Tuesday, December 2, 2014

Why I Don't Eat Muffins OR Why I Read Food Labels

Such a common purchase; a quick, easy and relatively cheap snack or "breakfast."  A food that somehow has earned the reputation of healthy, or at least neutral.

Do healthy muffins exist?  Yes, and I will elaborate below.  However, the healthy muffin is almost as elusive as the Easter bunny.  The vast majority of muffins, including the ones packaged to look like health food, are not.  Let's explore why.

SUGAR.  It's the main ingredient besides flour in the average muffin.  Even the ones with healthy ingredients like oats, carrots, fruit, and nuts often contain loads of sugar.  Worse, the fruit is often dried, which is not only high in sugar; it's also sticky.  It sticks to the teeth, giving them a sugar soak that bacteria adore (read this from the American Dental Association for more).  Sugar has zero health benefits, and causes or contributes to a host of health problems including, but certainly not limited to: weight gain, diabetes, cavities, and behavior problems.  Recently, the World Health Organization (WHO) dropped its recommended sugar limits from 10% of total caloric intake to only 5%, which means about 6 teaspoons for an average weight adult woman.  I am not opposed to occasional sugary treats, but I do not believe sugar should be in our healthy everyday foods.
Photo by Moyan Brenn; Flickr; no alterations

FAT.  Fat is not something I worry a lot about, especially for normal weight children.  There has been a lot of debate over the years about how much fat and what kinds of fat are acceptable or optimal.  All humans, and particularly children, need fat.  I won't get into the great fat debate here; I just want to mention that muffins often have a lot more fat than people realize.  A word of warning though: low fat and especially no fat muffins often have even more sugar than regular fat versions.  As I mentioned above, sugar does cause weight gain.

OILS.  Oils are not all created equal.  Some commonly used oils in muffins that are less than ideal are: soybean, cottonseed, and partially hydrogenated oils. 

Soybean oil is a problem because it is almost always genetically engineered.  Not everyone takes issue with genetically engineered foods (GMOs), and there is no science proving that they cause health problems in humans (other than allergic reactions).  However, the approval of GMOs was based on short term health studies.  We do not yet have solid long term data on how GMOs affect human health.  We do have data showing that they affect environmental health negatively, and that they have not solved world hunger, as they were supposedly intended.  There is a lot more to the story behind GMOs, but those are details for another blog.  Just be aware that if you want to avoid GMOs, you probably need to avoid soy oil.

Cottonseed oil is a problem not only because it too is almost always genetically engineered, but also because it is regulated as an agricultural product, not a food product.  Therefore chemicals (pesticides) not normally allowed in food production may be present in the oil.

Partially hydrogenated oils contain trans fats that can increase "bad" LDL cholesterol and decrease "good" HDL cholesterol.  Read more about these oils at the Mayo Clinic.

NATURAL FLAVORS.  Sounds fine right?  It may be, but it's ambivalent.  Here's how the FDA defines natural flavor:  "the essential oil, oleoresin, essence or extractive, protein hydrolysate, distillate, or any product of roasting, heating or enzymolysis, which contains the flavoring constituents derived from a spice, fruit or fruit juice, vegetable or vegetable juice, edible yeast, herb, bark, bud, root, leaf or similar plant material, meat, seafood, poultry, eggs, dairy products, or fermentation products thereof, whose significant function in food is flavoring rather than nutritional." Perfectly clear?  Basically, it's the byproduct of some type of processing of a flavor that is derived from a food or spice.  GMOs may be included here.  There is no clear data on the effects of natural flavors on human health, nor is there much regulation of these flavors.

ARTIFICIAL FLAVORS.  Sounds less fine, probably.  These are chemicals that are made in the lab, rather than extracted from a food source.  Any particular flavor's chemical composition may be exactly the same as that of a natural flavor.  They are used primarily because they are generally cheaper than natural flavors.  As with natural flavors, there is no clear data on their effects on human health, nor is there much regulation of them.
Photo by Susanne Nilsson; Flickr; no alterations

PRESERVATIVES and OTHER INGREDIENTS.  If you are a label reader, you know that packaged foods may contain a long list of ingredients you may struggle to pronounce.  The good news is that generally, food additives must be classified as "generally regarded as safe," or GRAS. While this determination is usually made by the FDA, the designation is sometimes made "independently from the FDA".  No, I'm not sure what they mean by that.  Does that mean that sometimes it's the industry itself that gets to label the additive GRAS?  I don't know.  Eater beware.

