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.

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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.

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Smart Medicine

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.

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Nutrition & Exercise Series


July 31, 2017
By request: I am going to change gears for a few weeks in order to address the issues of nutrition and exercise as this is the time of year when kids ramp up with sports. Far too often kids are eating poor quality nourishment and suffering the negative effects on conditioning.

Over the next few weeks, I will look at different macro nutrients, timing of ingestion and their effects on function.  


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Elimination: Sweating

July 31, 2017

Elimination: Sweating

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.

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Sweet Potato

Sweet potatoes are a staple in many kitchens. It is a starchy root tuber that has an edible orange flesh. While it is a distant cousin of the white potato from the Americas, it is not a yam which is a distinct tuber from Africa. Predominantly cultivated in China and the east, sweet potatoes are used for their rich energy profile to feed humans and cattle.


Nutritionally, sweet potatoes are loaded with energy in the form of complex carbohydrates. Fiber is found in good volume making this food a good gut bacteria food.


What makes this sweet potato so special is the micronutrient profile. The orange color is the tell tale sign that this is a vitamin A rich food. In undernourished areas of the world, this is a staple for reducing night blindness. Vitamin A volumes in 3 ounces of sweet potato meets an adults needs for the day from one food source. It is also high in vitamin C, manganese, B6. There are nice, albeit less, volumes of many other vitamins and minerals.

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Elimination: Constipation

July 24, 2017

Truth: Elimination is one of many keys to good health.

Elimination can occur in many ways including: sweating, defecation, expectorating, vomiting, urinating and exhaling.

In this piece, I am going to focus on defecation and specifically constipation. As a pediatrician, I see more constipation than almost any other disorder save for infectious diseases. Over the years, the number of children suffering from abnormal bowel movements has skyrocketed.

The classical presentation is a child between 2 and 16 years old who complains of intermittent abdominal pain concentrated around the belly button that is sharp and lasts around 10 to 30 minutes before totally resolving. Often they note relief upon having a bowel movement. Stools usually are produced daily that are small hard nuggets or abnormally large for the child's size. This is a key because of the great misconception that having a daily bowel movement means that one is not constipated.

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Maternal & Child Health Series

July 17, 2017

Part IV:

Pregnancy is a dynamic event where a mother's body changes in unbelievable ways, including physiologically, immunologically, hormonally and metabolically. The most amazing event is the change in the immune system from the aggressive infection fighting TH1 baseline to a TH2 mediated baby protecting mode. This occurs because the baby has 50% of dad's genes prompting the immune system to change in order to prevent the baby from being attacked and aborted. This effect is also highlighted by women with autoimmune diseases like Crohns that spontaneously improve once they become pregnant. Unfortunately, many become ill again after the child is born. The complexities of the immune system are still beyond complete understanding for us, however, we are learning.

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Strawberries are delicious. I love them any day of the week. The good news is that they are a powerhouse of goodies for our cells.

Strawberries are loaded with vitamin C and polyphenolic compounds like flavanols, phenolic acid and tannins. These compounds are all used by our cells to control oxidation reactions and inflammation.

Berries as a class are known to help prevent cardiovascular disease through many mechanisms including anti oxidation, anti inflammation and up regulation of coronary artery vasodilating nitric oxide enzymes.

Strawberries also have a lot of manganese which is a trace mineral involved in many metabolic function including sugar and fat metabolism.

The fiber content is excellent making strawberries a slowly digesting carbohydrate and a great food source for your intestinal microbial bacteria.

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Maternal & Child Health Series

July 10, 2017

Maternal health is critical to the growth and development of a newborn. When a mother is balanced nutritionally, has minimal stress and is physically active, the likelihood of a healthy newborn is high. The modern era has added a host of scientific evidence to support these beliefs.

In part three of the maternal health series, we will look at the neurodevelopment of infants as it relates to maternal health. Then in part four we will analyze the maternal microbiome which is primarily controlled by nutrition and secondarily by medicinal exposure. It is now the epicenter of study to understand the differences in pregnancy outcomes.

