Enjoy your soy!

Image via WikipediaEnjoy your Soy

For many years a debate has been brewing about whether soybeans contain compounds that could alter human puberty and sexual development.  Evidence now clearly proves it does not.

The specific concern has been that the soybean contains compounds called isoflavones, and at times phytoestrogens, that look suspiciously like estrogen.

Now, clearly eating estrogen could dramatically disrupt normal human pubertal development.  Eating compounds that have estrogen powers could lead to very early puberty onset in women, and could delay puberty in men, decrease their ultimate sperm count, and cause infertility.

But one thing to keep in mind is that truly tiny differences the estrogen molecule can create rather massive differences in what the molecule does.  For example, if you take actual human estrogen and only take away 3 atoms, all on the outside boundaries of this large molecule, you end up with a compound that looks almost exactly like human estrogen, except it is now called testosterone.  As you all know, estrogen is the central hormone of human femininity and testosterone of human masculinity.  How much more different can you get, and yet the molecules are only 3 atoms different.

Now lets consider the isoflavones, also known as phytoestrogens, found in soybeans.  They look like human estrogen, but what do they actually do in the human body?

It turns out, not much.

Perhaps the most dramatic proof of this statement comes from a 2009 study 

http://www.ncbi.nlm.nih.gov/pubmed/19819436

They gave young men rather massive quantities of pure soy isoflavone for nearly two months and then looked at their sperm.  They made sure the men took their medicine by measuring each man's isoflavone level in their urine- all the men had a huge rise in their soy isoflavone level.

And yet, by many, many measure of sperm health (count, motility, semen quality, etc.), there was no impact from the soybean isoflavone.  Soy isoflavone levels went up and absolutely nothing happened to the sperm.

It really does look like soy isoflavone may do something for soybeans but does nothing to people.

So enjoy your soy sauces, your tofu and its mimicry products, your edamame, and soy lecithin!

Bon Appetit,

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.

Acetaminophen: A Serious Question Leads to the Recommendation to Suspend Use

Acetaminophen: A Serious Question Leads to the Recommendation to Suspend Use

Over the last several years, a growing body of evidence has raised a troubling question about the use of acetaminophen (Tylenol™, Feverall™). A number of studies have proven an association between the use of acetaminophen and the risk of developing asthma. These studies have approached the issue from a number of different perspectives and in each instance have found an association.

            A recent study has tracked the use of acetaminophen in children (ages 6-7 and 13-14) over many years Their most recent publication described the experience of 320,000 young adolescents from 50 countries. What they observed was that if a child took acetaminophen once a month or more, that child had double the risk of developing asthma.

            Other studies have found:

1.  The more acetaminophen a child uses, the greater the risk of developing asthma. In some series, the risk has gone as high as sevenfold. That is, a group of children taking acetaminophen has been observed to have seven times the risk of developing asthma as children who do not take acetaminophen.

2.  As countries have adopted the use of acetaminophen, the rate of asthma in those countries has gone up.

3.  The risk of developing asthma in association with taking acetaminophen has been observed in utero, in infancy, in early childhood, in school age children, and in adolescence.

Advanced Pediatrics has been following these studies and our initial reaction was disbelief. How is it possible that something so widely used as acetaminophen could cause such a serious problem as asthma, and no one noticed? Further, if acetaminophen causes asthma, why doesn’t everyone have asthma, since nearly every child in the US has taken acetaminophen? And, what harm could be caused if Advanced Pediatrics sounded a false alarm? What if acetaminophen turns out to be harmless and we have obstructed access to a very helpful medicine?

One story that may turn out to be quite relevant is the story of aspirin and Reye’s syndrome; both obscure concepts to most parents since almost no children take aspirin anymore, and almost nobody has heard of Reye’s syndrome. But prior to 1980, nearly every child in the US took aspirin when they had a fever. And at that time in most major children’s hospitals in the US, there was often a child with Reye’s syndrome in their ICU in any given month. Reye’s syndrome was a rare but devastating collapse of the liver due to a very severe metabolic problem that would often lead to death. The idea that somehow Reye’s syndrome and aspirin use might be connected seemed far-fetched when first observed. After all, aspirin was used like water, all the time, and with no serious resultant problems. In stark contrast, Reye’s syndrome was a very rare problem, characterized by a very complex set of metabolic errors leading to the death of a vital organ. How could these two problems be related?

