Eating is Big News

Eating right is certainly in the news these days. From the latest fads like “The South Beach Diet” to the front page image of the First Lady planting an organic vegetable garden on the White House lawn, Americans are beginning to pay closer attention to their eating habits. Staggering reports of the epidemic of obesity are flooding the scientific community and serve as fodder for TV shows like “The Biggest Loser.” One in five children in the U.S. are obese today. The “Healthy Schools Act” of 2007 has federally mandated guidelines to improve nutritional standards in schools in order to promote better food choices among students. Many states like New York have recently earmarked millions of dollars in state funds to boost school meal reimbursements. It is now well recognized that poor nutrition affects cardiovascular health and is linked to the rising rates of type 2 diabetes and cancer. But poor nutrition also directly affects the way our children learn.

Why we eat

While choosing what we eat is certainly critical to our cognitive health, a truly holistic understanding of eating goes much farther in considering how we eat, where we eat, when we eat and why we eat. So why do we eat?
I pose this question to children all the time and they giggle and stumble around for answers like “we eat so we can grow.” But we are not just machines requiring the right set of nutrients as basic fuel to keep going. We are living organisms not automobiles! In a recent workshop, I asked participants to describe the taste of a blueberry. No one could get far past the fact that they’re sweet and blue. While scientists may accurately analyze all the phyto-nutrients in a blueberry, this tells us very little about the actual experience of eating blueberries. Eating is a deeply personal encounter. It conveys something about ourselves at a particular moment in time. It feeds our memory and points directly to who we are, to our mood and temperament. Eating reflects our basic sanity because it is how we make contact with the world, how we exchange with the world. Our hunger to grow and know the world is not just physical but intellectual and spiritual. Eating is how we become the world.

The Good Earth

In Chinese medicine, the ‘spleen/stomach network’ is considered the center of our world. It corresponds to the ground we live on, the good earth, which supplies all that we need to grow. But the spleen is home to our thoughts as well. We gather information from the world in all different forms. As we take it in, it gets sorted, some is integrated into our being, and some is eliminated. This gathering, sorting, integrating and eliminating is a cognitive process. It represents how we learn. The health of our immune system (learning to identify the world), digestive system (learning to taste the world), and neurologic system (learning to perceive the world) are interconnected aspects of information processing. The body does not know these are separate systems. They only seem separate to us because there are immunologists, gastroenterologists, and neurologists. As a field of medicine we might more accurately describe this cognitive network as Neuro-immuno-gastroenterology.

Industrially fed, Spiritually starved

If we take a minute to look at how we eat in America, we begin to see how it directly relates to the modern epidemics of childhood, obesity, allergies and ADHD. We eat as if we are in a race. This is the real purpose of “fast food.” It’s cheap and convenient just like a roadside gas station is for your car. But, again, we are living organisms not automobiles. The same kind of ‘assembly line mentality’ informs the way our children are force-fed information in school. We’ve been led to believe that education is a race and that the fastest child is the smartest. But in my 22 years as a developmental pediatrician watching children grow, this simply isn’t true. Sometimes the smartest kid turns out to be the one who took her time digesting the world. The current trends in standardized education have left us with a system that treats children as if they are USDA Grade A meat. The education of our children must be more than simply passing inspection! What’s more, when we are not given the time to digest the material, whether it is food or academics, it stagnates.

The Spiritual Deficit Disorder

Chinese medicine considers stagnation to be of grave significance. A healthy life is defined by the free flowing of qi; that which animates our life. Stagnation represents the accumulation of “stuff” that drags health down. It’s as if the body recognizes the need to SLOW DOWN in order to work on unfinished business even if it results in a pathological condition. This feeling of stagnation is not satisfying because things are simply not moving properly. The lack of movement is boring. Boredom leads to the need for distractions and so we try to spice up our lives. We try not to look at all that unfinished business accumulating within. This in turn makes us agitated. We try to get things moving; we try to shake up all that stagnation. This hyperactive state drives us to look for happiness somewhere else. TV ads capitalize on this, promising happiness with a “whopper” or a “happy meal.” This leads to infatuations, bizarre cravings, impulsive eating and binge-buying. We feel we deserve to be happy, we deserve that tub of ice cream for having had to work under these conditions. And when we can’t have what we think we deserve, we become hostile. Don’t take a piece of my pie.