Part III: In the Journal Pediatrics from April 2017, a team of doctors wrote a lengthy supplement called the "research gaps at the intersection of pediatric neurodevelopment, nutrition, and inflammation in low resource settings." This review is comprehensive and we are going to attempt to distill the information into palatable bites.

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It is time for a series of essays on food types. We are going to look at the health information for many of the major foods that we consume.

Broccoli is number one on my list. There are a million reasons why we should regularly consume broccoli from the cruciferous or brassica vegetable family. Broccoli is a green plant that grows in a stalk that is topped with small green leaves and resembles a tree. When I was a young child, I called them trees and loved to eat them with butter.

Broccoli is known to be extremely beneficial because of its anti-cancer and anti-inflammatory properties. It contains an enzyme called myrosinase that produces a chemical in the broccoli called sulfurophane. This compound is very important as it has the ability to down regulate the inflammatory signaling pathway of Nfkb which is critical in up regulating the entire cascade of inflammatory cells.

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Southern Hospitality and Choice

July 3, 2017

Southern Hospitality and Choice

Southern hospitality is a phrase used in American English to describe the stereotype of residents of the Southern United States as particularly warm, sweet, and welcoming to visitors to their homes, or to the South in general (wikipedia).

When I moved south in 1992, I was struck by the perceived truth of this definition. Coming from the antithetically behaving northern state of New York, I had a profound sense of happiness surrounded by people that chose to smile more than they frown. This was a wonderful development in my life at age 21. At the time I did not think much about this contrast, but over the years I have spent much time pondering the desire for a whole culture or group to behave very differently than another.

Psychologists call it a culture of honor which makes the South very similar to Japan in that way. Honor is revered and being polite was thought to reduce any risk of offending another's honor. This was believed to reduce conflict if practiced correctly. Statistically, the homicide rate is the highest in the South currently, so clearly this belief did not pan out over time.

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Kitchen Safety

June 26, 2017

Kitchen activities, random thoughts and safety in no particular order.

The kitchen is often the busiest room in any house. It is a place of much joy where young children can learn to feed themselves. The basics of kitchen life and cooking are rooted in experimentation. Knowing that children love to experiment, makes the kitchen a great place for a child to learn resilience after a failed recipe turns around in round two.

As you and your children mess around in the kitchen trying to produce a culinary masterpiece, here are a few ideas for health.

1) Most importantly - do not cook or reheat in plastic of any kind. This includes using plastic wrap during microwaving, boiling in plastic bags or styrofoam. Many of these plastic devices have endocrine disrupting chemicals in them. They are released during the heating process and then consumed by us. EDC"s can mess with your hormonal function by sending mis information. Steer clear of them.

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Fear Setting

Fear setting is a principled way of battling and over coming one's fears that the influential podcast specialist Tim Ferris uses quarterly. It is rooted in the philosophy of Stoicism. There is a nice description of the method and a link to his TED talk at this link.

It is less than 15 minutes long and worthy of your time.

Some Americans fear often and this can paralyze them from performing tasks or moving forward. Children by nature are usually fearless until we provide them with things to fear. This can be very counter productive if a parent makes a child truly fear based.

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June 19, 2017

Stealing is not uncommon in young children and often increases in adolescence to a parent's chagrin. Is it the end of the world? In most cases the answer is clearly, no. The bigger question is when is it a real worry and what can we do about it as parents to help our kids grow into respectful and law abiding humans.

Stealing is wrong. This is plain and simple without need for debate. However, in the young child's mind it is often a basic need of "I want" and generally not maliciously intended. Even teenagers often steal more to fit in than to be "BAD". They want the latest fashion item to fit in. Thinking in these terms can allow us to keep it all in perspective as we battle with our own emotions of parenting and failure.

Help to re-frame the issue as a hurtful event for the person that was stolen from instead of focusing on the act and the behavior. Even people that have much are hurt by the act of being robbed. Stealing from a retail store also hurts the workers who get blamed for inventory loss and we all eventually pay a little more for goods and services to make up for the lost items on the companies balance sheet.

