Wednesday, December 22, 2010

Blog #23 Men with Rashes Continues....

Returning to Alan’s skin of many irritations, I thought briefly about all the possible causes of rashes. In the almost 30 years I have been a nutrition detective, I have seen rashes caused by all manner of substances.

Here is a list of the ones I can remember:

• Food reactions to chicken, eggs, olive oil, nuts, fish, grains (especially wheat and sometimes rice), potatoes, seeds, most fruits, a few vegetables….any food can do it but vegetables and lamb react the least.

• Medicines especially anti-depressants, mood stabilizers, anti-seizure meds and antibiotics.

• Bad stuff added to foods including preservatives, additives, colors, pesticides and genetically modified organisms (GMOs) which is actually bacteria DNA spliced in to food.

• Contact rashes from creams, sun screen, soap, bubble bath, shampoo, dryer sheets, laundry detergent, pollen, swimming pool water, leaves, wool, animals (all sorts including a guinea pig).

• Molds (either outdoor varieties or from a sick house).

• Yeast problems.

• Touching water (true story). This was probably from the chlorine in tap water.

• Mites and other bug bite reactions.

• Essential fatty deficiency.

The list is long and basically includes almost anything you can think of but I had ten minutes to make a good guess. Most people can figure out topical contact irritants on their own unless it is something in the environment like pollen or mold. Once I saw a child with extensive eczema. The referring doctor and I tried all sorts of elimination diets and environmental changes but nothing helped. Finally, the family went to Italy for a month and the child’s skin completely cleared up. We then realized (through an additional process of elimination) that the problem was likely an environmental mold though we never knew exactly which one. Allergy testing also could not pinpoint it. Wouldn’t it be nice if your doctor recommended an extended European vacation for unresponsive eczema? Besides his wife had worked that angle pretty hard by eliminating the usual suspects without success. So, I ruled out topical culprits and circled in on the diet and family history.

If a food is causing such a complex ongoing rash it would have to be one that is commonly consumed. It cannot be mangos or pork chops because people do not eat enough of them through out the year to cause this much skin trouble. The number one frequently eaten food irritant responsible for bizarre, extensive rashes is gluten. I already knew his son was doing better off gluten. That made it very easy to ask the father to go on the same diet. For good measure, I added some supplemental fish oils to deal with the papules (or chicken skin) which are often a sign of essential fat deficiency. Those two steps are straight forward and will probably help. He readily agreed because he confessed after I suggested a gluten-free diet that eating too much bread gave him gas anyway.

You may be thinking, “oh come on!” After you go through all of this he admits that he thinks gluten bothers him. The answer was sooooo obvious all along. Why didn’t he figure out gluten was bothering him if his son could not tolerate it and he got gas when he ate it? Why most of us miss the obvious things about ourselves is one mystery I cannot figure out.

Tuesday, December 14, 2010

Blog #22 An Afternoon at a Different Conference

I decided I needed to understand hormones better, being menopausal and all. Getting good information on natural hormone replacement is much harder than you would think and as a result, I found myself on a plane to Las Vegas heading for the American Academy of Anti-Aging Medicine (A4M) conference.

Las Vegas, I discovered is not for anyone suffering from sensory processing disorder or a low tolerance to cigarette smoke. The hotels are designed so you have to walk through miles of underground casinos to get anywhere, including the registration desk or conference center. Casinos appear to be the only indoor facilities left in the country where cigarette smoking is not only allowed but possibly necessary so the calming effect of nicotine can help people deal with the stress of losing their nest eggs to computerized slot machines. “Gee, what are the chances of winning against a computer that sets the odds and makes up the rules?” I commented to my roommate, Victoria.

She informed me that I was missing the point and that it was all about the dopamine rush. Given the crowds, I would have to say she was right and I should probably learn more about dopamine since it is clearly popular. I made some mental adjustments to accommodate the environment and enjoy the conference.

For the next three days I immersed myself along with 4000 other physicians and practitioners in the latest research on maintaining/regaining vitality with aging. One speaker summed up the challenges of getting older with the Phillip Roth quote, “Aging isn’t a battle, it’s a massacre”. While it can certainly feel and look like that, there are many strategies people can use to manage the ravishes of time more effectively.

The hardest thing about an intensive conference, beyond the sitting, is information overload. Luckily, for me, I have a solid background and very specific questions I wanted answered which made the potential overwhelm manageable. There was so much generally interesting information that I compiled a list of the more fascinating little pearls.

So, here are:
The Top Ten Fascinating Facts and Observations Gleaned from the Anti-Aging Conference

1. Low testosterone is a common problem in aging men and reduces quality of life. The symptoms are low vitality (fatigue), passivity, low sex drive, weak erections, declining muscle tone and general grumpiness. It is also associated with increased mortality, cancer levels and heart disease. This condition is easy to diagnose and correct though it is generally considered to be vague and hard to treat.

2. Giving testosterone to men with low testosterone levels has never been proven to increase prostate cancer risk. The only time giving testosterone appears to feed prostate tumors is when a man’s testosterone level is extremely low (that is, at castration level which is very, very low).

Harvard urologist Abraham Morgentaler addressed this in great detail and prescribes testosterone even to men who have/had prostate cancer. In general, their PSA levels go down and their cancer growth is generally slower! He presented gobs of research. It took him 45 minutes to explain why there has been such general misunderstanding of the relationship between testosterone and cancer. For more info see his popular book: Testosterone for Life.

3. If you want to slow the aging and deterioration process, balance your hormones. Balanced hormones reduce the inflammation process and inflammation is associated with deterioration and most diseases.

4. Maintaining ideal weight is the best way to reduce inflammation, assuming you are doing this with a balanced diet. The short explanation is that gaining weight increases inflammation. Something about adiponectin inhibiting TNF-alpha (an inflammation marker that can now be measured in the blood) and dozens of other pathways that get thrown off as you put on the extra pounds. There were at least ten sessions on obesity and why it is bad for you. One presenter claimed Type 2 diabetes (usually from obesity) is now being called type 3 Alzheimer’s Disease.

5. Vitamin B-12 shots tied with correcting stomach issues can significantly reduce asthma attacks in adults and children. The theory is that most people with asthma have low stomach acid and absorption issues. When you think about it, the stomach and lungs and sinuses are all connected through a series of tubes. Something that affects one of them can bother the rest.

In children who are allergic or reactive to dairy products, a single exposure to milk can measurably reduce nutrient absorption capacity leading to low hydrochloric acid which causes vitamin B12 deficiency. Giving B-12 in a way that bypasses the stomach may help.

6. Synthetic progesterone (called progestins) does not have the diuretic and other beneficial properties of natural progesterone. Progestins also have more androgenic (testosterone) and pro-inflammation properties though they still appear to protect against uterine cancer. Increased inflammation leads to increased crankiness and headaches both of which are common side effects of the progestins.

7. Bioindentical hormones are well studied, especially in Europe. They are chemically and functionally completely different from the horse estrogen (Premarin) and synthetic estrogens given to most women seeking hormone replacement therapy. Studies have found the risk to breast cancer is significantly different depending on the estrogen being used. Estriol (found in bioidentical hormones) reduces breast cancer risk while high levels of estrones (found in synthetic estrogens) increase it.

8. Growth hormone treatment does not increase cancer risk. One study followed children treated for brain cancer who were later given growth hormone. The recurrence rate of cancer actually went down! This research was a pleasant surprise to hear and there was a lot of it. Once the presenter explained the biological link between growth hormone and immune function it made me wonder why so many people have been worried about growth hormone and cancer. (Probably because many of the early studies involved pouring growth hormone on a tumor in a dish and watching what happened.)

9. Hormone imbalances of all sorts contribute to the susceptibility to cancer. Higher cancer risk (in separate research presented over the course of the conference) was associated with low estriol, low testosterone, low oxytocin, low melatonin, low progesterone, low thyroid and low growth hormone. It does not take a rocket scientist to see the pattern there.

10. Information backed up with research is always sited as the thing practitioners most desire but nonetheless, the most popular speaker was Suzanne Somers. She was described as the most exciting event of the conference. She spoke about her personal experiences and quite the inspirational speaker. I developed a deeper appreciation for how much she has contributed to increasing awareness about alternative medicine. At 64, Somers is a walking testimonial to the wonders of bioidentical hormone replacement, alternative cancer treatment and plastic surgery though that last one was discreetly unmentioned.

In truth, there was nothing alternative about the research presented at this conference with the possible exception of the “aesthetic” courses. There was a whole tract, which I did not attend involving a bunch of frightening looking laser machines and Star Trek inspired apparatus for filing, zapping, exfoliating and otherwise revitalizing the skin and muscles. I did get a sample of the $250 a jar resveratrol rejuvenation cream. While I admit the claims are hard to swallow, wouldn’t it be nice if looking younger was as easy as putting on some really expensive cream?

Monday, December 6, 2010

Blog #21 Men with Rashes

If statistics are to be believed, men as a group, prefer to avoid doctors and perhaps more generally all of us in medically related fields. This has certainly also been my experience. A few times a year a man (or if the truth be told, a woman) will come in to see me just so I can look over what he is eating and taking to be sure he is up to date and doing the best for himself. I often catch myself looking at these people adoringly thinking this is so wonderful. They are taking care of themselves and being proactive. How rare. How inspirational. Prevention is so much more fun then disaster relief.

Sadly, most of us do not operate this way, especially those of the male persuasion. There was a book about this written a number of years ago by a physician’s wife. She relayed the story of how she had to force her husband, who was a cardiologist to go to the hospital because it was clear to her that he was having a heart attack. “I am fine,” he argued. But she was correct.

According to my husband, a self appointed expert on all guy things, being male and all, this attitude is completely understandable. “Men do not like to be seen as weak,” he explained as if it was patently obvious. “They will put up with a lot to keep up the appearance of strength.”

