2016-04-26

Get Ready to say Goodbye to Rice Cereal

Rice Cereal is Fading as a First Choice

In 2013, we reported that arsenic was emerging as a potent toxin capable of a surprising range of harm, including chronic lung disease, heart disease, and some cancers.  (see below)

It has been known for some time that rice is a plant that concentrates arsenic.  If grown in soil with arsenic in it, the plant sucks up those molecules and concentrates them in the part we eat, the grains of rice.

Now comes the AAP News, he official newsmagazine of the American Academy of Pediatrics to report that the FDA is proposing limits on the levels of arsenic in infant rice cereals.

The key findings from the FDA on rice cereal and arsenic are at http://www.fda.gov/food/foodborneillnesscontaminants/metals/ucm319870.htm

The FDA would like to limit rice cereal sold to infants contain less than 100 parts per billion of arsenic in the cereal.  The current standard in drinking water is that it must be less than 10 parts per billion.   The FDA found that infant rice cereals contain, on average, more than double the arsenic that other toddler foods contain.

Members of experts on arsenic in baby food sources at the AAP are now starting to promote use of other purees as first foods, and as infant foods.  They recommend other grains, fruits, and vegetables, in addition to rice cereal. 

This signal is new and suggests, along with the recent moves from the FDA, that the US is taking a new look at the long practice of using rice cereal as the first solid.  Rice milk is now currently not recommended.

BOTTOM LINE
1.  Arsenic is a very dangerous chemical element causing a surprising range of long-term damage and disease.
2.  Rice has long been known to concentrate arsenic, but now the FDA is finding elevations of arsenic in infant rice cereals.
3.  As initial steps in response, the FDA is setting a standard so that all infant rice cereals only have arsenic below the standard.
4.  The American Academy of Pediatrics is taking initial steps to move all parents away from dependence on infant rice cereal as the first solid, encouraging people to instead use other grains, fruit, and vegetable purees.

Our recommendation is to right now reconsider the use of rice cereal in infancy.  As the AAP has noted, other purees work just as well.  And if the FDA is raising alarms, why use rice cereal?

Rice cereal has been the American infant's first food for many, many decades, it will be sad to see it go, but the rise of arsenic in our rice demands us to be smart.

To your health,
Dr. Arthur Lavin 












Arsenic:  What it Does, Why to Worry, and What to Do


Recent reports have brought to all our minds the concern that arsenic may be causing us harm in our food supply, particularly from rice and apple juice.

This note will take a look at arsenic.  What is arsenic?  What sort of harm can it cause?  Should we be worried, and if so, what exactly is worrisome and what is not?  And given any real worry, what can be done?

What is Arsenic?
Most of us know arsenic as a poison, perhaps out of familiarity with the 1939 play by Thomas Kesselring, Arsenic and Old Lace.    And, indeed, this grey metal can be made into a powder that is quite poisonous to nearly every form of life, including insects and humans.   But what is arsenic?  Arsenic is an element that forms metal-like crystals, and is useful in making copper and lead more better in items we use, and is an important element in the materials that make electronic components.

How does Arsenic cause Harm?
Arsenic hurts nearly any living cell by blocking its ability to make energy.  Only a handful of unusual bacteria can live in the presence of arsenic, all other life is killed by the ability of arsenic to block the production of ATP, the currency of energy for all life.  Another famous poison, cyanide also blocks ATP production, but this poison creates a total and complete cessation of energy production, and hence sudden death.  Arsenic leads to varying levels of blocked energy production and so its typical method of harm has more to do with various organs and systems not working well, and eventually failing.  Death from arsenic is the result of various organs failing to work.

What is the Sort of Harm Most Often Seen Caused by Arsenic?
More typically, at the lower levels of the more common exposures, arsenic weakens organ functions, leading to a variety of complex problems and scenarios.  There is some indication that over time, continued exposure to even low levels of excessive arsenic can shorten life, but the most typical problems are more chronic in nature rather than deadly.

On September 20, 2013, the New York Times published an important article on findings on what arsenic is actually doing to us now. http://well.blogs.nytimes.com/2013/09/20/the-arsenic-in-our-drinking-water/?ref=health

The current evidence suggests that ongoing, low level exposure to excessive arsenic can cause people to increase their chance of having heart disease and strokes, diabetes, and cancers of the skin, bladder, and lung.  Curiously, the recent studies have found that arsenic can cause people to experience far more colds, even during infancy! 

