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OBESITY & HIGH FRUCTOSE CORN SYRUP

October 5, 2013

In 2011, the CDC  (Center for Disease Control) conducted a study of obesity in the United states and found that since 1980 the rate of obesity and type 2 diabetes mellitus sky rocketed over 100% of what the rates were in the 1960’s and 70’s.  What went on since the 1980’s to have such a drastic effect on this rate? In the 1980’s small farmers were drastically losing control of their farm business because of the emergence of big corporate food industries like Monsanto and Sysco.  There used to be small hardware stores in most neighborhoods until Home Depot and Lowes took over.  It’s hard to find a corner hardware store anymore. The same thing happened with the food industry. Small farmers could no longer compete. Well, if you now have a large conglomerate, for profit, public company, the number one priority is developing large enough profit margins to satisfy stock holders and maintaining the financial health of the company.

The tip of the human tongue has receptors that detect sweetness.  This is a very powerful stimulus to the brain that habit formation is quick to develop.  Who doesn’t like sweets?  Prior to the 1980’s most of our drinks and foods that called for sweetness used cane sugar. In fact, many other foods that we normally don’t associate with sweetness will have a small amount of sugar to create a habit for that particular brand. Caffeine is a good analogy here because neurologists certainly are aware of the habituation we humans have toward the drug and hence food and drink manufacturers added this to their products (i.e. soft drinks) so that we would be sure to come back and get that product again. Sugar cane does not grow well in the USA; most of its production comes from Central American countries like Trinidad, Haiti and the Dominican Republic.  This is one reason why these countries were so valuable to the French and other European countries because this “new spice” was even better than those found in the East Indies and China.

So, to use sugar in your foods as a major company you had to import the stuff and that cost money.  It’s logical that a major company, in order to increase the profit margin, would adopt a policy of “spending low and selling high.”  In the 1980’s chemical scientists working for the food industries began working on a new sweetener.  After much experimentation, they found the answer. Take corn which grows readily in the USA and extract its starch.  Dry the starch and what you have now is corn starch. Corn starch contains two sweeteners called fructose and glucose.  You simply had to add an enzyme chemical to the corn starch and you get these two products. Glucose didn’t pass the test for a sweetener because it simply was not sweet enough. Fructose was somewhat sweet (it’s the stuff that makes fruits sweet) but not as good as cane sugar.

So what the researchers did was to concentrate the fructose making it taste like cane sugar.  Now you have what we call high fructose corn syrup (also called modified corn syrup, modified corn starch, corn syrup solids).  It passed the taste test!!  Since then food manufacturers have been using high fructose corn syrup in everything!  Check the ingredient labels of your food in the pantry and as you go grocery shopping and you will be surprised as to how many products contain high fructose corn syrup.

Now here is where gets is “kinda” technical.  When we consume cane sugar (also called sucrose) it has to be broken down in the intestines.  This takes time and SLOWLY the products of cane sugar enter the blood stream.  The pancreas is the organ that takes the sugar in the blood (glucose) and acts like a security clearance agent that allows the glucose to enter every cell of the body for energy.  The more glucose, the more the pancreas has to work; the less glucose the less the pancreas has to work.  Fructose does not have to be digested and it RAPIDLY goes into the blood stream right after consumption. Well, this is OK to some degree (such as eating fruits) but if we have highly concentrated fructose rapidly enter the blood stream it overworks the pancreas.  When the pancreas is overworked the level of insulin produced by the pancreas is high and this is a signal to the brain to increase fat stores and do everything possible to increase body fat.  Since the pancreas is overworked, it will eventually become exhausted and fail at its function. This is when diabetes steps in.  The more we consume concentrated fructose the worse things become.  Down the road, heart disease, kidney disease and certain forms of cancer develop.

It’s cheap for the food industry but it is a slow poison to us consumers. This is the reason we are seeing not only high frequencies of obesity in children but also the emergence of type II diabetes. Pediatricians never thought they would be treating adult type diabetes in 12 or 13 year olds. We never though some of our patients would become so obese that the scales to weigh them were inadequate.  We never thought that our blood pressure cuffs couldn’t fit around their arms because of such obesity.  The life expectancy of those with extreme obesity certainly will be cut short. I will never forget a 15 year adolescent who was over 400 pounds and died that year from sleep apnea and heart failure because of his weight.