I would like to mention a few common and commonly debated additives:  propylene glycol, parabens, and sodium benzoate.   
  • Propylene glycol is manufactured from petroleum, and yes, it can be used as antifreeze.  It is known to be toxic when consumed in amounts larger than what would be consumed from diet (e.g. medications in a vulnerable patient such as an infant).  It is not known to be toxic or unsafe otherwise.
  • Parabens are commonly used in foods and cosmetics.  One study found parabens in all breast tumors examined.  However, that study does not prove that parabens caused the breast tumors.
  • Sodium Benzoate has been linked to hyperactivity in children.  Furthermore, it has been shown to react with added vitamin C to form the cancer causing compound benzene.

HEALTHY MUFFINS?  So, I lied.  I do actually eat muffins.  Healthy ones do exist, but they are usually homemade.  The bottom line is, read the labels.  Know what you are eating!  Don't assume because you buy it fresh at a bakery that it's healthy.   Here are some links to explore; please note, I do not get kickbacks from any of the links!
  • These are commercially available and healthy, but be aware; they have a dense and somewhat spongy texture.  
  • These homemade muffins are a big hit both at our house and our preschool (note: they are very soupy when they are raw, but cook up just like muffins).  
  • I have not made these, but they look great, and while they have some sugar, it's comparatively very little. 
If you prefer to know exactly what you are eating, and to be assured that your food was not made or altered in a lab, or genetically engineered, I suggest you stick with ingredients you can pronounce. 

WHO on sugar
Dietary Recommendations for Infants, Children, and Adolescents
American Hearth Association on Sugar
EWG on flavors 
EWG natural flavor safety rating 
FDA on food additives

Thursday, October 30, 2014

The Family Meal - Why Is It Good For My Picky Eater?

Picture This:
You eat special food, food that no one else in the house eats.  You eat alone, while your siblings and parents are off doing chores, watching TV, or playing.  When your curiosity and your loneliness get the best of you, and you get out of your chair to see what your family is doing, you are told to get back in your chair until you finish your plate.  That plate of food that is unique to you then becomes a punishment.  Make it disappear and you can join in the family fun.

Now Picture This:
You eat the same food everyone else eats, and you have, for as long as you can remember.  You eat when everyone else in the house is eating.  You all eat together, at the table.  You talk about your feelings, and what's gone on that day.  You commune.  It's quality time.  The food on your plate has never been strange, because everyone else is eating it and enjoying it.  For some families, this is the only time of day when everyone is together, when everyone gets to connect, and what's more enjoyable than eating while you connect?!

The first example is of course, extreme.  Most families probably fall somewhere in the middle of the two scenarios.  But my hope is to illustrate how a toddler sees our choices around food.  When you are an incessently busy parent, getting a nutritious meal on the table is just one more chore, done best with quickness and efficiency.  Or, is it?  Reworking the culture of food in our homes to include cooking, eating, and cleaning together, as a family, not only increases our own enjoyment of the evening routine, but goes a long way toward converting your once picky eater into a wholesome eater. 

You've heard me say before that getting your child to participate in food is a powerful tool in growing a healthy eater.  It's much easier to enjoy something that you participated in from the beginning.  Have your child, and the whole family, help you cook, set the table, and clean up after the meal.  Make dinner a family event.  And make it fun!  I'm not talking about a list of chores (set the table, chop the cucumber, spin the lettuce) that has to be completed before TV time.  I'm talking about the whole family in the kitchen, listening to music, having fun together while making a meal.  See my other food participation tips here.

You Eat What We Eat
Do not allow yourself to become a short order cook.  Cook one meal for the whole family.  If you are dealing with a picky eater, be sure you always cook at least one dish you know she likes (not the same one every time).  That way she's got something she can rely on for satiation, and other foods she gets to try.

Whether to insist on a "one bite" rule is tricky.  Some families do have success with this strategy (the child has to try at least one bite of each new dish), and some find that it creates food fights.  If you read my post "Growing Healthy Eaters," you know I don't condone food fights.  Whatever you do, do not set up a bribery / punishment system around trying new foods.  Either set the rule and make it clear you mean business, or don't.  But don't set up a system where a bite of vegetables wins them a brownie, or a failure to eat that bite results in a time out.