Some studies found that people exposed to levels of 19 parts per billion (ppb) in their drinking water began to show signs of chronic lung dysfunction, and at 120 ppb, their lung function was as abnormal as a chronic smoker.   In one country whose drinking water had levels of arsenic as high as 1,000 ppb, 24% of all deaths from all chronic illnesses could be blamed on the impact of arsenic.

Who Should be Worried?

Drinking Water
In the United States, arsenic is found in varying concentrations in the drinking water, depending on two key items:
1.  Does the family use a water system supply, or a private well?
2.  If they use a well, do the rocks in their region have a lot of arsenic in them or not?

The areas of the United States that have the highest levels of naturally occurring arsenic in the ground water are:
1.  The Southwest.  Areas of Nevada have well water with levels as high as 500 ppb.
2.  The Upper Midwest.
3.  A band of New England- from the coast of Maine to an area midway in Massachusetts.

Water supplied by a municipal water system is mandated by Federal law to keep the level of arsenic below 10 ppb.  This means you are very unlikely to be exposed to arsenic in your tap water if the water is from a municipal source.   Private well users must measure their arsenic level to be sure it is not over 10 ppb, particularly in the US Southwest, Upper Midwest, and the swath of New England noted above.

Food
Arsenic exposure can cause harm via the ability to concentrate in certain foods.  Rice, for example, is a plant that sucks arsenic out of the soil quite well, and so if it is planted in soil with arsenic contamination, that arsenic will end up in the rice grains and potentially cause harm to those eating rice.

Other foods that concentrate arsenic include leafy vegetables, seafood, and apple and grape juice.

Juice
In July, 2013, the FDA set a standard of 10 ppb, the same as drinking water, for apple juice, ensuring that apple juice that meets the FDA standard is as free of arsenic as safe, metropolitan, drinking water.

Rice
The problem with American-grown rice is that much of it is grown in fields that used to grow cotton- for a very long time.  Cotton was doused with arsenic very heavily- after all no one ate it.  But over the last few hundred years that meant the soil of these fields got good and soaked with arsenic.  As noted, rice sucks arsenic out of soil really well, and so rice from the American South can contain too much arsenic.

Bottom Line
Arsenic is a very dangerous and very insidious poison.  If you get too much you don't just keel over, you get chronic illnesses.  It is worth taking efforts to avoid exposure.  Here are the top 3 things to do to avoid eating too much arsenic:

1.  Make your water tap water.  If you must use a well, find out the arsenic concentration and don't drink it if it is over 10 parts per billion (ppb)
2.  Commercial apple juice is now regulated to have arsenic levels below 10 ppb, it should be safe.
3.  Rice is a real problem.   American rice from California is probably the safest bet.  Rice from the American South likely cannot be trusted to have low enough arsenic levels to be safe, and rice from the rest of the world, who knows.  So try to stick to California rice.


Our best,
Dr. Arthur Lavin



*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.

2016-04-22

Homework v. Play- We have a Winner

Homework v. Play- We have a Winner

There has long been a tremendous fascination and draw to homework across many American households.    It could reflect ongoing anxieties about how our children will do once they have to find a job, competing with the superachievers across the globe.  How will our children win the struggle for good jobs unless they have mastered countless hours of homework?  In fact, isn't the case that the more work we pile on, the better and more advanced our child's mind will be?  Without hours of homework a night, doesn't the child's brain wither and weaken, or at the very least, fail to reach is full potential?

Surely the agonies of hours of homework are more virtuous than empty hours of play.  Surely.

This is a question that has been inside educational theory for decades, probably since homework was first foisted on our unsuspecting kids.  And I suppose it makes some sense on the surface of things.

But, fortunately for children everywhere, someone has actually tested this question, had looked at how kids turn out as adults with and without homework, and the answer across such studies is clear.
Homework offers no benefits, play is the best way to grow a mind.

Isn't that incredible?  Kids who do no homework, learn just as much and do just as well as adults, as kids who do homework hours every night.  Incredible.

This conclusion has been dramatically demonstrated in the the country that is listed by most measures as the nation with the best schools in the world.  The students that graduate from the public schools in this country outperform all other nations.  The  country is Finland.  And their schools do three notable things:
1.  They assign NO homework from K-12, the only exception being some work now and then in high school.
2.  They do NO standardized tests.
3.  There are NO private schools in Finland, all students go to public schools.

