Can Reducing Plate Size Affect Obesity in Children?

A surprisingly good parenting tipFull article from TIME magazine: http://healthland.time.com/2013/04/08/size-matters-smaller-dishes-could-cut-childhood-obesity/
A study published in the journal Pediatrics discloses that Temple University researchers reduced the calories children consumed just by giving them smaller plates.

Childhood obesity is rampant in the US. We super-size everything. However, the incidence of diabetes and heart disease among children has increased dramatically with increasing rates of obesity.

Since prior studies found that adults using smaller bowls and spoons helped diminish food intake, the Temple scientists decided to investigate if using smaller plates helped fight the growing problem with childhood obesity.

The researchers found that when given adult-size dinner plates, the children served themselves larger portions of food. The larger portions resulted in nearly 50 percent of the extra calories they had put on their plates. According to the study, 80 percent of the kids served themselves 90 calories more at lunch when using the adult-sized plates.

“This provides new evidence that children’s self-served portion sizes are influenced by size-related facets of their eating environments, which, in turn, may influence children’s energy intake,” the authors wrote in the Pediatrics.

As the famous chef Julia Child (who lived to be 92 eating highly calorie food) noted, it’s all about portion control and moderation.

Full article from TIME magazine: http://healthland.time.com/2013/04/08/size-matters-smaller-dishes-could-cut-childhood-obesity/

Size Matters: Smaller Dishes Could Cut Childhood Obesity | TIME.com
healthland.time.com

What You Should Know About Supplements (part 2)

Are Cheerios medicine?

As stated in the Part 1 of this series, senator Durbin is leaning toward labeling all supplements as drugs. Need vitamin C? Calcium? You may have to get a prescription from your doctor if his bills pass. Stay informed.

Letter from the Food and Drug Administration.
Did you know the FDA went after General Mills for saying their Cheerios were heart healthy? See the full letter here: http://www.fda.gov/iceci/enforcementactions/warningletters/ucm162943.htm

As ridiculous as this seems (no one would overdose after eating even an entire box of Cheerios), the FDA wants you to know that making claims about cholesterol reduction would classify Cheerios as medicine even though clinical studies have shown it’s possible to reduce cholesterol after eating Cheerios due to the water soluble fiber contained in them.

The same nonsense occurred with POM Wonderful 100% Pomegranate Juice.

Supplements that make any medical claims would also be considered medicines. This is why you see this statement so frequently: “XXXX is not intended to treat or cure any disease. The claims made for XXXX have not be evaluated by the Food and Drug Administration.”

As stated in the Part 1 of this series, senator Durbin is leaning toward labeling all supplements as drugs. Need vitamin C? Calcium? You may have to get a prescription from your doctor if his bills pass. Stay informed.
General Mills, Inc. 5/5/09
www.fda.gov
Promotional Claims False & Misleading/Misbranded

The Top Vitamins, Supplements, and Foods for Your ADHD Child

http://www.additudemag.com/adhdblogs/11/9970.html

A FREE Webinar from ADDitude magazine

This is a great opportunity to learn how diet can make changes for your ADHD child.

http://www.additudemag.com/adhdblogs/11/9970.html

ADHD EXPERT WEBINAR: Best Bites — Top Nutritional Choices for Your ADHD Child
www.additudemag.com
Join us for the expert webinar hosted by Sandy Newmark, M.D., on Monday, March 18, 2013 at 1 PM EST. ADHD symptoms, diagnosis, and treatment information for adults.

What You Should Know About Vitamin D

The study was published the September 1, 2012 issue of the journal Pediatrics.
Is it related to good health?

Vitamin D is often called “the sunshine vitamin” because the body can synthesize it from cholesterol when sun exposure is adequate. Children don’t spend much time outdoors any longer. They have little or no recess. From school they go to dance class, karate, or home to sit in front of the TV or computer. Can we postulate that less time outdoors may contribute to lesser vitamin D levels?

Canadian researchers report a greater prevalence of deficient vitamin D levels in children hospitalized with critical illnesses. The study was published the September 1, 2012 issue of the journal Pediatrics.