When the first observations were published suggesting that those who took aspirin had a higher risk of Reye’s syndrome, the observations were met with nearly unanimous skepticism. Millions took aspirin, only hundreds got Reye’s syndrome. Aspirin is safe and common; Reye’s syndrome is deadly and rare.

But the observations kept rolling in. Eventually the question of a link could no longer be ignored and studies were set up in which very large numbers of children did not take aspirin, and wonder of wonders, none of them got Reye’s syndrome. Soon the FDA began warning that aspirin use in children, especially those with flu or chickenpox, could cause Reye’s syndrome. Parents suddenly stopped giving their kids aspirin. Since that moment, Reye’s syndrome has virtually ceased to exist. This last step was the final and definitive proof that aspirin caused Reye’s syndrome. Astounding as it was to all involved, the cessation of aspirin use by children saved many, many lives.

What about the question, if acetaminophen causes asthma, why doesn’t everyone have asthma? Well, consider the possibility that children run a 1 in 20 risk of developing asthma, which is indeed true, since about 5% of kids have asthma in the US. Now, if acetaminophen doubled the risk of developing asthma, the incidence would go from 5% to 10%. That would be a stunning level of harm. That would mean that of the 4 million kids born in the US every year, an additional 200,000 children would develop asthma, every year. And yet, 90% of children would still not develop asthma, even if they took acetaminophen.

            We are not yet at the point where we know that acetaminophen causes asthma to develop. But enough information has been gathered to say we should find out.

            It is in light of the Aspirin/Reyes Syndrome experience, the quality of the current studies on acetaminophen and asthma, and the fact that ibuprofen adequately covers the same medical needs, that Advanced Pediatrics has taken its position of not endorsing the use of acetaminophen for children of any age for the foreseeable future.  .  Please note that for the rare circumstance in which a child faces a danger from fever and cannot use ibuprofen for medical reasons, acetaminophen may still be a reasonable choice to use, but only under a doctor’s recommendation.




Addendum:
The New York Times has published an article, December 19, 2011 supporting the concern that acetaminophen may cause asthma to develop:
http://www.nytimes.com/2010/08/17/health/research/17risk.html

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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.

Tips for Meeting with School Officials about possible IEP's

Tips for Meeting with School Officials about Individualized

Education Plans

I was recently invited to speak at a national convention devoted to the care of children with a very rare metabolic disorder, but at the convention, a neuropsychologist from Denver, Colorado, Dr. Kendra Bjoraker, offered a series of tips to help parents in meetings with school officials.

These tips each were so insightful, so helpful, I wanted to make them available to you all.  Each really help put  you, the parent, in a better position to get the best educational plan for your child possible.

Keep in mind, these tips were designed for meetings with officials who have the power and authority to decide what help your family and your child will receive from their school.  As such these tips could be helpful for any such meeting, school or otherwise:


Your overall goal is to get the organization to help you and your child

• Be sure to sit next to the most senior decision-maker at the meeting.
• Dress formally, make sure you look like you take their time seriously
• Bring food, fruit or cookies, it is harder to say no to someone who feeds you.
• Print the Rules and Regulations of the State of Ohio on the subject you are discussing, for example, IEP services, and place them in a binder with the title Rules and Regulations of the State of Ohio on the spine of the binder.  Place the binder with the spine facing towards meeting participants.
• If an administrator states that the law forbids or does not allow them to help you in the way you request, ask them to point to the statute, in your binder.
• Take notes.
• Before you leave, insist on getting copy of the administrator's notes.  Often promises made at the meeting don't make it into the final report.
• Tape record the meeting and leave it on as everyone is saying their goodbyes.  Often promise are made as a friendly parting gesture.
• Be sure to go after the problem, not the people.  The challenge is to get help, not to go after individuals.  If you are getting angry at someone, the focus is off center.

