Vaccinations are the best immune booster

Posted April 26, 2017 by Dr. Roy
Categories: In the news, Medical problems

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The Pediatric Insider

© 2017 Roy Benaroch, MD

The human immune system is an amazing thing. There are thousands of microorganisms – millions, maybe – that are lurking out there, eager to make you sick. You breathe them in. They’re in every bite of food, and all over your hands when you rub your nose. We live in constant bombardment.

And they’re sneaky, too – with changing DNA and proteins to fool us. We’ve got soap and water and some pretty good antibiotics to fight them off, but, really, the vast majority of the work to keep us healthy is done by our own immune systems.

Wouldn’t it be nice to give your immune system a boost, to help it fight off infections? We know moderate (but not heavy) exercise can help, as can a good night’s sleep. What about those “immune booster” vitamin packs they sell? Hint: there’s a reason they say right on the package that they don’t prevent or treat any disease. Save your money.

Another idea: you can just get sick, and at least the next time around your immune system can recognize the germ and fight it off more effectively. Of course, you have to get sick first to enjoy those benefits. And some of those sicknesses can be pretty serious. Or might kill you. Still, no pain no gain, right?

Wrong. There’s a great way to get a real immune boost – a way to help your own immune system, or that of your children, fight off diseases without having to get sick first. They’re vaccinations. They give your immune system a glimpse, a quick safe view, of an infection in a way that won’t make you sick, but will still teach your immune system to recognize the infection if you ever have to fight it off. It’s the best way to prepare your immune army for battle against the infectious enemy, in a way that’s almost risk-free.

Get your sleep and exercise, and eat tasty, home-made foods. Grow a vegetable garden. Hug your kids. Sing like no one is listening, and dance like no one is watching. And vaccinate, too.  These are all great ways to keep your children happy, healthy, and safe.

National Infant Immunization Week Blog-a-thon with woman holding baby. #ivax2protect

Breastfeeding and vaccinations protect your baby in different ways

Posted April 24, 2017 by Dr. Roy
Categories: In the news, Medical problems

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The Pediatric Insider

© 2017 Roy Benaroch, MD

“Since I’m nursing my baby, she’s getting all of the antibodies in my breast milk. Doesn’t that protect her the same way vaccines do?”

There are antibodies in breast milk, and they can help protect your baby from some kinds of infections. But those kinds of antibodies are different from the ones your baby will make herself after vaccinations. Breastfeeding contributes to one kind of protection, but the protection from vaccines is more powerful and longer-lasting.

Antibodies (also called “immunoglobulins”) are proteins that are part of your immune system. They work by attaching to invading microorganisms and viruses, which helps signal your immune system to attack. Antibodies have to be specific to each kind of infection—one antibody doesn’t fight multiple germs—and your immune system learns how to make different antibodies based on your body’s exposures to infections.

There are two ways for your baby to get antibodies. She can get them passively, from mom, either across the placenta or via breastmilk. Both are important. Placental antibodies are IgGs, which circulate in the blood. These kinds of antibodies help fight off invasive diseases. After a baby is born, placental IgG antibodies fade away over several months. Moms can boost their own ability to give these IgGs by being vaccinated, themselves, during pregnancy (that’s why moms should get influenza and pertussis vaccines while they’re still pregnant.) Breast milk contains a different kind of antibody, IgAs, which aren’t found in the blood. They are a part of intestinal and respiratory mucus, protecting people from infections before they get to the blood. The effect of these IgA antibodies in breastmilk is especially important in the developing world, where safe water and food is harder to find, and where moms have especially high titers of their own antibodies from ongoing infectious exposures.

The other way for babies to get antibodies is to make them on their own. To learn to do this, they must either be exposed to the infection, or get an immune-boosting “glimpse” of the infection by receiving a vaccine. That’s the point of vaccines: to allow someone to make their own strong, protective antibodies without the risk of having to suffer through the disease. These antibodies, made after “active immunization”, are of very high titers and are long-lasting – in some cases, for a lifetime. They’re much more protective than the passive antibodies gained across the placenta or through breast milk.

Bottom line: families can help protect their babies from infection in many ways. Sick people should be kept away from newborns. Moms should get their own recommended vaccines. Nursing can help (though in the developed world, the impact of nursing on infections is modest.) And babies should get their own vaccines, as recommended, on schedule, to get the best possible protection.