This state of agitation, distractibility and impulsivity defines the Attention Deficit Disorder. It is said in the Chinese medicine classics that accumulation causes an inflamed state and this phlegm can “mist the mind.” We become confused, can’t think straight, and find it difficult to concentrate on one thing for very long. And so we take stimulants to try to wake ourselves up. Likewise, the same vicious cycle leads to the accumulation of phlegm in our bodies; our neuro-immuno-digestive system becomes confused, hostile, and inflamed. In my practice, I see a host of chronic health problems in children that can be traced back to the phlegm of stagnation: ear infections, asthma, obesity, colitis, and autoimmune disorders. These manifestations of chronic inflammation did not exist to such a degree one hundred years ago, or even fifty years ago. The inflamed state of autoimmunity is a spiritual crisis. When the mind-body remains in such a confused state, we no longer have time to recognize who we are. We are left with a Spiritual Deficit Disorder.

Taking time

Correcting this vicious cycle begins at birth. I work with many mothers on that first day, counseling them about breastfeeding or bottle-feeding. Right there in that moment is a real opportunity to learn how to learn, how to digest the world calmly, attentively, and with ease. Feeding a baby when she is crying is a common mistake. Moments of hunger are not necessarily a crime. Hunger is a way of waking up. We may naturally feel the urge to feed our child when he cries; feeding is a basic way we show our love. But it is vital to pause and consider the true reasons for eating. Babies feed much better when they are fully awake. They are less gassy and more likely to gain weight properly. They are actually learning to pay attention with their whole body-mind. This is a simple yet profound lesson for us all to live by. When you select information, whether food or academic, as a conscious process you are determining which aspects of the external environment you will allow inside your body to operate on an unconscious level. This is the meaning of “mindful eating”. We should take our lead from our babies. Whether we are stimulating our immune system, going to school, or sitting down at the dinner table as a family, taking time to digest is how we become truly sane in this world. Ultimately, taking time is the most alternative medicine. And taking time to digest the world is the ultimate spiritual practice.

In the midst of winter, having somehow survived the blitz of swine flu panic, we’re all ready to see what the wind will blow in next. One of the amazing things I witnessed during this illness was just how powerful a medicine sleep is. My mantra in counseling families became make sure you get enough sleep!

An immune system that stands on high alert needs sleep to regenerate its protective powers. In Chinese medicine the nighttime corresponds to the winter phase of our 24-hour cycle. We must reflect the cycles of the world we live in if we want our health to be harmonious. During the winter months, when it’s more dark than light, sleep is all the more vital to our well-being. Lack of sleep is associated with attention deficit disorder, migraine headaches, respiratory problems, increased susceptibility to colds, and poor growth.

This is common sense and everyone knows it, though few really practice it. I spend a lot of time in my practice discussing sleep with parents. Next to food and development, it is the most common topic of discussion. Many parents who come to me yearn for a ‘natural approach’ to sleep for their child. I often explain to them that I am not here to judge one particular sleep arrangement over another. The first thing to decide is what you want. Remember, a child is much more able to adapt than an adult is. This is “natural.” A small plant can actually withstand the wind, make its way through the ground, and deal with sudden environmental changes better than an old hardened tree. The same is true for small children. The younger they are, the more adaptable they are. This is because their brains are still making new connections, finding the most efficient way of surviving.

So my first advice regarding sleep is always to have your baby adapt to your life style not the other way around. I have seen so many parents go to wild extremes in order to get their baby to sleep only to complain that their baby doesn’t sleep unless they go through these wild extremes. One mother recently told me she could only get her child to sleep by going on the treadmill with her and now every time the baby wakes up, she has to go back on the treadmill. The whole routine had gotten the mom into great shape, but she was so exhausted she was getting sick and missing work.

This brings up a second important point: After around three or four months of age, we all naturally wake up every two to three hours during the night. This is because we’re dreaming. We wake briefly as we emerge from each dream. Back in our caveman days, it was dangerous to sleep too soundly – we needed to wake up to make sure no lion was coming to eat us. Our natural sleep cycles are vital to our survival; so don’t expect your child to sleep through the night without waking. We are not meant to sleep like dead bodies in the night. Quite the opposite: sleep is an active time for consolidating the material we’ve experienced in the day. Sleep is vital to our neuro-immunologic resilience. We actually do deep learning in our sleep.

