Dude Looks Like a Lady

Wow, it’s been a whole year since my last posting. I need to get back on the horse… how about another diet review…

I've been hearing a recent diet fad lately is taking the hormone 'hCG'. In doing my research, I found, it’s actually not new, and has been around since the 1930s. hCG stands for Human Chorionic Gonadotropin. It is the hormone than women make when they are pregnant, and the one that is detected in the urine for pregnancy tests. The basic theory doesn't sound too crazy. It is based on the idea that women who are pregnant and don't eat enough for their fetus just burn fat and not muscle, so if you take it when you diet, you should burn fat more specifically. It also has claims that it decreases feelings of hunger. There are two ways to take it orally or injection. And the earth shattering surprise: in addition to the daily dosage it is recommended to have 500 cal/day diet!

Hmmm, where do we start on the issues with this one? First off, I don't know how many pregnant people you know, but appetite suppression isn't one of the things I use to describe them. In fact with my wife's last pregnancy, the moment I really knew she was pregnant was when she wanted 'Animal Style' french fries from In-N-Out several days in a row. One order every 6 months or so is usually enough for her.

Plus, there are very few hormone therapies that can survive digestion, so those of you who take it orally are basically just taking whatever products are left after it passes through your stomach, which likely don't resemble or act like hCG at that point.

Most importantly, multiple studies (some even 50 years old!) have been shown that there is no difference between those taking an injection of hCG or placebo as far as weight loss or hunger pains go. In other words... it just plain doesn't work. So why all the attention? A guy (Kevin Trudeau) wrote a book about it in 2007 entitled,The Weight Loss Cure 'They' Don't Want You to Know About. I'm not sure who 'they' are, but I'll tell you what HE (Trudeau) doesn't want you to know about... He has been investigated by the FTC (Federal Trade Commission) for promoting all kinds of fake medicines and as of 2004 has been banned by said Commission from appearing in any infomercials on TV. Source: http://articles.latimes.com/2009/nov/02/health/he-nutrition2/2

Ease of following: As easy to follow as any 500 calorie/day diet. Which should be read as = hard. In my dieting experience, the lowest I ever got was 1200 cal/day and at that point I was constantly hungry and bit anyones head off that crossed me. Throw in daily injections and I'd say its not that easy.

Medical safety: It probably won't cause any major problems, but some side effects that have been reported are: headaches, mood swings, depression, blood clots, confusion, and dizziness. Women who use this hormone can also develop Ovarian Hyperstimulation Syndrome (OHSS), which is usually mild, but ironically can result in weight gain. And if you are a guy you could start to look like this:

Or this:

I do have concerns of living with a prolonged diet of 500 calories. You are basically starving yourself, and if done for a prolonged time you could suffer similar consequences of those with anorexia nervosa. If you decide to stop the diet after a prolonged period, be very careful not to increase your intake suddenly, even to a normal level, as it may cause ‘refeeding syndrome’, which is a common cause of death among anorexics.

I generally would not recommend ever being on a diet of 500 calories for any amount of time, but some people like to do it to ‘kick start’ their diet, and if you feel so inclined, I wouldn’t do it longer than a month. Decreased calorie diets are not only recommended, but needed, but you can go too far. For the RIGHT way to do so see my previous post:

http://exwandering.blogspot.com/2009/03/dont-count-me-out.html

Check this one out, too (because diet can’t do it all):

http://exwandering.blogspot.com/2009/04/body-movin.html

Chance of keeping weight off:

Almost zero unless you add to this diet a long term diet/lifestyle change to keep your calories down (but obviously not this low)… FOREVER. If not, weight will be regained, plus more. Starvation diets such as this decrease metabolic rate, and therefore will cause you to gain MORE weight when you return to your old habits. Which most people do.

Conclusion:

A friend of mine in medical school used to sit around and make plans for a diet supplement we were planning on making that just consisted of lawn clippings in a capsule with the recommendation of: “Best results obtained when used with a combination of diet and exercise changes.” Apparently this diet beat us to the punch. It is a sham is just about every way possible.

