Advanced Pediatrics

2013-12-05

Is Soy Safe for Pregnancy, Safe for Baby?

Is Soy Safe for Pregnancy, Safe for Baby?

The soybean is a wonderful food. It is rich in a wide range of nutrients, and an excellent source of protein.

From a food use perspective, the soybean is nearly infinitely adaptable in its ability to take on any taste and texture.

As a result, soy finds its way into a surprising number of foods we eat. Of course these include foods where the soybean is visible in the food or name, such as edamame, soy sauce, tofu, soy-based infant formulas, and soy milk. But if you consider the number of foods that have an ingredient with the word vegetable in it, with phrases such as vegetable flavoring, vegetable emulsifier, vegetable gum, vegetable starch, the exposure to soy in our food is extensive.

If soy is so wonderful, what controversy surrounds it? The controversy is limited to one chemical in soybeans, phytoestrogens. Phytoestrogens are molecules in plants that look like the molecule found in humans called estrogen. As you know, estrogen is the paradigm hormone of being female. It is estrogen that makes breasts develop, that helps control the menstrual cycle, and that helps maintain pregnancy and nursing.

The concern is whether the estrogen-like compounds in soybeans actually have estrogen effects in the human body. It turns out very tiny differences in hormone molecules lead to dramatic differences in function. Estrogen, for example, when altered by a very tiny amount becomes testosterone, the male hormone. So we know tiny differences change function quite a bit!

So the question is, if you eat phytoestrogen from soy, does it do anything? So far, the evidence leans heavily towards this answer: No. If it did act as an estrogen in humans, we should see breast development in children, puberty pushed early in girls, and later in boys. There is no evidence that any of these events occur in people who eat soy products. Some research actually raises the possibility that phytoestrogens may decrease the incidence, in adults, of developing breast and prostate cancer. But again, there are essentially no data on any group of people having a measurable difference in their lives in any way from eating or not eating soy.

Therefore, at this time, pending finding any actual impact on people, we are recommending to people that eating soy is safe for pregnant women, for infants, and all people.

*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.

2013-11-13

Breaking News on the Prevention of Autism (Really)

Breaking News on the Prevention of Autism (Really):

Folic Acid in the First Days of Pregnancy

I have been honored to be working with Dr. Irva Hertz-Picciotto of the University of California at Davis, who is widely regarded as the world's leading expert on the epidemiology of autism. She has very recently informed me of some very exciting news, news that for the first time opens the door to possibly preventing autism.

Many of you may recall that I met Dr. Hertz-Picciotto roughly 2 years ago in preparation for leading a roundtable on finding the reversible causes of autism convened and hosted by Senator Sherrod Brown in the US Senate Meeting Rooms.

The exciting news is the result of years of work on the part of Dr. Hertz-Picciotto and her team in the MARBLES study (Markers of Autism Risk in Babies). Her colleague Dr. Rebecca Schmidt has just reported that mothers who take sufficient folic acid in the days prior to and just after conception have sharp reduction in their risk of their babies developing autism. This is how dramatic the news is: if your folic acid levels are high enough, your baby's risk of developing autism drops FIVE-FOLD. This is very dramatic news.

The impact is supported by other studies, so it is a replicated result, making it unlikely to be disproven with further studies.

How much is enough? When do you have to take it to get the protection? These are key questions.

How much is enough?

The actual answer is only determined by testing a blood level of folic acid, but Dr. Schmidt states that for nearly everyone, taking 800 micrograms a day will get you to the levels needed to see a five-fold reduction in the chance your child will develop autism.

When do you have to take it to get the protection?

The protection works best the earlier in pregnancy that it is taken. After one month of pregnancy, the protective effect already weakens. This means for best protection, your folic acid levels should be at the protective level before conception. We recommend that all girls and women take 800 mcg of folic acid a day from their first period to their last. That way, whenever pregnancy occurs, the protective effect of folic acid will be in place for the first days of embryonic development, the key time the protection is necessary. If this routine cannot be sustained, then it is critical that the folic acid be taken the whole period of your life when you think you may be having a baby.