Sooooo,  What are we to do?  For all of us, get out and do something physical!  The body will pay you back for it. The next thing is to try reducing your consumption of high fructose corn syrup.  Do your grocery store research; look at the ingredients.  If it has high fructose sweeteners,  PUT IT BACK!  Although more expensive, there are usually substitutes that taste just as good if not better.  The body takes its time adjusting to new lifestyles; so be patient. After 4 to 6 weeks you will notice and see changes that will make you smile; not simply because of the way you look but more importantly, how you FEEL.

….till next time,

Dr. “D”

CHILDHOOD SAFETY

February 19, 2013

This blog is geared mostly to parents who have toddlers and young children but not limited to that age group.  I am going to assume that you have certain safety practices in place such as a car safety seats, guard rails and even outlet plug covers. Over this Winter I had encountered several accidents described below that should serve as good reminders.

A two year old boy “eyes” a coffee mug belonging to the parent near the edge of the table.  The cup contains hot tea that the mother just brewed and took a sip from. Mom was quick at catching the child’s desire to grab the cup and moved the tea toward the center of the table. You would think that all is well but moments later, when Mom was “off guard” the toddler pulled a chair over to the table, proceeded to climb onto the table and grabbed the cup. Well, that hot tea poured over the forearm resulting in a second degree burn, a trip to the hospital, lots of pain and parental guilt.

A four month old infant was placed on the exam table by the mother prior to my arrival so that a fresh diaper could be applied. The mother was by herself. When turning to retrieve a new diaper, WHAMM! Down goes the baby onto the floor. The intense scream caught my attention and upon my arrival the mother was understandably frantic with tears streaming down her face. Fortunately, the baby was not harmed.

A two and one half year old boy was in his crib as usual and one morning finally was able to exert enough muscle power to “pole vault” the crib’s guard rail. All was doing well when the toddler was at the top of the rail but when trying to descend toward the floor for freedom the right foot got caught and the boy was suspended head hanging downward and screaming louder than the alarm system. When the parents came to the rescue, they noticed the right thigh was grossly swollen. The emergency room evaluation revealed a spiral fracture of the right femur bone requiring surgery. The battle with Child Protective Service did not make it any easier for the parents. The child did well after all was said and done.

We had a round glass coffee table in the living room that was about three quarters inch thick. There were no sharp edges and the top was heavy enough that it seemed to present no problems.  My son (why is it always the boys?) loved to run into that room and use the table as a brace to stop his momentum. This went on for months so it was considered safe.  Well, one day the usual impact resulted in the table top tipping over. The weight of the top certainly would have caused a fracture of the foot or toe but what was earth shattering was that the glass broke in half right in front of him. Thanking all angels in heaven, he was not cut or injured in any way. We, as parents, were mortified. The table was never replaced.

The case I will never forget involves a one year old girl who, while exploring the floor, found Mom’s recently lost diamond earring stud. When Mom saw the child with it, suddenly time slowed down as Mom saw the child place the earring into the mouth and swallow it despite Mom’s attempt to run over and abort the mission. After finally reaching the child’s mouth, yep, it was gone! “My child has eaten my precious anniversary given diamond ear ring stud!” That’s when I got a call. Syrup of ipecac was given (over the counter) by mouth and after drinking some water the child vomited and the ear ring was recovered.

Over the 2012 year I cared for about 12 children involved in fairly serious auto accidents many involving the total destruction of the vehicle. I am presently involved with driver training for my last child, and what I realized, is that when you are teaching a teenager to drive defensively, you realize how inconsiderate other drivers can be even when there is a “rookie driver” sticker on the car. Despite the wide use of money making photo cameras throughout the D. C. area, when the coast is clear you see the release of frustration by many drivers speeding and cutting in and out of lanes. Placing your child in an automobile is one if not the most dangerous things we do to our children and we do it almost daily. When strapping them in simply give thought that this may be the time you get into a bad accident.

Just a few more comments.  While raising children there is one thing I’d suggest you NEVER have; a deep fryer. Third degree burns give rise to lifelong scars that surely will influence the psyche of that person eternally. Every child will have accidents no matter how hard you try to avoid them. Don’t be so hard on yourself with blame; assuming that you are doing your best.

See ya!