National Infant Immunization Week Blog-a-thon with woman holding baby. #ivax2protect

Obesity: It’s not just the sugar

Posted April 18, 2017 by Dr. Roy
Categories: Medical problems, Nutrition, Pediatric Insider information

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The Pediatric Insider

© 2017 Roy Benaroch, MD

For a while, fat was the culprit – eating too much fat was making us fat. We were swamped by low-fat products, like cheese and salad dressings and even low-fat potato chips. Briefly, Burger King even offered low-fat French fries (Those quickly disappeared from the menu. Don’t mess with the fries.) Yet, with or without the low-fat foods, obesity rates continued to climb.

More-recently, sugar has emerged as the “deadly villain” in the obesity epidemic. Forget the fat – it’s the sugar, or the refined high fructose corn syrup, that’s messing with our metabolism and expanding waistlines. Just cut back—or eliminate—added sugar, and our weight problems will be over.

But a recent study from Australia shows that maybe it’s not so simple as blaming the sugar, either. Researchers there found that, on a population level, reduced sugar consumption was associated with an increasing rate of obesity. It’s funny how real-world data seems to clash with our little pet theories sometimes.

The authors used data about food consumption from several different academic and government sources, creating graphs of overall per capita sugar consumption among Australian adults and children from 1980 and 2011. Although the exact numbers vary by demographic groups, there was a clear overall trend towards less sugar intake over those years. They then looked at obesity rates, based on national surveys.

The combined data is in the graph below. Sugar consumption is in blue, and though it goes up and down some years, the overall trend is downwards. In red you can see the Australian obesity rates. There’s more data in the paper about specific groups (men versus women, children versus adults), but overall the trend is clear: less sugar consumption is associated with more obesity.

The authors conclude, “There may be unintended consequences of a singular focus on refined sugars…”

So if it’s not the sugars, and it’s not the fat, what is it? I think it’s unlikely that there is a single boogeyman, or a “one thing” we can point our fingers at as the culprit. Obesity has many contributors, including decreasing physical activity, eating bigger portions, and eating more frequently. Low-quality “fast food” is quick and convenient, but it’s certainly not cheap in the long run. A ton of extra sugar can’t be good for your teeth, and is one source of extra calories you don’t need. But it’s not just the sugar that we’re eating too much.

What’s the best peanut policy to prevent severe allergic reactions in schools?

Posted April 12, 2017 by Dr. Roy
Categories: Medical problems

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The Pediatric Insider

© 2017 Roy Benaroch, MD

Peanut-free schools, peanut-free rooms, peanut-free tables – they’re all an effort to protect children who have severe peanut allergies from accidental exposures. We’d all like to make sure our school are as safe as possible for everyone. So what’s the best policy on peanuts and tree nuts?

A study in press at the Journal of Allergy and Clinical Immunology adds some science to the debate.  Researchers looked back at peanut allergy experiences at Massachusetts public schools from 2006-2011. They polled every public school from K through 12 to determine their “peanut policy”. Though the response rate was only about 55%, the policies varied a lot – from completely no-serve, no-bring peanut schools (about 2-3%), to no peanuts allowed from home (about 10%), no peanuts served by the school (60%), to keeping some classrooms peanut free (70%), to having designated “peanut free tables” in the cafeteria (this was the most common policy in place, accounting for about 90% of the schools). (Some schools had multiple policies, so the numbers are > 100%). The peanut policies remained about the same for the 5 years of the study, and didn’t vary too much from elementary to high schools.

Data was also collected on every episode at school where epinephrine was administered. Epinephrine is the drug given to treat a serious allergic reaction (that’s the medicine in those weirdly expensive Epi-pens.) It turns out that Massachusetts schools must file a form when epi is given, so those were easy to track. Over the 5 years, epinephrine was given to children having an allergic reaction to peanuts in Massachusetts public schools about 20-40 times per year, with a modest increase from year-to-year during the study. We’re not talking huge numbers, here. Epinephrine administration was used as a “proxy”, or substitute number, for the actual number of peanut reactions in the schools – though it’s possible that epi was sometimes given when it wasn’t indicated, or sometimes was withheld when it should have been given.