How certain is this finding to work?

At this point it is highly likely to work. The last step in proof is for the population to take 800 mcg before every pregnancy and then see if autism does drop five-fold as anticipated.

Bottom Line:

Good evidence is now in hand to strongly suggest that if you take 800 mcg of folic acid every day the month before and then throughout pregnancy, your child will drop their risk of developing autism quite substantially, perhaps as much as five-fold.

*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.

2013-11-08

Beware the Untested Drug

Herbal Supplements may not Have Herbal Supplements in Them

This week, the New York Times reported one of the most interesting health articles:

http://www.nytimes.com/2013/11/05/science/herbal-supplements-are-often-not-what-they-seem.html?src=me&_r=0

Someone took 44 bottles of various herbal supplements and analyzed the DNA in the herbal supplement in each bottle.

In one-third of all the bottles tested, the DNA revealed there was no herb present that the label promised would be in the bottle.

For example, one bottle of echinacea, had no echinacea in it, only rice. Rice was a common substitute, as were various weeds, and even plants that could cause harm. Bottles with no herbal remedy in them included bottles of ginko balboa.

In our view, herbal supplements should be held to the same standard as any drug, namely:
1. Does it work?
2. Is it safe?

For us the answer has to be yes to #1 for sure, and it has to be safe enough to justify use if it works.

Herbal supplements have been given a pass on both questions, very few have been tested to see if they work, and often when they are tested they are found to be powerless.

The price paid for pretending is now upon us. In this study, 1/3 of the herbal supplements were frank frauds, the worse type of scams- the label promises you are buying one thing, but the truth is you are buying powdered rice or lawn weeds that have no relation to the herb you seek.

BOTTOM LINE
Herbal supplements were recently tested using DNA analysis proving that in 1/3 of the samples, there was no trace of the herb promised on the label.

This is yet more reason to value actual proof that something works before believing it works.

It turns out it is very hard to find substances that reliably can end a problem.

Dr. 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.

2013-10-16

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

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

Much of the powdered arsenic in our food and water supply got there through the extremely widespread use of arsenic as insecticide.

*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 Back Up Throat Culture Becomes Optional

The Back Up Throat Culture Becomes Optional

Summary
The back up throat culture has been done in our office for many years when the rapid strep is negative. The accuracy of the rapid strep in our office combined with increased regulatory requirements to perform in office throat cultures leads us to a decision to move back up throat cultures to a reference lab and to make the back up throat culture process optional. That lab will be Child Lab (http://www.childlab.com/, 1-800-934-6575).

Nearly every child gets a sore throat at some point in their life that makes us wonder, is the child infected with strep?

There are two ways to tell. Both involve swabbing the back of the throat. With one of those swabs we do a chemistry reaction in our lab that within 5-10 minutes tells us if any proteins found on the strep germ are on your child's throat. This is the rapid strep test.

The other way is to take the second swab and rub it on a culture plate. This is like planting seeds in a garden. We then wait a day and see if any strep grows. This is the back up throat culture.

For many years we have used the two tests as follows:

1. If the rapid strep test is positive, we diagnose your child with strep throat and offer antibiotic therapy. In this situation there is no need for a back up throat culture.

2. If the rapid strep test is negative, we make an initial diagnosis that your child does not have strep and has some other cause of their sore throat- usually, but not always, a viral infection. We have done back up throat cultures in this instance, because the manufacturer of the rapid strep test informs us that a negative test is not 100% reliable.

Over the last 10 years, we have seen the rapid strep perform very, very well, even when negative. Of course, we do occasionally see someone with a rapid strep test negative on one day, only to have the back up throat culture come back positive.

Recently we have conducted three surveys of just how accurate a negative rapid strep test is.

In the first two surveys, we simply looked at 200 negative rapid strep tests and asked, how many of the back up throat cultures came back positive? We did this twice.

In the first run of 200 consecutive negative rapid strep tests, 0 of 200 of were found to have their back up throat culture come back positive.