J. Dayre McNally, MD, and colleagues examined vitamin D levels in 326 critically ill children between the ages of six months and thirteen years who were admitted to the intensive care units of six Canadian hospitals. Sixty-nine percent of the group had deficient vitamin D levels. McNally is a clinical researcher at the Children’s Hospital of Eastern Ontario and assistant professor in the Department of Pediatrics at the University of Ottawa.

Vitamin D deficiency was associated with longer intensive care unit (ICU) stays and increased Pediatric Risk of Mortality scores, which are used to evaluate illness severity. While five deaths occurred among the deficient group during their ICU admissions, no deaths occurred in those who were not deficient in vitamin D.

“This study provides evidence that vitamin D deficiency is both common among critically ill children and associated with greater severity of critical illness.” Further research will determine whether targeted vitamin D supplementation or rapid restoration will improve outcome.”

The Canadian study examined children with critical illnesses. It may or may not be appropriate to extrapolate it to children with non-critical illnesses. However, it is safe to say that activity outside will create vitamin D levels that can keep us healthy.

J. Dayre McNally, MD, is a clinical researcher at the Children’s Hospital of Eastern Ontario and assistant professor in the Department of Pediatrics at the University of Ottawa.

Prenatal Exposure to Mercury May Be Linked to ADHD

Mothers beware of your diet

We’re all concerned about contaminants in our environment. We worry about drinking clean water, breathing clean air, and eating non-toxic food. A recent study published online Oct. 8 in Archives of Pediatrics & Adolescent Medicine reveals another possible concern: mercury hidden in fish. The study links mercury exposure in expectant mothers to ADHD symptoms in their children at the age of 8. Mercury is known to affect the human nervous system.

As with other studies of mercury and its possible link to ADHD, the current study “adds to concerns about mercury consumption and to evidence about the benefits of fish consumption,” said Dr. Susan Korrick. Korrick is the study’s co-author and an assistant professor of medicine at Harvard Medical School and Brigham and Women’s Hospital in Boston.  Korrik’s team found that more mercury exposure leads to a higher incidence of ADHD symptoms. However, more fish consumption — the main source of mercury exposure — leads to a decreased risk.

“How much fish you eat is not equivalent to how much mercury you are exposed to,” said Dr. Korrick. “I think the public health conclusion that I would come to is that one can benefit from fish consumption, but it’s important to try to consume fish that are low in mercury.” Fish high in mercury include swordfish,shark, and fresh tuna. Fish with lower levels of mercury include salmon, haddock, shrimp, and cod.

Korrick and her reviewed data on children at age 8 from the New Bedford, Mass., area who were born between 1993 and 1998. New Bedford is on Massachusetts’ coast and is a fishing community where fish consumption is popular. Fish consumption is a primary source of mercury. Korrick’s team investigated whether greater mercury exposure before birth, prenatal exposure via mothers’ wombs, might lead to more behavioral problems in kids later in life.

The researchers tested the children and evaluated teacher reports. The researchers found that some children of mothers who had the highest levels of mercury before birth were 40 percent to 70 percent more likely to have the behavioral problems.

There are flaws to the research because of its design. It doesn’t prove that mercury is directly responsible for the behavioral problems or ADHD although prior studies have found links. Also, children in the study were not actually diagnosed with ADHD because the study only looked at ADHD symptoms. Better to be safe than sorry regarding mercury consumption.

Diet and ADHD Symptoms

The February 5, 2011 issue of The Lancet reports that researchers in the Netherlands and Belgium were able to significantly reduce ADHD symptoms through restrictive dietary measures.

This theory has long been advocated by such notable groups as The Feingold Association (http://www.feingold.org/). However, their studies have been limited to smaller groups and anecdotal evidence. While their findings have been compelling, medical doctors and adversarial attacks by the processed food industry quashed overall acceptance of dietary restriction. The NIMH give only limited credence to the theory.

Feingold and other advocates of the restrictive diet have suggested that the introduction of food additives can affect the human immune system sometimes causing reactions like hyperactivity, inattention, and even eczema, asthma and gastrointestinal problems. In light of research about food colorings and hyperactivity, the British have taken steps to eliminate certain preservatives and food dyes from their food supply.

The study published in the Lancet was funded by Foundation of Child and Behaviour, Foundation Nuts Ohra, Foundation for Children’s Welfare Stamps Netherlands, and the KF Hein Foundation.  The researchers placed  100 children from Belgium and the Netherlands into two groups: one that received the restrictive diet and the other that only received advice on healthy eating habits. The group that received only advice on healthy eating was the control group. All of the children had been diagnosed with ADHD and were between the ages of 4 and 8.