But if you are the type of person who is sensitive to placebos and need a kick start to your diet, I guess you could do worse. But seriously, I can sell you some capsules with lawn clippings for a lot cheaper than you are probably paying for the hCG. And PLEASE do yourself a favor and make plans for what changes you are going to make in your life AFTER the diet, or you will end up heavier than when you started…

More on the hcg diet:

http://health.howstuffworks.com/health-illness/wellness/physical-fitness/weight-loss/hcg-diet4.htm

http://www.dietsinreview.com/diet_column/07/hcg-diet-look-elsewhere-for-weight-loss/

RSV - P

Sorry, I've been on a bit of a hiatus from blogging. There were some crazy times around the extended Dr Jay family, and it's winter. Which makes pediatricians like me very busy. If this blog continues on for years and years, you will probably always see a slow down in the winter. Which brings me to my topic today, as it is the thing keeping me so busy right now: RSV.

Annoying call from emergency department or urgent care physicians (I know I disparage these poor folks, and most of them know better, but its the few that drive me crazy): I have a 2 year old kid here who has had several days of runny nose, cough, and fever. He looks great, but I tested him for RSV and it was positive, so we need to admit him.

Me: Doh! Where did you go to medical school?

There are many problems with what this ED/UC physician had to say, but its meant to illustrate that even many health professionals don't understand RSV all that well.

Lets have a little Q and A on the subject:

Q: What are the symptoms?

A: Most people who get RSV get a cold-like illness: runny nose, cough, fever, etc. This virus more than most other viruses produces TONS of snot. (I held back posting my snot pictures due to the reception they got last time). Some people, especially infants develop severe disease.

Q: What are the chances my baby will get RSV?

A: You should know that RSV is VERY common. Almost EVERY child will get it before they are two years old. VERY FEW of them are sick enough to need hospital admission.

Q: Which infants are a risk of getting severe disease?

A: The younger, the higher risk. Especially those who are premature (usually less than 35 weeks) or have significant congenital heart defects.

Q: How do you get it?

A: You mostly have to come in contact with the virus and then touch your eye/nose/etc. The virus can live on surfaces (doorknobs, shopping carts, etc) for many hours. There is some transmission by inhaling droplets, but you have to be within 3 feet of the sick one, and they basically have to cough in your face. Wash your hands!

Q: How long are you contagious?

A: The virus can be spread for a 3-4 weeks in nasal secretions after infection (but usually only for a week). Take home message #1 for this: if your child is in daycare they will get it. Take home message #2: Wash your hands!

Q: How can I prevent my kids from getting it?

A: Those high risk patients can get a very expensive vaccination once a month during RSV season, usually just premature babies and those with heart defects. If you think your baby may qualify, talk to your pediatrician. Wash your hands (and your kids')!

Q: I heard my child can only get this in the winter, is that true?

A: Kind of. It can happen at any time of the year, but for reasons not completely understood the VAST majority of cases happen within one month of the start of the outbreak. It seemed to hit here in California mid January, so we've got at least another week or so of the onslaught. If you child has had a cold the last few weeks or gets one the next few weeks, it is extremely likely that it is/was RSV.

Q: What do you feel is the most frustrating thing about RSV, Dr Jay?

A: Hmmm. This question doesn't sound spontaneous, a little forced. Almost as thought this conversation is scripted or something. RSV is one virus that DOES NOT confer lifelong immunity. So if you've had it once, congratulations, you can get it again. It is felt that we likely get RSV over and over again throughout life, but it isn't followed too much after childhood because it is usually mild disease from then on.

Q: My child was hospitalized for RSV, someone told me that it will give him asthma for the rest of his life, is that true doc?

A: Yes. I mean no. I mean I don't know. Babies that are hospitalized for RSV tend to develop asthma later in life. It really depends on if you are a fan of the chicken or the egg. I think I'm an egg fan, in that I think those kids who were going to get asthma anyway are likely the ones to get severe RSV, not that the RSV causes asthma. Or does that make me a chicken fan?