Dr. “D”

ABOUT OUR TEENAGERS

June 1, 2012

I was in a McDonald’s restaurant one Saturday afternoon after doing yard work and noticed four teenage males sitting at a table and having fun with their rambunctious conversations. The volume was loud and became louder. The cursing was mild and then became volatile. The “MF’s” the “N” word were in every sentence. The hats were carefully placed upon manicured braids and dreads. The blue jeans were tightly wrapped around the thighs so the “proud” buttocks could be imagined under the dirty underwear.

I didn’t budge very much since this is commonplace in the Washington D.C. area as probably in all urban areas. I kept reading my book as I continued to refresh my thirst with my cold drink.  Two fellows got out of their seats and began to play “tag” running around the eating area like four and five year olds.  The other two proceeded to do the same.  After a while the eating area transformed into a circus; the four teens acting like fools and the audience very quiet but attentive to what was going on.  I looked at the members of the audience and there was fear in their minds.  “I’m not going to get involved” I could imagine them saying.

At this point, my mental kettle began to hiss. I wasn’t sure I was upset at the teenagers or whether I was mad at the “do nothing” patrons. After a few more seconds, my primitive brain took over;  I couldn’t take it anymore!  It was deplorable behavior and frankly embarrassing to me because these kids were of my own African American race.  I stood up, came over to one of the boys, injected a very serious look into his eyes and told him to “cool it right now!!’ “You guys are acting like you WANT to be arrested when a patron secretly calls the police. What could have resulted in a confrontation with me and the teenagers turned into them looking at me with fear and eyes so wide open and apologetic. “I’m sorry mister” he said to me. I later sat down with all of them and explained how Michelle Alexander’s book, The New Jim Crow, explains how their behavior is profit material in the new prison industrial complex. THEY ACTUALLY LISTENED like no one has ever explained this to them before. They were all quiet now, sitting and apologetic again.

I then left what could have turned into a bad scene.

The lesson here is about fear. “You shouldn’t get involved; they may have a gun” is what we adults all hear. “Let the police take care of it.”   The above may all be true.  Approaching a teenager in public requires a great deal of sensitivity, however.  Let them know you have concern for them;  after all,  you are protecting them from what could result in a lifetime of derailment and an emerging hostile adult.  Be firm but not accusatory.

You will be surprised and renewed about the power you have as an adult. It may help when you have to chastise your own teenager when they challenge you,  often to the point of confrontation

They may look threatening but they are just physically grown up kids still.  Remember that.

…….talk with you soon,

Dr. “D”

MUSIC TO MY HEART

February 24, 2012

I was entering the exam room the other day to perform a routine physical exam for an eleven year old child. Nothing was unusual. Smiling faces from child and mom lifted the spirits and pleasantries were exchanged. What immediately flashed in my eye was a brand new iPhone with bright pink and silver ear plugs attached to the child; nothing unusual.  Since I am a music lover way back to elementary school, I am always curious as to what the young folks are listening to. “Can I listen to what you are hearing, I said.” As the ear phones were placed into my ear, I immediately started tapping and bopping to the rhythm. It was a female rapper. I inquired as to who it was but that info is not pertinent to my main take home message. What was different with this song was that I could clearly hear the words she was saying. What was more surprising was WHAT she was saying!!

I realize sex and all of its subsidiaries are central to lots of rap lyrics. It’s also central to American capitalism.  So to hear about sexual content on a rap lyric is no big thing as long as there is some discretion. What I heard on this piece was absolutely appalling.  The artist began begging her partner to explore and manipulate EVERY orifice of her body with every conceivable part of his body. (This is a nice way of saying that if there was such a thing as audio only pornography, this was it.)  There were no metaphors (which I could have better tolerated) to captivate the art of suggestion. Clear cut wording was what I heard. And by the way, the foul mouth cursing seemed mild compared to the content of her words.

So what is up with this experience?  I continued to bop and tap to conceal my astonishment and slowly removed the ear plugs from my ears. What bothered me was this was an eleven year old girl listening to this in front of her mother. I did not make a big deal out of this then because I had to calm my emotion of shock in order to be balanced. Obviously it continues to bother me so this is why I write about it.

Mom’s and Dad’s, I know you like your music relevant to what you grew up with, but do your own “study” on what your kids are listening to. Ask them to inform you of the latest rappers and video artist. Listen to them TOGETHER with your kids (they may be embarrassed but that’s ok). It’s a good intro into having family discussion about sex anyway. Our culture is such that this kind of entertainment WILL be out there for them no matter what. It is your job to put all of this into context as to:

  1. Maintaining your own morality within a sea of immorality
  2. Understanding that immorality sells
  3. Look at the target audience and surmise what influence media moguls would like to mold you into.