“How do they feel about dead?” I asked innocently at which point he suddenly developed an acute hearing problem.

Over the years I have noticed that most men come to see me for one of three reasons. First, and most popular, they are dragged kicking and screaming by a concerned loved one. Second, they have big complicated situations that have gotten so out of hand even they realize they have to do something. And my personal favorite, they come in with someone else and three minutes before the end of the session they want to know if they ask a “quick” question, really it is just a little thing they assure me. Is there anything they can do about the diarrhea they have had for the last ten years or this rash that covers their whole body and has confounded a gaggle of dermatologists?

You think I am exaggerating but this last situation happened recently. Alan came in with his wife who was the designated patient. I thought I was being clever and a full ten minutes before the end of the session, I anticipated there might be an issue and inquired if I could ask the gentleman a question. “Sure,” Alan replied.

“What are you doing about that rash?” I asked.

“Which one?” his wife cut in. “Lift up your shirt and show her, honey,” she cajoled apparently very happy that I had opened the subject.

I am not a dermatologist, but could see at least three different types of rashes. “If this was not so clearly irritating to you, “ I commented, “this would be fascinating. Look there is a ring worm,” I said pointing to a perfectly round red circle with a clear center. And there were hundreds, possibly thousands of little papules. “I wonder what they are from?” I mumbled thinking out loud. “These rough spots look like essential fatty acid deficiency,” I remarked pointing to several sand paper areas. “Though I bet that was diagnosed as keratosis pilaris.”

Keratosis pilaris (“chicken skin”) was indeed one of many diagnoses he had received over the years. Apparently, the numerous dermatologists and specialists he had consulted through the years were no longer fascinated and had given up on trying to unravel the situation, as had he.

Luckily, I am not a doctor and this allows me the freedom to take chances and say things that otherwise I would have to keep to myself to maintain decorum. “You must be miserable,” I blurted out. Alan responded with a shrug. “We have to do something about this,” I continued as if he had not been trying to fix the situation for years.

I assumed he had been tested for allergies. Alan confirmed he had and nothing significant had been found. I next asked if he ever found anything that had made it better or worse. His skin was obviously sensitive and his wife was careful with soaps and detergents she bought. Unfortunately, while some products used topically could make him worse, nothing he avoided in particular made him better. He had tried great numbers of ointments and salves through the years but nothing corrected the problem. Presently, he used moisturizers when he remembered or was particularly dry.

Since there were no clues in his dermatology history, I started asking about other symptoms (that might be related) and reviewed his children's medical histories. The original person I saw in his family was his son and he turned out to hold the answer to the mystery. To be continued……

Sunday, November 28, 2010

Blog #20 Toddler Crack

This week three parents asked me how to stop their second child from becoming a picky eater. In two of the cases, I am helping deal with said picky eating older child and the third was the mother of a baby with other red flags for developmental issues. Is there anything they could do to prevent the picky eating debacle?

The best suggestion I have is to not introduce the three C’s or what I call toddler crack. Everybody knows these three oh-so-friendly kid foods. One of them is in a container in practically every diaper bag/mommy purse in the country because they are universally adored. They are crackers, cookies and cereal and once kids discover them, they are as addicting as crack.

And why shouldn’t they prefer salty or sweet crunchy foods they can pick up with their own hands verses a non-descript mush mix spooned in by daddy? At two, the toddler has just discovered there is a connection between action and consequences and he wants to see what he controls. Eating looks promising so he wants to feed himself when possible. Utensils can be challenging so finger foods are better. Crackers, cereal and cookies fit the bill perfectly.

Once in the mouth, baby mouths can find the crackers because they are crunchy but as soon as the saliva hits them, they dissolve without much chewing. In the feeding world, these foods are called meltables. They are extremely convenient because the little ones do not have a full component of teeth yet but want eating independence.

The final attribute sealing the addictive quality of toddler crack is the taste. Face it. Chicken and peas cannot compete with highly flavored crackers and cookies. David Kessler has written extensively about how food companies use these ingredients heavily to encourage people to prefer and overeat empty calorie food. (See, The End of Overeating.)

This is how kids get hooked right from the cradle. You are out at the park in the afternoon and two and a half year old Seth is starting to get cranky. It has been several hours since lunch so clearly he is hungry. Carrying around a bean burrito for such occasions is impractical and tough for him to eat so you hand him a container of dry cereal that is perfectly fine after a month laying at the bottom of your diaper bag. Seth calms down immediately because he can pick up the little pieces and feed himself. (“He is building self esteem and self care skills,” you tell yourself.) There is an additional bonus of keeping him occupied for a full five minutes so you can get him in the car/stroller without screaming.

Once home, you make a lovely dinner which he does not want to eat because his tiny toddler tummy is full. Twenty minutes of coercion and three bites later, you give up only to have him tell you he is hungry right before bed. You already put away the salmon and green beans so you hand him, just this once, a few fish crackers which he eats happily. It is straight downhill from here.

It all sounds so innocent but crackers and dry cereal are like crack to babies. Most toddlers love them to the exclusion of anything else given the choice. If you want to raise a child who will eat fruits, vegetables and a variety of healthy foods, DO NOT BUY CRACKERS, LITTLE COOKIES OR DRY CEREAL, period. They have little if any nutritional value.

What to do instead? You have to think ahead a little but pack up cold cooked peas and carrots, bananas, grapes cut in half, ¼ of a sandwich or little pieces of cheese. In the heat of the summer you may have to throw in an ice pack. Eating pieces of fruit and vegetables also require more supervision, as they are not meltables. Small children can choke more easily as developmentally they have not completely mastered eating skills. When planning for snacks, think real food instead of empty calorie treats.

A recent October 2010 study found that 40% of the calories in children’s diets now come from empty calorie foods. The most common was grain desserts or cookies and granola bars. According to several articles reporting on the study, despite the horrifying state of children’s diets in this country, nobody seemed surprised by the findings.

Monday, November 22, 2010

Blog #19 Topsy Turnips

My husband, Jeff, and I would not survive well as farmers. Despite having a nice organic garden, we have poor crop planning skills. Left to his own devices, Jeff plants mostly tomatoes that he loves but I cannot eat. When they failed this year, I stepped in and we attempted a second cold crop of peas, lettuce, carrots, radishes and turnips. It was too late for the peas which climbed about half way up the trellis before the cold set and arrested their development at mid adolescence. The carrots were delicious but the size and width of a fountain pen. I ate a head of lettuce a day for several weeks and Jeff had plenty of radishes but the turnips…… The turnips went wild.

They grew in crowded clumps because we did not thin them properly. Ignorant suburban farmers that we are we thought how many turnips can a few seeds produce? It turned out to be enough for an army of underfed groundhogs. There were so many that they pushed each other out of the ground where we could just scoop them up rather than pull them out. Some were the size of soft balls.

Jeff gamely ate one or two every day and I gave them away to all of our friends/neighbors who liked them which was a grand total of one person. Nobody seemed to know what to do with them and they were starting to pile up. Finally, I decided to make a big turnip dish for Thanksgiving and invite a lot of people. The first challenge was finding a decent dish. After some experimentation, I decided on pureed turnips because I had them once at a fancy restaurant and deemed them to be a potential crowd pleaser.

Playing around with several recipes, I came up with this one. It would probably taste better with a half cup of heavy cream added but too many people in my family do not eat dairy. Besides, without the cream, it has the advantage of being extremely healthy.

Cut and peel turnips and carrots and put them in a greased roasting pan. I use two parts turnips to one part carrot. The farmer’s market had yellow carrots and they worked great because the puree is yellow rather than orange like sweet potatoes and they are sweeter. Roast them for 20 minutes or until tender. Next dump them into a food processor or better yet, a Vitamixer. Then add salt (to taste), chicken broth (to get it to the thickness you like) and a tablespoon of maple syrup. The maple syrup was important because the baseball size turnip was pretty strong tasting though the little ones were not. A couple of spins around the Vitamixer and the result was creamy and tasty. Now to find more people to eat it.

I called my virtual assistant, Tania who lives a few hours away. “So, do you want to come for Thanksgiving?” I asked.

“What are you serving?” she asked warily.

“Pureed organic turnips with a hint of maple syrup,” I said in my most seductive voice.

“Gee, it looks like we will be awfully busy that day,” she retorted.

“Well, I also got a delicious turkey from the Amish farmers,” I tried again. “After which, I signed up for their e-mail list.”

“You are making that up,” she gasped appalled.

“Am not. The Amish have e-mail now. I wonder what kind of horse powered generator they use to run their computers?” I mused.

“They do not have computers,” she corrected. “They probably hire outsiders like they do for driving and things.”

“Well, they are famously adaptive business people, “ I agreed. “But I still think there might be a poor horse walking around in circles somewhere long into the night so Amish teenagers can be on Facebook.”

“I think you better cut down on your turnip consumption, it is affecting your mind,” she countered.

I would love to cut down as I do not like plain turnips very much but what am I going to do with all of them? They are such an underdog vegetable that I am afraid if I donate them to the Manna Food Bank, they will wish it was carrots or green beans instead. One of the vendors selling them at the farmer’s market said he had no clue what to do with them but I bet the Amish farmers have some ideas. Maybe I will send them an e-mail.

Tuesday, November 16, 2010

Blog #18 What to do to prevent the flu

To read a detailed, technical chronicle of the foils of the flu shot, see my last blog. To summarize, the flu shot does not work but contains harmful toxins and preservatives like aluminum and mercury so thoughtful people avoid it. The pressing question is what really does prevent the flu? I will start with the boring stuff that everyone knows but does not want to do.