Resist the urge to be emotional about food.  Complements to the chefs and sous chefs should be encouraged.  However, going out of your way to say "yummmmm" when your toddler takes a bite, is counter-productive.  Children are naturally suspicious, so when an adult is over emphasizing the yum factor, they have to wonder why.  On the same note, adults and older children should avoid saying "I don't like this" or "I hate such and such food."  However, no one should be scolded for saying they don't like a food; just nod and say okay, and move on. 

Getting Out Of the Chair:
When to let kids get out of the chair is a bit of an art.  What you have to weigh is whether your child has eaten what seems like a fairly normal amount for him, at that time of day.  If he has, then let him go - no need to force him to ignore his toddler instincts to play, play, play.  This is yet another way to empower your child to make his own food choices, which helps remove the emotional restrictions from food.

If however, he has eaten only a small fraction of what he normally eats, and he just can't wait anymore to play with that shiny new toy that he just got two hours ago, it might be time to keep him at the table.  Try a calm but firm reminder that this is his last chance to eat before bed, and you don't want him waking up hungry in the middle of the night.  Again, this is about empowering your child with the information needed to make his own good choices.  Consider negotiating a few extra minutes after dinner before bedtime to play with that toy, but do not make this a recurring event.

These distraction scenarios are best prevented in the first place, by creating a structured and positive food environment.  In the case of the new toy, perhaps when you buy it, buy it in the morning, so he has all day to play with it.  Or, buy it 2 hours before dinner, but only after communicating clearly and firmly that the toy will be enjoyed after dinner.  And of course, make family meal time enjoyable, so it doesn't feel like torture to him.  Consider other situations which may arise that may distract from the dinner table, and brainstorm ways to prevent the distraction, or plan ahead for how best to handle it.
Credit USDA; Flickr; no amendments
Making Sure She's Full
A food culture to avoid is the one where the toddler eats a few bites, gets up to play, comes back to eat more, leaves to play, and continues this for two hours.  A meal is best eaten, warm, with the family, and in one sitting.  Breaking the "up, down" habit is much harder than preventing it.  In general, once your child has been dismissed from the table, he should not be allowed to return for snacking.  If you're wondering how to break the habit, that's mostly a question for a parent coach.  You'll need to establish the new rule with firmness and clarity that you the parents are in charge, but you'll need to avoid creating a negative environment around food, and sending him to bed hungry.

Making Sure She's Hungry
Have you ever eaten too many chips and salsa at the Mexican restaurant, and suddenly realized it only after your meal arrived?  You end up with a delicious looking piping hot plate of food that you have no appetite for.  Often, kids do the same thing.  They get hungry in the afternoon and fill up on a monster snack, and then have no appetite for dinner.  Watch what, and how much you are giving your child for snack.   Also, watch the timing of snack - too close to a meal will almost certainly ruin the meal.

No Magic Bullet
Some kids are more suspicious than others.  Some kids have a couple of years of less than ideal habits and ideas around food under their belts.  Following my suggestions once or twice will not turn your picky eater into a foie gras connoisseur.  However, reworking your family's food culture, while challenging, will, eventually, turn your child into a more adventurous eater and make meal time easier.

Thursday, September 25, 2014

Enterovirus D68

NOTE:  This post has been updated twice to follow new developments (see below).

The virus every parent is talking about.  Here are the facts:

According to the CDC, it has now been confirmed in 32 states, including Washington.  From mid-August to now, there have been 220 cases of confirmed Enterovirus D68.

I think whenever we as parents hear about a new threat to our children, we become at least a little more alert, if not downright afraid.  This virus is especially scary because it's spreading quickly, and it's landing kids in the hospital.  Find comfort in the fact that as of September 22, no deaths have been associated with Enterovirus D68 (Medscape).  Also, remember that every year the flu sends kids to the hospital too.  Finally, remember that not every child who goes to the hospital for respiratory distress tests positive for Enterovirus D68.  I say these things not to minimize the concern and the need for caution surrounding this virus, but to put those concerns in perspective for those of you who may be overcome with fear.

What You Can Do
A lot of what I'll suggest here echoes what I suggest every year as we go into cold and flu season.  Kids are starting school, the weather is changing, and with that come the inevitable runny noses, coughs, GI bugs and asthma attacks.  Basic precautions and a little kitchen table medicine go a long way toward keeping them well.
  • Wash hands.  I know you hear this one over and over and over, but it's for good reason. Researchers recently found that a virus placed on a single doorknob spread to over 50% of hands in that building within 4 hours.  Remember that kids are constantly touching their mouths, noses, and eyes, thereby giving germs direct access.

