Influenza is Arriving, Flu Shots are In

Influenza is Arriving, Flu Shots are In

The winter of 2014-2015 influenza season is now arriving.

We are seeing cases of influenza A and B infection across the US and Ohio starting to pick up.

As with most years, we anticipate the number of influenza infections peaking in December and January.

Influenza shots are in.

This year many families expressed a preference for the flu shot over the flu spray, but the flu shot manufacturer had delayed shipment.

We are pleased to report we now have all the flu shots needed for this winter season.

Bottom Line

The influenza virus is arriving.

Flu shots are in.

If you are not yet immunized against influenza infections, there is still time to get it done.

Dr. Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Got Milk?: You Really Shouldn't- New studies expand this no need list to any added calcium

Got Milk?:  You Really Shouldn't-
New studies expand this no need list to any added calcium

About a year ago, we shared this essay on how milk really offers no benefit to bones.

Now, in the fall of 2015, two new studies have been published that clearly demonstrate eating foods rich in calcium or taking calcium supplements have no real impact on bones and certainly offer no substantive help in preventing fractures.

Calcium Doesn’t Improve Bone Density, Analysis Finds http://nyti.ms/1RrfiqU

These are important findings, since nearly everyone was raised, and is continued to be told, that if you don't take calcium supplements of some sort, or fail to eat foods rich in calcium (like milk), you will miss the unique opportunities of childhood to build strong bones.  And what's the value if having strong bones?  Having fewer fractures.

Turns out your bones are as strong as they are going to be whether you eat calcium in food or take it in pills.  The body knows how to pull calcium out of a normal diet, one sufficient to support normal growth.  Adding more makes no difference.

So, the point made a year ago not only stands, but is made stronger.
Drinking milk, taking calcium supplements, and taking other measures to enrich the diet with calcium has no impact on the strength of your bones, and need not be done.

Here's the post from last year.   To your health, Dr. Lavin


Milk has had a good run.

During times of famine across the last 10,000 years, milk and milk products sustained human populations in Europe and parts of Africa.  This was milk's finest moment.

But as food supplies became more secure and reliable, milk faced a challenge, was it really still a good food to make part of our regular routines?

A new report in the NY Times makes clear the answer should be no:

http://www.nytimes.com/2014/11/18/upshot/got-milk-might-not-be-doing-you-much-good.html?ref=health&_r=0 

In the mid-twentieth century, the US Department of Agriculture tried to answer the question:  What do people really need to eat, what are the best foods for us?  What they found was very simple- it's fruits, vegetables, and whole grains.   A sprinkling of some meat, fish, and chicken is good too.   But milk was not listed as an important food for people.  When it came time to educate the American public on these findings, an industry group stepped forward to print up a graphic display and distribute it to every school across the nation.  The USDA agreed, and the poster was circulated to every school for many decades.  The sponsor turned out to be the Dairy Council, and the poster had nothing to do with the USDA findings.  Instead the poster promoted the idea of four food groups, and one of them was milk!

Now come two very large studies, one published in JAMA Pediatrics and the other in the British Medical Journal, following a report from the Journal of Bone and Mineral Research that look at the experience of over 400,000 people and compares the outcome of those who drink milk to those who do not.

The NY Times report on these studies also looked at a number of studies examining the impact of taking supplemental calcium and of taking supplemental Vitamin D on bone health.

Here is what they found:

1.  Drinking milk has no impact on the chance of a hip fracture later in life.  In fact, in one of the studies, the women who drank milk during their life actually had a higher incidence of hip fracture.

2.  The mortality rate in the group that drinks milk is actually higher than in the group that does not.

3.  Taking supplemental calcium failed to protect against fractures with age, in fact it may lead to more hip fractures.

4.  Taking supplemental Vitamin D had no impact on the bone density of the spine, hip, forearm, or overall body, but may have increased the bone density of at the top of the thighbone (femur).  

5.  Milk promotes obesity as it is a major source of needless calorie.  Even skim milk delivers an extra 250 calories in every 3 cups, from the sugar in it.