• Exercise
• Healthy Diet
• Getting enough sleep

These three basic steps are enormously effective at improving immune function but most people prefer the myth of a magic shot instead. Exercise is hard to squeeze in anytime but in the winter there are so many better weather excuses to avoid it. The truth is you do not have to train for the Boston marathon, just walk 25 minutes 4 or 5 days per week. My solution for this was to purchase some very comfortable ski pants. Now no matter how cold it is, I can walk comfortably with my dogs who never complain about the weather.

A healthier diet does not have to be intimidating either. Added sugar is the major immune suppressor in the diet. If you just cut that way down your immune function will pick up significantly. Eat fruit (fresh or dried) or put some raw honey (which has immune enhancing properties) in your tea to soothe your sweet tooth. This is the hardest step for me.

If you don’t build enough sleep into your schedule, your body will eventually correct that by making you sick so you have to sleep. By biggest problem with this is the &%$#%^ computer and e-mail. If I stay on too long, the e-mails run through my head when I’d rather be sleeping. In my practice I have noticed that turning off the computer is a particularly difficult problem for men.

Now for the more exciting, easier supplement strategies:
• Get your blood vitamin D level up to at least 60.
• Take vitamin C, probiotics and at least 15 mg of zinc daily.
• Keep a strong natural killer cell enhancer on hand in case you feel an illness coming on.

Robust vitamin D levels are highly associated with lower illness rates (including cancer). Blood levels over 30 or 32 ng/ml are considered “normal” but higher levels can protect against illness. Of course, the only way to know for sure if you have a decent vitamin D level is to have your doctor order a blood vitamin D test. Since about 70% of women and children are low, most doctors agree to this request and it is probably worth doing.

Vitamin D-3 (the natural version) is easily available in drops and pills. Several doctors I know recommend taking one large dose (25,000-30,000 IUs) immediately if you start feeling under the weather. For dosage recommendations for children, consult your pediatrician. Note that nutritional interventions to prevent illness do not work once the illness sets in. You must strike early when the immune system first notices a problem.

Consistently taking the immune trio of probiotics, vitamin C and zinc can keep up your defenses during the flu season. Keep probiotics in the refrigerator and find one that has at least 10 billion bugs. Take 500-2000 mg of vitamin C depending on age of the person and level of vulnerability to illness. You cannot overdose on vitamin C because when the body cannot absorb anymore, it causes diarrhea and out it goes. A good multiple vitamin/mineral may already contain the basic zinc most people need but you can take an extra 15 or 20mg daily during periods where you need an extra boost.

Keeping a strong immune enhancer on hand is a must because you know you are going to need it at 11:00 PM on a Tuesday night. Waiting 12 hours to get to the store (or days until it comes by mail) will be too late as the illness will have enough time to take hold. Viruses replicate very quickly and the more cells they have time to infect, the more serious the illness. Natural killer cells are the first line defense against viruses. Several products enhance these fighters and people have individualized responses to them. Some find one product works better for them than another. I will take one of these for a few days (or sometimes just one or two doses) if I feel like I am run down or fighting something.

My three favorite are:

• ProBoost Packets (http://www.proboostmed.com/faq.html)
• 4 Life Transfer Factor – Trifactor formula (http://www.amazon.com/4Life-Transfer-Factor-Classic-capsules/dp/B000OUY84U)
• American BioSciences ImmPower (http://www.vitacost.com/American-BioSciences-Immpower-AHCC).

The price of these products vary greatly but they all work great. Follow the directions on the bottle. This is a blog and should not be used as a substitute for medical advice. If you have questions, contact a knowledgeable medical professional.

Finally, use hand sanitizers frequently. Just kidding. These products have been found in studies to be as useless as the flu shot. You may as well rub your hands in the grass or on your pants. Better to wash your hands with plain old soap and water every once in awhile.

Just to let you know how long you need to wash your hands to significantly get the germ level down, imagine singing through a verse of “All the Single Ladies” or about 30 seconds. That is what it takes and unless you are preparing for surgery, you probably are not doing this.

Not to worry, while germs cause colds and flus, they are less responsible for illness then most people believe: Mainly because they are everywhere so one cannot avoid them. In one study, healthy volunteers were asked to play cards with other volunteers who had colds. (Warning: this is a gross study.) No tissues were provided so after awhile the cards were literally damp with the viral laden nasal discharge from the sick participants. The high virus exposure did not result in significantly more colds among the healthy volunteers.

As Pasteur said at the end of his life, “It is the environment”. It probably sounded better in French but after years of proving germs caused disease, in the end, he realized it was the environment the germs were introduced in to that often counted more than the bugs themselves. So, strengthen your environment and the germs will find somebody weaker to attack.

Monday, November 8, 2010

Blog #17 The Most Hysterical TIme of the Year

Bundled in my overcoat and out walking my dogs, I cannot help but appreciate the crisp air and beautiful foliage. The joggers are out and the left over Halloween pumpkins seem to wink as you pass by or perhaps they are just spoiling and sagging some. Still, fall would be absolutely perfect except for one sour note. Yes, it is time for the annual drug company induced flu hysteria.

“The flu is coming, the flu is coming,” is the battle cry. “Experts advise the best way to prevent the flu is to get the flu shot or flu mist,” shout the television commercials. I ran into flu shot "clinics" at the airport. And then, while looking for an elusive shower cap, at several pharmacies. All utilized cleverly worded signs to entice or frighten the consumer into submitting to unproven technologies. You cannot avoid being affected by the deluge or the very seductive word, “free”. Everyone likes getting stuff for free.

For me, the result is many phone calls and e-mails. The first came from my friend, Lizzy. Lizzy evaluates children for sensory processing issues. She sounded awful on the answering machine. “What should I do?” she wanted to know. She had been testing a child who had come directly to her office after getting a dose of the flu mist. He had been sneezing throughout the session and now, several hours later she was feeling heavy headed and achy.

You may recall from several years ago when experts unequivocally stated the flu mist did not work. Part of the problem was it contains a live virus so it had a tendency to cause the flu. That was the year that Walmart was naively squirting the viral mist up the noses of its shoppers only to find that they would wander over to the deodorant aisle and sneeze. Viral clean-up needed on aisle 7. It did not take them long to figure out they were potentially spreading more flu than they were preventing.

Now Lizzy was worried she was coming down with the flu. It was still early enough for her immune system to fight it off. She upped her vitamin C, probiotics and immediately took a packet of a powerful natural killer cell enhancer called ProBoost. I had introduced her to ProBoost several years ago and she has not been sick since. I told her to take a second packet the next morning and to take one large (25,000 IU) one time dose of vitamin D. When I talked to her a few days later, she was doing fine, disaster averted.

The calls and e-mails, however, were just beginning. Tania, my loyal assistant called soon after. “They are offering the flu shot and flu mist at my son’s school,” she reported. “I was wondering if I should keep him home that day.”

Good question. “If they were sprinkling virus around the Nordstrom Rack, what would you do?” I asked.

“Show up early to avoid the crowds?” she retorted smarty pants that she is.

Very funny,

“Go to TJ Maxx instead?” she continued on a roll. “I never really liked Nordstrom Rack anyway.”

It is a start, I agreed.

What about the flu shot? That does not contain live virus. Putting aside the questions about the mercury content and other potentially dangerous preservatives for the moment, does it work? Apparently not as the number of people getting the flu is not decreasing despite dramatically higher vaccination levels.


The research, what little there is, has never proven the efficacy of the flu shot. In fact, there have never been the basic studies done on the flu shot that are required of other FDA approved medication. Not a single double blind study.

What a review of 15 studies found was that influenza vaccines were ineffective against influenza-like illnesses, influenza and pneumonia. (The Cochrane Database of Systematic Reviews 2006.) It also works equivalent to placebo in children under 2. (The Cochrane Database of Systematic Reviews 2008.) In other words, it does not work.

One study found the flu vaccine may triple the risk for flu-related hospitalization in children with asthma. (May 25, 2009, www.medscape.com/viewarticle/703235). There are a shocking number of negative studies yet the shot is consistently recommended. (For more flu shot info see: www.drtenpenny.com.)

The best explanation for this incomprehensible disconnect was offered in a brilliant article in the Atlantic Magazine (November 2009), “Does the Vaccine Matter?” According to the article, the research often quoted to promote the shot does not prove the vaccine works but uses conclusions from cohort studies. These studies look at death rates associated with various factors. It is often observed that people who get the flu shot die at a much lower rate than those who do not. So, therefore, the flu shot saves lives, right?

Nope. It turns out that people who get the flu shot die much less often than other people summer, winter, spring and fall. In fact, they die less from all causes all the time because they tend to be healthier to begin with. It is called a “healthy user effect” and completely accounts for the lower death rate in flu shot receivers. When Dr. Lisa Jackson, a brave Seattle based researcher and physician studied the association more closely, she found the shot did not reduce death whatsoever.

But the November 2009 Atlantic Magazine article said it better than I can:

“…. in 2004, Jackson and three colleagues set out to determine whether the mortality difference between the vaccinated and the unvaccinated might be caused by a phenomenon known as the “healthy user effect.” They hypothesized that on average, people who get vaccinated are simply healthier than those who don’t, and thus less liable to die over the short term. People who don’t get vaccinated may be bedridden or otherwise too sick to go get a shot. They may also be more likely to succumb to flu or any other illness, because they are generally older and sicker. To test their thesis, Jackson and her colleagues combed through eight years of medical data on more than 72,000 people 65 and older. They looked at who got flu shots and who didn’t. Then they examined which group’s members were more likely to die of any cause when it was not flu season.


Jackson’s findings showed that outside of flu season, the baseline risk of death among people who did not get vaccinated was approximately 60 percent higher than among those who did, lending support to the hypothesis that on average, healthy people chose to get the vaccine, while the “frail elderly” didn’t or couldn’t. In fact, the healthy-user effect explained the entire benefit that other researchers were attributing to flu vaccine, suggesting that the vaccine itself might not reduce mortality at all. Jackson’s papers “are beautiful,” says Lone Simonsen, who is a professor of global health at George Washington University, in Washington, D.C., and an internationally recognized expert in influenza and vaccine epidemiology. “They are classic studies in epidemiology, they are so carefully done.”

