Daily Dose of DrGreene

Adult Diabetes and Kids

A huge study of millions of kids revealed for the first time the true measure of type 2 diabetes in children in the United States. The results appeared in the June 27, 2007 Journal of the American Medical Association. In the recent past, type 2 diabetes was called adult-onset diabetes because this obesity-related condition was a problem of the middle-aged and the elderly. It usually takes years of unhealthy eating to tip someone into this type of diabetes. It was rarely seen before age 30 or even 40. Sadly, today we do see type 2 diabetes in children. A family I saw yesterday had a 10-year-old who already had it. Pediatricians across the country are having similar experiences. But until this significant study none of us knew exactly how large the problem had become. Stunningly, 22 percent of all diabetes diagnosed in US children was type 2. And in kids aged 10-19, type 2 diabetes was more common than the autoimmune type 1 (previously called juvenile diabetes) – even though type 1 has also been increasing over the last 2 decades around the world. The consequences of overfed, undernourished, inactive lifestyles have reached from middle age into childhood. The message is clear: it’s time to feed our kids healthy amounts of healthy foods and to ensure that they get a liberal dose of active play every day.

Alan Greene MD FAAP

Preventing Allergies and Asthma with Diet

Why are nasal allergies and asthma so uncommon in children in Crete – even though genetic susceptibility to these conditions is moderately high? Researchers at the National Heart and Lung Institute in the UK did a detailed analysis of the children there, aged 7 to 18 years, and found some very exciting results that will be published soon in the journal Thorax. Unlike in America, 80 percent of the children in this study ate fresh fruit at least twice a day. And 68 percent ate vegetables at least twice a day. And those who did enjoyed clear benefits. For those in the study, eating grapes, apples, oranges, and fresh tomatoes (the main local produce in Crete) all appeared to be protective against both wheezing and hay fever symptoms. Eating nuts also appeared helpful, cutting the odds of asthma symptoms in half! On the flip side, eating trans fats, such as margarine, every week more than doubled the chance of experiencing asthma symptoms and more than doubled than chance of experiencing seasonal allergies! Overall, those who stuck closest to a traditional Mediterranean diet had a lower risk of symptoms of asthma, eczema, and seasonal allergies.

Asthma has skyrocketed in the last twenty years in many developed countries. This change has paralleled the move away from natural, fresh meals to fast foods with chemically altered ingredients. Intake of many protective nutrients found in foods has been falling, leaving kids more vulnerable to unhealthy exposures. Meanwhile, intake of processed foods has soared.

When taken together with earlier studies, it’s very motivating to help our kids learn to enjoy fresh fruits and vegetables and nuts. Even once or twice a week appears to be significantly protective, compared to less often. And of course, getting the recommended daily amounts is even better. Meanwhile, let’s wean our kids off trans fats, high fructose corn syrup, chemical dyes, and other ingredients that do nothing to help them thrive.

Alan Greene MD FAAP

The Asthma-Antibiotics Link

Why should you care about this if asthma does not run in your family? For the last quarter century, asthma has been increasing rapidly in the industrialized world and has become one of the most important chronic illnesses of children. It’s unlikely that this recent increase has come from changes in children’s genes. Instead, changes in diet, activity, and environmental exposures could all contribute. A number of studies have suggested a link between antibiotic use and asthma. But is it that children’s tendency toward asthma causes more respiratory infections and the need for more antibiotics? Or that greater antibiotic use can trigger asthma? To answer this question, the Study of Asthma, Genes, and the Environment has been following 13,116 children born in 1995. The results of the study were published in the June 2007 Chest. It looks like the antibiotic use can trigger asthma – probably by altering our internal environments by killing beneficial bacteria in the gut that are needed for optimum immune development. In this study, the children who received antibiotics in the first year of life were more likely to have developed asthma by age 7 – whether or not the antibiotics were for respiratory infections. Those who received more than four courses of antibiotics before the first birthday were about 1.5 times more likely to end up with asthma than their peers. The effect was strongest for broad spectrum antibiotics. The connection was clearest for children without a strong family history of asthma.

Antibiotics are important, life-saving tools. Nevertheless, it is wise to avoid over-using them. They should only be used where there is a considerable benefit to the child. And when they are used, it is wise to select the narrowest-spectrum antibiotic appropriate, in order to preserve beneficial bacteria when possible. I am also a fan of giving children probiotics and/or prebiotics whenever antibiotics are given, to help replenish the healthy, helpful bacteria in their guts. This could help reduce side effects (such as diarrhea) and help to prevent later allergic diseases such as eczema or asthma.

Alan Greene MD FAAP