Fructose FYI
January 27th, 2020
Fruit sugar, fructose, in its natural whole food form is generally very safe to consume in moderate quantities. Fructose is metabolized only in the liver and thus needs to be consumed in moderation. The human body is genetically predisposed to making fat in the liver from fructose or converting it to glucose for further storage as triglyceride fat peripherally. This is a great adaptation if you are planning to fatten up to survive the winter!
This week: Wheezing in young children
January 27, 2020
I am taking a one week pause on the cardiology story to refine the next tricky section.
Winter is here and we are seeing an increased volume of children with viral related wheezing disorders. Bronchiolitis, a term that means inflammation of the bronchioles, is a viral associated illness that causes significant lung inflammation in children under the age of three years old. It is one of the leading causes of hospitalization in this age group.
This illness is usually benign and self limited as the cough and wheezing fade away over a few days to a week without intervention. However, it can also be scary as some children will present with cough, fever, wheezing and further respiratory compromise over time. Some high risk individuals need to be aware of this disease, including: premature or low birth weight newborns, children with immune system defects, cardiac disease, chronic lung disease and/or severe neurological disease.
Cholesterol Lipid Hypothesis Part III
January 20, 2020
So far, I have put forth some hypotheses that are controversial and raise questions about the American College of Cardiology guidelines.This is fine with me because this is about stimulating a conversation about disease etiology and treatment. Readers are never encouraged to go against their physician's recommendations. The choice to change a current therapeutic regimen is solely between the patient and their provider and frankly is likely predicated on how much damage has occurred over one's current lifetime coupled with genetic risk and the ability to alter lifestyle risk factors effectively.
I believe that pharmacotherapy, i.e. statin drugs, are likely necessary for patients
Snacking and Motility
January 13th, 2020
Is snacking a good idea? The simple answer is NO!
There are many reasons as to the why for this NO answer.
Snacking is the process of frequently eating small volumes of food stuffs to alleviate hunger or emotional symptoms or for the very, very few among us that have low blood sugar issues.
Why is snacking a problem?
Cholesterol Lipid Hypothesis Part II
January 13, 2020
The hypothesis: cholesterol and lipoproteins like LDL are inherently good and necessary unless they become unbalanced either through genetics or lifestyle choices.
From last week: It turns out that the carrier lipoproteins like LDL and HDL cholesterol are an ancient part of our innate immune system that have an important function in fighting infection. We have always used these lipoproteins to clear infectious material before they can do damage.
Remember that the carrier lipoprotein cars are known as chylomicrons, VLDL, IDL, LDL, and HDL. They have a primary role to carry fats/energy around the body. While they serve the fat carrying primary role dutifully, these same little cars float around in your blood stream looking for disturbed infectious particles or pathogens to throw in their trunk in order to transport them back for elimination in the liver. (Harris et. al. 1993) (Vreugdenhil et. al. 2003)
Cholesterol Lipid Hypotheses
January 6, 2020
Part 1
Is cholesterol the problem? Or just a response to the bodies inflammation, dysbiosis and/or infectious issues? Why do we need cholesterol? Is the cholesterol you eat the issue or the type that your body makes? Is it the genetic mutations related to lipoprotein receptors that clear cholesterol? Or a mix of all of the above? We will look at these questions and others over the course of this article set.
Coronary artery disease or atherosclerosis is the medical name given to the disease that leads to a heart attack. What is atherosclerosis?
EDC'c and Immune Function
December 30th, 2019
If you have an allergic phenotype, a tendency toward allergic diseases like allergic rhinitis, asthma and eczema, then you really want to avoid endocrine disrupting chemicals, EDC's. The allergic phenotype immunologically is known as a TH2 or T helper cell type 2 polarized immune state. This means that at baseline your immune system releases chemicals that promote the release of cells like eosinophils and mast cells which in turn release chemicals like histamine that cause our nasty symptoms of sneezing, wheezing and itching.
Cardiology #1
December 30, 2019
The new year is upon us and as I promised here is the new and updated cardiovascular disease story. This article series may be the most important series that I will and have tackled as it is the leading cause of death in this country and is entirely preventable with smart prevention oriented choices that begin at birth! Our children are the future.
After three decades of research and a 15-hour deep dive into the world of lipids and cholesterol with Dr. Peter Attia via his excellent podcast "Drive", it is time to update the cholesterol cardiovascular disease story as it exists in 2019/20.
Open Letter
December 23rd, 2019
After discussing the patient doctor care relationship topic with a few people, it was recommended that it be shared here. Here it is:
Open letter to parents and patients:
Over the past few years, I have noted with dismay the statements people make in the doctor's office or in other locations related to doctors and care providers. What I am about to say is not about my hurt feelings or just my general complaining. Rather, I am hoping that this passage will give everyone a better understanding of patient care, work load and time constraints that exist today.
