Too Much Sugar - Part 2

(...continued from Tuesday's post...)

The kinds of calories that we eat affect are bodies in different ways. For example, fat in the diet has no effect on our insulin levels. Protein generally does not have much impact on insulin levels either, but in excess amounts protein can also be stored as fat. Carbohydrates exist in many forms such as complex carbohydrates and simple sugars. The rate at which a carbohydrate is absorbed into the blood affects the body's insulin response. In general, carbohydrates that are absorbed rapidly will cause higher increases in insulin levels. This can be a problem because insulin is a storage hormone. Broadly speaking, it promotes fat storage and inhibits our ability to burn fat. People who have chronically high insulin levels tend to hold on to their fat and will actually burn their muscle for energy when their glycogen stores are low. If you are insulin resistant, you are in a tough hole because you have decreased muscle mass (muscle at rest is metabolically active and burns more calories than fat) and your body has a hard time burning fat. That is why so many obese people have a hard time losing weight.

Glycemic index takes the body's insulin response into account. High glycemic index foods tend to lead to higher blood sugar levels, higher insulin levels, insulin resistance, and over time, lead to higher body fat levels and increased risk for obesity, heart disease and diabetes. Some high glycemic index foods include: white bread, pasta, rice, many cereals, foods containing a lot of simple sugar (candy and most desserts), sweetened beverages and low fiber baked goods. Low glycemic index foods include: vegetables, most fruits, minimally processed grains, legumes, lean meats and natural fats. You can “Google” glycemic index and easily find references on the internet. But a simpler rule to follow is avoiding processed food. Processed food is mostly that stuff in the middle of the grocery store. You know what I'm talking about. Man-made food. Stuff that comes in a box that you add boiling water to, or that you get in the freezer section and you throw in the microwave or heat up in the oven. Ready to eat. That's what I call factory food. It tends to have all sorts of stabilizers and preservatives in it. If the bacteria and mold won't eat it, why should you?

Soft drinks, juices and sports drinks are basically sugar water. Remember the 4.2 grams of glucose in your bloodstream. Well, a 12 ounce can of Coca Cola contains 39 grams of sugar (high fructose corn syrup - we'll save that battle for another day). Sorry to beat up on you Coke, it could just as easily be Pepsi. But let's face it, I had to dig around on your website for 10 minutes and bounce my way through 5 pop-up pages just to get to your nutritional information. Are you trying to hide something? I don't know many teenagers who limit themselves to a mere 12 ounces of a soft drink. So the average 12 ounces of soda contains almost 10 times your body's active glucose load.

I think I can say with a degree of certainty that we consume too much sugar. In fact, the average American consumes 300 to 600 grams of carbohydrate in all its forms on a daily basis. It is no wonder so many of us are overweight. For healthy weight management I recommend between 100 to 150 grams of carbohydrate daily (that's for an adult). It should come in the form of vegetables and fruits (yes, vegetables and fruits are nature's carbs). If you read Dr. Grant's post and are running regularly (please give it a try - you'll only have yourself and Dr. Grant to thank) you can allow yourself more. Read his excellent introduction to running for novices.

Endurance athletes can burn through a lot of glucose. But please try to avoid processed foods and sugary/high glycemic foods in your diet, and I promise you it will be easier to maintain a healthy weight. Eat foods that are as unprocessed as possible and avoid anything that is "modified" "processed" "trans" "partially trans" "inverted" or any other industrial sounding word.

Dr. George Idarraga
Pediatrician
Meriter McKee
3102 Meriter Way, Madison
6008.417.8388
meriterkids.com

Too Much Sugar – Part 1

I recently read that the average adult has about 1 teaspoon of glucose (sugar) in his or her bloodstream at one time. That's a normal size adult with a normal blood glucose level. So that's about 4.2 grams of sugar dissolved in the bloodstream at any time. It doesn't seem like very much but even a small excess of sugar (glucose) in the blood, if present for a long time, can start to cause all sorts of damage.

People with poor blood glucose control, be they type 1 or type 2 diabetic, or even pre-diabetic, are at risk for all sorts of medical problems: kidney disease, heart disease, hardening of the blood vessels, loss of vision, nerve damage, poor blood circulation - to name a few. That is why when we consume sugar, in any of its forms, the pancreas secretes insulin to transport the sugar (glucose) out of the bloodstream and into cells where it won't cause harm.

So what does our body do with the sugar we consume? Some of it will be used as fuel to support our immediate metabolic needs. Some of it will be stored as glycogen in the liver and muscles. Our brain will burn a significant portion of it and store a small fraction of it in glial cells (a type of nerve cell). The average brain can go through about 500 Calories of glucose a day. You may have heard that the brain runs only on glucose. Well, that's not entirely true. The brain needs a minimum of about 20 percent of its Calories from glucose, but it can actually run mostly on ketones, another type of fuel that our body can use. Our red blood cells run exclusively on glucose. If there is excess sugar present after all this it will be stored as - fat. Yes. Fat. It's important to remember that this is a dynamic process. We are constantly consuming and expending energy, and hopefully if the intake matches the output, our weight stays constant and we don't get fat.