The children were placed on the restrictive diet for a period of five weeks. They were allowed to eat only rice, meat, vegetables, pears and water. Later, the children were allowed to additionally consume potatoes, fruits and wheat. The researchers assessed ADHD symptoms during this period.

Over the course of the next four weeks, researchers reintroduced processed foods into the restricted diet group. The researchers selected foods that were previously considered to negatively affect body or immune responses.

Nine children withdrew from the restrictive diet group. Attrition in all studies is common. Of the forty-one children who completed the restrictive diet program, 78 percent had a reduction in their ADHD symptoms, compared with no improvement in the controls. Assessment was performed using an ADHD symptom scale that ranges from 0 to 72 points. Higher scores in the scale indicate more severe symptoms. The average reduction was 24 points, a significant reduction.

Thirty children who demonstrated decreased ADHD symptoms resulting from the restrictive diet were selected for reintroduction of foods outside the restrictive diet. This was deemed the ‘challenge test.’ Nineteen of the thirty children had a relapse in symptoms on the challenge test. Sensitivity to foods thought to produce high immune response didn’t seem to produce any greater negative effects than foods thought to produce lower immune response.

Limitations of the study include restriction to ADHD; it cannot be discerned whether it would apply to ADD. Secondly, not all children responded to the restrictive diet. Of those who did respond, responses to foods seemed to be equal no matter what processed food was introduced back into the diet. Additionally, under this research design, it was not possible to have a blind control; parents knew what group their child was in. If they also knew the expected outcome of the study, it might have influenced the outcome.

On the practical side, the restrictive diet is very difficult to follow consistently. However, if your child seems to respond well when you remove certain processed foods, this research seems to support your observation although the certainty about diet and ADHD symptoms has not been clearly established by this study.

Does this ADHD make me look fat?

Ever think that your ADHD child likes to dip into the cookie jar more than the average child? You may be right according to research reported in the International Journal of Obesity (26 October 2010| doi:10.1038/ijo.2010.214) .

Researchers at Duke University Medical Center found an interesting correlation: the greater the number of ADHD symptoms, the greater risk of obesity later in life.

They examined data extracted from 15,197 respondents from the National Longitudinal Study of Adolescent Health in the US. The Duke researchers attempted to assess the association between ADHD symptoms and naturally occurring changes in body mass index (BMI) from adolescence to adulthood. The data were collected over the years 1995 until 2009.

“This is the first study to take this concept out of the clinic and into the population and show that it’s not just the diagnosis of ADHD that matters; it’s the symptoms,” said study co-author Scott Kollins, adding, “The most exciting thing about this research is it gives us a thread to follow in determining why kids with ADHD symptoms might be at risk for developing obesity. It establishes the path for identifying these kids earlier and focusing on intervention methods.”

It’s well established that ADHD kids have impulse control issues. We also know that foods high in fat, sugar, and calories have the same reaction on the brain’s reward systems as stimulant drugs. This combination could likely cause higher BMI as a child ages.

To be forewarned is to be forearmed. It’s likely good parenting to closely observe your child’s impulse control and assist your child to control food intake as he ages. It’s also a healthy idea to limit consumption of high fat, high sodium, and sugary foods.

ADHD and the Western diet

A study published online in the international Journal of Attention Disorders examines the possible link between ADHD and a ‘Western-style’ diet in children.

The study was conducted by Perth’s Telethon Institute for Child Health Research in Australia. The researchers found that a diet typically consumed in the Western world consisting of ‘fast foods,’ sugar/corn syrup, processed meats and flour, fried, and refined foods nearly doubled the risk of an ADHD diagnosis. This Western diet is rich in total fat, saturated fat, refined sugar and sodium.

“We found a diet high in the Western pattern of foods was associated with more than double the risk of having an ADHD diagnosis
compared with a diet low in the Western pattern, after adjusting for numerous other social and family influences. We looked at the dietary patterns amongst the adolescents and compared the diet information against whether or not the adolescent had received a diagnosis of ADHD by the age of 14 years. In our research, 115 adolescents had been diagnosed with ADHD, 91 boys and 24 girls,” says Associate Professor Wendy Oddy.