But beware: When a baby wakes in the night and finds itself in a different place from where it fell asleep this can be very startling. Imagine if you fell asleep in one room and woke up in the bathtub! That’s what it feels like when a baby falls asleep in your arms (or on a treadmill) and wakes up in a crib two hours later after a dream. That startling effect alerts the nervous system, making it much more difficult to get back to sleep.

And then there’s the whole routine of going to sleep itself. We humans are creatures of habit. It gives us security. The lead-up to sleep prepares the brain for a different kind of activity. The environment in which we prepare – the room, the lighting, the smells, the people there with us – will determine our habit of falling sleep. That’s why it’s so important to develop a routine as soon as the primitive baby reflexes have disappeared around three to four months of age. In designing a routine for your baby remember that you may have to repeat it every two to three hours in the night so make it as simple as possible.

Remember again that your baby is much better at adapting than you are! Not all babies adapt in exactly the same way. Trust him or her to figure it out. Many times we over-think these situations. Often a baby has already begun adapting to your habits even by three months of age, and will resist any new, conscious changes in routine you introduce.

This makes perfect sense. From his perspective, he’s thinking ‘Hey, you guys are crazy! That’s not how we do things!’ and he voices his objections with the only thing he knows how to do, cry. But the younger he is when you decide to develop a healthy training routine, the easier it is for him to readjust to it. Trust this! There is nothing worse than trying to re-train a two or three-year-old child whose habits are already pretty hardwired. Not impossible, it just involves a lot more time, and a lot more crying.

Developing a new sleep routine requires calm, consistency, and confidence in what you are doing. A baby knows when you are ambivalent and will resist all the longer. This brings up the whole idea of what is ‘natural’ about sleeping arrangements. Many parents know it just doesn’t feel natural to have their baby sleeping in another room. So why do we do this? As best as I can figure it, this began as a result of the industrial revolution when we began working nine to five (or more like eight to seven) hour workdays. Before this, we all slept together. Indeed, from cave days until around the 18th century, it was customary to sleep together in one big bed. We kept warm together, bonded together, but don’t kid yourself, we didn’t sleep more soundly. People were always moving around, elbows in faces, getting up to pee, tossing and turning. But we could always take naps during the day. In fact, in cultures where naps are still a part of the daily lifestyle, sleeping together is much more socially accepted practice. But here in our industrialized society, we have to get up and get to work and stay awake all day long! That’s the part that’s unnatural, so expecting the nights to be ‘natural’ but then to live unnaturally during the day simply never works. That’s a good way to get fired. And believe me, I have had a number of parents come in complaining to me about just that.

Nothing would make me happier than if we could bring back mandatory nap times for adults. After all, we are all babies at heart.

To summarize:

1. Sleep refreshes us.
2. Sleep is vital to our cognitive functioning, our immune resilience and our connection with the day-night changes in our environment. It literally helps us harmonize with our world.
3. Getting proper sleep is not just about how many hours, but the quality of sleep cycles we get. Waking up is a natural part of the cycle. It’s how you get back to sleep where problems arise.
4. Dreaming is an important part of our integration of learning and it only occurs in the deepest levels of sleep.
5. Start early in training your child to sleep. Let her adapt to your lifestyle. (No tiptoeing around the house unless you want to be tiptoeing forever!)
6. Routine is security. Set up a calming bedtime routine that allows your child to prepare for down time. (No videogames and then to bed).
7. Bedtime arrangements are extremely personal decisions. Don’t worry about what other people are doing if what you are doing is working.
8. Be consistent from one day to the next. It is the quickest way to show your child what you would like him to adapt to.
9. Be compassionate. Think what it feels like to be your baby trying to figure out how to get through the night.