So why are so many of us overweight and obese? Well. While inactivity definitely contributes to obesity, it turns out that the answer is a little more complicated than “calories in = calories out.” Visit again on Thursday when I’ll post “part 2” to answer this question.

Dr. George Idarraga
Pediatrician
Meriter McKee
3102 Meriter Way, Madison
608.417.8388
meriterkids.com

The Importance of Family Time

When I was growing up, my parents always made it a point to sit down and eat dinner as a family. Although like most siblings, my sister and I would often end up arguing or bothering each other, it was our family time to catch up and talk at the end of the day. If I had a good day, it was my chance to share my happiness with my family. If my day wasn't so good, it was my chance to unburden myself at the end of a long day. Sometimes I did not talk, but instead listened. I listened to my sister talk about her plans for the weekend with her friends, or about the teacher who she was sure hated her. I heard about my father’s day at work or about something interesting my mom had heard from her friends. Sometimes, on occasion, I even heard stories from my parents about their childhood.

Flash forward many years later, I have two children, a great wife, and a wonderfully hectic life. Between work and extracurricular activities, we seem to always be on the go. However, despite the occasional craziness, we try to maintain one constant--the family dinner. Of course, due to busy schedules, it isn't always possible for all of us to eat together. So, we've created another family tradition, sharing time before bed. We spend a few minutes before bed talking about what made us happy during our day and what made us feel not so happy. And if there's time, my wife and I take a few minutes to tell family stories, either about our children when they were smaller, or about our own childhoods.

I truly believe that it is important for families to consistently take the time to talk at the end of the day. Families may choose dinner or bedtime, or even some other time that works best for them, but regardless of what they do, the end results is the same--bringing the family closer and bringing security to our children. In fact, studies have suggested that teens that engage in family dinners more than 5 times a week were less likely to engage in smoking, drinking or using drugs, and in fact, performed better in school.

Now being a parent, I completely understand why my parents made this a routine. Times are different now, compared to then, but the need to connect as a family still remains. I'd be interested to hear what "family-time routines" you've started - please leave me a comment on Facebook.

Viren Bavishi, D.O.

Pediatrician

Meriter Pediatrics

2275 Deming Way, Suite 220

Middleton, WI 53562

608.417.8388

meriterkids.com

What to Watch for: Hand, Foot and Mouth Disease

Summer is a time for children to play outside, be active, and enjoy freedom from the classroom. However, summer is also the season when some of the most common pediatric illnesses rear their ugly heads. One of these illnesses that is showing up recently in children in the Madison area is Hand, Foot and Mouth disease (HFMD).

HFMD is a viral illness that typically occurs during the summer months in children ages 10 years and younger. The usual symptoms include fever, mouth sores and a rash. The fever is often the first symptom to develop. This is typically followed by the development of blisters in the mouth, and sometimes on the hands and feet (hence the name!). Some children may also develop this blistery rash on their buttocks and genitals. As one can imagine, with these blisters, children may refuse to walk, eat or drink and may cry with urination.

Unfortunately, there is no specific treatment for HFMD. The most important steps a parent can take to help their child through this illness is to give acetaminophen or ibuprofen for comfort and fever reduction and to make sure that the child is getting plenty of fluids. Children with HFMD are at risk for dehydration because the mouth pain prevents them from drinking enough liquids. Offering popsicles or soup can help to soothe the throat while also providing fluids.

If you fear that your child may have become dehydrated or have other complications from HFMD, please contact your child’s primary care provider.

The best way to fight HFMD is through stopping the spread of the virus. Help children have a happy and healthy summer…teach them good hand washing!

Dr. Nicole Baumann-Blackmore
Medical Director, Pediatric Hospitalist Program
Meriter Hospital
meriterkids.com

Swimming Safety

Summer break is finally here and kids will soon be spending more time in and around water. Swimming is a great way for kids to get exercise and stay cool during the summer, but it is important to swim safely.

Remember to protect children from the sun. Sunburn is a risk factor for skin cancer. In 2003, a total of 45,625 new cases of melanoma were diagnosed in the U.S., and 7,818 people died from the disease. Check out Dr. Johnson’s Sun Safety blog (March 22, 2010).

Drowning is the second leading cause of unintentional injury deaths for children ages 1 to 14.

• Never – even for a moment – leave small children alone while in bathtubs, pools, spas or wading pools, or near standing water. With infants, toddlers and weak swimmers, an adult should be within an arm’s length.


• If you have a pool, install a four-sided fence. This includes inflatable and above ground pools.


• Children need to learn to swim. AAP supports swimming lessons for most children 4 years and older. New studies suggest classes may reduce the risk of drowning in younger children aged 1-4 as well.


• Parents, caregivers and pool owners should learn CPR.