The results are interesting. Of the peanut policies in place, the only one associated with a significantly decreased number of epinephrine uses was the presence of peanut-free tables in eating areas. Other policies, including having an entirely peanut-free school, did not result in fewer instances of epinephrine use. In other words, a school with a policy to be completely free of peanuts didn’t seem safer for peanut-allergic kids than a school that allowed peanuts to be brought from home.

These results aren’t super-strong. The number of serious reactions was small, and the number of absolutely peanut-free schools was small, too. There were only two nut reactions in the peanut-free schools (and one of them was in a boy that brought his own walnut cookie from home, despite being known to be walnut allergic.) When you crunch the numbers, the per capita chance of reactions in nut-free schools was actually higher than in schools with less-restrictive numbers, but with numbers so small I don’t think you can hang your hat on that conclusion.

A few lessons can be learned from this study. Even among schools that claimed to be “peanut free”, many allowed peanuts to be brought from home. Schools should have clear policies that make sense to parents. It’s also clear that even truly peanut-free schools aren’t a guarantee that no peanut exposures will occur—schools shouldn’t just declare no nuts, and leave it at that.

I wonder if the relative superiority of peanut-free tables is because that policy is easier to enforce. When an entire school is meant to be “peanut free”, you might be more likely to have some families break the rules. Also, “peanut free” policies might lead to a false sense of security among children who are nut allergic. They still have to watch what they eat. This study didn’t look into these factors, or how well peanut policies were enforced, or exactly how children were exposed in every instance.

Allergic reactions to peanuts are not common in schools, but when they do occur they can rapidly become life-threatening. Avoidance of exposures is the main way to treat peanut allergies; and when a serious reaction does occur, epinephrine should be given immediately. Beyond that, we just don’t know what the most-effective school policy should be. This study gives us some insight, but we’ve still got more to learn.

 

edit: Here’s a tangentially-related, sickening story about the apparent hazing of a peanut-allergic college student. What the hell is wrong with people? Accidents happen, but this is just…. just… I have no words.

 

 

 

Great news about pertussis protection for newborns: Vaccinate mom!

Posted April 3, 2017 by Dr. Roy
Categories: In the news

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The Pediatric Insider

© 2017 Roy Benaroch, MD

Pertussis (AKA “whooping cough”) is a nasty bear of an illness in older children and adults. People with pertussis cough for about 100 days – and it’s a horrible cough that sometimes makes people puke, pass out, or wet their pants. Seriously. Three months of that.

But it’s even worse for little babies, especially newborns, who just don’t have the lung power to expel the mucus. They cough, sure, but a lot of them get encephalitis and seizures, and some of them just stop breathing. So it’s especially important to protect the youngest babies.

Rates of pertussis have been climbing, in part because the newer vaccine that we started using in the 1990s doesn’t seem to give as lasting immunity as the old-school, whole-cell vaccine of earlier days. And as more pertussis circulates in communities, it’s the little babies who suffer the most. Pertussis vaccines are given to babies at 2, 4, and 6 months – and that means they build own protection slowly over the first year. Fortunately, a study published today shows that we can prevent most cases of newborn pertussis – even in babies too young to have gotten the full benefit of their own vaccines.

Researchers from the Kaiser Group of Northern California looked at records of all of the babies born at their facilities from 2000-2015 (those years spanned two big California pertussis outbreaks, in 2010 and 2014.) They hypothesized that a strategy of vaccinating pregnant women against pertussis, recommended since 2011, would help prevent pertussis in their newborns. Since people enrolled in Kaiser get all of their care at Kaiser locations, they could track which babies caught pertussis and they could tell which moms got a dose of pertussis vaccine during pregnancy.

They had a lot of babies to track – about 150,000. 17 of those babies caught pertussis in the first 2 months of their lives, and 110 caught it within the first year. The authors compared the rates of pertussis among babies whose mom got the Tdap (tetanus-diphtheria-pertussis) vaccine during pregnancy versus those who did not.

Of the 17 newborns less than 2 months with pertussis, only 1 had a mom who was vaccinated during pregnancy – working out to a vaccine effectiveness of about 90%. Looking down the road as the babies got older and received their own doses of pertussis vaccine, the effectiveness of maternal Tdap remained strong throughout the first year. There were no signs that maternal vaccination interfered with the effectiveness of the babies’ vaccines.