  • Manage asthma.  Most (but not all) of the kids ending up in the hospital have asthma.  Be sure you have recently visited your doctor, and that you have an up to date asthma action plan.  Also, be sure you are using all your preventive medicines:  discuss a steroid inhaler with your doctor, as well as herbs and supplements that can decrease attacks and their severity.  Finally, be sure your child always has access to her rescue medication.
  • Know the signs.  Respiratory distress can actually be missed quite easily.  The untrained eye might not notice anything wrong.  Review the signs with your doctor; any child can go into respiratory distress, not just those with asthma.  For more information on respiratory distress, see the "Unrecognized Respiratory Distress" section of my previous blog post.  If you do notice any difficulty breathing, call 911, go to the ER, or call your child's provider.
  • Support the immune system.  Your Naturopathic Doctor can recommend his or her favorites to you, but here are some of my most basic and easy tricks for getting through the winter:  (NOTE:  you should ALWAYS discuss any supplements, herbs, or medications with your doctor before taking them.)

    • Vitamin D: Your doctor can personalize your dose, but the American Academy of Pediatrics and the Institute of Medicine both recommend 600 iu daily for children over 1 year of age. 
    • Fish oil:  Unless you and your kids eat fish high in omega 3s several times a week, taking a supplement is indicated (although there are some people who need to be cautious with omega 3 supplements, or must avoid them completely).  There is no set dosage; discuss with your child's provider.  Be sure to get a good quality product that tests for impurities.
    • Probiotics:  Not just for the gut, these little guys are great at supporting the immune system.  As with fish oil, discuss dosing with your doctor as there is no set dosage, and be sure you get a good quality product so you know it will work.
    • Bone broth:  extremely rich in nutrients, including those that kick start the immune system.  If you are new to bone broth, Nourished Kitchen has a great introduction and good recipes.
    • Elderberry syrup:  Anti-viral, immune supportive, and great tasting, this is one I give myself and my kid every morning during the cold months.  Again, dosing varies widely, so discuss with your child's provider.
    • Get enough rest: The immune system works best when we are well rested.  Be sure your child is getting plenty of sleep.
    • Decrease sugar: this includes juice.  Studies have shown that sugar, including juice, dampens the immune response for hours after exposure.

  • Stay home.  As always, taking your sick child out not only spreads the illness to other people, but it makes recovery for him more difficult.  When we are sick, we should be home resting, not running errands, going to school or play dates.
A note on immune compromised children:  be especially sure that you have had a recent visit with your child's provider.  There may be extra steps you can take to protect your child, including certain vaccines not recommended for the general public.

While these tips may not keep your child from ever getting sick, they should lessen the frequency and the severity of illness.  As Benjamin Franklin said, "an ounce of prevention is worth a pound of cure."

Your local Health Department 

I have no affiliations to disclose.  Please note that this blog does not constitute medical advice; even specific supplement recommendations should be cleared by your child's provider.  Always be sure that you address any questions or concerns directly to your child's provider.

Unfortunately, Enterovirus D68 has taken a turn for the uglier.  It has been associated with paralysis in rare cases.  We do not yet know whether this paralysis is temporary or permanent.   We also are not certain that it is Enterovirus D68 causing the paralysis; it is possible that the people with Enterovirus D68 and paralysis have a co-infection with some other paralysis causing virus.

Furthermore, the CDC is currently investigating four deaths potentially associated with Enterovirus D68.  One of the deaths was not caused by Enterovirus D68, but rather by sepsis caused by the bacteria Staphylococcus aureus.  The girl did test positive for Enterovirus D68, but it is not entirely clear what role the virus played in her death.  The other three deaths occurred in patients who tested positive for the virus, but it is not clear yet what role the virus played in their deaths.

More resources:
Medscape "Paralysis in Children with Enterovirus D68"
Medscape "CDC Investigating Four Deaths Linked to Enterovirus D68"

Sadly, there has now been one confirmed death attributed to Enterovirus D68.  A four year old in New Jersey stayed home from school with pink eye, went to bed with no other symptoms, and did not wake up the next day.  Officials have confirmed the cause of death to be Enterovirus D68.  As you all know, I am the parent of a toddler; obviously I find this news terrifying.  However, what we have to do at this point is two things:  remember our immune support protocol, and remember that viruses like the flu actually claim many more lives every year.  I don't mean to make us all terrified of the flu, but just to put Enterovirus D68 into perspective.  So let's take our supplements, wash hands, and go out and enjoy each day as it comes.