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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.

Time to Rethink the use of Acetaminophen (aka Tylenol)

Time to Rethink the use of Acetaminophen (aka Tylenol)

On August 16, 2010, The New York Times published a brief account of a research study looking at the association of asthma and use of acetaminophen (the medication in Tylenol, known in Europe as paracetamol).

Image via Wikipedia

http://www.nytimes.com/2010/08/17/health/research/17risk.html?_r=1&ref=health&pagewanted=print

This study, looked at hundreds of thousands of children across 50 countries and found that if kids took Tylenol, the chance of them having asthma, hay fever, or itchy eyes increased.

There have been some indicators that acetaminophen could increase the chance of developing allergic problems like asthma, runny nose, and itchy eyes, but now the evidence is strong enough for we at Advanced Pediatrics to issue the following recommendation, particularly since ibuprofen works just as well:

Advanced Pediatrics recommends that pregnant women, infants, children, and adolescents no longer use acetaminophen (Tylenol).

Why?  Sufficient evidence now exists to be concerned that use of acetaminophen during pregnancy, infancy, childhood, and/or adolescence can increase the chance of developing asthma, hay fever, and/or allergic itchy eyes.

What about fever, pain, inflammation?  It turns out ibuprofen (Advil, Motrin) works as well or better than acetaminophen, so stopping the use of acetaminophen still allows you to give something for fever, pain, and/or inflammations.

What about high fevers and alternating meds?  It also turns out that if you use ibuprofen to control fever, adding an alternating dosage of acetaminophen does not lower the fever any further.  So stopping the use of acetaminophen will not cause the fever to go higher.

See below for abstracts on the NYT quoted study, and a recent survey of the biologic plausability of acetaminophen really causing asthma to develop.

Dr. Arthur Lavin

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Published ahead of print on August 13, 2010
Am. J. Respir. Crit. Care Med. 2010, doi:10.1164/rccm.201005-0757OC

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Beasley, R. W. PubMed PubMed Citation Articles by Beasley, R. W.

Submitted on May 12, 2010
Accepted on August 13, 2010

Acetaminophen Use and Risk of Asthma, Rhinoconjunctivitis and Eczema in Adolescents: ISAAC Phase Three

Richard W Beasley^1*, Tadd O Clayton², Julian Crane³, Christopher K.W. Lai⁴, Stephen R Montefort⁵, Erika von Mutius⁶, Alistair W Stewart², and the ISAAC Phase Three Study Group¹ Medical Research Institute of New Zealand, Wellington, New Zealand, ²Faculty of Medical & Health Sciences, The University of Auckland, Auckland, New Zealand, ³ Otago University Wellington, Wellington, New Zealand, ⁴Chinese University of Hong Kong, Hong Kong, China, ⁵ University of Malta, Malta, Malta, ⁶ Dr von Haunersches University Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
^* To whom correspondence should be addressed. E-mail: richard.beasley@mrinz.ac.nz.

Rationale: There is epidemiological evidence that the use of acetaminophen may increase the risk of developing asthma. Objective: To investigate the risk of asthma and other allergic disorders associated with the current use of acetaminophen in 13 to 14 year old children in different populations worldwide. Methods: As part of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three, 13 to 14 year old children completed written and video questionnaires, obtaining data on current symptoms of asthma, rhinoconjunctivitis and eczema, and a written environmental questionnaire obtaining data on putative risk factors including acetaminophen use in the past 12 months. Measurements: The primary outcome measure was the odds ratio (OR) of current asthma symptoms associated withacetaminophen use calculated by logistic regression. Main results: A total of 322,959 adolescent children from 113 centres in 50 countries participated. In the multivariate analyses the recent use of acetaminophen was associated with an exposure-dependent increased risk of current asthma symptoms [OR 1.43 (95% CI 1.33 to 1.53) and 2.51 (95% CI 2.33 to 2.70) for medium and high versus no use respectively]. Acetaminophen use was also associated with an exposure-dependent increased risk of current symptoms of rhinoconjunctivitis and eczema. Conclusions: Acetaminophenuse may represent an important risk factor for the development and/or maintenance of asthma, rhinoconjunctivitis and eczema in adolescent children.

