Marc Joseph Nutrition - Blog

Oh my:

[T]he intersection of money and medicine, and its effect on the well-being of patients, has become one of the most contentious issues in health care. Nowhere is that more true than in psychiatry, where increasing payments to doctors have coincided with the growing use in children of a relatively new class of drugs known as atypical antipsychotics.

These best-selling drugs, including Risperdal, Seroquel, Zyprexa, Abilify and Geodon, are now being prescribed to more than half a million children in the United States to help parents deal with behavior problems despite profound risks and almost no approved uses for minors.

A New York Times analysis of records in Minnesota, the only state that requires public reports of all drug company marketing payments to doctors, provides rare documentation of how financial relationships between doctors and drug makers correspond to the growing use of atypicals in children.

From 2000 to 2005, drug maker payments to Minnesota psychiatrists rose more than sixfold, to $1.6 million. During those same years, prescriptions of antipsychotics for children in Minnesota’s Medicaid program rose more than ninefold.

Those who took the most money from makers of atypicals tended to prescribe the drugs to children the most often, the data suggest. On average, Minnesota psychiatrists who received at least $5,000 from atypical makers from 2000 to 2005 appear to have written three times as many atypical prescriptions for children as psychiatrists who received less or no money.

The excerpt above is from a recent NY Times article that provides an excellent “behind-the-scenes” look at the use and marketing of prescription antipsychotic drugs for children. It’s truly eye-opening. Read the whole thing.

Unfortunately, Minnesota is the only state that requires disclosure of drug company marketing payments to doctors. It would be great to see the entire industry-wide picture — and not just for psychiatric drugs.

Increasing Number of Diagnoses

Another question worth answering is why has there been such an increase in the perceived need for using these drugs with children?

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Environmental advocacy agency, Environment California (EC), just issued an interesting report titled, “Toxic Baby Bottles,” on the potential health risks of bisphenol-A released from common polycarbonate plastic baby bottles:

Press Release

Executive Summary

Report (PDF)

EC found that five of the leading plastic baby bottles leached bisphenol-A at levels greater than those shown to cause harm in several animal studies.

Bisphenol-A is an estrogen-mimicking chemical and a widespread environmental contaminant. From the press release above:

The U.S. Centers for Disease Control and Prevention found bisphenol A in the urine of over 95% of people they tested. Alarmingly, the median level of bisphenol A found in humans is higher than the level that causes adverse health effects in animal studies.

Sources

Bisphenol-A is commonly used to make clear polycarbonate plastic for baby bottles and is also found in:

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Last Fall, I posted on a study that looked at vitamin D deficiency among pregnant women in Northern Europe:

Vitamin D Deficiency During Pregnancy

And now, a new North American study has been released that both confirms and heightens the need for concern regarding vitamin D levels in both pregnant women and their newborns.

In this latest study published in the Journal of Nutrition, researchers looked at vitamin D levels in both black and white women and their newborns in Pittsburgh, PA. Over 90 percent of the women took prenatal vitamins during pregnancy.

What the researchers found was simply amazing:

• More than 83 percent of black women and 47 percent of white women had insufficient or deficient levels* of vitamin D at delivery.
• More than 92 percent of black newborns and 66 percent of white newborns had insufficient or deficient levels* of vitamin D at delivery.

* In this study, deficiency and insufficiency levels were defined as <37.5 nmol/L and 37.5 to 80 nmol/L, respectively. 80 nmol/L is recognized by most leading vitamin D researchers as a minimum level of sufficiency, with higher levels (e.g., 110 to 125 nmol/L) likely being more optimal.

Clearly, the current vitamin D intake recommendation for pregnant women (600 IU/day) is not adequate. Remember, nearly all of the mothers in this study were also taking prenatal supplements.

The results of this study give even more urgency to the call earlier this year for an increase in the vitamin D upper-limit (UL) recommendation.

Bottom line

Mothers and their newborns in Northern latitudes are at significant risk for vitamin D deficiency. Sunshine (UVB rays) hitting the skin is the primary source of vitamin D. And with many adults in sunnier climates diligently avoiding the sun and using high-number sunscreens, even mothers living in Southern latitudes are potentially at risk for deficiency.

As discussed here, adequate daily intake levels may be at least 2,000 IU/day, and possibly higher, for individuals not getting regular, limited sun exposure.

Ideally, you want to target a vitamin D (25-hydroxyvitamin D) blood level toward the high-end of the sufficiency range (45 to 50 ng/mL or 112 to 125 nmol/L).

Vitamin D isn’t just important for pregnant women and their children. It’s also key in helping to reduce the risk of:

• Several types of cancer (colon, breast, pancreatic, prostate, ovarian, etc.)
• Multiple sclerosis
• Influenza
• Nursing home admission
• And more …

Vitamin D is one nutrient in which you definitely don’t want to be deficient.