More resources: 

Thursday, September 11, 2014

Don't Drink the Water?

Water.  Such a basic need that a lot of us take for granted.  In this country, we are so lucky to have (mostly) clean, safe water at our fingertips.   In Seattle, we are even luckier in that we have some of the best water in the country.

Water contamination does occur, but according to the EPA:  "actual events of drinking water contamination are rare, and typically do not occur at levels likely to pose health concerns."  But, what are the potential issues with water quality in this country?

Microbial Contaminants
  • Bacteria, viruses, and parasites can all find their way into our water.
  • In general, these contaminants cause diarrhea and vomiting.
  • Shallow wells are most vulnerable to this type of contamination, particularly after flooding.
Chemical Contaminants
  • Lead:  can get into your water from chipped lead paint or other contamination of source water (rare) or, more likely, comes from your own pipes.  Old homes are more likely to have leaded pipes, but new homes may have them too.  According to the EPA, certified "lead free" pipes may still contain lead that leaches into your water.  Find more information here.
  • Arsenic:  occurs naturally in the earth, or can come from industrial / agricultural waste.  Find more information here.
  • Other heavy metals:  cadmium, selenium, and chromium can all leach into water from the earth.
  • Fluoride:  occurs naturally in the earth, and can leach into the water at amounts that are high enough to discolor teeth.  (Yes, I have an upcoming post exploring fluoride in more detail.)
  • Nitrate: gets into the water via fertilizer.  High levels of nitrates can cause "Blue Baby Syndrome," which can be fatal.  It usually occurs in already ill babies who are drinking formula made with the water.

Is It Safe Or Not?  
Annual quality reports should be readily available for your municipal water supply.  If your jurisdiction reports to the EPA, you can access a report here.  Otherwise, try doing an internet search, or call your local jurisdiction.

Well Water Quality
Wells have a special set of potential problems, and are not regulated by the EPA regulations that protect drinking water.   Here are some highlights of potential well water contamination sources (this list is by no means exhaustive):
  • Radon
  • Bacteria (from septic tanks)
  • Barnyard runoff
  • Pesticide and fertilizer residues on re-purposed former farmland

Bottled Water Quality
Why not just go with bottled water to be on the safe side? 
  • You may be wasting your money:  bottled water may just be tap water!  This is according to an NRDC study; the same study found that bottled water was no safer or cleaner than tap water.  They found that some brands even contained contaminants above the legal limit allowed in tap water.
  • You are exposing yourself to extra chemicals:  plastic bottles contain phthalates and BPA, which may disrupt your body's hormone production, and may cause asthma.  For more information on phthalates and BPA, see WebMD, Medscape, and CNN.
  • You are increasing your carbon footprint:  all those bottles have to be made, and then recycled (if not put in a landfill); those processes have a great impact on the environment.  For more information on the environmental impact of bottled water, see this article.

What types of water are available in bottles?
  • Distilled:  boiled and re-condensed, which removes microbes and minerals and electrolytes.  I don't recommend distilled water, since we need minerals and electrolytes.
  • Spring:  collected straight from a natural spring.
  • Artesian:  collected from a well that taps an aquifer directly.
  • Purified:  could be collected from any source.
  • Mineral:  groundwater that naturally contains a specific quantity of minerals.
  • PWS:  public water supply
Water Filters
Water filters can be a great option if your tap water is less than ideal.  Consumer Reports has a useful article summarizing water filter options.  Remember to find out exactly what your filter can and cannot filter out!  Also, consider what's touching your water: if your water sits in a plastic reservoir or passes through plastic tubing, then you're getting filtered water at the high cost of BPA and phthalate exposure.


Special Populations
Newborns drinking formula, young babies drinking water for the first time, elderly people, and people with immune compromise are all more susceptible to water-born contaminants.  Before giving your baby water, whether it's straight or mixed with formula, consult your child's health care provider for his or her opinion on the best water to use.

Drink Your Water!
I'm always telling patients to drink more water.  Without it we die; without adequate amounts of it, we fall ill or show symptoms such as headache and fatigue.  So, take a quick moment to assess the quality of your water, and then, go forth and drink! 

EPA on drinking water
USGS on well water
EPA on well water
EPA on well water testing
NRDC on bottled water

Find more information on the problem of exposure to BPA and phthalates at:
WebMD Fetal Exposure to Plastics and Asthma Risk 

This blog does not constitute medical advice.  I have no affiliations to disclose.