Clin Exp Allergy. 2010 Jan;40(1):32-41.

The role of paracetamol in the pathogenesis of asthma.

Farquhar H, Stewart A, Mitchell E, Crane J, Eyers S, Weatherall M, Beasley R.

Medical Research Institute of New Zealand, Wellington, New Zealand.

Abstract

Paracetamol use represents a putative risk factor for the development of asthma. There is convincing epidemiological evidence that the risk of asthma may be increased with exposure to paracetamol in the intrauterine environment, infancy, later childhood and adult life. A dose-dependent association has also been observed in these different age groups in different populations world-wide. An association has also been shown between paracetamol use in both rhinoconjunctivitis and eczema. There is biological plausibility with paracetamol use leading to decreased glutathione levels resulting in increased oxidant-induced inflammation and potentially enhanced T-helper type 2 responses. At the population level, patterns of paracetamol use might explain, to some extent, the world-wide variation in the prevalence of asthma and related disorders, particularly the high rates in English-speaking countries, which have high per capita prescription and over-the-counter use of paracetamol. A temporal association also exists between the international trends of increasing paracetamol use and increasing prevalence of asthma over recent decades. Further research is urgently required, in particular randomized-controlled trials (RCTs) into the long-term effects of frequent paracetamol use in childhood, to determine the magnitude and characteristics of any such risk. Importantly, RCTs will also enable evidence-based guidelines for the recommended use of paracetamol to be developed.

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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.

Concerns about the New Meningitis Vaccine- Menactra- Now Resolved

Image via Wikipedia

Concerns about the New Meningitis Vaccine- Menactra- 

Now Resolved

Several years ago, improvements to the meningococcal meningitis vaccine led to the licensure of Menactra.

Menactra offers the advantage of a longer duration of coverage.

However, soon after it was licensed, a group of 6 people who got the vaccine developed a syndrome of temporary paralysis called Guillan-Barre Syndrome.  The FDA launched a study to see if the vaccine was at fault.  We have held off recommending this vaccine until this issue was settled.  Note that our stance was never that the Menactra vaccine was dangerous, we just wanted to ensure its safety before recommending it.

Two important studies have now been published and establish that the Menactra vaccine does not cause Guillan-Barre syndrome and we now recommend its use to prevent meningococcal meningitis, the type of meningitis seen in college.

One of the studies looked at the experience of 1.4 million children who got the Menactra shot, in Boston.  There were no cases of Guillan-Barre syndrome associated with the shot.

The other study was from the CDC showing no increased risk of developing Guillan Barre syndrome after being immunized with Menactra.

Bottom Line:

Advanced Pediatrics, on the basis of recent evidence that Menactra has no connection to Guillan-Barre syndrome, is now recommending the routine use of Menactra in all children, starting at age 11-12.

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.

The Evolution of Mother-Child Interactions- Interesting News

The Evolution of Mother-Child Interactions-

How Our Three Smallest Bones Led to

Human Brains and Love for Mom

One of the world's leading experts on how humanity came to be, Dr. Melvin Konner,

has recently published a work that has been 25 years in the making: The Evolution of Childhood: Relationships, Emotion, Mind (Belknap Harvard University Press, 2010,  943 pages)

I had the pleasure of knowing Dr. Konner during my time in Boston, and have been studying his book this summer.

From time to time, I would like to post some of his most fascinating findings in this monumental, and historic exploration of how humans came to be.

Today's observation has to do with the emergence of mammals from reptiles and how the mother-child bond helped define our history.

Mammals first appeared on our planet about 225 million years ago, clearly descended from reptiles.

Most people think that to be a mammal you have to nurse your young and/or give birth to a live child, not an egg.  Now nearly all mammals do both these things, including humans.  But platypuses are mammals and lay eggs, and have no fully developed breasts.

