October 9, 2017
if you remember the newsletter on individuals a few months back, I was discussing the importance of the individual when educating teenagers and young children. No one is inherently good or bad, nor does their religious preference, skin color, sex or other potentially stereotyping characteristic define them or a group that they are associated with.
Each person is understood on the merits of their actions. These action events also define that person's nature for a period of time until their course is changed for good or bad. I think that it is critical in this polarized world that we train our youth to avoid broad conclusions for groups of people and focus mightily on the individual.
October 9, 2017
Influenza season is starting in the United States. Last year's flu season was particularly rough in North Carolina. We had long lines of patients waiting to be seen. Influenza claims 10's of thousands of lives a year in this country among the elderly. There were 107 pediatric deaths last year primarily among young children and children with chronic health conditions of which the majority were not vaccinated.
Every year, I blog about this virus primarily to keep it fresh on your mind in order to prepare and secondarily because it causes so much morbidity and mortality. There is never a good time to ignore this virus and its potential to cause havoc. Influenza comes back to annoy us every year and it is hard to completely avoid by quarantining yourself.
Preventing the virus from taking root in your body is the key to avoiding a bad outcome.
October 2, 2017
Well known: A warm relationship between a father and his child portends a good outcome for the child as he grows up. A child is less likely to have behavioral problems if their father is present and emotionally warm. Boys often want to be like their fathers if the father is close to the child emotionally.
Not well known: The old masculine male archetype was thought to induce the same attitude in a male offspring. However, research has shown that it is not likely to produce the same behavior in a child despite the masculine parenting style. Boys, it turns out are innately masculine or not.
What is a father's role in this parenting dyad?
Fathers have a strong influence on a child's risk taking and confidence development. This is primarily based on the fact that father's are more likely to let their children explore the world and take risks.
October 2, 2017
This is a continually evolving problem for all of us. Historically, significant antibiotic resistance was confined to the hospitals and intensive care units primarily. Over the past decade, these bacterial resistance issues have entered the everyday world with the likes of MRSA, methicillin resistant Staphlococcus aureus.
Every day we are seeing children with MRSA abscess/skin infections. Luckily, we still have 2 good oral antibiotics to fight this trouble maker. Hypothetically, these antibiotics could start to fail. Then what? Death is the outcome for many untreatable serious infections. Why would this problem exist?
We have abused antibiotics in the patient care world for decades by over treating viral disease as bacterial. Unfortunately, I still see too many patients coming in for follow up after being on vacation or out of town with 10 day courses of antibiotics for 2 days of viral cold symptoms. The use of these drugs indiscriminately is a danger to everyone over time.
September 25, 2017
Work is the key to happiness!
Passion in your work is the key to bliss.
Trust me, I have found it. I just reread a section of the Tim Ferriss book, the Tools for Titans, and found a passage very moving. Tim has a section devoted to an interview with Maria Popova where they discuss her life and thoughts. In a section called, "what text do you refer to again and again?" she discusses the work of Henry David Thoreau and his musings on life.
He writes, "the really efficient laborer will be found not to crowd his day with work, but will saunter to his task surrounded by a wide halo of ease and leisure. There will be a wide margin for relaxation to his day. He is only earnest to secure the kernels of time, and does not exaggerate the value of the husk." "Those who work much, do not work hard."
Cars and Safety
September 25, 2017
In the United States, 2016 was a deadly year for car related fatalities. This is impressive considering how much safer cars are today. Over 40,000 Americans died last year alone. This is a sobering statistic that we need to pay attention to.
When it comes to safe driving, we have a major problem now, cell phones! Distracted driving is rapidly becoming the greatest risk to us all. Never a day goes by that a person is not looking at their phone and driving away.
Unfortunately, we cannot control our neighbor, however, we can control ourselves. Being alert to your surroundings while driving increases the chances that you can avoid a distracted driver. Using any and all safety devices in your car is another important avenue to safety.
September 18, 2017
Infectious diarrheal disease is a common issue in children especially those attending daycare and school. The key to successful survival of a diarrheal illness is maintaining hydration. Viral and most bacterially derived diarrheal illnesses are self limited. Knowing this, when should you worry? You should seek medical attention if your child has blood in his stools, is showing signs of dehydration, lethargy, or diarrhea past 7 days.