The results were also so unexpected that many experts simply refused to believe them. Jackson’s papers were turned down for publication in the top-ranked medical journals. One flu expert who reviewed her studies for the Journal of the American Medical Association wrote, “To accept these results would be to say that the earth is flat!” When the papers were finally published in 2006, in the less prominent International Journal of Epidemiology, they were largely ignored by doctors and public-health officials. “The answer I got,” says Jackson, “was not the right answer.”

The entire article is available online.


So, the flu shot and the flu mist do not work. So what does work? To be continued………

Monday, November 1, 2010

Blog #16 Vitamin M Continued......

“You were soooooo right,” Ellen enthused. Oh goodie, I thought. I love being right. Then it occurred to me that I had no idea to what she was referring.

“About what?” I queried.

“You know,” she continued. “About movement and speech. Remember that story you told me?”

I did. It was currently my favorite story about movement involving a 5-year-old boy on the autism spectrum. I will call him, Kirk. Kirk hopped from one thing to the next with limited attention or engagement. His language consisted of demands and basic observations with little conversation. If you work with or have a child with autism, you may know about the concept of closing circles of communication. Basically, you say something, the child acknowledges your opening and responds with something related to what you said and sends the conversation back to you. That is one circle.

The late Dr. Stanley Greenspan stressed the importance of closing circles of communication and developed many techniques to help improve conversational skills. The child needs to be interested enough in another person to engage and then respond appropriately to unexpected conversational gambits. An autistic conversation is more like a political debate on TV when one question is asked and another is answered. This “conversation” tends to be one-sided. Something like this:

“What did you do at school today?”

“Thomas”

“Oh, you played with Thomas?”

“No, want to play with Thomas.”

“You want to play with Thomas the tank engine. Okay, but did you have music today?

“Eat cookies.”

Etcetera.

Kirk communicated at this level with much prompting and redirection needed to have any level of conversation. The parents and speech therapist were working hard to improve the quality and complexity of the interactions. I explained to the mother that the language centers were right next to the movement centers. Parents so often concentrate directly on speech rather than working on motor skills and/or sensory function. When language is not improving, improving sensory and motor function can create a neurological foundation for better speech. It is the reason children usually walk before they talk and why boys, in particular, use movement to help them think straight.

With this little developmental tidbit in mind, the Kirk’s family headed off to Disney World. It had been a tough year and the parents decided for one day to allow Kirk to do whatever he wanted. What Kirk wanted was to go on the Disney equivalent of the roller coaster “20 times”. So, they let him.

At the end of the day, Kirk was communicating better than he ever had. He was answering questions and initiating more conversation. His parents were so excited but did not know how to sustain the gains.

Since they did not have room for a roller coaster in their living room and they could not move to Disney World, the question was what to do to get Kirk’s level of movement and sensory input way up. We talked about using Wii fit and checking in with their occupational therapist about what equipment could be installed and used at home. This was the story I told Ellen.

Ellen took her son with speech delays to a local amusement park and used the same strategy with similar results. “You should have heard him talk,” she reported. “It was unbelievable”.

Once again, I had a conversation about increasing the levels of vitamin M in a little boy. “Sometimes I think there is not enough movement in the world for him,” his mother cracked.

The difference between these two children and Colin, discussed in the previous vitamin M blog is in the type of movement. For Colin, it was direct heavy exercise while in Kirk and this young boy it was machinery moving them. While the child moving himself is generally preferable, the intense movement of a roller coaster is very stimulating to the nervous system and can also do the trick. The key is finding a way to get lots of movement into everyday life.

Monday, October 25, 2010

One afternoon at the conference (#15)

Recently, I was at a large medical conference. After my talk, I thought I would sit in on an open discussion of a case being presented by a well known doctor. When I arrived there were about 40 other physicians/practitioners as well as the mother of the child, whose history was laid out in front of us. She sat calm and poised on the platform next to the doctor.

The mother and doctor went back and forth filling in the details of her son’s history. The blood and other medical test results were flashed on to a large screen and the presentation was going as these things generally do.

Somebody asked a question which I did not hear. The mother responded that the most important factor in a successful patient-doctor relationship was utter and complete confidence in the doctor, which she had. Many of the attendees nodded their heads in solemn agreement but this type of comment to me, usually means bad things are a comin’.

I am all for complete confidence in the medical professional one works with but draw the line at utter. In any relationship, there has to be one finger of yourself left to raise questions and consider other possibilities in case the practitioner is human and prone to mistakes or has a few gigantic blind spots, like everyone in the world. “Don’t give all your power away,” I wanted to shout. “Retain your right to question authority.” Alas, it was too late. Not only had she given all of her power away, most of the practitioners in the room seemed only too happy to take it.

Yet, she seemed peaceful and satisfied with her care and she had a right to her own views so I got off my little mental soapbox and decided to get what information I could from the session. With all of these highly educated people in the room, there should be some good clinical pearls, I reasoned optimistically.

The doctor finished showing the blood tests and explained what he had done in response and a lively back and forth with the audience ensued. Most of comments were started with, “I spent 20 years as head researcher on this topic….” or “I used to be clinical director of….” These were followed by an observation or advice wrapped in a question. “In the hundreds of similar cases I have seen,” went one, “I found such and such worked best. Why didn’t you use that?”

The presenter took these Monday morning quarterbacking comments equitably, explaining his thinking about this or throwing questions back to the audience when an unfamiliar concept was broached. The audience jumped on these like bears at a salmon convention. And they were so smart. Obscure and fascinating research was quoted. The usual wind up for these tidbits was,” You are no doubt familiar with Dopplehoffer’s seminal work on blah, blah, blah.” I wasn’t! I furiously took notes.

As the presentation went along, I waited to hear what the doctor did to figure out what type of infection this child had. There was a significant infection marker in the blood work that he had skipped but surely would come up in his treatment protocol. It did not. I tentatively raised my hand and asked. He looked at me blankly. “Nothing,” he said and moved on to the next comment.

I eyed the audience suspiciously and stopped writing. This could not be good. Why aren’t these doctors concerned about a possible infection? Instead, he highlighted a low iron level which he explained needed to be corrected. Many heads nodded in agreement once again and there was a brisk discussion about how everyone is afraid of iron but how important it is. One former clinical director claimed he even prescribed iron injections. The consensus was, iron: excellent choice.

MayDay! MayDay! Iron goes low when there is an infection. The body has a protein called lactoferrin that eats it up so the bacteria don’t get it because bacteria need iron to thrive. The case went straight downhill from there. A secondary gastrointestinal infection was uncovered which was treated with antibiotics. Iron stops antibiotics from working so I was not surprised to hear that the child had the same recurring GI infection. The doctor treated the problem with antibiotics but sighed with frustration when reporting it just was not going away.

Here I thought I was in an educational seminar but I had forgotten about how myopic the culture of medicine can be. Everyone was more interested in quoting medical literature and looking brilliant than considering new perspectives or asking real questions. I tried to raise a few delicate points without being insulting but nobody was listening.

Afterwards, I realized my failure was in being polite and not coldly explaining the forgotten basic principles of infections and iron. I was not speaking their language. The most important criteria for being heard is thrusting forth with unassailable confidence. “To anyone familiar, as I am sure you all are, with the studies by Smurf that found that iron deactivates antibiotics,” is what I should have said. I have done this many times one on one with other medical professionals to help clients. The trouble is that Smurf did not do those studies and I would have to look up who did in order to posture effectively. And though I can be an intellectual bully when arguing for proper patient care, it always leaves a bad taste in my mouth.

When I left, I was downtrodden. Intellectual arrogance and jockeying is usually bad for patient care. That poor kid. He has some kind of primary infection nobody is looking for, he is being treated for a secondary infection with antibiotics which might even accidentally help the primary infection but are being deactivated by supplemental iron and everybody just thinks this is an unusually tough case.

I took a breath. There are many ways to do things and mine may not be the only or dare I say, the best. I should take my own advice to question my own thinking. Iron is an important nutrient so perhaps I am not using it effectively and often enough. Perhaps this child will get better because of other unknown factors. Maybe the mother’s unquestioning faith in her doctor will overcome the biochemical factors. Question everything, I told myself. Try not to be attached to what you think you know.

The truth is the price for good health care is eternal vigilance. Ask more questions if the advice you are getting does not feel right. Get a second or third opinion. Like your doctor or nutritionist but do not adore them unconditionally because they are human and therefore, will screw up sometimes.

But don’t take my word for it.

Sunday, October 17, 2010

Blog #14 Coming soon to a store new you

A good detective keeps up to date with what’s new in her field and to that end every year my husband and I spend a day at the Natural Products Expo. This is an enormous natural foods convention where new products are trotted out and old standards search for new vendors. The fun part is getting to taste everything.

Through the years we have noticed the health food industry, like everything else is subject to trends. One year there was a whole aisle of soy enhanced foods including soy meats, drinks and puddings. Another time it was the year of the obscure berries and exotic fruit like acai, goji berries and mangosteen. Goji berries tasted like red lint no matter what they mix with them including chocolate. But we try everything.

Once we ran into our friend, Enrique, who works for the FDA. Last we had heard he was hot on the trail of a dangerous man parts enhancer that was heavily advertised on the internet. “You should see what happens to the poor slubs when this goes wrong,” he confided, shuttering. The whole project was depressing him. We were glad to see him out doing some fun field work but though we love Enrique, we could not bring ourselves to invite him to walk around with us.