Q: What is the treatment?

A: You are going to love this: fluids, rest, etc - you know the old cold/flu/virus protocol. Infants only need hospitalization if they are having difficulty breathing, needing extra oxygen, or if they are so sick they are refusing to drink (and thus getting dehydrated).

I wanted to run, but she made me walk...

Have you reached a plateau in your workout, weight loss routine? Do you just want to get 10 more pounds off? I've got a great suggestion for you... INTERVAL TRAINING.

Just a few months I was feeling stuck in my routine of running 30 minutes three times a week* (with weight training interspersed on other days). I substituted interval training for one of my 30 minute cardio workouts, and dropped 10 pounds quickly. My other runs during the week got faster, too.

The fitness guru pediatrician at my work says he tells marathon runners that they aren't really in shape unless they do anaerobic exercise. I wouldn't go that far, but it really does make a big difference.

Anaerobic exercise means it can't be sustained for extended periods of time without resting to breathe. (As opposed to aerobic exercise that theoretically can be maintained indefinitely - jogging, aerobics, etc). Here's where interval training comes in. Interval training is mixing in high intesity workouts sporadically (in intervals) with low intesity workouts. Some explanation and suggested workouts can be found here.

I personally run around a squarish park with 4 equal sides (not perfectly, but close). We'll say each side has distance of X. I sprint at about 80% of my max for 2X (two sides) and then walk one. I do this for 30 minutes and get a great workout.

If you haven't tried it, give it a try. It doesn't take any more time, just takes more calories.

*For the record, most health providers are recommending 5 cardio workouts a week (including myself). Yes, I usually only can make it to 3 a week, but I'm working on it, too!

Meat is Murder

Now on to the next of my diet reviews. I'll just clump all of these in the same bunch: Protein diet, low carb diet, Atkins diet, South Beach diet, etc.





They are basically all built around a basic concept: increase the protein and decrease the carbs. What you do with 'fat' varies from one diet to the other. Here's the secret (and the thing you can really take away from these diets when coming up with your own personal diet): protein/meat has relatively low calorie density (compared to carbs and fat) but helps you feel satisfied sooner and stay full longer. So in other words, this is another low calorie diet 'in disguise'. You'll see that ALL weight loss diets are just way to get you to eat less calories.

Ease of following: In the short term, not too difficult, especially if you are a carnivore. Due to the popularity of these diets, there are tons of recipe books and frozen dinners available. In the long term, some people have hard time staying on a diet with so many rules. Some are more strict than others on the amount of carbs you can take. The 'no carb' diets can be very difficult, because carbs actually make up a high percentage of Americans' diets and are difficult to avoid.

Medical safety: Pretty safe. There are some concerns about the extreme diets that force your body into ketoacidosis (due to no carbs) which is basically a form of starvation. WARNING: any time your body thinks its starving the metabolism slows down, and you NEED exercise to keep it up. All weight loss diets cause your metabolism to go down to some extent, but these tend to do so a little more (theoretically). Also there are some that feel so much protein can be hard on the kidneys if the diet is maintained for an extended time, but I haven't heard that this has shown to be true when studied.

Chance of keeping weight off: If you stay on the diet, it will. But if you come off of the diet, you will likely gain the weight back and more (due to decreased metabolism) if the diet was done without exercise. The best practice would be to transition to a more 'regular' diet that still keeps the calories down enought to maintain your weight.

Conclusion: It works... But long term is rarely successful.

What you should take from this diet: LEARN about calorie content in your food. Eat foods you like, but limit your portions to limit your calories (see previous posts on this). But feel free to add some additional protein in if you are finding it difficult to stay satisfied/not hungry before your next meal.

Don't Look Back In Anger

Parent complaint: "Everytime I ask my three year old to do something he doesn't want to do he flips out. He seems to be full of rage. I'm worried he will turn out to be a serial killer or something. Please FIX HIM."

Diagnosis: Normal

While I can't promise that any given three year old won't turn out to be a serial killer, this behavior definitely doesn't guarantee it.

