafy green vegetables, a 14% reduction in diabetes risk was apparent between the highest and lowest levels of consumption. 

The authors cite the antioxidant effects of beta-carotene, polyphenols, and vitamin C as possible mechanisms for this effect. Editorialists comment that dietary advice "may be just as beneficial, if not more so, than prescribing drugs" to patients at risk.

http://click.jwatch.org/cts/click?q=227%3B67434060%3Bb0QR6PSnmG5deubAwAGMYzMpIyc9PDnm2j1caQ%2Bdd4s%3D

Recurrent Headaches in Teens Linked to Unhealthy Lifestyle

From the American College of Preventive Medicine website...

Adolescents who smoke, are overweight, or are inactive face increased risk for recurrent headaches, according to a cross-sectional study in Neurology. Nearly 6000 teenagers in Norway completed headache interviews and lifestyle questionnaires and underwent clinical examinations. After adjustment for confounders, smoking conferred a 50% increased risk for recurrent headache (migraine, tension-type, or nonclassifiable); overweight, a 40% increased risk; and physical inactivity, a 20% increased risk. The more unhealthy lifestyle factors a teen had, the greater the risk. Editorialists note that given its design, the study could not determine whether smoking, overweight, and inactivity are headache risk factors, exacerbating factors, or trigger factors. Still, they conclude that the report "sets the stage for lifestyle interventions" for headache disorders in adolescents.

Sugary drinks linked to Diabetes, but not only because they lead to weight gain

In a seemingly obvious way, sugary drinks (ie, non-diet sodas, juices, sports drinks, energy drinks, etc) lead to Metabolic Syndrome (ie, bad cholesterol, obesity, pre-diabetes) and full-blown Diabetes Mellitus. However, recent research from the Harvard School of Public Health found an association between these sugary drinks and "increased dietary glycemic load"...that leads to "insulin resistance, beta-cell dysfunction, and inflammation."


What this means is that these drinks not only cause you to gain weight, but they also disrupt the way sugar (glucose) is broken down and absorbed in your body, leading to excess circulating sugars and insulin (the hormone that enables the cells to take the sugar into cells, enabling its use) in the blood. Over the long term, this "impaired glucose tolerance" (as we say in the medical field) can wreak havoc on your pancreas, nerves and blood vessels, causing diabetes and/or it's complications, respectively. Medical practitioners have known this for a while, however, the concept gets lost in translation in the clinic...practitioners say 'don't drink sodas' but fail to explain exactly why or how they can negatively affect health. It is my belief, that this lack of understanding is what truly inhibits patients' willingness to change. So, here is yet another reason to avoid sodas and other fructose-laden drinks.

Not to mention...sugary drinks are AWFUL for your teeth : )

Props for UTMB study on when to take supplements (before or after working out)

The jist..."muscle protein synthesis was significantly greater in the PRE supplement group, primarily because of an increased delivery of amino acids, the building blocks for the protein found in muscles"...take that to the gym!



http://www.mercurynews.com/peninsula/ci_15823509?source=email&nclick_check=1

The dirty and clean of organic shopping...

Dirty dozen you SHOULD buy organic - http://www.thedailygreen.com/healthy-eating/eat-safe/Dirty-Dozen-Foods

Clean ones you DON'T - http://www.thedailygreen.com/healthy-eating/eat-safe/Save-on-Sustainable-Gallery-44032808

1 in 5 teenagers suffer some degree of hearing loss; not music to my ears!

Sorry for the technical tone to this post...I wrote it up as part of a newsletter for the American College of Preventive Medicine. Enjoy and feel free to comment or ask questions. :)

According to a cross-sectional study published in this week’s JAMA, the prevalence of slight to mild hearing loss among US adolescents is on the rise. The Harvard-affiliated researchers compared the most recent National Health and Nutrition Examination Survey (NHANES) data, from 2005-2006, to NHANES III data from 1988-1994, citing a 31% increased prevalence in hearing loss among subjects since NHANES III. This increase in prevalence was observed in all, high-frequency, unilateral, and bilateral hearing loss of slight or mild or greater intensity. It was not observed with low-frequency hearing loss. The prevalence of mild or worse hearing loss (defined by a decrease in hearing by 25 decibels or more) was significantly higher (P < .001) in NHANES 2005-2006 than in the 1988-1994 survey, representing a 77% increase in prevalence. No significant differences, including self-reported number of ear infections, exposure to more than or equal to 5 hours of loud noise per week and exposure to firearms, existed between the two groups surveyed.