“Being with you is like wearing a “cooties” badge,” I apologized lamely. “Nobody will tell us anything interesting when they see you are from the FDA.” He understood and was not offended. To make amends, we told him where all the good organic ice cream samples were.

This year was all about gluten free foods. Coming to a store near you soon is gluten free….everything. The best was a line of naturally gluten free frozen soups by Kettle Cuisine. Their yet-to-be released Thai chicken with a coconut milk base was particularly yummy. The cookies and cakes on the other hand were consistently too sweet. After trying a half dozen, I could not stomach them any more. For gluten free treats stick to chocolate, ice cream, macaroons or Pamela’s cookies is my advice.

As for new cool discoveries, my husband’s favorite was a naturally fermented “soda”. Technically, it was a type of water kefir made with probiotics. They make it using a process similar to the one used to make kombucha. It is sweeter than kombucha however and only has 40 calories. His favorite flavor was tarragon. Check out: www.eatcavemanfood.com.

My fun new find was Sea Buckthorn. It only grows in the harshest environments like salty marshes and the Himalayas. To survive these inhospitable environments the plant has developed some unique bio-defense mechanisms. These chemical mechanisms are often anti-oxidants and nutrients to the plant consumer.

“Sea Buckthorn is the world’s only source of essential omega 7 fatty acids,” the enthusiastic sales rep informed me.

“I was not aware that omega 7 fats were essential,’” I replied.

“Oh, they are for the skin,” he assured me. “In fact, my girlfriend complains my skin is too soft because I work with them so much.”

“That seems like an unusual complaint,” I retorted eyeing him suspiciously. “Let me see your hands.”

His hands were spookily soft for a man; it was like touching Gumby. “Very impressive,” I commented. “What else is it good for?”

“Acne,” he said with confidence. “Clears it right up.”

Luckily, Enrique was not here to witness such a claim but I wanted to know more. “I wonder how it works,” I mused while trying to read the bottle. “You know omega 7 fats have to be made from something else, so are they long chain polyunsaturated fats?” I asked.

He looked at me blankly and then recovered. “I am not sure but they are essential.”

No, they are not, I explained. There are two essential fats and omega 7 is not one of them. Every other fat is made from these two though it is sometimes useful to get non-essential long chain fats like DHA and EPA directly. Now, he was stepping back from me.

“Think about it,” I challenged, “how could this fat for which there is only one direct food source in the world, be essential? Ninety nine point nine percent of the people in the world would not have access to it. The question is, what is the structure of it and why is this form particularly good for the skin?”

“You need to talk to Dr. Liu,” he decided and scribbled a name and number on a card. In the meantime, I ordered a few bottles. I thought about someone who might be willing to be a guinea pig to test it out.

But all this talk about chemistry was making me hungry. “Look,” called my husband, “I found some high antioxidant chocolate.” Now that sounded essential.

Wednesday, October 13, 2010

About the book.....

Dear Rosa Maria....

Thank you for asking about the book. "What's Eating Your Child? The Hidden Connections Between Food and Your Child’s Well-Being — and What Every Parent Can Do," is deep in the process of editing which takes a long, long time. In fact, it feels like I produced three children in less time. The good news is that this paperback baby is expected from Workman Press in April 2011. Hopefully, Jim Carey will be between movies and will be available to star in the movie version. Just kidding. I want Diane Lane.

Friday, October 8, 2010

Blog #13 Vitamin M

Julia dropped by to discuss her son, Colin. I had seen him many years ago but now he was attending a famous military college that starts with “The”. I will call it, “The Academy” though it is not really THE Academy but a different equally famous The something. Anyway, she was worried because Colin was diagnosed with ADHD and she wanted him to be successful at The Academy. Colin had discovered the reported wonders of Ritalin by scoring it from some buddies and believed he was not nearly as focused without it. The Academy, like all military institutions, did not allow its cadets to take stimulants, prescription or otherwise. In fact, they randomly and frequently drug test the students.

I love this place! I wish all universities did the same thing though for all I know one of my own children might have been kicked out which such a policy. I have talked to many college students and most of them have admitted to me (usually without their parents) that they have tried stimulants for studying and/or test taking. They are the most abused drugs on college campuses. The military thinking is you cannot have a soldier running out of medicine while under fire somewhere, especially a narcotic. (Technically, stimulants are narcotics.) Who knows who you would be dealing with? They certainly do not want to find out.

Colin had survived freshman year with a “B” average. It was rough physically with many hours of intense physical training every day plus academics. There was little we could do about his diet. He had to eat at the dining hall and he was already making good choices eating salads and vegetables whenever they did not look too soggy.. And, he was doing the best he had ever done academically I think I know why.

He was getting a gigantic dose of vitamin M: Movement. For a certain type of attention issue, the best strategy in the entire world is loading up with vitamin M. Colin was getting 4 or 5 hours a day of motion and physical activity. The Academy was doing for him what no other university and a fistful of medication would ever match.

The movement centers are right next to the language centers in the brain. All that running around was organizing Colin’s thinking and putting his frenetic energy to productive use. His mother admitted he was calm and happy. The biggest problem was he was comparing his present performance to how he felt taking stimulants. The stimulants gave him a false sense of confidence because his thinking was so remarkably sharp. What can I say? This is why people like cocaine and stimulants are similar.

I assured Colin’s mom he was thriving and that the magic of vitamin M would keep him in balance. I also explained the concept of neurodiversity. That is, there is a wide range of ways that brains function and process and there was not anything particularly wrong with Colin’s. I call people like Colin who have been diagnosed with ADHD, Warriors. Until recently, Warriors were highly prized in society. They were the knights and warriors you called (and paid) when the village needed to be cleared of marauders. They were athletic types who had no trouble riding their horses all day and were what we would now call, “risk takers”. They would shoot first and ask questions later. It makes you wonder if Clint Eastwoods’s Dirty Harry would be classified as ADHD if he had to get through the police academy today. You can imagine the report. “Has trouble following directions. Cannot sit still. Tends to shoot first and ask questions later suggesting impulsive tendencies. “

Today, the valued jobs go to people with brains that can concentrate for long periods of time while sitting at a desk. The physical warrior has been replaced with the computer warrior. Not a better brain, just a different, presently in more style brain. (For more on this fascinating subject see one of Thom Hartmann’s 8 books on neurodiversity at www.neurodiversity.com )

Along with many assurances, I suggested some nutrients that help with cognition and would not trip any drug tests…..just for insurance. Besides, it can never hurt to be a little smarter. But this is not all vitamin M can do……(To be continued.)

Tuesday, September 28, 2010

# 12 How to Have a Difficult Conversation

I first started seeing Helen three years ago when she was nine. She had a terrible memory problem, could not understand the simplest math concepts (especially when it came to using money), was socially immature and melted down a lot at home. Of course, she was the epitome of sweetness at school which made her mother, Debbie wonder what was going on with her little Dr. Jekyll and Mr. Hyde.

The diagnosis, as expected, was learning disabilities but her adoption from the former Soviet Union made me uncertain. This pattern of learning disability connected to a Russian adoption always makes me wonder about Fetal Alcohol Syndrome (FAS). It’s true that children with full blown FAS are rarely released for adoption anymore. They have physical characteristics that mark the condition and I shutter to contemplate where they all end up. But Fetal Alcohol Syndrome Effect (FASE) has no physical markings. It is FAS light and all the damage is inside. In my experience it is horrifyingly common in adoptions from that particular area of the world and looks just like this.

FASE was not mentioned so I asked if the possibility had been explored. “We consulted an expert,” Debbie replied defensively, “ and she doesn’t have it. She is beautiful and has none of the traits,” she concluded, case closed.

Uh oh. Either this “expert” was not the sharpest stiletto at the shoe store or more likely did not want to open up an uncomfortable or unproductive conversation. Some people believe there is nothing that can be done about FAS(E) anyway, so why make parents feel bad?

I don’t like having these conversations any more than the next person. They are hard and don’t always go well. But who am I to decide what is or is not possible? I am committed to being honest but I don’t want to be cruel. I grew up in a culture where you could walk around with a worm coming out of your head and nobody over the age of 16 would be “rude” enough to mention it. They might call you worm ear behind your back- but would politely avert their eyes and pretend not to notice.

Today, you would get your own reality show, “Keeping up with the Worm” or Dr. Phil would boom at you to “ lose the worm”. None of these extremes helps people or involves conversation.

So, I took a breathe and explained to Helen’s mother how you could not see FASE but that there might be some strategies we could try if we know what we were dealing with. There is some theory, for example, that high doses of folic acid might help brain development in FASE. She asked questions but objected to everything I suggested.

I mentioned specific bonding therapies and supplements that might improve cognitive function. “I am not comfortable with all of these supplements, “ she asserted but continued to talk with me. During the whole conversation I neither got defensive nor offensive but just hung in there with her.

A few months later Debbie returned. Surprisingly, she had purchased and had started giving Helen the nutritional supplements. “But, I don’t see any difference,” she insisted.

I again explained how the brain injury from prenatal alcohol exposure is persistent and pernicious. “This is a long haul operation,” I told her. “Looking back we hope she will have made more progress than expected or be functioning better than she might have otherwise.”

Debbie remained dubious.

Over two years passed and I did not hear from Helen’s mom. Last week she reappeared. “Remember, Helen?” she asked. “She is a 12 year old girl with FAS.”

Clearly something had changed. Debbie and Helen had been busy the last two years. Debbie had enrolled her in a special therapy program for children with FAS(E). She had been evaluated by one of the world’s experts on the condition who opined that Helen was progressing unusually well to therapy and supplements. Finally, Debbie had started a blog about raising a child with FAS to help other families.

“I don’t think the supplements are helping,” Debbie reported though Helen was actually doing better in many ways. The meltdowns were mostly gone, her memory was better and she was doing well at school, though still behind her peers. Math remained her big area of academic weakness and she was still significantly immature for her age.