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Complaining II

June 12, 2017

Last weeks article about "Complaining" brought out some interesting questions which I thought worthy of a follow up article. The questions were: 1) What can we do to stop the potential hippocampal shrinkage? 2) Is complaining caused by nature or nurture? 3) Can we change our ways as complaining humans?

1) To stop or reverse any neurological injury that is not a structural end stage defect, I think of the work of Dale Bredesen and Terry Wahls. Both of these cutting edge researchers have taken a functional system's based medical approach to reversing and controlling two severe chronic neurological disorders, Alzheimers and multiple sclerosis. After reviewing their work multiple times, I think that the principles that they apply to their patients would be the best path to take to reverse any hippocampal injury that could have occurred from chronic negativity and stress. For the purposes of this article, I will not go into the details of the studies. See the links below for details.

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Genetic Testing

Genetic testing is gaining in popularity in medical circles despite the inherent unknowns to a comprehensive genotyping for humans. Newborn screening is a current analysis of a newborns blood looking for diseases that if discovered can be controlled by changing diet, adding hormones or medicines. These tests are primarily based on metabolites of diseased metabolic pathways that give clues to genetic defects. The effects of these screening programs has been nothing less than life saving for the children involved.

What about genetic testing?

What is coming is far different. The future will be a comprehensive analysis of a child's genome that will allow us to understand a child's risk for disease as well as more functional issues like how he or she will metabolize and thus handle a medicine or herb. How nice will it be to know that a child needs drug X and not drug Y because of a cassette of genes that decrease the function and benefit of drug Y.

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June 5, 2017

Complaining is mostly unproductive, yet, we still do it all the time and some of us perform the art of complaining like an Oscar winning actor. Children are expert complainers and often learn how to perfect the complaint from their disgruntled parents. When they see parents complaining about fairness or how they were wronged, they identify with this method of stress management. It feels right to them to complain about their unjust experiences.

Interestingly, I don't know anyone that enjoys being with a complainer for any length of time. When people complain, others generally walk away. There is a passage in Tools for Titans regarding Stephen Hawking who said," When you complain, nobody wants to help you." He clearly needed the help as his body was failing him from ALS. What he discovered in his suffering was that positivity is the key to life and help.

When one complains, the internal feeling is negative and stress hormones like cortisol are released. Negativity then breeds more negativity and the effect of the stress response is compounded. If this occurs repeatedly over time, the stress hormones become dysfunctional.

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May 29, 2017

Lice outbreaks are becoming a bit of a problem in the United States. With summer camps, sleep overs and various close contact events coming up this summer, we need to be prepared for the inevitable lice events that follow.

First, a lice infestation has nothing to do with cleanliness or socioeconomic status. It has everything to do with close contact children's activities where the scalp of one child is near another. This tends to happen often in daycare and elementary school settings. The classic ages of infestation are 3 to 11 years of age.

A louse is the size of a sesame seed, cannot fly and is a fast runner. They cannot be transmitted by animals as humans are their only source of food. From the CDC, "Spread by contact with clothing (such as hats, scarves, coats) or other personal items (such as combs, brushes, or towels) used by an infested person is uncommon". Survival off of a human for 1 to 2 days can occur without a blood meal, however, it is believed that they stop their ability to propagate within hours. Active lice lay eggs called nits within a quarter inch of the scalp. Nits found farther away from the scalp are usually empty casings and not viable. Nits are not indicative of active disease unless they are close to the scalp.

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Stevia or sweet leaf is a sweet tasting herb that is commonly used as a non nutritive sweetener in commercial food and beverage products. The plant can be found in the southern US all the way down to South America. The leaf is 40 times sweeter than sucrose, table sugar.

Stevia can be converted to a derivative, sterol glycoside, which is 300 times sweeter than sucrose. A teaspoon of stevia is equivalent to a cup of sugar in sweetness. It has negligible effects on blood sugar making it an excellent choice for diabetics to avoid hyperglycemic events.

Stevia has been used in Japan for over 30 years with no evidence of human health hazard. It continues to gain in popularity in the US.

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