Here are my thoughts on diarrhea and treatment.
September 18, 2017
Stress - the true troublemaker in all our lives.
When I think about children and disease, I am always thrown with how poorly kids feel somatically when they are under psychological or physical abuse/stress. Over the last 18 years in clinic, over and over again, I have found the root cause of most belly and headaches to be diet and stress. When these two variables are fixed, disease abates.
I think of the great book, The Blue Zones, where two pillars of a long life are a whole foods, predominantly vegetarian diet and a village support structure. Modern American life is fragmented at best with jobs moving families away from their village support structure and a diet that is fast and non nutritious.
Modern studies have shown us that a specific carbohydrate diet can "cure" Chrohn's disease. I put "cure" in quotes because, in effect, we are putting the disease in remission by removing the antigenic protein triggers for disease. We have patients in practice that are clinically "cured" by following this diet.
September 11, 2017
We all try to avoid pain once it arrives. What we really need to do is to understand what pain really is. When we understand the concept of pain as a physiologic process of healing, then we can truly understand how to heal. As a lifelong athlete, I believe that understanding pain is a key to a long life in athletics whether competitive or not.
What is pain?
When we sense pain, we are receiving advanced warning that damage to the physical nature of the body is occurring or has occurred. For most people this is self explanatory, yet how often do we not heed the signal. We press on after an injury because we do not have time to stop. We do not listen to our body and get help early when it is easiest to repair.
I think back to a shoulder injury that I sustained skiing in my early 20's. I never had it checked out and eventually after 6+ months, the pain subsided and I wrongly assumed that all things were healed.
Allergy Season and School - What is your plan?
September 11, 2017
School is back in full swing for most kids and they are filled with joy and excitement. For the parents of allergy suffering kids, this is a time for check ups, medicines and the countless forms required by school. I know! What a pain!
The goal for parents and educators is to limit missed or unproductive school days due to asthma and allergies and to get the most out of the learning environment for all children. We can work together to make sure allergic children stay healthy.
September 4, 2017
When we reflect on our teen years, most of us realize that it was a struggle for individuality while conforming where we had to to preserve a sense of self within the pack order of middle and high school. The enlightened children with a strong core belief in self rarely conform as they are already on their path to individuality. They are more the exception than the rule.
What really matters in a teen's life? Friends? Clothes? Appearance? Learning? Fitting in?
All of the above. Teens are by nature a petulant, growing, angst filled creatures trying to fit in society. They want to be loved by their parents even when they act the entirely opposite way. They need to explore everything to find out how their sense of self aligns within the group and life.
As parents, it is our job to help them with constant love as they struggle with this identity crisis. Encouraging the individual is key as this is the route to self esteem. Generally, honoring your individual gifts and working hard to be grateful for them is a key to happiness.
Sports & Nutrition Part 4
August 28, 2017
Water and Staying Hydrated
There is so much controversy surrounding this topic ever since Gatorade was pushed onto the market in the 80's and 90's paralleling the obesity epidemic. We have been told that we need sports drinks in order to perform and prevent dehydration. What is the truth?
From the British Medical Journal:
"Water is the major constituent of the human body and the total body water content is tightly regulated. The goal is to ensure that the water content of the cells and hence their size remains within a homeostatically regulated range.
Humans evolved as long distance persistence hunters on the arid savannahs of south and east Africa. We inherited the capacity to regulate our body temperatures during prolonged exercise in dry heat despite quite large reductions in total body water-no other mammal has the equivalent capacity.
August 28, 2017
Is being kind to yourself a route to laziness and weakness or is it a pathway to self growth? This question gets a vigorous workout in the 2017 May edition of Scientific American Mind. In the article, The Self Compassion Solution, written by Marina Krakovsky we find a discussion on the merits of self compassion in modern times with an important look at the potential downside to this behavior.
As the competitive nature of society has increased in recent years, parents around the country are putting lots and lots of pressure on their children to succeed in school and on the sports field. The obvious downside to this pressure is stress and eventually anxiety and depression when the attempts are made but the demands are not met. This is a real problem in society today. From the parent's perspective, if the child is not pressured than they will fall way behind their peers and miss out on a top tier college or and athletic/academic scholarship.