You may also be worried that they will turn out like this woman:



Again, I can't make any promises. I do have some advice, though. The answer is the same one you hear when you go to therapy for any relationship: communication. Your child still has limited vocabulary and it can be frustrating to want to say something, but not know how. Plus, ever since they were a baby, the way they got attention was by crying. Here's a few tips to help your toddler/preschooler with their 'rage' issues (actually most of these work at any age):

- Help them identify their feelings by pointing them out yourself. Example, "It looks like you are really disappointed that you can't have any more red hot Cheetos."
- It is important that you remain unemotional in your exchange. It shows your child that emotions don't have to heightened for every trivial matter. Plus, yelling at them only seems to fuel the fire at times. (My wife will readily admit that this is one area I have the hardest time with)
- Encourage them to 'use their words' instead of tantruming. Only give them what they want when they ask in a calm voice. Example, "It seems like you want these red hot Cheetos, but you can only have them if you uses your words in a calm voice." If you give them what they are 'raging' over without improving their behavior, you are just rewarding their rage, and it will be harder to overcome later.... which leads to my next point.
- Ignore. We've heard this one from when we were kids. "Why can't you just ignore your little brother, he's only doing it to get attention." Well you'll find its even harder as a parent to ignore it. There may be a component of attention-getting to their behavior. The less attention they get, the less reward they get. My parents always tell a story of a preschooler tantrum I threw at a movie theater once laying on the floor and kicking. They said they just left me there and walked away. I stopped my tantrum, jumped up and ran after them. Apparently that was my last tantrum.
- Work on your own feeling communication. Explain to your child why you are doing what you are doing. Don't say, "because I'm the daddy, that's why." Say, "I don't want you to have any more red hot Cheetos because you've already eaten a lot, and we are going to eat dinner soon."
- Positive reinforcement. When they respond in a 'grown up' way give them a reward. A sticker. A healthy treat. While they usually won't choose it over the other things, physical affection (a hug, etc) seems to work best of all. "I'm so proud of you that you were able to talk in a big boy voice instead of whining" (accompanied with a hug). Kids are suckers for that crap.

The good news is most people grow out of it (ignore the woman in the airport above). Through your excellent parenting skills you can help them get there sooner rather than later.

Fell free to add any comments of methods you have used to share...

Flu update

There have been many developments on the 'swine flu' front, so I thought I'd give my readers an update... I guess we are now calling it H1N1 to start off...


I'll be honest and admit that there was a much more significant outbreak this summer than I expected. It is still about equivalent to the regular flu for your average healthy individual. Here are some numbers you may be interested in: H1N1 deaths in the US = about 300. Number of deaths of regular flu per year in the US = 36,000.

We have learned a few things about this new strain of flu: It seems to be harder on pregnant women than previous strains of flu. There seem to be some concerns that it is easier to develop secondary infections (like pneumonia) from this strain than the average American strain. This risk seems to be increased in the teenage/20-something age group than 'regular' flu.

Things to do to protect yourself now, and during flu season
1) Get vaccinated (more on this later)
2) Be free with the hand sanitizer/hand washing especially before touching your eyes, nose or mouth (they both work!)
3) DO NOT wear a mask. There are very few masks (which are currently in low supply) that work for more than a few minutes against flu particles. In fact, wearing a mask in public may increase your risk of getting it, because it may make the flu particles get lodged between the mask and your face, increasing exposure time. You can wear a mask if you think you have swine flu to keep it from spreading to others, but do yourself and others a favor and just stay home (the CDC recommends staying home until your fever is gone for more than 24 hours).
4) Take antiviral medication. One of the antiviral medications appears to be more affective against this strain than others, but it is in short supply, so you may not be able to get it unless you are at high risk of developing severe disease. Ask your doctor if you are concerned.

5) Get plenty of rest, exercise and a healthy diet while you are well to keep your immune system up. Always good advice!