Saturday, August 30, 2014

Sneaky Chemical Exposures - Sunscreen?

Is your sunscreen poisoning you?  The Environmental Working Group has a fabulous database ranking sunscreens in terms of the safety of their ingredients.  But it can feel a little overwhelming.  So let's break it down.

What's So Toxic About Sunscreen?  (Endocrine Disruption and Allergic Reaction)
Sunscreens block sun using either chemical or mineral (physical) filters.  Unfortunately, any of these filters can pose a risk to human health; fortunately, the mineral filters seem to pose much less of a concern. 

Several of the chemical filters are "endocrine disrupters," meaning they disrupt normal hormone function in the body, and several pose a high risk for allergic reaction.  The concerns with the mineral filters (zinc oxide and titanium dioxide) are limited, for now, to inhalation concerns (which is why spray sunscreens are not recommended, even if they are "safe" and "natural;" see below).  For more detailed information, refer to this chart put together by the EWG.

What's an Endocrine Disrupter?
This is an umbrella term for anything that throws off the normal hormone balance and functioning of the body.  The list of symptoms and disorders that can result from hormone dysregulation is vast.  Specifically, the sunscreen chemicals researched by the EWG were found:
  • To disrupt sperm production (animal studies);
  • To be associated (meaning not proven to cause) with endometriosis in women;
  • To mimic estrogen in the body (not just a problem for men);
  • To disrupt thyroid and reproductive system functioning (animal studies); and finally,
  • To cause behavioral problems (animal studies).

Mineral Sunscreen to the Rescue?
Not necessarily.  While mineral filters do have a better safety profile, you still have to be aware of the other ingredients in the sunscreen: certain ingredient combinations can cause a problem, and many "inactive" ingredients are less than ideal.  In fact, a whole host of problems can be associated with inactive ingredients.  The EWG database addresses the safety of inactive as well as active ingredients.  The EWG asserts that we need increased (FDA) regulation of these mineral sunscreens, and more research, before we can be sure that we are using the safest and most effective products.  But for now, it states that mineral sunscreens are nevertheless the safer option.  For more information on mineral sunscreen safety, read this article.

Bottom line: don't use them.   The FDA, Consumer Reports, and the EWG all have concerns regarding the safety of allowing kids to inhale the ingredients in these sunscreens, no matter how "safe" or "natural" they may be.  Why?  In a nutshell, these chemicals have been studied for safety as applied on the skin; they have not been adequately studied for exposure via inhalation, a much more direct exposure than skin absorption.  Some studies have shown them to be dangerous when inhaled.

Parents talk about how well their favorite sunscreen rubs in to the skin, and I'm sure some do better than others.  However, of the 4 that I have personally tried, none of them rub in any better than the other.  We look like ghosts for at least 10 minutes after applying.  So don't expect much - in my experience if it's a truly safe, natural product, it's not going to rub in well; it's going to absorb in slowly over time.  Take it as a reminder to apply well before going outside, which is what we should be doing for maximum efficacy anyway.

So How Do I Choose the Right Product?
The information available to us as sunscreen consumers is both vast and overwhelming, and frustratingly lacking.  I rely heavily on the research done by EWG in choosing sunscreens for my family.  I basically familiarize myself with their top rated products, and then make a final choice based on cost, availability, and what I do know of the ingredients.  They have not let me down yet.
What If I Use a Poorly Rated Sunscreen?
Don't get me wrong.  I believe that, in a pinch, any sunscreen is better than no sunscreen.  Skin cancer rates (melanoma) are on the rise.  Sun exposure does appear to increase risk for melanoma.  So if your choice that day is avoid the beach, get a sunburn, or wear a poorly rated sunscreen, then wear the poorly rated sunscreen.  But for the sunscreen that you will apply to your child, or yourself, day in and day out, I think it pays to find the safest one you can.

The Best Protection

Sunscreen is not the only factor in the sun safety equation.  Other important sun safety tips include:
  • Avoid it:  Avoid sun exposure between the hours of about 10 and 3.
  • Shade it:  Wear a broad brimmed hat that shades the face, ears, and neck.  They make great ones for kids that tie around the chin, contain SPF, and can be worn in the water.
  • Wear it:  Wear protective clothing - long sleeve shirts and light pants are your best bet when possible.  There are long sleeve "rash guards" for kids that can be worn in the water and contain SPF.
  • Protect the eyes:  Wear UV blocking sunglasses.
  • Do it right:  Sunscreen should be "broad spectrum" meaning it blocks UVA and UVB rays.  It should be applied at least 15 minutes before going outside.  It should be reapplied frequently, as per package directions.  
  • Don't tan:  All the evidence points to tanning beds being dangerous; don't use them, and don't allow your kids to use them.