Baby Food
December 23rd, 2019
Baby food remains contaminated! So says a new published report from the Healthy Babies Bright Futures Non profit group. They state: "The problem, uncovered nearly a decade ago, is far from solved. New tests of 168 baby foods commissioned by Healthy Babies Bright Futures (HBBF) found toxic heavy metals in 95 percent of containers tested. One in four baby foods contained all four metals assessed by our testing lab-arsenic, lead, cadmium, and mercury.
Merry Christmas and Happy Holidays From the Salisbury Pediatrics Team
December 23, 2019
As the New Years Holiday approaches, I have a personal request. If you have any positive or negative criticism for my team and I regarding this newsletter, I would greatly like to hear from you! I have settled on two facts over the last decade.
1) The technical nature of the newsletter at times is well regarded by many and will continue moving forward.
2) Readers seem to really like the forward forecasting view of health and disease risk.
The plan is to continue the free format moving forward for all readers.
Appreciate all of you
Update on Measles
December 16th, 2019
Measles will erase some immune memory.
As measles cases continue to climb worldwide, a group out of the Netherlands has shown that the measles virus can hijack the immune system of sick individuals wiping out it's memory to other pathogens. This is not a good thing as this makes the individual susceptible to these infections all over again potentially raising risk of a bad outcome.
Dr. Mina, lead author on the study in the Journal Science this year, noted that between 11 and 73% of the circulating antibodies that protect against diseases are lost post natural measles infection.
Great books to give for Christmas!
December 16th, 2019
Christmas Books
For Teens:
1) Extreme Ownership - Jocko Willink
2) Anything You Want - Derek Sivers
3) The Seven Habits of Highly Effective Teens - Sean Covey
4) Make Your Bed - Admiral William McRaven
5) The Daily Stoic - Ryan Holiday
6) Priciples - Ray Dalio
7) The Millionaire Next Door - Thomas Stanley
8) Tuesday's with Morie - Mitch Albom
This is the beginning of Year 10!
December 16, 2019
It is very exciting to think of all the things that will come to pass in 2020 for our collective learning and health outcomes. Last year, I promised a new updated story on cardiovascular disease and risk all the way back to childhood. Alas, it did not get finished in time. Too many other projects got in the way and 2020 will be the year of the CVD risk discussion. The multi article discussion is being looked at by a few brilliant cardiology friends for completeness and correctness.
This year, I hope to tackle autoimmune disease, allergic disease and metabolism further and deeper as the research keeps mounting.
Habits
December 9th, 2019
How do we change when making a conscious significant decision is difficult?
The answer really lies in what works for you.
Developing a habit maybe the inflection point for meaningful change. Think about the New Year's Resolution that many people try yearly. They hit the gym or change up their eating plan aggressively only to fade away from the behavior because of the difficulty in maintaining such a draconian change.
What did we learn in 2019?
December 9, 2019
This is the year end edition of the SPA newsletter. This is the end of 9 years of writing and somewhere around 934 articles. This is always a great time to reflect on this year's learning and the themes that are developing in human health. This was an interesting year as many cutting edge scientific advances are gaining prominence in medical journals and not just the basic science literature. We are getting significantly smarter about the causes of disease. The comical part is that the answers have been around for a thousand years!
BB Guns
December 2nd, 2019
BB guns and non lethal projectile firearms
Ove a 26 year period Dr. Jones and colleagues looked at the injuries related to non powder and non lethal firearms in over 360,000 patient emergency visits.
"From 1990 to 2016, the number and rate of nonpowder firearm injuries decreased by 47.8% and 54.5%, respectively.
Influenza 2019
December 2, 2019
Influenza season is starting in the United States. "During 2010-2016, the incidence of symptomatic influenza among vaccinated and unvaccinated US residents, including both medically attended and nonattended infections, was approximately 8% and varied from 3% to 11% among seasons." (Tokars et. al. 2018) Last year's flu season was not particularly rough in North Carolina, however, influenza claims 10's of thousands of lives a year in this country, especially among the elderly. According to the CDC there were 143 pediatric deaths last year primarily among young children and children with chronic health conditions of which the majority were not vaccinated. (CDC stats)
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.
Choices
Novemeber 25th, 2019
Perth Amboy Raritan Bay, NJ
People that know me will tell you that this is my favorite word. The word "choice" pervades everything around us. Did you go left or right? Did you sleep in or get up and seize the day? Did you act in a kind way or not? There is always a choice even when you think that there is not. On that note and with great pleasure, I will share a link to Jeff Bezos' 2010 commencement speech at Princeton University.
Back to sleep - what is the story in 2019?
November 25, 2019
Sudden infant death syndrome, SIDS, is a sad and serious disease that we still know very little about. One risk factor that has been nailed down scientifically is sleeping prone as an infant. Dr. John Kattwinkel at the University of Virginia developed the Back To Sleep program that significantly reduced SIDS issues nationally.
In the Journal Pediatrics this month, Dr. Hirai and colleagues looked at socioeconomic demographics and guideline adherence in the US.