In the second run of 200 consecutive negative rapid strep tests, we found 1 of 200 back up throat cultures came back positive.

Then, in August of 2013, we chose one person from each month of the last 2 years who had a back up throat culture, and found in 25 cases reviewed, not one had a positive back up throat culture.

So, out of 400 consecutive throat cultures, one back up was positive. And in a 2 year review of fairly randomly selected cases, no back up throat culture was positive in that 2 year review.

Put it all together, and the data are compelling. Yes, some people come back positive after a negative rapid strep test, but it turns out to be a very small number.

The key finding is that if your child is found to have a negative rapid strep test, there is a 99.9975% chance they do not have strep and do not need a back up throat culture.

Because of these findings and increased regulatory requirements to perform throat cultures in a doctor's office setting, we decided to stop doing back throat cultures in our office.

We will still make the back-up throat culture available to your family at the sore throat visit.

But instead of that back up throat culture happening in the office, we will send it out to our reference laboratory, Child Lab.

We have been impressed over the years with Child Lab. Based out of Nationwide Children's Hospital in Columbus with labs in Cleveland, they only do tests for children. As such they are the only such lab in our region with special expertise in pediatric lab services.

So, we will continue to use two swabs when we test your child for strep throat. And we will continue to run the rapid strep test in our office so you can get results in a few minutes. The back up throat culture, however, will only be done at the family's request, or if your child's history suggests a strong chance of a wrong rapid strep test.

Keep in mind, that if we run a back up throat culture, it will be done by Child Lab. So we want you to check with your insurer to be sure that will cover a back up throat culture for strep throat at Child Lab.

Their official name is Child Lab, their web page address is http://www.childlab.com/, and their phone number is 1-800-934-6575.

Bottom Line

The performance of the rapid strep test in our hands is highly reliable. If positive, we are confident your child has a strep throat. And, if negative, we are so confident that your child does not have strep throat, we can say that the chance we are right is 99.9975%. And so we are no longer going to do in office back up throat cultures for negative rapid strep tests.

But, we will continue to offer the back up throat culture to any family that wants that test done, and in those unusual situations where someone has had several positive throat cultures when the rapid strep is positive.

These throat cultures will be sent out to Child Lab, so check with your insurer to make sure that you are covered if we, together, decide your child needs a back up throat culture after a negative strep.

We hope our efforts to improve quality of care continue to advance your child's health, and we continue to appreciate the opportunity to work together to do so.

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.

2013-08-29

Flu Immunizations at Advanced Pediatrics 2013-2014

Flu Immunizations 2013-2014

Advanced Pediatrics is pleased to announce that this year’s influenza immunizations are now available in our office.

Call now for your appointment on September 21, October 12, or November 9 for our Flu Vaccine
Days (appointments are 8AM-Noon each of the three days).

Influenza is a virus that sweeps across our region every winter, typically appearing in December and leaving our community around April.

This virus is responsible for a rather astounding amount of winter illness, causing fully 1/3 of all colds, flus, and ear infections.

Influenza immunization is now recommended for everyone, except for those less than 6 months old.

Influenza immunization comes in two formats: a shot and a nasal spray. The shot contains dead virus and is fine for anyone over 6 months of age to use. The nasal spray contains live virus and should not be used by anyone less than 2 years old, older than 50 years old, or anyone with a chronic illness, including asthma.

With regard to how many influenza vaccines is a complete series, the answer is very simple. Anyone under age 9 who has never had an influenza vaccine, needs two influenza vaccines at least one month apart to be fully protected.

That also means anyone who has had an influenza vaccine in the past only needs one this year.

Overall, the data show that the nasal spray tends to work better- the immunity covers more strains than are in the vaccine and lasts longer. But, at the same time, the shot works quite well, too.

Getting Your Influenza Vaccine at Advanced Pediatrics

In order to make sure the entire practice gets the chance to be protected from influenza infection in a timely and easy manner, we are going to offer influenza vaccinations in two ways:

Any child in the practice 6 months of age or older can get their influenza vaccine at any visit to office, whether it be for a health supervision visit (check-up), sick visit, or conference.
We will once again offer special Flu Vaccine Clinic days to allow a large number of people the chance to simply come in and get their flu vaccine in a few minutes time.