The Perth researchers analyzed the dietary patterns of 1800 youth and separated them as having  ‘Healthy’ or ‘Western’ patterns. A diet rich in fresh fruits and vegetables, whole grains and fish was designated as a healthy pattern.

Dr. Oddy added, “When we looked at specific foods, having an ADHD diagnosis was associated with a diet high in takeaway foods, processed meats, red meat, high fat dairy products and confectionary. We suggest that a Western dietary pattern may indicate the adolescent has a less optimal fatty acid profile, whereas a diet higher in omega-3 fatty acids is thought to hold benefits for mental health and optimal brain function. It also may be that the Western dietary pattern doesn’t provide enough essential micronutrients that are needed for brain function, particularly attention and concentration, or that a Western diet might contain more colors, flavors and additives that have been linked to an increase in ADHD symptoms. It may also be that impulsivity, which is a characteristic of ADHD, leads to poor dietary choices such as quick snacks when hungry.”

Of note, the scientists were unable to determine if poor diet causes ADHD or ADHD leads to poor dietary choices and cravings – a problem of antecedence.  Furthermore, the researchers had to determine and adjust for social and family influences. This, in itself could greatly skew final data. 

The British have performed similar studies examining the role of refined or processed foods and ADHD.  Certain food colorings were found to influence hyperactivity.  Knowing this, in addition to research that indicates better cognitive function through better diet, it would be wise to greatly reduce or totally extinguish consumption of fast food, refined and processed foods, etc. if one wishes to maximize one’s cognitive potential.

Diet alone will not solve the ADHD riddle. Cognitive training, memory training, behavioral shaping, and attention training are key ingredients to the solution.

Summer ADHD brain drain

Research tells us that during the summer, the average student loses one to three month’s math and reading gains made over the prior year. Academic losses are so common among students that educators have given the phenomena a name: Summer Brain Drain.

Summer Brain Drain may even be worse for ADHD students already having trouble at school.

Going to school daily provides schedules and routines. The summer break means those routines aren’t there. Expectations are lowered or relaxed. Even sleep schedules are often totally abandoned.

Unfortunately, exercise is often replaced with computer time, watching movies, or playing video games with friends. That’s a bad idea. While there’s nothing wrong with playing video games or watching movies, sedentary activity must always be balanced with exercise. This is especially important for an ADHD student. 

I’ve included some specific articles that approach this topic from varying perspectives. Enjoy and gain the benefits this summer!

Children with ADHD benefit from time outdoors enjoying nature

(http://www.news.uiuc.edu/NEWS/04/0827adhd.html)

News Bureau at the University of Illinois at Urbana-Champaign from May 15 through June 8. — Kids with attention deficit hyperactive disorder (ADHD) should spend some quality after-school hours and weekend time outdoors enjoying nature, say researchers at the University of Illinois at Urbana-Champaign.

The payoff for this “treatment” of children 5 to 18 years old, who participated in a nationwide study, was a significant reduction of symptoms. The study appears in the September issue of the American Journal of Public Health.

“The advantage for green outdoor activities was observed among children living in different regions of the United States and among children living in a range of settings, from rural to large city environments,” wrote co-authors Frances E. Kuo and Andrea Faber Taylor. “Overall, our findings indicate that exposure to ordinary natural settings in the course of common after-school and weekend activities may be widely effective in reducing attention deficit symptoms in children.”

ADHD is a neurological disorder that affects some 2 million school-aged children, as well as up to 2 to 4 percent of adults, in the United States. Those with ADHD often face serious consequences, such as problems in school and relationships, depression, substance abuse and on-the-job difficulties.

“These findings are exciting,” said Kuo, a professor in the departments of natural resources and environmental sciences and of psychology at Illinois.

“I think we’re on the track of something really important, something that could affect a lot of lives in a substantial way,” she said. “We’re on the trail of a potential treatment for a disorder that afflicts one of every 14 children – that’s one or two kids in every classroom.”

If clinical trials and additional research confirm the value of exposure to nature for ameliorating ADHD, daily doses of “green time” might supplement medications and behavioral approaches to ADHD, the authors suggest in their conclusion.