Note:  The long held belief that using sunscreen decreases your risk for melanoma has become slightly controversial of late.  The controversy is outside the realm of this post, and I believe that protecting your child from prolonged sun exposure, and using sunscreen that blocks both UVA and UVB rays, is one of the best ways to keep her safe from melanoma.  

I have no affiliations or financial interests to disclose.  This post does not constitute medical advice.

Wednesday, August 13, 2014

First Food Choices - To Rice Cereal, or Not?

Everyone asks about it.  Some doctors still recommend it.  A lot don't. So what's so special about rice?

Iron Supplementation
When babies hit about 6 months of age, they start absorbing less iron from breast milk.  This happens about the same time that iron stores from birth drop.  This will be a problem for some babies, but not all.  There are symptoms of iron deficiency anemia, but most babies with low iron will show no symptoms at all.  So there's no way to know if your baby needs extra iron-rich foods or iron supplementation.  The idea behind rice cereal was to address this issue by supplementing every baby; add iron to rice, which is a food that most babies will not react to, and give it to every baby as a first food. 

The Problem
When you add iron, a constipating nutrient, to rice, a constipating food, you get a lot of constipated babies.  Furthermore, white rice turns to sugar quite quickly in the body.  Feeding babies rice cereal may be associated with problems such as diabetes and obesity in later life.   Note that this is certainly not a proven fact, and it is a hot and controversial topic right now.  One of the most noted rice cereal opponents is Alan Greene, MD.  You can read his piece on rice here.

Most importantly, there is arsenic in rice.  Brown rice used to be a good alternative to white rice, including for babies: it does not turn quickly to sugar in the body and has health benefits that white rice lacks.  However, there is more arsenic in brown rice than in white.  The FDA, Consumer Reports, and The American Academy of Pediatrics (AAP) all advise parents to provide a variety of grains to children, rather than just rice.  The AAP goes on to advise that it is best to provide children with a varied diet in general, and that vegetables, meat, and other grain cereals are all reasonable alternatives to rice cereal as a first food for baby.

The Solution
I do not recommend rice cereal, or any cereal as a first food.  I think cereals are a fine and necessary food for children, but they are not super foods like yams, spinach, blueberries, and salmon are.  Eventually you will introduce your child to grains; I just don't think there's any rush.  I recommend starting grains once you've established a good variety of vegetables, meat, and fruits.  At that point, whole grains can be a tasty, nutritious, and filling supplement to your child's diet.  Once you do introduce grains, limit rice, both white and brown, until the arsenic issue is resolved. 

Finally, let me be clear: some babies do need extra iron.  Some may even need supplementation.  This is something you really should discuss with your child's provider.  BUT, there are iron-rich foods that are not rice cereal.  Meat, broccoli, and dark leafy greens are all high in iron and great choices for first foods.   Note, however, that meat may also cause constipation in your little one.

I typically recommend yams / sweet potatoes (these are always mislabeled in the store - I'm talking about the ones with reddish skin and orange flesh), winter squash, and avocado as first foods.  Yams and winter squash are high in nutrients and lend themselves quite easily to baby food.  Avocado is rich in fats and also lends itself well to baby food. 

I do think it's a good idea to give vegetables before fruits.   Although there is no scientific proof to the idea of discouraging the sweet tooth by starting with veggies, it certainly doesn't hurt to try.  There's no limit to the veggies and fruits you can offer, but here are some factors to keep in mind:  broccoli, cauliflower, brussels sprouts, and cabbage may cause gas; bananas and apples may cause constipation.

There is evidence that baby's preferences for certain foods begin developing in utero, based on exposure via the placenta, and continue through exposure via the breast milk, and on through early food experiences.  For more on this idea, see this article.  In other words, now is the time to expose baby to a wide variety of foods and spices.  Keep this in mind as you are choosing first foods.

Tuesday, July 29, 2014

Sneaky Chemical Exposures - the Nursery

Baby's on the way.  You're busy nesting.  Painting the nursery, buying the crib, the dresser, the glider, the toy chest.  It's an exciting time.  But, the hundreds of decisions that have to be made regarding exactly what to buy can be stressful.  Well, add another stressor:  between flame retardants, formaldehyde-laced particle board, and volatile organic compounds (VOCs) in paint, you have a lot of chemicals to try to block at the door of baby's room.