The Flu Vaccine Clinic days will be held on three Saturdays:

September 21
October 12 and
November 9,
Each starting at 8AM. You can call now to set up your time for these days.

The outlook for our supply looks good, no shortages are expected.

Even so, due to regulations we have to limit our flu vaccine offerings to children in families, we are not able to offer influenza vaccinations to parents anymore.

We at Advanced Pediatrics are very pleased to be able to help make sure this winter is as healthy as possible.

*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.

2013-08-19

Dr. Lavin Publishes a Letter in The New York Times

English: Book 1, page 1, of De Rerum Natura by Titus Lucretius Carus, from the 1675 edition by Tanaquil Faber (Photo credit: Wikipedia)

Dr. Lavin Publishes a Letter in

The New York Times

On August 13, 2013, The New York Times published a letter to the Editor by Dr. Arthur Lavin on a topic of science.

Here is the link:

http://www.nytimes.com/2013/08/13/science/space/atoms-everywhere.html?ref=science&_r=0

The letter was in response to an article in the Science Times about the notion that everything in the universe is made out of the same stuff- atoms. That is, the atoms in stars, in trees, in rivers, in Saturn's rings, in birds, and in us, are exactly the same material.

The Times article noted that the first person to make such a claim made it in 1929.

My letter noted that this notion, that we are all made of the same stuff, actually goes back over 2,400 years to the Greek philosopher Epicurus, who developed the original notion of atoms made by Democritus over 2,500 years ago. The notion that stars, tables, and humans are all made of exactly the same material was deeply offensive to many religions early in their history, leading to a vilification of Epicurus.

That is why we tend to think of his thinking as simply promoting a life of pleasure, hence the phrase Epicurean. But Epicurus was not a hedonist, he was a very thoughtful philosopher whose core thought was indeed that we are all made out of atoms, that the atoms themselves are forever. But they tend to aggregate into various forms that are temporary. Some of these forms work well, some do not. Those that work well continue, and so he was the first person to write about natural selection and evolution. He did speak about pleasure, but his thought was that it is so extraordinary that of all ways atoms could combine, some form living beings, and against all odds, some form each of us. The moral of his view of things was that to be alive is so extraordinary, that each of us should be profoundly grateful to be alive and take pleasure in this tremendous gift. This was the pleasure he promoted, not hedonism.

Epicurus' philosophy was expressed in a magnificent poem by the Roman Lucretius about 2100 years ago, in a piece called De Rerum Natura. The reaction to Epicurus philosophy was so extreme that nearly every copy of this masterpiece was destroyed. For over a thousand years it was forgotten, until its rediscovery in a remote German monastery by a great Italian bibliophile in the 1400's. The rediscovery of this poem inspired thinkers across Europe, and revived the notion that we are of the same stuff as all else. Many credit the power of this idea coming back into European minds as a great source of the power of the Renaissance. We know, for example the poem had a great impact on Galileo and helped propel him towards his discoveries, which in turn created the foundation for modern science.

Lately science has gotten a bad rap. Certain products of science pose great risks to us, including military technology, nuclear reactors. Others cause great worry such as genetically altered foods. And science seems behind the relentless creation of products that continue to be hawked such as prescription drugs.

But science is also the entire basis of all the extraordinary benefits of modern life. We now live over twice as long as people did, as recently as 1900. Our children now live to adulthood nearly free of the once nearly universal threat of disease. Food is more abundant than ever in history. We live in clean homes that are adjusted to stay at a comfortable temperature the year round. And the explosion of information and innovation allows me to write this essay and have it available to everyone in the world with the stroke of one button.

So, enjoy the brief letter. It is a reminder that science was not always allowed to flourish in human societies. I do think we live in an era where science is vulnerable. Let the story of Epicurus and Lucretius remind us that we can only count on science continuing to help us live well if we defend the very idea of science.

My best,