The influence of industry promoting the use of milk is known to all.  The got milk campaign was lots of fun, seeing prominent celebrities sport a white milkstache.  But beyond that, as recently as 1983, the US Congress continued to pass laws to make milk promoted in the food marketplace.

These studies, taken together, debunk the notion that milk is good for you.  Like any beverage loaded with calories and offering no health benefit, it probably is fine to enjoy it from time to time.  But the time has come for all of us, especially parents of children, to stop using milk as a health promoting food.

Milk turns out to offer no important nutritional benefit, has no protective power on bones, and contributes to the obesity epidemic.

Also of note is the fact that although we have been promoting calcium and Vitamin D supplementation across the country for decades, when someone actually took a look at whether doing so actually helps strengthen bones, it turns out that it fails to do so.

So, take a look at this NY Times review:  http://www.nytimes.com/2014/11/18/upshot/got-milk-might-not-be-doing-you-much-good.html?ref=health&_r=0

Bottom Line

1.  Milk is not a good food.  

2.  Regular milk contains needless fat, skim milk contains needless calories.

3.  The calcium and Vitamin D in milk have no impact on the actual experience of bone fractures later in life.

4.  Even supplemental calcium and Vitamin D don't help strengthen bones.

5.  Milk is OK to enjoy from time to time, like juice and soda, but should not be a regular part of anyone's diet, even toddlers and young children.
6.  Milk has been supported as a natural and important part of our diet by marketing efforts, supported by large budgets and even Congressional legislation.
7.  The best thing to drink is water and the best foods to eat are fruits, vegetables, and whole grains.

Be well.

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

School Lunches, Obesity, the American Marketplace, and Your Child

School Lunches, Obesity, the American Marketplace, 
and Your Child

An extremely important article in the world's leading medical journal, The New England Journal of Medicine, makes clear how important the role of school lunches is in the explosion of childhood obesity in the United States, and how the food industry wants to keep it that way.

http://www.nejm.org/doi/full/10.1056/NEJMp1409353

School lunches tend to provide our children with a caricature of what a responsible person would feed their child.  In almost every category of what matters when it comes to what our kids should eat, the school lunch stands out as a example of what not to do.

What type of foods are good for your health- fruits and vegetables.  This is the one category of food school lunches deliver most poorly.

How much food should a child eat at a meal?  School lunches typically deliver 500 extra calories a day!

What sorts of foods can cause the most harm?  That would be fat and sugar, school lunches deliver these in abundance as well as excess salt.

There are two big problems with this picture:

1.  Schools provide about half of all the food our children eat during their school aged years.  So whatever school lunches are, our kids have no choice but to be at least 50% nutritionally defined by that offering.
2.  Schools are responsible.  We place our children there with hopes that they will learn skills that will provide a long, healthy, and successful life to them.   Children think that what happens at school reflects our best wishes for them.

Put those two simple facts together, and it becomes all the more outrageous that on every count of what a reasonable person would do to eat to become healthy rather than ill, that our schools do the exact opposite of what should be done.

The article then goes on to point out that we the people have actually tried to fix this terrible situation.  In 2010 a law was passed that would move school lunches towards less caloric overloading, more fruits and vegetables, and less fat and sugar and salt.  Not a very radical idea, really more of an act of care and responsibility to our children.

Now, we come to why the doctors from Boston wrote and published this article.  The food industry is trying to kill the law.   It actually is fighting to make sure our kids continue to be stuffed with large extras of calories, fat, and sugar.  Most shocking?  That schools are joining industry in fighting the new standards.

Their main objections to the law are that the improved nutrition leads to more food being thrown away and more students dropping out of school lunch programs.  The data proves neither happens.

So here we are, finally doing something about the scandal of the grown-ups of our country feeding our children exactly the wrong things, and the industry that makes the food, and schools (!) are organizing to keep hurting them.

About 1/3 of our children, at this time, will end up obese.   At the very least this dooms millions of our children to diabetes and a shorter life for no very good reason.