And, again, their graduates have better academic skills than any graduates in the world!

You might wonder, when will these lessons ever be put into practice here at home?

The answer is now.   I have just learned that the Shaker Heights Public School system is embarking on a sharp decrease of homework in their K-4 elementary schools.  Given all we know, I applaud this move, and am so happy for these students.  There are a number of other schools that already have done this and more that are considering it.

In fact, enough private and public schools are moving in this direction that it appears the victory of play over homework for American children may be approaching.

This is good news not only because homework offers little educational benefit, but because there is no activity of the brain more helpful to brain function than play.  This is true in infancy, childhood, adolescence, and adulthood.   Dr. Alice Kolb at the Weatherhead School of Business at Case has devoted her long career to the role of play in advanced cognitive functioning in business, and has found abundant evident that the playful mind outperforms the mind blocked from play.

BOTTOM LINES
1.  Nothing tops play as an activity to promote the development and function of the mind, at any age.
2.  Homework, often thought to be a useful discipline to improve learning, is not.
3.  The best school system in the world, the schools of Finland, assign essentially no homework from Kindergarten through senior year in high school.
4.  Many schools in the US are moving away from giving homework, we are pleased to report the Shaker Heights Public School system is doing that for next year.

So play with your kids, and let your kids play.  Nothing will be better for their minds.

To your health,
Dr. Arthur Lavin





*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.

2016-04-15

The American Academy of Pediatrics Opens its Doors to Families

The American Academy of Pediatrics Opens
Its Doors to Families

A new venture from the American Academy of Pediatrics (AAP), the FamilY Partnerships Network www.aap.org/fpn has been launched.

Nearly all pediatricians in the United States belong to the Academy, which has 65,000 members. Medical students and pediatric dentists and nurse practitioners are members of the Academy as well.
Most of the world turns to the AAP for its expertise and guidance across a very wide range of issues that determine how children receive medical care.

So it is especially good news that two legends of advocacy for children, Ms. Betsy Anderson, and Ms. Julie Beckett, who helped found and direct Family Voices, have teamed up with the AAP to create a new program, the FamilY Partnerships Network or FPN.

FPN, you may have noticed, has a capital Y at the end of family to emphasize that the organization addresses needs of youth and young adults as well as young children.

The FPN is an advisory group to the Academy's Board of Directors, and will represent the perspective of parents to the Academy as it pursues its wide range of activities on behalf of infants, children, and adolescents.

The activities of the FPN will include:
  • Develop and promote education to doctors about family concerns
  • Review and contribute to policy and publications of the AAP
  • Advocate for the needs of children and families with the AAP
  • Develop AAP resources to help explain a range of issues to families
The actual topics of interest to the FPN will range as widely as the parents who constitute it.

An exciting aspect to the FPN is that membership in the Network is open for consideration by any parent of a child.  And it's easy for parents to inquire.

Simply fill out this inquiry survey and someone from the FPN will be in touch to answer questions and see if you are interested in participating:  https://www.surveymonkey.com/r/FPNApp 

I have to say that having participated at the national level at the AAP for many years, it is an amazing experience.  The level of expertise and caring is truly inspiring, and the work really does help a nation of children.   If you have a particular interest when it comes to how the nation's doctors care for our children, what issues need attention, and how they should be attended to, the FamilY Partnerships Network could be an incredible opportunity for you.

Please do let me know if you are interested, just send an email to info@advancedped.org

To your health,
Dr. Arthur Lavin




*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.

Participation in a Major New Paper- from the AAP, on Poverty

Participation in a Major New Paper- 
from the AAP, on Poverty

The American Academy of Pediatrics (AAP) has published a major new policy statement on the topic of poverty in this month's (April, 2016) issue of Pediatrics.    And I am very honored to be listed as one of the authors as the member of an AAP Committee that participated in the drafting of the document.

http://pediatrics.aappublications.org/content/early/2016/03/07/peds.2016-0339

As many of you know the AAP is one of the world's leading pediatric professional societies.   It has a very wonderful history of helping children.  The AAP, in fact, was founded in protest against AMA actions that tried to block the government from providing free milk to poor children, in the 1920's.  When the AMA lobbied Congress to block this bill from passing, the pediatricians walked out of the AMA in protest and created the AAP.