Kuo and Faber Taylor, a postdoctoral researcher who specializes in children’s environments and behavior, recruited the parents of 322 boys and 84 girls, all diagnosed with ADHD, through ads in major newspapers and the Web site of Children and Adults with Attention Deficit/Hyperactivity Disorder. Parents were interviewed by means of the Web and asked to report how their children performed after participating in a wide range of activities. Some activities were conducted inside, others in outdoor places without much greenery, such as parking lots and downtown areas, and others in relatively natural outdoor settings such as a tree-lined street, back yard or park.

The researchers found that symptoms were reduced most in green outdoor settings, even when the same activities were compared across different settings.

“In each of 56 different comparisons, green outdoor activities received more positive ratings than did activities taking place in other settings, and this difference was significant or marginally significant in 54 of the 56 analyses,” Kuo said. “The findings are very consistent.”

The two researchers have been pursuing the ADHD issue as an extension of a long line of previous research they’ve conducted on the nature-attention connection among the general population in mostly urban settings.

“The medications for ADHD that are currently available work for most kids, but not all,” Kuo said. “They often have serious side effects. Who wants to give their growing child a drug that kills their appetite day after day and, night after night, makes it hard for them to get a decent night’s rest? Not to mention the stigma and expense of medication.”

Simply using nature, Kuo said, “may offer a way to help manage ADHD symptoms that is readily available, doesn’t have any stigma associated with it, doesn’t cost anything, and doesn’t have any side effects – except maybe splinters!”

There are a number of exciting possible ways in which “nature treatments” could supplement current treatments, she said.

Spending time in ordinary “urban nature” – a tree-lined street, a green yard or neighborhood park – may offer additional relief from ADHD symptoms when medications aren’t quite enough. Some kids might be able to substitute a “green dose” for their afternoon medication, allowing them to get a good night’s sleep.

“A green dose could be a lifesaver for the 10 percent of children whose symptoms don’t respond to medication, who are just stuck with the symptoms,” Kuo said. As Kuo and Faber Taylor wrote, a dose could be as simple as “a greener route for the walk to school, doing classwork or homework at a window with a relatively green view, or playing in a green yard or ball field at recess and after school.”

The National Urban and Community Forestry Advisory Council, U.S. Forest Service, and the U.S. Department of Agriculture’s Cooperative State Research, Education, and Extension Service supported the project.

Exercise Improves Learning and Memory
Chalk up another benefit for regular exercise. Investigators from the Howard Hughes Medical Institute (HHMI) have found that voluntary running boosts the growth of new nerve cells and improves learning and memory in adult mice.
"Until recently it was thought that the growth of new neurons, or neurogenesis, did not occur in the adult mammalian brain," said Terrence Sejnowski, an HHMI investigator at The Salk Institute for Biological Studies. "But we now have evidence for it, and it appears that exercise helps this happen."
USA Today (http://www.usatoday.com/news/health/2006-03-26-adhd-treatment_x.htm)

ADHD treatment is getting a workout

http://www.usatoday.com/news/health/2006-03-26-adhd-treatment_x.htm
Doctors haven’t done many definitive studies about exercise and ADHD, says David Goodman, an assistant professor of psychiatry at the Johns Hopkins University School of Medicine. But Goodman says it makes sense that working out would help people cope with the condition. Studies show that exercise increases levels of two key brain chemicals — dopamine and norepinephrine — that help people focus.

"Your cognitive function is probably better for one to three hours after exercise," Goodman says. "The difficulty is that by the next day, the effect has worn off."

If kids could exercise strenuously three to five times a day, they might not need medications at all, says John Ratey, an associate clinical professor of psychiatry at Harvard Medical School. Ratey is so intrigued by the question that he’s writing a book about how exercise can reduce symptoms of ADHD or at least help patients cope.

Team sports might help children with ADHD in several ways, says James Perrin, a professor of pediatrics at Boston’s MassGeneral Hospital for Children. Children with the condition benefit from following a regular schedule. Coaches who lead kids through structured exercises also might help build concentration and organizational skills.

Sleep Disorders & ADHD

It’s suspected that nearly 25% of all cases identified as attention deficit hyperactivity disorder (ADHD) are not really ADHD at all, but are symptoms related to sleep disorders.