Nestle appears to be developing an infant formula that will include both probiotics (bacteria that help to promote a healthy gut flora) and prebiotics (substances that help to feed these bacteria and promote their growth).

Researchers just completed a study, published in the journal Nutrition, using a formula containing both pro- and pre-biotics. The probiotic used was a strain of bifidobacterium (often found in large numbers in infant digestive tracts), and the prebiotics used were galacto- and fructo-oligosaccharides.

They found that:

Infants in the experimental [formula + pro/pre-biotics] group had fewer incidences of constipation and had stool characteristics that suggest that the experimental formula was tolerated well. Furthermore, these infants showed a trend toward fewer respiratory tract infections.

Infants on the experimental formula also experienced a slight increase in stool frequency, but that is what is usually seen in breastfed infants.

Importantly, the researchers found no significant differences in weight gain, height, or head circumference between the pre/pro-biotics formula and control group formula groups in the study.

Of course, breast milk is preferred over formula for many reasons, including*:

1. Provides hormones that promote physiological development.
2. Provides essential fatty acids that improve cognitive and vision development - e.g., docosahexanoic acid (DHA), arachidonic acid (ARA). These fatty acids have been added to some formulas.
3. Provides immunoglobuins and other protective factors that protect against infections - e.g., immunoglobulins, colustrum, probiotics, lactoferrin, and more.
4. Possibly protects against some chronic diseases later in life - e.g., type 1 diabetes, hypertension, obesity, etc.
5. Protects against food allergies - lower incidence of allergic reactions - e.g., asthma, recurrent wheezing, skin rash, eczema, etc.
6. Intimate feeding relationship promotes attachment to and affective interaction with the mother. Encourages socialization and positive feeding behavior.

But, for those people who can’t breastfeed their infants, it’s good to see that manufacturers are trying to improve their products to encourage better digestive and overall health in infants.

*You can read more about the advantages of breastfeeding, with references to medical studies, at this site.

A recent New York Times article highlighted what has become a growing trend over the last few years: giving multiple psychiatric medications to children:

[A] growing number of children and teenagers in the United States are taking not just a single drug for discrete psychiatric difficulties but combinations of powerful and even life-threatening medications to treat a dizzying array of problems.

Last year in the United States, about 1.6 million children and teenagers — 280,000 of them under age 10 — were given at least two psychiatric drugs in combination, according to an analysis performed by Medco Health Solutions at the request of The New York Times. More than 500,000 were prescribed at least three psychiatric drugs. More than 160,000 got at least four medications together, the analysis found.

The numbers are amazing, aren’t they?

The article notes that there is evidence that suggests individual medications may be useful for certain conditions, but that there is “virtually no scientific evidence to justify this multiplication of pills.”

The majority of the child prescriptions are for ADD/ADHD and depression (click image to expand):

What’s going on here? Stimulants, antidepressants, antipsychotics and anticonvulsants in young children? Why the greater use of these serious drugs (many with significant risk for side effects)? Most importantly, why the increasing prevalence of conditions in children requiring their use?

I think dietary factors and toxin exposure likely play significant roles in the greater prevalence of these conditions and the use of these drugs in children. Taking multiple prescription drugs without a closer look at potential root causes doesn’t seem to make much sense.

The behavior of many children (and adults) with attention deficit disorders often significantly improves with a shift to a whole foods diet that eliminates chemical additives. For others, exposure to toxins, such as those found in some vaccines and in the environment at large, may be an underlying cause. Safely reducing a child’s toxic body burden may help to improve the situation.

You can read more about a better approach to ADD/ADHD that attempts to identify and address underlying root causes here.

The American Heart Association and the Clinton Foundation recently announced the Healthy Schools Program initiative as part of their own Alliance for a Healthier Generation.

The program sets up a criteria-based recognition program that recognizes schools that adopt nutrition and exercise guidelines. The nutrition guidelines include calorie, fat, sugar, and salt content of foods sold in the schools and served in the schools’ cafeterias.

With 16% of all U.S. school children (11 million) overweight (and that’s a 2002 number), the program is an admirable effort to help improve the nutrition and overall health of children.

Changing the system in dramatic and significant ways, though, won’t be easy. As mentioned in this recent interesting article (”The School Lunch Test“) highlighting the efforts of one group to implement improvements to several school districts’ food offerings, such efforts face resistance from both school districts and the children.

Surprisingly, as the article notes, some of the biggest resistance to change comes from parents. Without the parents on-board and reinforcing the healthy habits at home, it’ll be difficult to see significant change.