As parents who care for our children, we urge everyone to make sure their school district chooses to make the improvements in school  lunches the Health, Hungry-Free Kids Act of 2010 (HHFKA) ask it to.   Make sure your schools do not seek a waiver from this law.  From our point of view, the idea that our kids need to be fed food that will not make them ill over time is a rather basic responsibility of their parents and schools.

http://www.nejm.org/doi/full/10.1056/NEJMp1409353

To your health,
Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Antibiotics- A brief review

Antibiotics:

A Brief Review

With the terrible fright of the danger of Ebola, the emergence of the unusual Enterovirus 68 causing breathing troubles, and the re-appearance of measles, the idea that we have conquered infectious diseases seems less solid.

Some basics
So it seems like a good time to briefly review one of our two great success stories in creating a world in which we can feel safe from harm from infections.  Those two great defenses are immunizations and antibiotics.

The word antibiotic literally means, against life, but really refers to chemicals that kill bacteria but not us.  There are 4 forms of life that infect us:  Bacteria, virus (e.g., colds, flus, measles, chickenpox, Ebola), parasites (e.g., giardia, worms), and fungi (e.g., ringworm, yeast infections).   Antibiotics only kill bacteria.  There are some medications that kill a very few viruses, such as acyclovir for herpes, but these are called anti-virals.  And there are many drugs that kill parasites and fungi, but these are called anti-fungals and anti-parasitic drugs.

That leaves drugs for bacteria, the antibiotics.  Of all the drugs that kill the various germs, antibiotics have been the most remarkable in their ability to kill the germ, but not harm the person (more on that below).

They have this rather strong safety record because bacteria have many different chemistries than animal cells.  So a drug could stop a bacterial chemical reaction without interfering with ours.

Resistance
But this is the first problem with antibiotics, they attack a living cell, the bacteria.  And all life tends to find a way to adapt.  Bacteria adapt by mutating and reproducing rapidly.   Bacteria divide so rapidly that one can become millions in a relatively short period of time.  Add in the ability to mutate, and a one in 10 million change can appear in a short time.  If that change alters a chemical reaction that the antibiotic for that bacteria blocks, the antibiotic will no longer harm the bacteria- this is what is meant by resistance.

Keep in mind that if one person takes a course of one antibiotic, it is very, very unlikely a new bacteria no longer affected by that antibiotic will appear.  Resistance is almost always the result of millions of doses of antibiotics across a population.

But we do see this happening when millions of animals are given antibiotics every day.  Or when people are given antibiotics for common viral problems that antibiotics, exposing millions of people and their bacteria to antibiotics for no actual benefit (remember, antibiotics do nothing to viruses).

Harm from antibiotics
Compared to most cures for other diseases, antibiotics are pretty gentle.  Think of surgery and chemotherapy as the main curative interventions, and you can see 10 days of an antibiotic often has no or few side effects compared to other cures.

But, there are three ways antibiotics can cause serious trouble:

1. Allergic reactions.   Antibiotics can allergic reactions more than most drugs.  Usually the reactions are mild, mainly an itchy rash, but sometimes the reactions can be very severe, even dangerous.  In the case of penicillin, it is estimated that the most severe reaction, a deadly anaphylaxis, occurs 1 in every 100,000 doses!
2. Discomfort.  Antibiotics are associated with stomach ache, changes in stooling, headache, and other discomforts.
3. Changes in your natural bacterial environment.  This is potentially the most worrisome side of using antibiotics.  They kill bacteria, which is incredibly important when it comes to curing dangerous bacterial infections, but they kill not just your infection, but your normal bacterial populations, especially in your gut.   It turns out our guts require healthy thriving bacteria in order to work well.  Without them, inflammations of the gut with diarrhea and abdominal pain, can begin to appear.  This is the power of probiotics, to replenish diminished normal gut bacteria after a course of antibiotics.

Bottom Lines

1.  Antibiotics are the drugs that kill bacteria and should be used to cure significant bacterial infections.  They have no power over or impact on viruses- that's why they don't help anyone with a cold.

2.  Resistance is not seen with one course of antibiotics in one person, not even in several, but rather from millions of doses across large populations.

3.  Use of antibiotics is safe, but comes with some risks, so they should never be used for situations they will not work (like viral infections), and only when curing the bacterial infection is important.

One last point, it is very hard for science to find or create new antibiotics.  Most development efforts by drug companies fail to create new antibiotics, and they do not generate big sales as people take them for a week or two, not every day like a cholesterol lowering drug.