I decided to change the cognitive program away from motor planning and memory. Helen had been taking everything for 2 years and had probably gotten all the benefit she was going to get from the old compounds. We kept the folic acid and fish oil but decided to try something new I had discovered. It is a unique supplement that helps regenerate the proteins used to send signals in the brain. I was not sure it would work because nobody knows exactly what will work in FAS(E) and said so.

Debbie was not enthusiastic but is considering the suggestion. She also mentioned that Helen had gone through puberty and now had the body of a lovely young woman, “with the emotional development of a 7 year old”.

I froze. That is a bigger gap than I had expected given our conversation so far. “How social is she?”

“Oh, she is so friendly and is very eager to please these days,” was the response.

I asked several more questions about Helen’s life, took a deep breath and started the new difficult conversation. “So, what are you going to do about birth control?” I ventured.

Helen’s mother sighed.

Sunday, September 19, 2010

Blog #11 The Subtle Bouquet of Pear Juice

“Dear Mrs. Dorfman,” the ordinary sounding e-mail started. I knew immediately it was from a stranger as nobody that knows me calls me, Mrs. Dorfman because I don’t like being called Mrs. Dorfman. Maybe if I had a cool last name like Starfish or Ravenhurst: but it was not to be. I digress. The e-mail continued.

The writer went on to compliment me on my work with children, etc. etc. and as a result of my interest in the well being of children, she thought I would want to know about her new very yummy organic pear juice. Perhaps, she continued, I would even be willing to taste and comment on it.

It was a request for a product endorsement! This will be so much fun, I thought. The product is certified organic, which is particularly important for products utilizing pears and apples. Both are on the dirty dozen list of produce with the most pesticides (See: www.ewg.org.) Pears are also low in salicylates, which makes this juice a better choice for children with hyperactivity. Finally, pears juice is less sweet than apple juice. Apple juice has about 28 grams of sugar per 8 oz. serving while pear juice has 20 grams. The only problem is that I am not much of a juice fan unless it is green or purple and comes out of my Vitamixer. Still, I recognize the need for healthier drinks for kids and in small amounts, it could be a good choice.

“Absolutely, send some,” I enthusiastically replied.

A few weeks later, the juice arrived. It was in a plastic bottle which is not optimal but is admittedly more practical when small children are involved. I opened it up and took a sip. It tasted just like…..pear juice. It was good, as promised, and sufficiently, peary. I detected no subtle undercurrent of wildflowers or hints of honeybee pollen, not that I could if they were present.

What is there to say about pear juice? “Not too sweet,” would not fly as an endorsement. Maybe, “If you like pears, this is just like them.” Or, “For busy moms who do not have time to juice their own pears….”

Maybe the lady will not get back to me, I hoped fervently. Within days she did and wanted to know if I could comment on her product for her website.

“What am I going to say?” I asked my ever helpful assistant, Tania.

“Maybe if you mixed it with tequila, that would spruce it up,” she offered. “You could call it a Peargarita.”

It probably would make a good Peargarita and would still be low in salicylates. However, the target audience is a different age group.

I was determined to come up with something useful. I like the idea of helping a small independent food entrepreneur. Producing high quality food is a lot of work and there is not enough of it. My husband is the juice drinker in the house, so I asked him to taste it.

“This is really tasty,” he remarked taking a large swig. I leaned forward excitedly.

“What’s so good about it?” I asked nonchalantly.

“Well, it is not too sweet,” he said drinking some more, “and it is very flavorful. I like it.”

I ran back to my computer and started typing. “GoGo Juice is a good choice if you are looking for a pure, flavorful lower sugar juice,” I wrote. It is short, to the point and true. I think it is a GoGo.

Monday, September 13, 2010

Blog #10 I want to thank Jim Carrey.....

I spent an enormous amount of time last year writing a book. It is about how many common childhood ailments can be caused by nutritional problems and how to fix them. Anyway, we are in the edit phase, an extremely painful process. It is akin to walking to your car after running a marathon: necessary but agonizing. As I am reading the comments to “clarify this” and “take out” that, I feel a little like a three year old. I don’t want to take out that and I think this is clear enough! But when it comes to editing a book, I am a three year old. Consequently, the editor is usually right.

To calm myself down, I have to remind myself how lucky I am to be writing a book at all. For this privilege, I have to thank the actor, Jim Carrey. Really. It is all because of him that I am in the editing process now even though I have never met him.

My unlikely story started with a con man named, Steven Russell. He was a swindler, imposter and multiple prison escapee who was born in the mid-west but now resides permanently in a Texas Prison. With nothing else to do in solitary confinement, he decides to write his memoirs. His escapades are so outlandish that nobody would believe him if he had not gotten a 25 years to life sentence to prove it.

The memoirs landed on the desk of a book agent working for a large literary agency. Russell is clearly crazy but many of his more outrageous antics such as escaping from prison numerous times, he does for love: specifically the love of another inmate named Phillip Morris. Phillip Morris has the misfortune of being named after a controversial cigarette company but that is small potatoes compared to the misfortune of falling in love with Steven Russell.

Peter, the agent, loved the manuscript and options it under the title, “I Love You, Phillip Morris”. He figures, it will be one of those little gem, specialty audience quirky books. And it is. What he does not predict is that one of the specialty audience members will be Jim Carrey. Carrey sees himself playing Russell and buys the movie rights to the book.

Peter’s talent for spotting a great story pays and he makes enough money from the movie rights to start his own literary agency. About that time I was giving a talk in New York City, which is attended by Peter’s wife. She identifies me as a potentially interesting project for her newly minted independent literary agent husband. Peter has the time and inclination to help me along and voila′, a book is born.


You are probably wondering what happened to Jim Carrey’s movie. Carrey got Ewan McGregor to play Phillip Morris and the love story is released in 2009…..in Europe. Even fans of Brokeback Mountain might find the movie a bit racy. I know this because my daughter’s convenient computer nerd boyfriend located a copy of the DVD. I didn’t ask questions; just watched it. It will be interesting to see what happens to Carrey’s career when it is released here in November. He is perfectly cast but perhaps he should not plan a trip to the mid-west anytime soon. Or, maybe they will edit it for American audiences.

So, that is how I came to be rewriting chapter 6 for the third time and daydreaming about who might star in the highly unlikely event that a nutrition detective book would be turned into a movie. Maybe they could call it, “Nutrition, CSI Unit” or “I Love You, Peas and Carrots.” I had better get back to work.

Wednesday, September 8, 2010

Blog #9 Me and the GI Continued......(Blog #5 follow-up)

Remember my neighbor who was throwing up every time she went to visit her apartment in New York? After several weeks, she returned. The doorbell rang and there she was. “Some of your mail ended up at our house,” she said by way of greeting.

She handed me the errant envelop but underneath it I spied a lab report. “So, you got back the mold test results?” I ventured.

“Yes, and they were very bad,” she frowned handing me them to me. “Apparently, the counts are high enough to make the occupants sick. That would be me.”

Glancing over the results, l saw the level of aspergillus was moderately high in the kitchen but off the charts in the bedroom. Aspergillus is the genus name for a group of 200 some species of mold. Most of them are harmless or even useful. For example, one species is used to turn soybeans into soy sauce. Others can decompose plastic. I can think of a few landfills that might be able to benefit from an Aspergillus invasion rather than waiting 10,000 years for the mountains of plastic bottles to breakdown on their own.

Around 20 or so of Aspergillus species cause illness. The most common symptoms of exposure are chest pain, fever, cough and trouble breathing but vomiting is also a less frequent but known symptom. My neighbor had the sudden vomiting episodes whenever she visited the apartment.

“So, what are you going to do?” I asked tentatively. Correcting mold in apartment buildings can be tricky. Often the problem extends beyond one unit and getting a condominium association involved can get messy. In addition, once discovered, mold issues may have to be disclosed before selling a house or remediation proof provided.

“Well, it turns out there is a problem with the air conditioning system and they are replacing all of the units. They have not gotten to ours yet.” She explained. “ I am hoping that will take care of it.”

An old air conditioning unit could be the problem. Aspergillus mold can be found literally wherever there is water or dampness. An old, malfunctioning air conditioning system would certainly qualify as a mold breeder. I would have been tempted to avoid the apartment until the work was done and then retest. My neighbor seemed content just knowing the source of the problem and addressing it over time. She was tied up with other family issues and her husband was unaffected by the problem.

This is a common and fascinating phenomena; several people living in an infected home but only some of them getting sick. I always wonder if the injury being done to the person without symptoms is just attributed to something else later and/or they are truly unaffected. Maybe they have a super mold resistant gene. Since the most adaptive people survive best, in the future, the ability to withstand mold will be the gene to have.

People always think of cockroaches as being the ultimate survival organism but molds are far more resilient. I remarked to Tania, my assistant, that if molds were competing with cockroaches for adaptability, the molds would win hands down. They have already adapted to global temperature shifts and as a result are more virulent and toxic to people. “I think the cockroaches would win,” Tania remarked, “unless aliens were involved. Then they would win, “ she snickered. Sometimes, I don’t think she takes my work very seriously.

Monday, August 30, 2010

#8 And you thought your teenager was tough.....

I was asked to write an article for an online site about food reactions and performance. I decided to tell the story of a teenager I saw this week. Here is the grittier blog version…..

When I looked at my schedule at the beginning of the summer and saw Sam’s name, I sighed. Sam is a thirteen year old boy that defines the concept of a child “only his mother could love”. I have known him since he was seven. Being kind one might say he had a tendency to be negative but defiant, belligerent, argumentative and angry were more accurate.