This general panic about the flu this year raises some important questions about how you can protect yourself and your children- Deciding on vaccination is a complex question. As you know I prefer to approach each child individually and yet public health policy is demanding that we make decisions without regard to personal situations. We are still gathering info on the swine flu- It is spreading very quickly which in NO WAY means it is more deadly than any other flu- its just that there are more numbers! This will naturally increase the numbers of very sick among the not-so-sick. The elderly seem to be at less risk due to ‘herd immunity’ from the 70′s swine flu epidemic. This naturally shifts our focus to children and pregnant women. We have now seen over 200 cases of h1n1 in our practice and so far and they all seem to be very mild, (3-4 days of fever). But it’s still THE FLU! And that must be taken seriously. Most of the information that is being put out on the media is based on hospitalized patients (the sickest cases) and is meant to scare you into following the CDC guidelines without question. Fear does not help make rational decisions. The flu is never something to be taken lightly. Every year 35,000 people die in the US from the flu. If there is any history of underlying respiratory, cardiac or immune disorder then one should consider getting the flu vaccine.

The H1N1 influenza is spreading very fast. Once we reach a critical mass of people exposed to this flu, we as a community will develop what’s called ‘herd immunity’ which means even if we don’t get it we develop some immune protection. This is a fascinating phenomenon that demonstrates the power of the human community. I hope, in light of how quickly it is spreading, that this will happen before the seasonal flu begins.

General Preventive Measures for Flu season

Adults

Maintain a healthy immune system. Many forms of supplements will fortify immunity so that an attack by viruses will be less successful. If you tend to get acute illnesses easily, then begin a program of immune strengthening. A good herbal and antioxidant immune enhancing supplement will help build the strength of your system. These formulas are usually built around the herb Astragalus, a potent herb for augmenting the body’s protective defenses and stabilizing the exterior against invasion by pathogens and physical stresses such as cold and wind. Other supplements have similar immune enhancing properties.

Vitamin D3 is essential for a prevention program. Adults need 5,000 IU when midday sun exposure is not possible, infants need 1,000 IU, and older children need 2,000 IU.

Mushrooms: Several species of mushrooms have significant immune stimulating effects. Each contains high percentages of polysaccharides, long chain sugar molecules that regulate immunity. They activate white blood cells and stimulate complements and antibodies. These mushrooms include reishi (ganoderma), maitake (grifola), shiitake (lentinus), polyporus, and tremella. Many preparations of mushroom combinations in tablet, powder, or liquid extract form are available at major health food stores.

Colostrum is an excellent source of immune system stimulants. Colostrum contains a host of factors that stimulate the immune system and help to prevent illness. Immunoglobulin IgA coats the intestinal lining preventing attack by pathogens. Lactoferrin locks onto iron releasing it to red blood cells and depriving bacteria of the iron they need for reproduction. Lysozyme destroys microorganisms on contact. Cytokines boost T-cell activity and stimulate production of your baby’s own protective immunoglobulins. Polysaccharides bind to bacteria and block their attachment to mucus membranes. Take two capsules twice a day through the winter months.

Vitamin C at 2-4 grams per day prevents inflammation and maintains the body’s vigilance against infection.

Vitamin A is essential to immune function and mucous membrane integrity.

Zinc has potent immune protective effects. Take 25 mg zinc per day, but if you continue zinc for an extended period of time you will also need to take copper to prevent a deficiency (10:1 ratio of copper to zinc). Get a supplement that contains both.

Immune supplements for adults

Mushrooms (reiki, mitake, shiitake)

Colostrum – 4 capsules

Vitamin C – 2-4 grams

Vitamin D – 5,000 IU

Zinc – 25 mg with copper 2 mg

Influenzinum is a specific preventive for the flu. You can begin taking Influenzinum (9C, 12C, or 30C) if you are exposed to the flu. Take one dose each week for four weeks at that time, or you can take it once a week for four doses during the flu season.

The flu, like other respiratory viruses is spread through droplet transmission from human to human. You can minimize your exposure by not shaking hands. Frequent hand washing will also prevent you from inadvertently inoculating viruses into your nose and eyes. Simply avoiding touching your nose, mouth, and eyes during flu season will also help reduce your exposure. Of course, as common courtesy everyone should cover their mouth when they cough or sneeze to prevent transmission of viruses.

Get plenty of sleep, eat well. Eat warm foods during the winter. Soups and stews are excellent sources of concentrated nutrients. Exercise regularly despite the cold weather. Eat plenty of fruits and vegetables for their vitamin and antioxidant content. Stay warm and avoid getting chilled.