VOCs are what gives paint that terrible chemical smell.  The EPA lists the following as side effects of exposure to VOCs:  "eye, nose, and throat irritation; headaches, loss of coordination, nausea; damage to liver, kidney, and central nervous system, as well as cancer.  Granted, the health effects of VOCs vary by specific compound (some compounds are not known to have any side effects) and by length and route of exposure to the compound(s).   Pregnant women and young children may be especially sensitive to VOCs.  You can find more information on VOCs here and here.

Fortunately, paint has come a long way.  There are now plenty of low- and no-VOC paints on the market.  Taking the VOCs out not only means your house doesn't stink to high heaven while you're painting and for days afterward, but also that you and your family are not sucking in hazardous chemicals all day and night.  These paints vary in price, just as high-VOC paints do, and are not necessarily more expensive.  Quality and performance can vary, just as they do with high-VOC paints.  So you'll want to research these matters.  Also, there doesn't seem to be a lot of oversight to the industry, and it seems some low- or zero- VOC paints do still put out that smell, leaving me to wonder if they are mislabeled.  So you'll need to research that as well.  When you're painting the room baby will spend half of his life in, it's time well spent.

Flame retardants and formaldehyde are the big ones to be aware of here.  Exposure to both has been linked to serious health problems. 

Flame Retardants are found in upholstered furniture, mattresses, carpet, and children's items such as car seats, changing pads, infant sleep positioners, nursing pillows and strollers.   

The following list references those problems that have been directly studied and shown to be linked to flame retardant exposure:
Formaldehyde is found in composite woods including MDF, plywood, and particle board; paneling; and some insulation.  

The following list references those problems that have been directly studied and shown to be linked to formaldehyde exposure:
Unfortunately, a blog on home safety would not be complete without a discussion of lead, radon, and air freshener.

Lead is found in the paint of old homes (pre 1978).  It can also be found in your soil, if the outside of your home was ever scraped or sanded improperly.  Most landlords tend to gloss over the lead clause of their leases, saying something like, "don't lick the walls."  There are two problems with this attitude.  One is that if you live with kids, they just might lick the walls, and eat the paint chips.  The other is that lead turns to dust easily.  That dust falls to the furniture and floor.  Your children then end up with that dust on their hands and lick them.  Also, everyone breathes in the dust.  Lead is the most problematic where paint is chipping and where doors or windows rub against wood frames causing lead paint to turn to dust.  If you have lead in your soil outside, your children may play in the dirt and thereby ingest it, or you may grow edible plants that may absorb it.  

Lead exposure in children can lead to decreased IQ; neurotoxicity; behavioral problems; anemia; liver and kidney problems; hearing problems; developmental problems; and in extreme cases, even death.  It can cause a multitude of problems in adults as well.  See more from the US EPA.

Radon is found in some homes and causes cancer.  It's quite easy to test for and can be an easy problem to fix.  See more from the US EPA.

According to the National Resources Defense Council (NRDC), air freshener may contain allergens, VOCs, and phthalates.  A study done by UC Berkeley found other harmful chemicals, as well as some which may be benign on their own, but react when sprayed to form such chemicals as formaldehyde.  Phthalates are associated with reproductive and fertility problems, possible insulin problems, possible weight gain and possible cancer.

So what can you do to decrease your child's exposure?  
  • Buy zero-VOC paint from a reputable source
  • Don't buy composite woods
  • Buy products known to be free of unnecessary chemicals
    • There's not a lot of regulation here, so an "organic" or "natural" label may not mean it's 100% safe
    • Buy products from a reputable source, or those that have been studied and proven safe
    • Check out Healthy Child for further guidance
  • Vacuum frequently with a HEPA filter
  • Wash hands frequently, especially before eating
  • Damp clean floors and surfaces frequently
  • Test your paint, inside and out, for lead
  • Test your soil for lead (note that this is controversial, and can lead false negative results) 
  • Avoid the use of air fresheners, even those labeled "natural"
For more information:
Healthy Child on Formaldehyde
EWG on Flame Retardants
Surprising Health Hazards in Your Home
Flame Retardants are Everywhere
Hazards in Berkeley Homes
Four Lessons About Formaldehyde
Furniture and Flame Retardants
Radon Resources
NRDC on Air Fresheners
NRDC on Air Fresheners
Science Daily on Air Fresheners