I always use to think there is not enough money in the world for someone to want to deal with young teenage boys. They are sullen, mouthy and generally smelly. One had to admire middle and high school teachers for their commitment to this age group and I thought their work was a kind of calling, like the priesthood. (It pays about as well, too.) So, inexplicably I have found I love dealing with the these little hormone bombs professionally. Most of them are fun and interesting if you can get them talking and I do not take the sullenness too seriously because I understand the chemistry of it. They rarely get to me.

Sam, unfortunately, is the exception.

He was so difficult at age seven that his parents gave up before they were able to put into practice any of the dietary changes I had suggested. Sam was a rigid, fussy eater and refused to eat at all if mom did not make exactly what he wanted. His parents worried about his size (extra small) and his temperament (extra prickly) but decided medication was the way to go. It was an ongoing disaster.

His mother dragged him to see me every few years between medication trials with the same results. We would develop a plan which he would dig in his heals and refuse to do. At one visit when he was ten, he glared at me and then yelled at his mother, “I like being small.” When concerns about academic performance were raised he declared that he “hated school” and his teachers “sucked”.

I could only imagine how much more impossible he was going to be as a fullblown teenager. It was a spiritual practice staying calm under his provocative attacks. Change can take a long time, however and I had to give his mother points for tenaciousness. Maybe this would be the year.

Gloomy as ever, Sam plopped himself into a chair and narrowed his eyes, ready to rumble. What it must have taken his mother to get him here! He was still peanut size and his diet remained mostly pizza, cereal, pasta and sugar with a little meat thrown in from time to time. There was a new development however; he now had chronic stomach pain. His doctor had prescribed a reflux medicine which helped a little.

Food reactions do not always affect behavior and performance. When they do, the substance most likely to cause stomach pain and make a child chronically angry is gluten. Throw in poor growth as a symptom and the result is practically a textbook case of gluten sensitivity (and maybe even celiac disease). Gluten is a protein found in many grains like wheat, rye and spelt. There are gluten like substances in all grains and many families of gluten. Consequently, what contains gluten and what does not can be arguable.

To simplify matters for an initial trial, I often recommend just removing anything made with wheat or rye flour. Foods like quiche, pasta, bread, croutons, bagels, pizza and cereal are eliminated or a gluten free alternative chosen. Minor gluten ingredients are present/hidden in many processed foods such as salad dressings, soy and other sauces. If celiac disease (an autoimmune condition associated with gluten intolerance) is suspected, all gluten sources must be strictly avoided. With gluten sensitivity, sometimes small amounts can be tolerated and allowing more flexibility in the beginning is less intimidating. Highly sensitive children are discovered quickly when reactive foods are removed but by then, the parents are more comfortable with elimination and can tighten up.

I had been trying to get Sam’s parents to remove all gluten based foods from his diet for six years because of he was so difficult and not growing. Now there was chronic tummy pain to add to the list. During one of our aborted trials, his mother had stopped eating gluten herself as a gesture of support and felt so much better that she had stayed off.

Getting a few fruits and vegetables in would also have been nice, but my first concern was getting the gluten out. Occasionally, that will miraculously open the rest of the diet. Besides, I was getting nowhere, so I was down to one change.

I have found with angry teenage boys, truthful and straightforward work best. Luckily, I can be straightforward to the point of bluntness. “How is the small thing working for you these days?” I asked looking straight at him. Apparently: not so well. Sam was an excellent athlete despite (and possibly because of, if you watch professional sports) his temper. I don’t know how he lasted through a game with his diet, but he had until his stomach started acting up. Now, he was trying out for the high school team and was nervous.

I pounced. “You have a month before try-outs start to straighten out your stomach and get growing. This is the perfect time, “ I shamelessly enthused. “Just say you’ll try it.”

He glared at me.

“Come on, Sam. Just say, ‘yes’,” I coaxed. I shamelessly use the used car salesman just-say-yes-to something trick often and successfully. Research on persuasion has found that once a person says, “yes” to one thing, they are more likely to be open to a bigger commitment. This is why a common first question asked when you walk into a car showroom is, “you want to save money don’t you?” Of course you do, so you say, “yes”. Then before you know it, you have bought a previously owned Hummer.

I cajoled and prompted; bullied and soothed and he folded.

“Fine,” he muttered and the no gluten diet trial was in place.

The half smile when he returned a month later was thus significant. A month is not enough time to evaluate growth but the stomach pains were gone and he was pleasant. Reluctantly, he agreed to continue if he could cheat once a month. “Absolutely, try,” I explained. Some people can have small amounts of the problem food without symptoms and others cannot. It is all trial and terror to find out who belongs in what group.

In the meantime, this school year is looking a whole lot better and in a few months we will see if he is growing. I am sending him to an endocrinologist, just in case we are too late with the dietary changes and he needs growth hormone. Shockingly, he agreed to go even when I told him there would be a blood test.

I actually think he has felt bad all of his life and for the first time is feeling, dare I say, pleasant. All I know is there will be a lot less groaning on my end next time I see he is coming in. That has got to be a good thing.

Monday, August 23, 2010

#7 Two Salads to Go: Hold the receipts

“You should read this,” my husband declared while sliding an article in front of me.

“What is it about?” I asked suspiciously. Jeff is very thoughtful about digging up interesting items for me to read but has been known to occasionally slip in something about global transfer pricing or taxation of international financial instruments. As a result, I know more about Subpart F of the Internal Revenue Code than the average nutritionist, the only purpose of which is to make me a better conversational partner when he wants to talk about work.

“You won’t believe it,” he says cryptically and dashes off to work.

The article was written by Dr. David Williams, a clever, holistically oriented physician who produces a subscription newsletter and sells his own line of supplements. The subject was a nasty chemical called bisphenol A (BPA). BPA is used in the manufacture of polycarbonate plastics, such as water and baby bottles. It is one reason we have been warned to minimize drinking out of plastic bottles.

I have dutifully informed my clients not to microwave in plastic and encourage the use of glass storage containers to reduce BPA exposure. While scientists continue to debate exactly how dangerous BPA (a known hormone disruptor/synthetic estrogen) is, I figure it is better to be safe while the industry subsidized “experts” duke it out.

Williams’ report claimed a new study suggested all this fuss about BPA in plastic bottles is misplaced. The major danger from BPA actually comes from store receipts. Huh?

You could chew plastic bottles all day, he asserts and only accumulate a small percentage of the BPA you could get from TOUCHING grocery store and post office receipts. The culprit is the thermal ink-less paper used to print receipts at big retailers, restaurants, gas stations and practically any place else one shops. They are coated with tons of the toxin which absorbs right through your skin.

All this time I have been trying to figure out which number plastic bottle is safest and the real health danger is shopping!

Further research on my part discovered an Environmental Working Group (www.EWG.org) report which found BPA in 40% of the receipts they collected from stores. Another study found 80%. In 2006, the nation’s largest manufacture of this poison paper dropped BPA from its formulation because of “growing concerns” about its safety.

The US Postal Service stopped buying BPA coated paper in Sept. 2009 but samples taken in March 2010 were still all positive for BPA. I go to the post office all the time! Perhaps I should collect hazard pay for mailing boxes. I try not to be a nut about my living habits but these findings call for action.

My action plan is to only accept the receipts I need for tax or record keeping purposes. Good thing all my reading on obscure parts of the tax code allows me to immediately identify the important receipts. I now wash my hands as soon as possible after handling receipts and no longer throw them on top of my food or newly purchased underwear.

Unfortunately, these behavioral changes move me one step closer to the “out there” level of healthy/environmentally sound living. I already take my own bags, even to the mall, much to the distress of my teenage daughter. Imagine her mortifications when I whip out my cotton gloves before taking the receipt. I am not sure I am ready for that step.

She is also about to start a job in retail sales. Are the potential long term dangers of exposure to BPA for such a benign occupation now to be compared to working in a coal mine? If she can’t have children one day, will we be blaming all that receipt handling?

This scenario sounds ridiculous yet that is exactly the kind of detective work I employed this week with one of my 60 year old clients with complex medical problems. Some of her symptoms harken back to her employment in a perfume factory while in college. Who knows what class of possible poisons were used to create scents in the 70’s and what effect it could be having on her present health. Perfume may sound innocent, pleasant even but we suspect the effect of the chemical exposure is still significant today.

Now consider the innocent receipt…….

Sunday, August 15, 2010

#6 The Secret Life of a Nutritionist

Because I am a nutritionist, people think I eat nothing but braised bean sprouts or that I spend an inordinate amount of time taking the personal eating inventory of all those around me. Sometimes if I am eating out with new acquaintances they will eye the menu nervously and then ask what I am ordering, imagining that I am carefully cataloging their every nutritional move for later dissection and harsh judgment. Mothers of my daughter’s friends regularly ask her what I eat and what it is like to live with a nutritionist.

“She has a huge sweet tooth, “ my 19 year old daughter, Tory will divulge conspiratorially. Then she will come home and lament the fact that her friends and their mothers are all obsessed with food. “It’s annoying,” she complains while rummaging through the refrigerator. “Do we have any sushi?”

“Did you tell them that we drink a pureed chard drink for breakfast?” I asked once, figuring it is always good to keep the mystique going though this is true.

“No, I told them you sometimes hide candy in your office drawer,” she says as she eyes the refrigerator contents critically. This is also true. “Did you make any salsa?”

I had.

The next morning, Miriam came to the office. She is 83 and a real firecracker but I had not seen her for over 8 months. Most of my clients drop by or call if there is a problem so while I was happy to see her, I was concerned something might have happened. “I spent Saturday at the emergency room,” she said without much preamble. “ I am dehydrated and look awful,” she continued. “What in the world are you drinking?”

It was chard, spinach, parsley, apples, blueberries and grapes Vitamixed into my morning drink.

“It looks awful,” she opined distracted for the moment. “I would never drink that.”

I assured her it was very tasty and asked if she wanted to try it.

“You would have to blindfold me first,” she replied. “It looks like pond scum.”