Since that time, the AAP has been one of the only doctors' societies whose main purpose has not been the doctors, but rather the children we serve.

This major paper is firmly in that tradition.  Every few years, the AAP identifies the top three priorities facing children in America.   When the Academy identified poverty as a top priority, that was a major event.  Our Academy found that one of the top three priorities defining the health of children was not a disease, was not an infection, but a creation of our own national community.

I applauded that decision, as I agree with our Academy that poverty creates worlds of suffering and dire impacts that are at the root of many of the major catastrophes children face today, including
mental health conditions, lethal and disabling injuries from gunfire and other violence, malnutrition, and higher rates of more traditional diseases such as asthma.

It is a real honor that for several years I have served on one of the national committees of the AAP, the committee charged with setting policy for the Academy on matters pertaining to the psychological and social health of children and their families.  One of the jobs of this committee is to draft and/or review policy statements adopted by the Academy and published in Pediatrics, widely regarded as the leading journal for pediatric papers in the world.  

I would encourage you to read this paper, Poverty and Child Health in the United States.
http://pediatrics.aappublications.org/content/early/2016/03/07/peds.2016-0339
I consider it an historic publication, as it calls our national community to witness that poverty is a problem we have created, that we can dramatically reduce, and that not doing so has very real, durable, and identifiable health consequences for our children.

As our committee publishes other policy statements of the Academy, I will be keeping you informed.

To your health,
Dr. Arthur Lavin



*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.

2016-04-13

Zika Pandemic Update: April 13, 2016

The Zika pandemic:  
UPDATE APRIL 13, 2016

Three items are new since the last update:

1.  The Zika virus has now reached close to complete confirmation that it does grave harm the developing brain of the embryo and fetus, at anytime during pregnancy, not just the first trimester.

2.  There are Americans who have traveled to areas where Zika have spread and have come home to the US infected with Zika virus.  Over 300 such cases now have been reported in nearly every state, including Ohio.

3.  Men seem to harbor the living virus in their reproductive fluids longer than women.   For men with the virus, therefore, it can be transmitted for over a month after the man gets infected, whereas once the woman recovers from the infection, typically a week or so after the mosquito bite, she is no longer able to pass the virus along to a partner or baby.

4.  There are still NO KNOWN CASES of transmission of the Zika virus from someone who is in the continental US to a person in the continental US via a mosquit0.   However, enough people in the US have the virus, that once the mosquitoes come out, it is very possible that transmission via mosquito will start taking place.  It is currently thought that such outbreaks in the US will be in small clusters, and mainly in the southernmost parts of the country, namely southern Florida and Texas, but only time will tell.

The last update from February remains very current, and is placed here for your reference once more, some edits to update this post are included:

The Zika virus continues to erupt across the tropical Americas.

A great resource as this epidemic unfolds will always be the CDC at:
http://www.cdc.gov/zika/index.html

Please note that there have been zero (0) cases of the Zika virus caught BY MOSQUITO in any state of the United States.    This is still true as of April 13, 2016/

There have been new cases caught by mosquito in Puerto Rico and the US Virgin Islands, but none in Florida, Texas, or any other state.

With more cases of sexual transmission of the Zika virus documented, Zika viral infection is now fully established as a known STD.

Now, how long is a man with Zika virus contagious, via sexual contact?  No one knows, but one semen sample was positive 10 weeks after the man was infected.

It still remains the case that by far the gravest danger posed by the Zika virus may be to developing babies.

But some deaths have been reported from people infected with Zika, so the risk is no longer considered solely born by the fetus.  But the infection in anyone from childhood through adulthood is very unlikely to cause harm, 80% of all people infected, at any age, have no symptoms.

The bottom line at this time is that if you want to avoid getting infected by the Zika virus, you and your family need to stay out of areas where it is now very active, namely the tropical Americas [Mexico, Central America, Northern half of South America, the Caribbean], Samoa, and the Cape Verde Islands.  Men who travel there should abstain from sexual contact or practice completely safe use of condoms for an indeterminate number of months.  If their wives are or may become pregnant, the precautions must be taken for the duration of the pregnancy.