This is great news – an easy and effective easy way to prevent a potentially devastating disease of young babies. Previous studies have shown that this vaccine is also very safe for both pregnant women and their babies. Keep your babies safe – make sure, moms, you get a dose of Tdap during every pregnancy.

Homemade slime isn’t hurting your child

Posted March 20, 2017 by Dr. Roy
Categories: In the news, Pediatric Insider information, The Media Blows It Again

The Pediatric Insider

© 2017 Roy Benaroch, MD

Another day, another internet scare. This time it’s about that homemade slime, and all the toxins and poisons in it – the ones that are pretty much killing our kids. Except there aren’t any toxins, and kids aren’t getting sick.

This rumor started with an article from the Daily Mail, a British “newspaper” that Wikipedia has deemed “generally unreliable.” In the fine tradition of crappy supermarket tabloids, the Daily Mail is on a par with the National Enquirer, the Star, the Sun, and Weekly World News – it’s a site that makes stuff up, or blows things crazy out of proportion to sell newspapers. Admit it – you were tempted to buy that cheap paper that proclaimed that Hillary was from Venus, or that there’s a Miracle Cream that Allows People to Grow a Sixth Toe. The story was amplified by a blog post at “This talk ain’t cheap”, where the author points out in the second sentence that she’s “not a doctor or a scientist or a chemist.”

As is the manner of clickbait about things hurting children, this one has been posted -n- reposted on Facebook and parenting blogs. In an effort to make sure the barn door is firmly bolted shut now that the horses are long gone, let me give you the quick version: there’s nothing in homemade slime that’s likely to hurt anyone, as long as it’s “used as directed.” Don’t eat the stuff, rub it in your eyes, or lie in a bathtub of it for an hour. Other than that, it’s safe.

We’ve still got an unopened box of borax and bottles of glue downstairs from my youngest’s “slime phase” last year. You mix up a bunch of chemicals (See! Chemicals! That’s your first warning, right there!!) to make a sort of gooey, hand-clinging, squishy mess. It even makes comical sounds when you squarsh it around between your hands. Harmless fun?

The Daily Mail article focuses on one ingredient in homemade slime, pointing out that boric acid (Borax) is labeled by the European Chemicals Agency as ‘toxic to reproduction’, and potentially irritating to eyes and lungs. The box in my basement says those things, too. Don’t eat it, and don’t rub it in your eyes, and don’t stick your face in the box and whiff it. If your children are too young to handle this on their own, they probably shouldn’t be making slime without supervision. Apart from the breathless and frightening tone, The Daily Mail’s critique of Borax is at least reasonably close to the truth. It’s conceivable that an unsupervised or particularly reckless child could get hurt by the stuff. It’s also possible that some kids could have more-sensitive skin, and could end up with a rash or the itchies (do I need to say: if your child gets irritated skin after playing with slime, he or she should stop playing with slime. The same is true if your child gets itchy skin after petting a cat or eating finger-fuls of cookie dough.)

But the blog post goes a step further, heading off the rails of the worry train. The blogger points out imaginary dangers of other ingredients, like glue. She says white glue – essentially, Elmer’s – can cause anxiety, convulsions, seizures (both convulsions AND seizures!), respiratory failure, and loss of appetite. Except none of this is true. In the manner of googlers-who-call-themselves-researchers everywhere, the author mistakes one kind of glue for another. Elmer’s white glue causes sticky hands, but is otherwise non toxic. What she’s quoting are side effects of huffing industrial glue or model cement, which is a different product entirely, and is not an ingredient in homemade slime.

There’s also shaving cream – which the blogger implies contains carcinogens and “very controversial” ingredients. I think of it as something people rub on their faces (men, typically), legs (often women), or all over the walls of the shower (children). If you’re afraid of your children touching shaving cream, I cannot help you.

By the way, homemade slime also contains water (AKA deadly dihydrogen monoxide) and often food coloring (I believe green is best, but mixing green and purple makes a hideous and wonderful color called “ocky” that has a certain charm.) A complete recipe is here. You can also make it with other, non-borax compounds like cornstarch or laundry detergent.