I started to laugh. “Well, it does,” she insisted unfazed. “So explain to me what these tests mean,” she demanded pulling out a stack of papers from her hospital visit. “My doctor won’t tell me anything.”

So, not everyone cares about what I eat and my personal consumption is not necessarily relevant to anyone else. Like most nutritionists, I have played extensively with my diet because it is interesting to me and I want to experience what I recommend. Through the years I have toyed with macrobiotic, raw, vegetarian and vegan diets. I have tried dairy free, gluten free and sugar free elimination routines. Most nutritionists I know are also diet dabblers.

In the end, we figure out what works for us, personally and develop a bag of tools for everyone else. For example, I consume almost no alcohol because it makes me tired but realize this experience has limited application to most people in my practice. On the other hand, I avoid artificial colors, sweeteners and flavors and eat plenty of fruits/ vegetables and believe these principles have general application. Most other factors, especially when it comes to food avoidance, applies to some people but not others. Other nutritionists I know imbibe with abandon, are vegetarians or are not, smoke pot, avoid hemp, eat cheese, don’t eat cheese; We are pretty much all over the place in diet and personality.

The one consistent factor is a vast majority of us are not obese. We are an intimidating group of thin-ish women in a society rift with distorted body images and unhealthy relationships to food. I believe this is the real source of questions from the mothers of Tory’s friends. They do not ask me directly what I eat because I might ask them back. Better to secretly compare what they are eating to someone who, in theory, knows what they are doing and is thin. The question they are really asking is the dietary equivalent of, “does this skirt make me look fat?” That is, does my diet look like it is making me fat?

As any husband knows, answering THAT question is a minefield.

Monday, August 9, 2010

#5 Me and the GI Guy

“The GI (gastrointestinal specialist) agrees with you,” my neighbor announced triumphantly when I opened the door.

“Then it must be right,” I drawled dryly.

Undaunted, she walked in and happily relayed the details. Several weeks ago, she had approached me with the seductive come on…”I know how much you like medical mysteries…..”

She then went on to explain a strange vomiting illness that she developed every time she went to visit her husband who worked and lived in another city. After 24 hours, she would be overcome with a flu-like illness and have to spend a day or two in bed. She and her husband traveled extensively but this situation only occurred and it occurred every time, she went to their apartment in New York. China, Rome and Chicago: No problem. New York: Two days in the bathroom.

She had already talked to several doctors and specialists when she approached me and they were all “baffled”, in her words. She had been given a clean bill of health and sent from one specialist to the next.

I started with the kind of questions that come to mind when the unusual occurs….
Did it ever happen, even once, somewhere else?

No.

Are the symptoms always the same?

Yes. I am fine for the first 24 hours and then get the same vomiting illness.

Are there any other symptoms? Itching? Fever? Tingling of the hands?

No.

Do you have any other medical problems or are you taking any medication that could sometimes cause these symptoms?

My internist says, “no”.

Does it happen if you stay other places in New York?

Not sure because I always stay at the apartment.

Is the apartment in an old building?

Yes, but we renovated it.

The insides are new?

Yes.


I told her I was suspicious about the building and suspected a reaction to mold. I had run into several cases of building mold causing strange symptoms and too many were linked to pre-war buildings in New York City. Nonetheless, I asked her if I could present her case to a medical study group I belong to, to see if any of the doctors or therapists in it had any additional ideas. She agreed and until she rang my doorbell, I had not seen her for several weeks.

The study group had two alternate lines of consideration. One line was psychological and the other biochemical. Was she emotionally reacting to moving between two very different lives: one here and the other in the big city? Interestingly, the doctors in the group were curious about psychological causes. The other idea was solvents from sealing floors or other chemicals used to renovate.

I presented both these possibilities to her. She balked at the psychological suggestion claiming it was more relaxing in New York than being here where she was on frequent grandmother duty (which she loved but was exhausting). The floors were installed pre-finished, so there was no off-gasing, there. The paint had dried and aired out long ago.

So, we were back to GI guy agreeing it was something in the apartment and reconsidering mold. I gave her the number of a great company that sells mold test plates and she said she would run the tests. (FYI…the company is called Tennessee Mold Consultants and not only do they run a mean test, the results provide specific counts and mold type.)

Will let you know what happens.

Sunday, August 1, 2010

# 4 Looking for Mr. Rightcheese

Cheese substitutes for the dairy-free have traditionally been pitiful. Without casein, the most abundant protein in milk products, the darn things won’t melt. Like a wad of rubber cement, they lay on your faux pizza defying any amount of heat a conventional oven can muster. I often wondered if an acetylene torch could do the job but my husband will not let me near one. Besides, there would still be the unappealing taste to contend with.

Through the years I would watch one digestion disturbing contender after another appear then disappear from the shelves of the nearby health food markets. I would imagine the dairy free newbie demanding their local establishment stock these alternatives and then buy exactly one package. I know I did. However, one taste and the verdict was inevitably, “blech”. The remaining packages would sit in the dairy case until the expiration date arrived. Then the unsold items would be tossed away and the product unavailable until the next unsuspecting consumer approached the store buyer and the whole cycle started again.

Every year I went to the National Health Expo, where new products for the health food industry are rolled out and dutifully tasted any new cheese substitute offering. About 10 years ago, a melting soy based product was introduced. It was soy-y tasting but acceptable and it melted without the addition of casein. I was hopeful, but the company was not viable and the product died a quiet death before anyone even heard of it.

A few months ago, a client reported they had found a great cheese substitute. Since we were speaking by phone, I could roll my eyes with abandon. I asked the critical questions:

Does it melt?

“It does,” she swore.

Does it taste like old socks?

“Not a bit,” she claimed.

I dutifully wrote the name down in case I ever ran into it. (A good detective checks things out.)

The product is called, Daiya and within a week, I spotted a package at Whole Foods. It comes shredded in two flavors, cheddar and mozzarella. I bought the mozzarella version and for the first time in many years, I made a pizza.

The good news is that it is tasty though Wisconsin does not have to worry about losing its share of the cheese market to it. Nobody who eats cheese would willingly choose Daiya. It does indeed melt and within a few weeks, Whole Foods was using it to make a vegan pizza alternative.

Now, the bad news: it is not health food. The main component is tapioca. The result is 6 grams of carbohydrate and one gram of protein per serving, it is about the nutritional equivalent of putting white rice on your pizza. Still, if you load your pizza shell with tomato sauce and vegetables, a sprinkling of Daiya makes it much more like regular pizza. Or if you use a little to melt on top of a turkey sandwich or vegetables rather than trying to make a plain “cheese” sandwich with it, there should not be too many nutritional concerns.

Bottom line: Daiya is a useful condiment.

Friday, July 23, 2010

#3 PANDAS continued.…….

“Alex’s doctor wants to talk to you today,” Tania, my stalwart assistant informs me.

“Which one?” I ask. This clarification was important as Alex’s mother had now consulted at least four physicians/specialists plus the ever present Dr. Internet.

“Well, let’s have a look see, shall we?” Tania chirps.

I hear the unmistakable click click tap tap of computer keys.

“That would be Dr. W.” she clarifies. “Do you have her number?”

I did but I could not help but have an uneasy feeling. Mrs. P had taken Alex to a well known PANDAS expert for diagnosis confirmation plus the most up to date treatment protocol. Alex had been on antibiotics for a week and from all accounts was making remarkable progress. Her repetitive behavior had reduced significantly and I was hoping for a quick and full resolution. Mrs. P had been aggressive and rapid in her response. She had latched on to the PANDAS idea and had become a lay expert in an incredibly short period of time. Consequently, she had been in almost daily contact with questions and reports. She was a bit of a nervous Nelly but who wouldn’t be after witnessing such dramatic behavior changes in their child?

“Mrs. P is going too far,” Dr. W blurted with little preamble.

I suspected she was referring to the daily e-mails and blow by blow tic reports that were cc’d to the group of professionals Mrs. P had assembled.

“Every small flick or head toss the mother is attributing to PANDAS and is pursuing more and more involved treatment. I saw Alex this week and she is perfectly fine,” the doctor continued.

“Well, it is still pretty early in the treatment,” I countered. “Mrs. P does not understand the long range view and is trying to calm her anxiety by having a back up plan.”

“ No way,” the physician argued. “Something has to be done. I think we are dealing with a case of M√ľnchausen syndrome by proxy.”

Oh boy. M√ľnchausen syndrome by proxy (MSP) is a condition where someone, usually a caretaker or parent, invents or exaggerates medical symptoms leading to excessive medical procedures or unnecessary treatment of their charge. It is a particularly twisted form of child abuse but I am reluctant to jump on the MSP bandwagon. Not because I want to ignore potential child abuse but because the label is thrown around way too often when a parent is a little overbearing or if the mother (in particular) is persistent about a course of treatment her physician does not support. The more mysterious the illness, the more often one hears about suspicions of MSP.

I wish the doctor had just said she couldn’t stand Mrs. P and had blown off steam the old fashioned way by calling her a witch or a pain in the butt but that would have been unprofessional. So, instead, she had to hide behind this devastating charge of serious mental illness.

Mrs. P did not have MSP and Dr. W was not a bad doctor, they were both just wielding the tools they had but the result was about to get ugly. I spent the next few weeks bouncing between the two of them (usually via e-mail) emphasizing common goals and places of agreement. Mrs. P started relaxing as Alex’s tics continued to diminish. She dropped the idea of pursuing further experimental treatments and agreed to a monitoring program instead. Dr. W. with further input from the PANDAS expert, developed a deeper understanding of the condition and was able to help Mrs. P evaluate neurological symptoms that could signal a recurrence of strep.

Alex finished a long round of antibiotics and recovered completely. Ironically, Mrs. P calmed down enough to realize she did not need so many doctors and got rid of Dr. W. first.