Should I vaccinate my family?
Unfortunately the regular flu shot isn't very affective against H1N1, and as of this year, the H1N1 strain is too new to be added to this year's flu shot. They are, however, feverishly working on developing an H1N1 flu shot. Which means this: you will have to get multiple shots to be protected from all strains of flu this year. It will likely be combined in the future, but not now.

Some people feel it isn't worthwhile to get vaccinated against something that probably won't kill you, since you are healthy. In fact, there's a good chance you won't even catch it. You may be right, unfortunately, your kids don't fit in that group. I highly recommend getting the flu shot (flu shot's' this year) if you are a kid or have kids. ESPECIALLY if you are pregnant or want to become pregnant. 6% of the swine flu deaths have been pregnant women. Here are the target groups the CDC gives for those who should be vaccinated this year:

- Pregnant women
- People who live with/provide care for infants besides being a pediatrician - and everyone knows pediatricians love to torture children with needles): kids are the vectors! Studies have shown that just vaccinating school age children signficantly decreases the load on ALL OTHER demographics. Kids spread germs. That's the reality. You decrease the germs amongst the kids, and everyone is better off.


For more info, see the CDC webpage on H1N1
http://www.cdc.gov/h1n1flu/

Senses working overtime

"Doctor, my 3 year old totally has ADHD. He cannot sit still. He has a hard time concentrating and staying on task. Can I get something to help with him? Please FIX HIM!"

Diagnosis: normal 3 year old.

ADD/ADHD (I'll just refer to it as ADHD from here on out because I'm lazy) seemed to be all the rage in the 90's. Seems to now to have taken a back seat to 'Autistic Spectrum Disorders'. It is still relevant, and while it doesn't get the press/publicity of autism, it is definitely more common.

First question: Does it really exist, or is it just a reflection of a generation of bad parents?
First answer: Yes, it does exist.

There are many kids that seem to very obviously have this diagnosis. The medication to treat is consists of a group of stimulants. If you give someone a stimulant and it CALMS THEM DOWN, I'd say that's pretty good evidence that they have some 'crossed wires' so to speak. It is a highly genetic situation, so kids with it are likely to have parents that suffered similarly as a child (and some continue to as adults).

Second question: Does my child with ADHD need medication?
Second answer: Maybe.

Parenting plays a large roll in ADHD. No, a bad parent cannot make a child get ADHD. There is something that genetically predisposes these children to behave they way they do, but poor parenting can really bring it out. Parent training has found to be so beneficial that many kids not longer need medication after their parents learn the right way to 'parent' them. Most of this training focuses on teaching the child organizational skills including making daily schedules/routines, simple and CONSISTENT house rules, close supervision, and a reward system that focuses on effort, not necessarily results. Sleep schedule is extremely important, as lack of sleep really exacerbates the symptoms. In fact, sometimes obstructive sleep apnea is misdiagnosed as ADHD. So if you have a hyper child that snores, get that checked out. After all that, though, there will still be a quite a few children that will need medication to function well.

Third question: Isn't it just easier to give them a pill to pop than to learn how to be a better parent?
Third answer: Yes.

Studies clearly show that even with medication, proper parenting techniques are invaluable. Do your kid a favor and get the training you need in order to give them the best chance to succeed. I will admit, though, I have had some parents that are so disorganized and ADHD themselves (its genetic, remember) that I don't even bring up parent training, because I don't believe in exercises in futility.

Fourth question: If I eliminate sugar from his diet, will he be normal?
Fourth answer: Probably not.

There are may people out there trying to sell their diet plans to help with ADHD. There is very little scientific basis for this. Most of the time, it is the case of a person who wants to prey upon someone else who is desperate for help (which describes pretty much any parent of an ADHD child). That doesn't mean they don't help at all. There may be a diet component, but I think these dietary needs can vary wildly between children. I don't see any problem trying different diet routines, as long as it doesn't but an undue financial (or other) stress upon your family. NONE of the diets work for every child. The parenting techniques described above help to some extent for EVERY child. Start with those, then consider diet therapy, but keep your expectations low and your wallet tightly closed.