Parents, if your kids are taking a break from their iPhones to do something fun and icky with their hands, let them enjoy themselves. It may get messy, and you don’t want them (or the dog, or even the cat) eating their homemade slime. But it’s pretty much harmless fun. Today’s lesson: don’t let the internet scare you.

Fight the Fearmongers: MTHFR variants are nothing to worry about

Posted March 13, 2017 by Dr. Roy
Categories: In the news, Pediatric Insider information, The Media Blows It Again

The Pediatric Insider

© 2017 Roy Benaroch, MD

Another day, another scare. Honestly, if you take Facebook and The Interwebs seriously, we’d all be dead three times over already.  (By the way: Facebook and the Interwebs would make a good name for a 2000’s cover rock band.)

Here’s one that’s come up a few times at my office this month: parents worried about MTHFR “mutations” that are making themselves and their children sick and vulnerable to all kinds of diseases. It’s another example of alarmists taking advantage of a tiny speck of science to scare you and sell things. Don’t believe any of it.

Background: MTHFR stands for…. Ah, forget it. Who cares what it stands for. It’s a shorthand name for a gene that encodes a protein that does important things involving the metabolism of the vitamin folic acid.

It turns out that there are hundreds of variations in the MTHFR gene we all carry. Genes, actually, with an “s” – we all carry two copies. Some variations work more or less efficiently, and a few very rare ones don’t work well at all. But the important thing to remember is that these are examples of the normal variation of our species. Having a different MTHFR gene from your neighbor doesn’t make you strange or broken.

In fact, having these variations is very common – so common, that variation is the rule, not the exception. As we learn more about these variations, the percentage of people with “variants” continues to go up – maybe about 60% of us, now, have at least 1 copy of a “variant.” And since almost all of the variants work just fine, this doesn’t matter at all.

 Part of the problem comes from the language of genetics, and the way gene science is depicted in the media. Use the term “mutant” and you think Patrick Stewart lifting things with his mind. A mutant is changed gene – and in science, that term is used for one-time or rare events. These MTHFR things are NOT mutants, at least not in the way a genetic scientist would use the word. Having one of them will not give you a tail, allow you to change the weather, or make lasers shoot out of your eyes. It also won’t make you or your child more likely to get sick.

The correct, more-specific word for what I’ve been calling “variants” is “polymorphisms.” These are genes that are different in subtle ways, and have become fairly common in a population. Hint: if a polymorphism made you sick, people with it wouldn’t reproduce, and the polymorphism would become rarer. Polymorphisms that don’t change health (like these MTHFR polymorphisms) can spread and linger in a population, like blue eyes or the ability to taste a tiny speck of cilantro.

Nonetheless, there are scads of web sites out there pushing MTHFR testing, and trying to sell books and products to people with these polymorphisms (which, as I mentioned, are most of us.) This is called “fear-mongering” –creating fear of a non-existent disease to get attention and make money. I’m not going to link to any of these sites, but here’s a sampling of some of the headlines and what the sites are pushing:

  • The MTHFR Gene Mutation And How To Rewire Your Genetics – Note the use of the scare-word, mutation. And, of course, you cannot rewire your genetics. Nonetheless, this site pushes worthless genetic testing, suggests treating non-existent yeast infections, encourages the use of a dozen supplements you don’t need, and suggests “detoxing” with coconut charcoal. Absolute, bat-shit nonsense – all for a made-up health scare.
  • Someone calling themselves “Your Functional Medicine Expert ®” (followed by 16 letters – do not trust anyone who has more letters in their “degrees” than in their own name) has her own top ten list of things to do for what she calls your “mutation.” Some of these are perfectly healthy for all of us: get exercise, eat leafy greens, spend time in the sauna. But she goes off the rails, too, referring people to a “trained biologic dentist” and “dry skin brushing” to detox da chemicalz dat’ll killz ya.

There are also alt-med freakshow sites that somehow link MTHFR variants as a warning against (of course) vaccines. This is an absolute crock.

Bottom line: genuine medical geneticists do not recommend MTHFR testing. Just because something sounds sciency doesn’t mean it’s something that is going to kill you. Don’t worry about things because you read about them on the internet. Go hug your kids, enjoy some sunshine, and take a break from Facebook and the Interwebs. Their show is starting to get old, and you’ve got better and healthier things to do with your time.