These findings were unexpected given numerous public health measures to reduce hearing loss among children and adolescents, including vaccination against Haemophilus influenzae and Streptococcus pneumoniae as well as greater awareness of music-induced hearing loss. Although it is unclear as to the etiology of these findings, a possible connection between loud personal music systems and hearing loss cannot be ruled out and must be further investigated. The implications of the study are important for the fields of education, public health and child development.


http://www.redorbit.com/news/health/1905859/1_in_5_us_teens_suffers_hearing_loss/index.html?source=r_health

Meat lovers beware!

It is somewhat intuitive...people who eat meat have the potential to weigh more. This is what the authors found. However, what was most interesting from this article, is the fact that the researchers found that those who ate poultry had the highest association with weight gain! That's completely counter-intuitive and I will have to explore the article a little more to see to what they attribute this finding.

Another interesting tidbit they found...a person who cut their meat consumption by 250 grams daily (about a half-pound) could conceivably reduce their 5-year weight gain by around 4 pounds. That is not so much to ask...if I do say so myself! I have successfully decreased the amount of meat I eat to 1 serving a day and I feel healthy and energetic. Not to mention, I feel like I am doing something positive in terms of decreasing my carbon footprint. See the Facebook page - "I'm helping my health, animals, and the environment by eating less meat!" for more information.

http://www.reuters.com/article/idUSTRE66J57920100720?loomia_ow=t0%3As0%3Aa49%3Ag43%3Ar4%3Ac0.064516%3Ab35836212%3Az0

Report from The President's Cancer Panel 2010

This lengthy report sheds some light (although not a spotlight as the evidence is still up in the air...pun intended) on the impact of various potentially cancer-causing environmental toxins. It includes hormone-disrupting perfumes, home cleaners, etc., and really puts our consumer-driven beauty and cleaning markets into perspective. 

From NY Times reviewer, Nicholas D. Kristof:

'The President’s Cancer Panel is the Mount Everest of the medical mainstream, so it is astonishing to learn that it is poised to join ranks with the organic food movement and declare: chemicals threaten our bodies.'

 Check it out!

http://deainfo.nci.nih.gov/advisory/pcp/pcp08-09rpt/PCP_Report_08-09_508.pdf

Some inspiration for those who've been fighting the lifelong battle of obesity

http://health.msn.com/weight-loss/slideshow.aspx?cp-documentid=100261909&imageindex=1&q=A+Lifelong+Battle
It is possible to change!

NIH "Going Green with Nutrition" pamphlet

http://dnrc.nih.gov/highlights/NutritionMonthFlyer2010.pdf

Moderate exercise

Directly from my NIH cancer prevention course - regular moderate exercise is strongly shown to decrease risk of developing colon and breast cancers. Also, moderately shown to decrease risk of endometrial and lung ca's. So, get up people!! Official article to follow.

Obesity takes over

Obesity rates in the U.S. are trending upward more quickly than expected. CDC’s recently-released report, “State-Specific Obesity Prevalence Among Adults – United States, 2009,” 2.4 million more Americans became obese from 2007 to 2009. The report estimates the medical costs of obesity to be as high as $147 billion a year, and stated that medical costs for obese people were $1,429 higher than those of normal weight.

Scary! How can you help in promoting healthy behaviors? Get involved with your community! 

 - Volunteer at a local health fair
 - Maintain your sidewalk and streets so that others can use them for exercise
 - Contact local authorities and urge them to take actions to improve your neighborhood by making it more walker-friendly if your neighborhood needs it
 - Discuss actions to improve health of school lunches and increase recess time with school board members

The opportunities are endless...You can easily be a part of the solution!

Toxic receipts

http://unearthed.earthjustice.org/blog/2010-august/keep-change-and-toxic-receipt

Interesting non-scientific article

http://www.nytimes.com/2010/08/16/technology/16brain.html?ref=your_brain_on_computers