BOTTOM LINES
1.  A virus long dormant in Africa spread to French Polynesia in 2007, and now is exploding across the tropical Americas, the Zika virus.
2.  In adults, the vast majority of infected people either don't get sick at all or have mild symptoms.
3.  Less commonly, adults can get significant pain in muscles and joints.
4.  Adults with the infection can have the neurologic complication of Guillan-Barre syndrome which is typically transient.  Now some have died from the infection.
5.  A very disturbing aspect of the Zika virus is its ability to infect babies of pregnant women and that it is now known to  cause damage to brain development at any time during pregnancy.
6.  Adults and children need to weigh the risk of serious infection if they plan to travel to tropical Americas, Samoa, and Cape Verde Islands.  The risk of getting infected is real.  There are neurologic complications and now even death reported.
7.  Pregnant women should know that traveling to tropical Americas, Samoa, and Cape Verde Islands could be catastrophic for their developing baby.
8.  If a woman who even may become pregnant has a partner who has traveled to the  tropical Americas, Samoa, or Cape Verde Islands, she should abstain from sexual contact during the entire pregnancy.

The main point is that no one in Ohio can currently, or is likely ever to, catch Zika virus while in Ohio, except through sexual contact with an infected partner.  Travel to Zika active areas is a very real risk to all.  This would only change should mosquitoes in Ohio start carrying the virus, a very unlikely possibility.

To your health,
Dr. Arthur Lavin



*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.

2016-04-01

Strong, Frequent Hits to the Head aren't Good for the Brain

Strong, Frequent Hits to the Head aren't Good for the Brain

This may be one of the dumbest headlines we have written ever.

Who wouldn't guess that hitting your head hard, and often, could increase the chance of brain damage?

But it turns out to be very big news for any person who plays football or has a child who plays football, or other head impact sports.

The Journal of Neurotrauma has just published a study that shows that the number of times your head is snapped back during sports play after your body (not just your head) is hit, predicts later loss of brain function better than the number of concussions.   http://online.liebertpub.com/doi/abs/10.1089/neu.2016.4413

The New York Times has a summary of their findings.  http://www.nytimes.com/2016/04/01/health/study-focuses-on-repeated-hits-not-concussions.html?rref=health&module=Ribbon&version=origin&region=Header&action=click&contentCollection=Health&pgtype=Multimedia

The findings, although very plausible, are very disturbing.  The key findings were as follows:
  • The risk from snapping of the head to the brain begins in high school.  It is not an NFL only problem.   Head injuries and high school and college can cause lifelong impairments.
  • The harm to the brain can come from direct hits to the head, or body blows that snap the brain.  It is the acceleration of the head, moving suddenly, even more than a blow to the head that hurts the brain.
  • The life-long impairments following such blows to the body and head include:
    • Loss of the ability to think clearly (cognitive impairment)
    • Impaired ability to complete tasks at home and work (impaired executive function)
    • Depressed mood and energy levels (depression)
    • Loss of interest in life (apathy)
    • The development of outbursts of abnormal behavior (behavioral dysregulation)
  • These impairments can start to show up anywhere from age 25 to 85, well after the person stops playing the sport that causes the head injuries.
  • Even if the person experiences few or no concussions, these head snapping injuries still are associated with all these impairments.
BOTTOM LINES
  • Sports are not free of risk- the most worrisome risk is the risk of losing brain function from sports that ask our kids to hit or snap their heads, hard
  • Loss of brain function can be set in high school and college
  • Sports that involve injuries to the brain may cause impairments in thinking, mood, even ability to be effective in the world that can last a lifetime and appear long after the person leaves high school and college.
  • Football in particular stands out as a sport that can hurt the brain, even in young people, even in high school and college, not just the NFL.  In many ways, the impact of football on the brain is being revealed as more and more like boxing.
  • The choices are also becoming very clear:
    • Change football so that the brain is no longer hurt
    • OR, protect our youth from these injuries by not playing football.
  • Football is not alone, heading the ball in soccer, and other sports that require hitting the head in the sport should change their practices, and avoid brain injury.
  • Since tracking concussions may miss most of the harm done, it becomes all the more important to focus efforts on making sure our children don't engage in activities that hit their head frequently.
  • THE BOTTOM LINE:  The brain is important.  Frequent hits to the brain may cause permanent damage.  Some responses are inadequate, including trying to treat these injuries.  The only approach that makes sense is to stop the injuries from happening to begin with.

To your health,
Dr. Arthur Lavin







*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.