Immune System Supplementation for Kids

Children can take a few simple, specific supplements to maintain a strong and vital immune system during the fall and winter months when colds and flus predominate.

Omega-3 fatty acid supplement in the form of fish oil capsules or liquid fish oil will establish healthy cell membranes that prevent inflammation and resist toxins and attack by pathogens.

Vitamin D is essential for kids as well as adults to maintain immune function.

Vitamin E will ensure that fatty acids are maintained at optimum efficiency once they are absorbed into cells. In addition, vitamin E has anti-inflammatory effects and increases resistance to infection. Use only natural vitamin E (d-alpha-tocopherol), not the synthetic form (dl-alpha-tocopherol). A mixed tocopherol form of vitamin E is best because children need the gamma as well as the alpha forms. An appropriate dose is 100 mg for children under two and 200 mg for children aged 2-12.

Vitamin A is needed for proper mucous membrane function. It is essential for the growth and repair of body tissues, and for efficient digestion of protein. Vitamin A promotes good eyesight, strong bones and teeth, and a vital immune system. White blood cells, T -lymphocytes, and every cell in the important mucosal barriers of the respiratory, digestive, and urinary tracts require vitamin A.  A diet containing significant amounts of fruit and fat will help ensure adequate vitamin A intake. Whole milk products, butter, and free range eggs will help maintain necessary levels of this important nutrient. Use organic sources. For those who may not be getting enough vitamin A, a supplement is essential.

The recommended daily amount (RDA) of vitamin A is 1,000-2,000 IU for children, depending on their age (1,000 at one year of age, 2,000 by age nine). Primitive diets probably maintained 10 times that amount. One egg contains 300 IU, one cup of whole milk or whole milk yogurt contains about 225-250 IU of vitamin A. One tablespoon of butter contains 350 IU of A. The amount of vitamin A may vary by the season and the feed of the animals.

Colostrum is great for children as well as adults.

Zinc stimulates immune function, prevents infections, and acts as a cofactor in many enzyme reactions, including the creation of antioxidants. Normal dosage is 10-20 mg. per day. If zinc supplementation is continued over a prolonged period of time, it should be given in conjunction with copper in a ratio of ten to one to prevent copper deficiency.

Vitamin C has anti-inflammatory effects, antioxidant activity, and antibiotic qualities. A daily supplement of vitamin C during the winter months will round out the immune system prevention program. Use 500 mg for children under 3 years old and 1,000 mg for older children.

The easiest way to give supplements to children is through powdered sources mixed in a blender with fruit, fruit juice, yogurt or milk (rice milk for younger children and children with milk sensitivities), and honey (for children over 12 months old). Capsules can be opened and dumped into the blender. Children can chew oil-based supplements in soft gels or you can stick a pin into them and squirt out the contents onto something they will eat.

Immune Supplements for Children-Daily Dosage

* (d-alpha-tocopherol or  mixed tocopherols)

Elderberry syrup and osscillococcinum are extremely helpful as soon as your child gets sick.

Homeopathics considerations during illness:

Osccillococcinum 3 X a day for 2-3 days

Belladonna early then Gelsemium

Bryonia if prefers not moving

Rhus Tox if prefers movement

Eupatorium with myalgia + tender eyeballs

Spring of 2009, when news of the H1N1 swine flu began to hit the media, I contacted our local health department and the CDC, to “get the facts” and prepare our office for the onslaught of questions that parents of my patients would naturally have. We have seen this all before.

Here in my busy general pediatric practice, each time there is a news story about a case of lyme disease or meningitis, we get swamped with phone calls and emergency visits from concerned and panicking parents. With the flu it always seems to be a crisis.

Each year I watch how the 24 hour news media kindles the fires of panic about the flu. There is invariably a tragic story that comes out sometime in November or December about a child dying somewhere in the country and suddenly everyone is demanding flu vaccine and/or their own personal supply of Tamiflu. This is a very human response. It’s a kind of reality check that wakes us into action. And we are all easy victims to the panic of “breaking news”. Fear, though, can fuel all kinds of rash decisions. Naturally, when something like this occurs, people look to their doctor to be a voice of reason.