• Do not use air-filled swimming aids (such as inflatable arm bands) in place of life jackets.


• Counsel teenagers about the increased risk of drowning when alcohol is involved.

Check out the American Academy of Pediatrics (AAP) updated guidelines on water safety and drowning prevention: http://www.aap.org/advocacy/releases/may2410studies.htm#drowning

Learn basic facts about recreational water illnesses.
The number of recreational water-associated outbreaks is increasing with a total of 78 outbreaks affecting 4,412 people reported for 2005-2006. The CDC recommends the following steps to prevent outbreaks:

• Never let your child swim when they’re not feeling well.


• Don’t let them swallow pool water.


• Practice good hygiene. Shower with soap before swimming and wash your hands after using the toilet or changing diapers.


• Take your kids on bathroom breaks or check diapers often.

Public and pool users can test water at their local pool or hot tub. Free test strip kits can be ordered at: http://healthypools.org/freeteststrips/

You can check the quality of water at local lakes and beaches at the following sites:
http://www.wibeaches.us/apex/f?p=BEACH:HOME:620813377447211 and http://dnr.wi.gov/lakes/

Stay cool!

Dr. Sumita Ram
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriterkids.com

Taking Time to Enjoy Summer

I remember that when I was a kid, summer seemed to last forever. I couldn't wait for the school year to end because I knew that those endless days were just around the corner. Those last few weeks of the school year were agony - the weather had already turned and we would sit in our desks perspiring (schools didn't have air conditioning in the stone age) and pretending that we were dutifully attending to our studies, but really we were dreaming of the summer's promise.

I recall afternoons spent shooting hoops on the Bauer's driveway or playing baseball with all the other neighborhood kids in the empty lot across the street - the ball diamond was a well worn path in the weedy grass. Sometimes we would cross the train tracks to go across the big highway (two lanes really, but to us it seemed tantamount to crossing a national border) to buy a few pieces of candy, some Zots, Pop Rocks, Root Beer Barrels, with the change we had managed to hoard from Dad's pockets. Aside from Little League and swimming lessons, my three brothers and I didn't really get a lot done over the summer. Or at least it seemed that way. I did manage to catch you-know-what from my Mom once when I went fishing all day and forgot about my piano lesson. But as I look back upon my childhood summers I do realize that they were a valuable component of my upbringing. I now appreciate that I was given the opportunity of free time, time that I could spend exploring, playing, engaging in what I found value in, even as a kid. I learned a lot about myself. And I learned a lot about how to occupy my free time without being told what to do.

I worry that we are depriving our children this same opportunity when we overschedule them. I hear ads on the radio offering academic day camps - so kids won't forget all the precious knowledge that has been pumped into them over the school year. (Not to disparage, but when's the last time you used the quadratic equation?) I think it's important to maintain a sense of balance in our childrens' summer schedules. They really do need some unscheduled time over the summer. Sometimes a kid just needs to be a kid.

So as summer approaches, I ask you to keep in mind, and think back to your own childhoods, what you remember most fondly about your summers growing up. And to give your kids some free time.

Dr. George Idarraga
Pediatrician
Meriter Pediatrics
2275 Deming Way, Suite 220
Middleton, WI 53562
608.417.8388
meriterkids.com

Get Rid of Your Unwanted Medications at MedDrop

With the recent voluntary recall on Infants’ and Children’s Tylenol, Motrin, Benadryl, and Zyrtec, you may have some bottles sitting around in the cabinet gathering dust. (For more information about the recall and to get a refund or product coupon, please see http://www.mcneilproductrecall.com/.) Maybe there are some nearly empty vitamin drops, unfinished antibiotics, old inhalers, or even unused pain pills? Maybe there are medications that have expired, and you just haven’t gotten around to disposing them?

There’s no point in keeping them in the house. Expired medications can be ineffective. Leftover meds can be a safety risk with kids or pets in the house. But, throwing medications into the trash or flushing them down the toilet can harm the environment, affect our water supply, and in the end, come back to us in ways we don’t want.

MedDrop is a volunteer run program where you can drive through with your meds, answer some very basic questions (e.g., what is your zip code; is the drop-off place a good location for you), and feel good that the meds will be disposed of in a safe manner.

Saturday, June 5, from 9am to 1pm, volunteers will be at three locations: LaFollette HS, Middleton HS, and the Sun Prairie Recycling Center. You can bring prescription meds, over-the-counter meds, meds for pets, inhalers, vitamins, and even illegal drugs (which will be taken with no questions asked). If possible, please keep them in their original containers. The meds and their containers will be disposed of in a way that will maintain patient confidentiality, but feel free to cross off your name and other personal info if you like. Just leave the name of the medication visible, so the volunteers can properly dispose them.

For addresses, detailed instructions, background information on the program, volunteer opportunities, and lots more, please check out their Web site.

Dr. Tracy Lee
Pediatric Hospitalist
Meriter Hospital
meriterkids.com