It turns out that the one difference between reptiles and mammals has to do with might appear to be a very minor anatomic detail.

Reptiles have three little bones in their jaw joint.  Mammals do not.

Feel your jaw, the jawbone connects directly to your skull.  Go ahead, open and close your mouth with your finger on your jaw joint.  You can feel the jaw connect directly to your skull.  Reptiles have three tiny bones in this joint that act as a major hinge, allowing the reptile to open their mouth far more widely than we can.  It explains how a snake can swallow a mongoose- their hinged jaw opens that widely.  Ours never will.

So where are the three tiny bones of the reptile jaw in mammals, including us?  They have moved inwards, just a few millimeters, and taken their place as the three tiny bones of hearing- the hammer, anvil, and stirrup.

We are not sure what got those bones to move, but the fossil record clearly proves that their movement led to the development of the ear of the mammal, which opened up hearing a much wider range of sounds.  With the movement of these, our smallest three bones, the ear of a mammal was born, able to hear high pitches that even today no reptile can hear.  

Now you might ask, how does the development of a better ear lead to closer infant-mother connections and the human brain?  It turns out, rather directly.

With the advantage of better hearing, the newborn of a mammal can cry out for help in as loud a voice as it wants, the predator reptile cannot hear the baby, but the baby's Mom can.  Now, for the first time, a baby can cry out with the predator at the door, without fear of the predator hearing it, and confident the mother will respond.

This new reality ushered in the era of the mammal, and the central fact of mammal life- its babies are deeply connected to their Mamas.  

But since hearing became the foundation and starting point for this connection, this move also opened the door to another powerful, and ultimately decisive, advantage for the mammals- the growth of the thinking brain.  After all, with the development of better hearing and communication comes the development of language.  And many hold that one of the main drivers for the development of the human brain has been language.

So, from the chance movement of the three smallest bones from the jaw to the ear comes a new type of animal, the mammal, the creation of a new type of hearing that leads to a quantum leap in the depth of attachment between newborn and mother, the creation of language, and the direction towards a human brain.

Extraordinary how the random events of evolution can lead to the most extraordinary outcomes!

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.

A Natural Product for Babies Retail Store in Beachwood.

Dear Families,

I wanted to let you know about an interesting place to get BPA and phthalate free plastic baby products. It's called Teeks Natural Garden, and it's in the Beachwood Place mall:

http://www.malls.com/beachwood-place/teeks-natural-garden-kiosk

The owners recently sent along this description of their offerings, which I am pleased to send along to you:

Teeks Natural Garden really started out to be able to offer alternatives to the many chemical driven products  that has the potential to harm our babies and children. From phthalates,  BPA,pvc, styrene  and conventionally grown cotton. 

Pesticide and chemically treated clothing, diapers and bedding block the natural balance of the skin by trapping heat and preventing it from breathing. 

We now know through research that parents must wash foods and try to purchase as much organic pesticide  free foods.   Does it not make sense that chemically treated clothing wrapped around our babies, absorbing into their skin not have the same results.

Our store is filled with organic clothing, diapers, bedding and even our stuffed animals.  Our products are all environmentally safe. We are the local distributor of

Bum Genius Cloth Diapers,

The Wean Machine, a  portable food smasher allowing your child to eat the same foods as the parents while out.

The Tummy Tub,  a baby bathtub with advantages such as a special design which allows the baby to relax in the familiar fetal position. Soft baby material. Stress free bathing for your baby. It is exceptionally beneficial for babies who tend to be unsettled or suffer from wind/colic. It is fully recyclable and saves energy.

Sophie the Giraffe.  The most requested natural teether on the market.

Oh Plah  teething bracelets

Rockin Green, cloth diaper and laundry detergent. Tree hugger approved and phosphate free. Wonderful for cloth diapers and all babies clothing.

Under the NIle organic clothing

Baby LuLu organic clothing

Sage Creek organic clothing

Parade organic clothing

Fierce Hugs organic onesies.

Our clothes fit babies from birth to 24 months and we carry preemie clothing as well.

Hope you find this source of safe baby products of interest,

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.