After reading the article, I was moved to write this piece for all parents struggling with raising a child.
Sports & Nutrition Part 3
August 21, 2017
Increasing muscle mass is a strong teenage desire that often causes some teens to seek drugs like steroids to achieve this goal. This is definitely not recommended as all of these drugs carry side effects and long term risks. Naturally, muscle hypertrophy occurs with proper workout routines coupled with a solid nutritional approach to feed the muscles.
Consuming adequate amounts of protein is a key need for the anabolic growth of a muscle. Anabolic cellular growth occurs when we stimulate certain pathways like mTOR which occurs during the feeding of all three macronutrients: carbohydrate, fat and protein. Anabolism also occurs via stretch receptors in muscle after weight lifting and when heated. This combination is the key.
In regards to protein, carbs and fat, study after study does show that the protein intake is the key. Is carbohydrate consumption necessary for muscle hypertrophy?
Adaptation and Extremes
August 21, 2017
Adaptation and Extremes
Since the days of Naturalists Darwin and Lamarck, humans have thought about the changes that occur within mammalian species as they attempt to adapt to the ever changing environment. Current times are no different as temperatures and sea levels rise, food has dramatically changed and sedentary attitudes plague humans.
All mammals have cassettes of genes with the sole purpose of dealing with extremes of all environmental inputs. Some genes encode for stress proteins like the class of temperature shock proteins, heat and cold shock proteins. Others encode for adrenal gland cortisol receptors to handle differential psychological and physical stress. Further yet, are groups that encode for receptors that sense any physical perturbations.
Taken all together, we see a picture of mammals having the ability to change as needed to stress or environmental shifts. If stress or shifts do not occur, then logically there will be no adaptation. Whether this is good or bad is now being understood.
Elimination: Exhaling, Expectorating, Urinating and Vomiting
August 14, 2017
Elimination Part 3 - exhaling, expectorating, urinating and vomiting.
Although defecating and sweating are critical functions for the human body, these other elimination methods are important in their own respective ways. These four elimination pathways are also involved in removing toxins, heat and excess water.
Exhaling is basically a path for removing carbon dioxide after a successful breath. The vast majority of exhaled air is CO2. There are a few other volatile organic compounds like ethanol and methanol that are released making the lungs and blood more clean.
Effective exhalation controls the autonomic nervous system inducing a relaxed posture. The effect of breathing in a pattern of 1 beat of inhalation to every 2 beats of exhalation is to induce the relaxed parasympathetic tone to the autonomic nervous system.
Sports Nutrition Part 2
August 7, 2017
More on carbohydrtaes for endurance (not muscle building)
Now that endurance athletes have preloaded their muscles with glucose/glycogen days before the event, what do they do dietarily the day of and during the event?
This is where we need to understand nature a bit. When you run a race away from a bull, your body releases chemicals called catecholamines which alters the physiology of your metabolism to reduce the insulin breakdown for energy. In this way your body makes as much sugar available as possible to feed your muscle in order to evade the bull.
August 7, 2017
Smart medicine is hopefully going to save us from ourselves. So says a recent article in the Wall Street Journal. Eric Topol makes a compelling case that we are on the cusp of a revolution in medicine that will make the archaic way we are doing things seem ridiculous in hindsight. I think that he is right. We have been working with cutting edge laboratories to better understand a child's disease risk. This lab analysis provides a window into the child's physiology that was previously a mystery.
Nutrition & Exercise Series
Over the next few weeks, I will look at different macro nutrients, timing of ingestion and their effects on function.
July 31, 2017
Sweating is another very important tool that the body uses to eliminate unwanted stuff. In this case, the body primarily is eliminating heat and toxins via liquid sweat.
When we exercise vigorously or it is a hot day or we find ourselves overheating while fighting an infection, sweat will pour from our skin through glands and an endothermic reaction. The water that is released caries heat from the body with it. It evaporates into the air liberating the heat and thus cooling the body.
In this sweated liquid are electrolytes and toxins. Primarily the sweat fluid has a natural release of small amounts of sodium and to an even lesser extent, potassium and calcium.