By the time that eleven year old begins his or her introduction to sexuality, there is already a preconceived acceptability about sexual inappropriateness. Sex and sexuality is part of being human. It is a very wonderful and enjoyable entity. I tell this to teenagers. It is a process however and not an immediate act to be followed because famous celebrities (and their money suppliers) promote it. The process should be slowly started by Mother Nature and guided by adults. Only then will the result be a healthy sex life which is important for long term adult committed relationships.

Oh, and by the way, don’t think that I am not going to bring this subject up to the mother I mentioned. I am sure the mom bought the IPOD; she has a right to listen to everything on it!

….talk to you later this Spring….

Dr. “D”

The FLU Confusion

October 11, 2011

By now I am sure you have seen plenty of visual and radio advertisements about getting your flu shot. Every drug store seems to be in on it. We physicians are called, e-mailed and faxed weekly about stocking up on flu vaccines. I got a call in June from a pharmaceutical rep pushing the sale of flu vaccines and encouraging me to start giving the shots in the summer. Wow!

Influenza (also called the flu) is an illness that usually starts in the winter and can continue until next spring. The majority of times the illness last for 5-7 days and is characterized by fever, malaise, body aches, headache and the typical cold symptoms of nasal congestion and cough. The majority of times people recover without problems. People who are at risk for complications are the very young (under 2 years of age) and the elderly.

When pharmaceutical companies make the vaccine (which is done for every year) they are guessing what strain of virus is going to be present that year. Sometimes they are right; sometimes they are wrong. It is clear that the flu virus changes every year- this is called changing the strain- If one gets a flu shot and it is not the particular strain that arrives in the winter then the shot is of no value. Generally, the side effects of the vaccines are minimal. There will always be the potential for someone to get severe side effects such as damage to heart muscle, allergic reactions and neurologic problems such as Gullain-Barre and Reye’s syndrome but these are rare. This poses a dilemma for the individual if they realize the shot may not work and there are possible side effects. Focus has been on encouraging the young and old to get the vaccine but this is the age category that is at greater risk for further morbidity if a serious complication arises.

The vaccine is available in a nasal spray for those over 2 years of age. This type of vaccine is what I encourage because of ease of administration, better protection of the blood and mucous membranes and fewer side effects. The time to get the vaccine is obviously close to the time of the disease. It takes about two weeks for the body to develop antibodies to fight the disease so any shot or spray given two weeks prior to winter is fine.  In our area of Greater Washington D. C., our winter usually kicks in during late December or January. I generally don’t start giving flu vaccines until late October; getting a flu shot very early may weaken one’s antibody level to fight the disease.

Of practical concern are the measures one can do to prevent getting the flu.

These include:

  1. Focusing on good nutrition;
  2. Increasing sleep time an additional hour more than usual;
  3. Airing  out your home or office or daycare center weekly for 15 minutes by opening windows and allowing for fresh air if possible;
  4. Using  HEPA filters in daycare centers and the work place would be great;
  5. Practicing good hand hygiene with good hand washing and use of sanitizers.

Fortunately the cost of the vaccine is not too expensive. The average cost around the country is about $30.00

I’ll talk to you again in December!!     Happy Thanksgiving!!

THAT ADOLESCENT TALK TIME

June 30, 2011

As I view the streets during morning and lunch time I no longer see the familiar sights; no school buses, no students, no uniforms; summer is here! It may mean easier commutes, a little more peace and quieter streets, but just remember it’s an excellent time for our teenagers to find trouble.

I have learned to believe that out of all bad things that happen in life there is goodness that emerges from it. The media has recently exposed many negatives of our adult world; Mr. Weiner ( along with Edwards, Spitzer, Ensign, Lee, Foley, Mark Cisneros, Craig, Livingston, Vitter and former President Clinton) has exposed to our teens our low level of adult morality. It simply is deplorable. Since teens subliminally model after our age in life, it makes since to find teens engaged in things shocking to us.