One of the leaders in this research is University of Michigan professor Ronald Chervin.  Chervin theorizes that very important brain development is done during sleep. Among other things, this includes the ability to regulate emotion and processing. So, if a child has chronic sleep problems, brain development may be impaired. Chervin also suspects that the brain does not receive enough oxygen if the child snores which further inhibits development.  According to Chervin’s research, children who snore are more likely to have ADHD.

He likens the ADHD-sleep connection to a child who doesn’t get a nap; he becomes restless, irritable, and acts out.

Chervin developed his theory based on a sleep/behavior survey of the parents of 866 children.  Chervin’s data exposed a sleep disorder -behavior relationship.  It was only logical to conclude that if the sleep disorder could be corrected, the ADHD symptoms would be extinguished.

According to Newsweek: “To test this theory, Chervin then studied 79 kids (5 to13 years old) who were about to have an adenotonsillectomy. Prior to the surgery, 22 of the 79 were categorized as having ADHD, based on standard measures for such a diagnosis. One year later,  Chervin’s team tracked down the kids for a follow-up. Of the 22 identified as having ADHD, 11 kids no longer qualified as having the disorder.”

Two problems lingered: 1) New cases of ADHD cropped up and 2) 50% of the surgical patients received no benefit at all.

Before you go and get your child’s tonsils and adenoids out, let’s discuss the distinct problems in the logic associated with this research.

First, we have a problem of antecedence; does ADHD exist because of sleep problems? or does the sleep problem exist because of  ADHD? That relationship cannot be clearly identified and is a confounding problem.

Secondly, new cases of ADHD appeared and others did not benefit at all from the surgery. This would lead one to think that the outcomes may not be related at all to the procedure.

I’m reminded of an old story about researchers who taught a frog to jump upon saying, “Jump!” Many weeks were spent training the frog.  The researchers were quite happy that they had proved the frog could hear and could respond to the human voice. One of the researchers  decided they should amputate the frogs hind legs. After carefully surgically removing the frog’s legs and rehabilitating the poor frog, the researchers stood in front of the frog and yelled, “Jump!” When the frog did not respond, they all heartily nodded in agreement that the frog’s hearing was severely impaired by the removal of his hind legs.

There is little doubt that sleep problems affect brain development. Past studies have demonstrated that preschoolers with a sleep disorder are twice as prone to substance abuse by early adolescence and more likely to suffer from anxiety in their 20s. Even the American Academy of Pediatrics concurs that sleep problems are not benign.

However, before we undertake invasive, painful surgery as an option, far more research should be performed to absolutely indicate a direct correlation. One currently does not exist and other options should be explored. playing241

It has become obvious that adequate, restful, uninterrupted sleep is essential to our personal well being. Abnormal sleep patterns may result in behaviors that can be easily confused with ADHD.

If your child has a sleep problem, taking them to a sleep specialist may help. Getting adequate exercise, providing a consistent sleep routine/schedule, reducing stress,  and eating a proper diet may also assist in getting better sleep and better behavior.

 

  • Chervin RD, Arcbold KH, Dillon JE, et al. Inattention, hyperactivity and symptoms of sleep disordered breathing. Pediatrics. 2002;109:449-456
  • Chervin RD, Dillon JE, Bassett C, et al. Symptoms of sleep disorders, inattention and hyperactivity in children. Sleep. 1997;20:1185-1192
  • Chervin, RD, Rusicka DL, Giordani BJ, et al. Sleep disordered breathing, behavior and cognition in children before and after adenotonsillectomy. Pediatrics. 2006;117:e769-e778
  • Cortese S, Konofal E, Lecendreux M, et al. Restless leg syndrome and attention deficit/hyperactivity disorder: a review of the literature. Sleep. 2005;28:1007-1013
  • Cortese S, Konofal E, Yateman N,et al. Sleep and alertness in children with attention deficit hyperactivity disorder: a systematic review of the literature. Sleep. 2006;29:504-511
  • Harnish MJ, Boyer S, Kukas L, Bowles AM, et al. The relationship between sleep disorders and attention deficit hyperactivity disorder (ADHD): objective findings. Sleep. 2001;24:A14.
  • Owens JA. The ADHD and sleep conundrum: a review. Journal of Developmental and Behavioral Pediatrics. 2005;26:312-322.