As a result of both facts, nearly all pharmaceutical companies have stopped trying to create new antibiotics.   As resistance to our known antibiotics grows, an inevitable result of evolution, we may find ourselves in a time when no available antibiotics will work, which would be a rather horrible development.

This last point leads to two imperatives:

1.  We must all be careful not to use antibiotics for viral infections, such a practice leads to the millions of extra doses that breeds resistance.

2.  We must find a way to make the creation of new antibiotics a viable pursuit, or no matter what we do, the ones we have will one day no longer work.

To your health,

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Ebola Update November 12, 2014 Good News

Ebola Update
November 19, 2014  The Facts Hold, Ebola Fades

First of all, thank you to everyone who has responded so enthusiastically to this series on the Ebola virus.

This update will hopefully be our last for some time on the occurrence of Ebola virus infection in the United States.

And, the update is quite good- as of now, we know of no one present in the entire United States who is infected with Ebola.  The feared spread of Ebola never happened in this country.

It is worth a moment to reflect on the course, not of Ebola, but our fear.

The fear was not surprising given how deadly this disease is, in fact.   Fear is a natural response to a threat, particularly one that is unfamiliar.

What was disappointing was how little the impact of the actual facts of the matter had on our fear across the nation.

And the fact that no one in the United States is currently infected with the Ebola virus confirms every fact put forward in discussions of this virus.

The key facts were very simple:

• The Ebola virus is not contagious when you first get infected, but gets more contagious as the disease progresses, becoming very contagious as the infected person nears death from the illness.
• The virus cannot be spread once it dries out.  That means to catch it you need wet body fluids contacting an open surface in your body.  Saliva and sweat can spread it, but dried out droplets from cough and sneeze cannot.
• This disease is very containable.  With proper isolation techniques, the spread of Ebola can be reliably stopped.

If we had really thought about these three facts, the visit of an infected nurse who was not very ill to Ohio should have caused no concern in Ohio.  And, as it all turned out, not a single person in Ohio she contacted caught her Ebola, not a single person.  More dramatically, if we look at the entire planet of 7 billion people, the complete total of cases of Ebola seen in any country outside of Africa is a grand total of 15 to date.  This is indeed dramatic proof that this virus can be contained.

I am also very relieved to see that all but two of the patients infected with Ebola treated in the US (all but two caught it in Africa) survived.  There appear to be treatments available that work well.  The two deaths, including one just this week, were in people whose infection was in advanced stages before arriving in the US.

Of course, biology can be complicated, and viruses evolve, so I am very pleased, and relieved the nature of Ebola virus and its three key facts did not change.  It is really because of these three facts that no one in the US has the infection.

Bottom Line

• There is no Ebola virus infection in the United States today.
• The three key facts about Ebola have turned out to remain true, making the threat from Ebola, even in the future, quite tiny to Americans in the US.
• Treatments are in development that worked quite well.
• Thanks to all who have found these posts helpful

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Flu Immunization Update- New Shipment of Shots Due at end of Month

Flu Immunization Update:

New Shipment of Shots Due at end of Month

Today marks the completion of two of our three FluFest 2014 sessions.   The program has been a big hit in large part due to the generosity of Mitchell's Ice Cream, making a scoop of their great ice cream or sorbet available to those getting their flu immunizations on FluFest days.   Our last FluFest session will be Saturday, November 8.

We have also just received notice that a shipment of the flu shot for older children (age 3 and up) has been delayed to the end of the month of November.  At this time (November 4) we have no flu shots for older children in hand, but we will be getting a shipment in a few weeks, by December, we are told by the drug manufacturer.

We have abundant supplies of flu shots for infants and young children (age 6 months to age 3 years) and plenty of the nasal form (FluMist) for anyone in good health over age 2.

Many thanks to all the families for protecting your children and participating in FluFest 2014.  It is such a pleasure to see everyone, we are very happy we were able to make it more fun this year.  And, most importantly, we have seen this active influenza immunization program really drop the chances of getting a cold or flu in January-March.

Here is to your health!

Dr. Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.