New Guidelines for Fighting Obesity and Heart Disease in Children

There are new recommendations on cholesterol screening, and much more, just issued by the National Heart, Lung and Blood Institute (NHLBI). TheirBob Tozzi at the November 2011 AHA Conference mission is clear from the document’s title: “Cardiovascular Risk Reduction in Children and Adolescents: The New NHLBI Guideline.”

The document is in direct response to the alarming proportion of children who have markedly abnormal cholesterol levels and evidence of atherosclerosis – a disease normally thought of as an adult medical problem. These recommendations are designed to help reverse the epidemic of obesity and the related diseases that are growing at an alarming rate in our children.

At the November 2011 American Heart Association Convention in Orlando, as I observed the NHLBI presentation about these new and much-anticipated recommendations for preventing heart disease in children, I looked around at the sparsely-filled room. It was set up with seats to accommodate 600 professionals. There were fewer than 200 in attendance. Perhaps this was because it was an evening presentation, or maybe it reflects physician frustration at the enormity of the public-health issue of obesity, with its secondary problems of hypertension, hypercholesterolemia and resultant heart disease.

In any case, the guideline document needs to be widely disseminated within the medical community.

The comprehensive NHLBI review began with a computer-generated initial list of 1 million articles. The final document incorporated the best-of-the-best research on the topic, representing a derived-consensus document.

These are the significant take-away points:

  • High cholesterol in children is related to the development of heart disease in the adult.
  • With the obesity epidemic, cholesterol levels are rising even higher. Reduction in obesity will lower cholesterol levels.
  • Early intervention is needed for hypercholesterolemia and poor health habits in children (the behaviors as well as the diseases continue into adulthood).
    Initial management for abnormal serum cholesterol is education about healthy diet and exercise.
  • Healthy diet-education is best handled with the entire family involved and a dietitian.
  • Examples of healthy diet include the DASH diet and the Mediterranean diet.
  • There should be universal screening for elevated cholesterol for ages 9-11 years.
  • There should be earlier screening for high-risk individuals.
  • Medications may be needed in about 1percent of children (upwards of 200,000 children).
  • Parents must increase the activity level of children and reduce TV and computer time. The recommended activity level for 5 years and older is one hour of moderate to vigorous exercise per day.

Quite simply, this list should be posted in every pediatric physician’s office across the United States.

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Where Have All the Parents Gone?

It was a typical office day…

“Dr. TOZZI, she will not LISTEN to me!” shrieked the irate mom, pointing to her daughter. “Tell her that she CANNOT have Chicken McNuggets and supersized fries for dinner. That’s all she wants to eat!”

Rebellious teenager gone wild? Not this time: This was about an overweight four-year-old girl.

Truth be told, I could substitute a boy or girl of any age for this four-year-old, and the story would be the same.

I remember listening to this particular mom because it was not one of my shining moments as a giver of good counsel. Perhaps like any parent with a history of disciplining unruly youngsters, I had heard enough by the time the woman uttered the word “McNuggets,” and this time I responded poorly.

I turned to the mother and said, “Why should I tell her? Is she old enough to drive? No – she’s a child – you have a responsibility here.”

It was, as I say, an unfortunate reaction.

We as parents, teachers and health professionals must slow down and take the time to teach by structured example.

We must support each other as parents, and share experiences and knowledge. Most of all, we must be willing to set limits and make the tough choices. It may be fast food now, but it will be drugs, alcohol, and risky behavior next.

Confronting our responsibilities as parents in the early years earns us the moral authority (and respect) that we will need in those later years to steer our growing children away from harmful temptation and the pitfalls of peer pressure.

Are Your Supplements Killing You?

Certain benefits that have been widely publicized for many years regarding dietary supplements may be ill-advised at best, according to a recent study in the Archives of Internal Medicine.

Indeed, one might almost say that confusion abounds. This new study on women’s health reports that dietary supplements are resulting in a higher mortality rate for women. But before we start to panic, let’s look at a few facts.

1) This study was conducted on older women with a mean age of 61 years.

2) Those taking iron supplements showed the greatest risk of earlier mortality.

Excess iron in the bloodstream is associated with increased atherosclerosis and subsequent heart attacks and strokes. It acts as a catalyst that increases the risk of free radical damage to the vascular system and associated tissue, thereby accelerating the aging process.

But back to the study.

When attempting to analyze this study, the most important piece of information is that these women are in a post-menopausal group that would no longer need to take extra iron to maintain health. After loss of menses, the risk of iron-deficiency anemia is low, and the risk of over accumulation increases.

Of course, most women who are trying to stay healthy are probably getting enough iron from fortified foods and dark green vegetables, as well as the occasional intake of red meat.

So here’s the bottom line: Iron supplementation is needed for the iron-deficient person. This is much more common in younger women, especially those who experience a heavy menstrual flow each month.

So, my recommendation for older men and women is to be smart, have blood work to check your iron status. Unless you receive a doctor’s indication that you are iron deficient, it’s best to skip that vitamin that contains iron.

High Cholesterol in Children: To Screen or not to Screen?

When there is a family history of early-onset coronary artery disease, or a family history of high cholesterol, the current recommendation is to screen a child for elevated cholesterol levels. In addition, screening for high cholesterol is required if a child is obese or suffering from childhood forms of hypertension or diabetes. It is currently recommended that this screening should occur between the ages of two and 10 years.

Unfortunately, these recommendations do not go far enough, and physicians risk missing many cases of significantly elevated levels of cholesterol in children.