Moms and Dads, I’ll let you in a secret your teenagers don’t want you to know. Oral sex as well as same sex exploration is “in.” Many confiding teenagers have discussed this with me since it appears to bypass the fear of contracting HIV and pregnancy. (seems logical) Now don’t get me wrong; sexual intercourse is still alive and well. The use of condoms is well understood intellectually but there are times when intellect goes out the window. Other than alcohol and the use of marijuana, sex seems to fill the void teens seek for excitement. It is a valuable mark of esteem to let other teens know they not only have a boyfriend or girlfriend, but that they are adult like and “mature” enough to be sexually active. Think about how much esteem junior must have when they talk to freshmen or sophomores about their sexual escapades. This is their secret world you are not suppose to know about. What is worse is that our society isn’t handing out many options for teens to fulfill their lives.

It is incumbent upon you as the individual parent to:

  1. apologize to your teen about our low level of morality even if you uphold a high one yourself;
  2. let them realize the consequences these aforementioned politicians will have to deal with for the rest of their lives- the embarrassment, shame, family discord, depression and unemployment; and,
  3. (this is the most difficult) exposing your own adolescence to your child.

What do I mean about number #3?  The “sex-drug and alcohol talk” should NOT be focused on the child.  It is not about “ I don’t want you to do this or I don’t want you to do that.” Rather it should be about telling them the parables of your own teenage life. I bet you’ll find their ears intensely “glued” to your conversation. Remember you are the most impressive role model for your child; the emergence of a duplicated morality set may not emerge immediately, but with time and maturity you will see your children take on much of your own character. Now this implies that your character and level of morality as a teenager was fairly good. Suppose it was NOT good and you were one of the most difficult teenagers your parent(s) could ever imagine. Suppose you were sexually active at a young age, suppose you were “busted for drugs or alcohol”, suppose you had a child during your teen years. That is OK as long as you can atone and tell the rest of the story as to how you have survived, learned and prospered from those “dark” times. Tell them that “if I had to do it all again” story. They will understand. You don’t have to be very graphic or detailed; they know how to fill in the rest themselves. And remember, these stories should come from both Mom and Dad.  It offers great dinnertime conversation and can sometimes be entertaining and fun.

Our teenagers have free will; what they don’t have is a complete set of internal rule books to effectively govern their own behavior. That’s what they are working on. That is the essence of adolescence. Yes, sometimes they will make the wrong choice be it small or large. Just remember, of all the negative things we may have to correct or clean up as parents, our children will always gain from bad experiences. This gaining may not become evident immediately, but trust that it will ultimately emerge.

I’ll write again next month, until then take care.

Dr. “D,”

Spring Allergy

April 15, 2011

I am sure everyone of us is looking forward to warmer weather, short sleeve shirts and the return of environmental beauty. Spring is here!  Unfortunately about 20% of you have allergies and of that number, about 2-5% of you have allergies to tree pollen. When the temperature of the air sustains itself above 50 degrees day and night, the buds on deciduous trees begin to open up releasing pollen grains throughout the air. Tree pollen is big; you can see it on your car and when really bad, the windshield wipers are of necessity. Along the eastern seaboard, most of our pollen comes from the Allegheny mountain range as well as our local tree population. The pollen count you hear on the news is the amount of pollen grains in a cubic centimeter of air (about the size of large garden pea) Pollen counts in the range of 200-500 cause the eyes and nose to itch and lots of runny noses and sniffling and sneezing. In May the pollen counts reach into the thousands however and this poses serious health hazards to those allergic to it. It is not uncommon for a person to have breathing difficulty so badly that a visit to the emergency room is needed. Often times admittance into the hospital is needed.

Tree pollen begins to fall late May especially if you’re fortunate to have lots of rain.  By Memorial Day tree pollen is usually spent and finally those who suffer can go out to play!

The most important aspect of treatment is avoidance of the pollen.   This means keeping windows up on the cars (even during beautiful comfortable days) and your homes.  Running the AC in your cars or homes helps.  Avoid long outings.  Children in daycare are most vulnerable since they will invariably go outside during the day. Riding bikes of any kind is traitorous.

If you must be outside to cut grass or watching a game, wearing close fitting sunglasses help. Over the counter allergy medications are of limited help since the pollen counts become ridiculous.   Of importance is using medications to directly treat the eyes since the surface of the eye ball doesn’t get a blood supply.  Many times doctors use a combination of antihistamines, allergy prevention agents and sometimes steroids.  If you remember suffering last year during the Spring, it would be wise to prospectively see your doctor for treatment before it gets too late.  Those of you who have asthma should definitely check in with your doctor; it may prevent all the costly aspects of being hospitalized.

Enjoy your Spring!  But don’t get too close!

Dr. “D”