In this American Journal of Clinical Nutrition editorial, the authors discuss the important issue of vitamin D deficiency during pregnancy.

The authors mention a recent study of women in the Netherlands, and note that the study found that >50% (!) of darker-skinned women were deficient in vitamin D (whereas only 8% of fairer-skinned women were).

But the numbers were likely even worse than those. The study used a very conservative level of vitamin D to indicate vitamin D deficiency, one that was likely much too low.

The correct vitamin D form to measure for deficiency is 25-hydroxyvitamin D. The study used 25 nmol/L as the cut-off, while levels closer to 80 nmol/L are increasingly being shown in research to be optimal.

As the editorial notes, Vitamin D levels during pregnancy and the early years of development are critical not only for bone development, but also for the immune system and nervous system development — and may have lifelong implications.

It is difficult to get adequate vitamin D through the diet, since dairy is really the only food category that contains significant amounts of the nutrient.

The primary source of vitamin D is from sunshine. The sun’s UV-B rays hit the skin and a molecule is converted that starts a multi-step process toward the formation of active vitamin D in the body. Exposure to mid-day summer sun at the beach can generate up to 20,000 IU of active vitamin D.

In Northern latitudes during the winter months, the sun’s rays are not strong enough to generate sufficient vitamin D levels. Also, individuals with darker skin require significantly greater levels of sun exposure to generate adequate amounts of vitamin D.

Unfortunately, the U.S. government’s current recommended adequate intake level for vitamin D (200 to 600 IU) is set way below the level necessary to maintain vitamin D near optimal levels. As discussed here, adequate daily intake levels may be at least 2,000 IU/day, and possibly higher, for individuals not getting regular, limited sun exposure*.

During the winter months and in groups of people with limited sun exposure (e.g., infants, the elderly, darker-skinned people spending lots of time indoors), supplementation with vitamin D, either in the form of cholecalciferol or obtained via a good quality (toxin-free) cod liver oil will likely be important in helping to maintain adequate vitamin D levels.

(Vitamin D is a critically important nutrient that is commonly deficient. I’ll regularly revisit this topic in future posts.)

* Note: Neither vitamin D researchers or I are suggesting that you should spend a lot of time in the sun. Excessive exposure to the sun’s rays can damage the skin. The amount of exposure required for adequate vitamin D formation is brief — 10 to 15 minutes a day on the exposed arms/neck/face a few times a week during spring, summer, and early fall.

A small recent study took a look at how soy isoflavone levels changed in infants fed soy isoflavone-containing breast milk, in infants fed tofu, and in mothers drinking a soy protein beverage.

The researchers found that soy isoflavone levels increased significantly in mothers consuming a single soy protein beverage for 2 to 4 days, and by even higher amounts in the infants exposed to breast milk from these mothers. The increase in soy isoflavone levels in tofu-fed infants was even greater — more than ten times greater.

To the extent that the soy isoflavones have an estrogenic effect, these results suggest that nursing mothers and infants may want to avoid/minimize the consumption of soy products.

The estrogenic equivalent of five birth control pills.

That’s the amount calculated by one toxicologist of what an infant exclusively fed soy formula* is exposed to each day.

* Approximately 25% of infants in the U.S. are raised on soy formula.

And that’s just one example of the potential negative effects of sustained high-level intake of soy products. Elevated levels of metals such as manganese and aluminum are also concerns.

Additionally, Israeli and French public health agencies have recently issued warnings about eating high amounts of soy, especially by young children.

Two recent articles provide good overviews of the potential issues regarding soy in our food supply:

1. Should We Worry About Soya in Our Food?
2. Too Much of a Good Thing?

They’re both well-written and worth reading if soy is currently a regular part of your diet or you’re considering making it so.

My take is that the evidence on soy isoflavones is inconclusive. I’m
skeptical of many of the pro-soy studies given their funding sources. There seems to be enough research evidence to raise significant and reasonable questions.

For an unbiased look at the research evidence for soy in preventing and treating disease, see this link.

Whether it’s heart disease, prostate cancer, osteoporosis, or
menopause issues, there seem to be other reasonable and
effective diet and supplement alternatives that provide benefits
without the potential risks associated with soy isoflavones.

Interesting article discussing the changes in the size of the average American since the 19th century.

The big surprise discussed in the article is that even though people today are on average 25% heavier (and only ~3″ taller) than people in 1850:

• Life expectancy is ~20 years longer
• Chronic illnesses are now occurring 10 to 25 years later than they used to
• And the average IQ has been increasing for decades

Exactly why is unclear, although much better nutrition during the first two years of life and avoidance of deadly infectious diseases are thought to be primary factors.

An interesting read. Check it out.