How early should parents intervene in order to prevent potential development of coronary artery disease in their baby? The answer is that it is never too early to intervene.

A little known medical fact is that the damage caused by high cholesterol, called dyslipidemia, can begin to occur before a child’s birth, during fetal life. The diet and eating habits of the mother during pregnancy lay the groundwork for blood vessel development in the gestational fetus. After birth, the single most important and protective food a child can consume is its mother’s breast milk. Many studies have shown that breast-fed children develop far fewer chronic diseases as they grow into young adulthood, with fewer incidences of obesity, hypertension, diabetes and heart disease.

When being transitioned away from breast milk or formula, children still need a certain intake of fats, but these need to be healthy fats. Between one and two years of age, low-fat dairy foods are acceptable, and above two years of age, non-fat dairy can be introduced as part of the regular diet. When integrating eggs or meat as part of the daily menu, it is best to be assured that both poultry and cattle were raised as grain-fed livestock. A grain-based diet for these animal sources results in foods that have a higher concentration of healthy fats for the child’s intake.

To screen or not to screen may be the question of the day, but the answer to being healthy lies in what you eat. The following foods and adjustments to diet have been proven to lower serum cholesterol:

  1. Whole citrus (the pulp absorbs cholesterol)
  2. Nuts and seeds (ligands bind cholesterol)
  3. Ground flaxseed (ligands bind cholesterol)
  4. Soy protein
  5. Chick peas (hummus)
  6. Fish or fish oil 2 grams per day
  7. Dark chocolate
  8. Dark green vegetables like spinach (they are the anti-diabetes food and a good source of Omega 3)
  9. Whole grains (even instant oatmeal)
  10. Reduce the simple sugar

Eat the fruits and vegetables that stain your clothes (these tend to come from the more moderate climates like the Mediterranean region). In general, limit the fruits from the more tropical regions. Tropical fruits are healthy, but they tend to have higher free-sugar content, and if consumed to excess, they may increase the level of bad cholesterol.

Finally, do not forget the best exercise: Walking. Walking is the live-longer, anti-diabetes and lower-your-cholesterol sport for all weathers and all ages, starting in early childhood – just as soon as your toddler learns to stand on his or her own two feet.

In fact, in the healthiest cultures, there is a common proverb that sums up the basis of health living: “We have with us at all times two doctors – the right foot, and the left foot.”

Technology & the Natural Approach to Medicine

Cardio TheaterAs recent medical history demonstrates, it is not a question of making a choice between natural approaches to health vs. technology.

What is required is a new synergy that can only come from a greater human respect for nature and the natural needs and responses of the human body, to be followed by the intelligent application of lessons learned.

Man’s technological arrogance has led us down a mistaken path in medicine on more than one occasion, only to reveal the damage that results from a lack of applied wisdom.

In the 1980s, a study was designed to test how we could improve the survival of men who had suffered a heart attack.

The first trial was meant as a study of the efficacy of Drug A. When Drug A caused statistically more deaths when taken by study participants than if no drug had been taken, it was abandoned. A new trial was begun to study the efficacy of Drug B. The result of the tests using Drug B was the same as the tests using Drug A: More men dying. Based on the overall results, the entire study was eventually abandoned.

Some years later, a review of the study revealed that the men who were more likely to survive had one peculiar thing in common: They were frequent dog-walkers.

But was this really an unpredictable revelation? Walking has been perceived as man’s best medicine since it was first proclaimed as such by Hippocrates in 450 BC.

What should we do with this knowledge? Prescribe scooters to overweight post-MI patients? Operate on patients with coronary artery disease who could have been treated, along with obesity, hypertension and diabetes, by regular walking? Perform leg-bypass operations on individuals with claudication who could have been equally well treated with a regimen of walking and a healthy lifestyle?

Or do we come to a realization that spending billions of dollars bailing out the automobile industry only fuels the fire of mass inactivity – regardless of the effects on the manufacturing sector and the broader economy.

Curiously, the relatively new phenomenon of “exergaming” may be one persuasive answer to preventing obesity, diabetes and hypertension in our youth.

Exergaming is the catch-name for video games and technology-based activities that result in calorie burning. One of the more commonly known exergames is Wii Fit. The problem is that “evidence exists that spending time outdoors is the strongest correlate of physical activity among preschool-aged children,” as quoted from the July 2011 Archives of Pediatric & Adolescent Medicine, 2011; 165(7): 667-669.

I have repeatedly cautioned about using technology-based answers to problems that are for the most part a result of technology dependency.

An easy, simplistic example that highlights the unintended consequences of this type of approach is the handicapped scooter. With obesity at the root of so many of our nation’s health and financial problems, we have companies marketing scooters directly to the public as a medically necessary device. At first glance, these scooters may appear as a great solution that enables handicapped people to be mobile indoors and out. But the ultimate effect is that the overweight diabetic person moves less, resulting in more weight gain, worsening diabetes and the deterioration of vascular health. This further results in even poorer blood flow to the legs, further limiting the patient’s mobility.

Which leads me to conclude by reprising another oft-repeated piece of advice that I impart to all of my patients.

Do not forget the best exercise: Walking.

Walking is the live-longer, anti-diabetes and lower-your-cholesterol sport for all weathers and all ages, starting in early childhood – just as soon as your toddler learns to stand on his or her own two feet.

In fact, in the healthiest cultures, there is a common proverb that sums up the basis for healthy living: “We have with us at all times two doctors – the right foot, and the left foot.” Words to live by.

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