This year was a particularly extreme version of that scenario. Perhaps it stems from the persistent underlying stress we’re all feeling about the economy, or the fact that around here the weather’s been a bit bizarre (it’s been raining pretty much every day since April) but when people heard about a “new” virus that could reach the level of “pandemic”, they were just about at a break point of panic. Trying to remain a calm source of guidance to my patients has been a daunting task when we are faced with unknowns and misinformation. Here is a list of the contradictory information that concerns us all as we prepare for next autumn.

• The statistics on severity of the disease are completely skewed because the number of cases collected by the department of health reflects only people who ended up in the hospital and there were millions of cases of people who had relatively mild unreported cases of the flu, though the press never reported this. In-office testing for Flu misses at least 50% of the cases.
• Each year the seasonal flu vaccine provides only partial or no coverage for influenza strains not included in that vaccine. We’re being told that the ‘seasonal’ flu vaccine this year will NOT cover the new swine flu, which, they say is why we need a swine flu vaccine. The reason for fearing the swine flu and mandating a swine flu vaccine stems from the projected (but as yet unknown) mutations that may occur in the coming year however there is no evidence that the new vaccine will protect us from those mutations since it is being created based only on this past years H1N1 virus. (the vaccine has not as yet been fully tested here in the states.)
• The swine flu this year was a relatively mild illness, and while it is important to recognize that every flu can cause death, the mortality rate for this particular “new flu” was actually quite low, based on corrected statistics. This exposure might actually provide the millions of people who had the swine flu this year some protection next year if it does not mutate. (indeed there is the distinct possibility that they may have partial protection even if it does mutate though it’s too early to tell!). The irresponsible overuse of Tamiflu and other antiviral drugs as “preventive” treatments only serves to encourage mutations and mounting resistance, making us more vulnerable.
• The 24 hour news media will continue to create fear and stress in the general population because it’s good for business. Stress itself depresses our immunity and may actually make us more susceptible to the flu! When people’s judgment is jaded by fear, they will demand any antiviral treatment whether it is warranted or not.

This is the doctor’s dilemma for anyone working on the ‘front line’ of health care, particularly in a crisis where fear is fueling the debate.  Is medicine to be about policy-making or fostering individual relationships? Is it political or personal?  Can one sustain both in the midst of a crisis?

A wise man once said, “At the doctor’s gate, many sick people wait.” People are not looking just for mandates and policies when they’re sick. What they seek is a trustworthy companion when the fear of illness knocks at their door.  While decisions in emergencies typically require protocols, it is the wise clinician that sees beyond statistics to the ‘whole’ patient with calm attentiveness.  We must be careful not to get caught treating data at the expense of people. Trust can only be generated when the standards of care that a doctor follows do not constrain the connections he makes with those who have come for help.  This is what I call real “participatory medicine”.

The legal pressures on physicians reach far beyond legislation however.  “Standards of Care” tend to preserve the status quo and do not encourage ‘thinking outside the box’. This can greatly limit our creativity in finding solutions to the problem at hand. But what’s more worrisome is how they tend to undermine the personal trust we’ve developed with our patients. This can be very dangerous in a crisis.

Can we envision a standard of care that is not grounded in fear but rather in the mutual respect and trust between physician and patient?  Standards of care were meant to be rational guidelines, not tools to measure liability and yet that is exactly what they have become. Indeed this is why so many physicians are afraid to use alternative therapies in their practice. This merely creates a rather generic impersonal medical assessment though.  In an acute emergency like the flu, what we need (and what most of us want) is a personalized medicine that addresses the different affinities, strengths and weaknesses, of each individual.  A medicine that recognizes the amazing resilience of our immune system, embracing it as a kind of bridge to the outside world rather than a wall needing constant fortification.

The viral “xenophobia” we’re seeing now runs counter to the way we actually exist in nature. Our immune system is much more like a brain open for learning, being shaped by our environment than a military tank.  Perhaps it’s time we start looking at ways to make it more resilient rather than more resistant.  As I watch how “well” the children in my practice recovered from this past flu, the discussion with parents naturally turns to what lessons we’ve learned and what we can use from this in the coming year. This kind of dialogue seems personal and reasonable.  Ultimately that is what each family desires.

This is compassionate medicine. And it is rewarding to both patient and physician.