Athletic Kids and Vitamins

Little Sis calls and asks what should we give to my future linebacker and Olympic swimmer nephews.   Loaded question as anyone I care for knows, handing out a one size fits all diet/supplement regime is basic but probably not sustainable.

Reminiscing to early practice.... I still remember in my old clinic at CDH, I used to have a folder of exercises put together for specific body aches.  Thought I was smart by having things pre-printed for my staff to hand out after I came up with a diagnosis.  One day I was walking out after clinic and saw the handouts sitting in the trash at patient checkout.  They didn't even wait to get home and dumped the one-size-fits-all hand out in our garbage.  Not everyone can afford physical therapy co-pays but if the suffering is bad enough/long enough or surgery is coming-I rather have a personally designed rehab program applied, modified and re-applied to get the body to heal itself properly.

Reminiscing to youth, my Sis and I grew up in a kitchen where mom had a meat dinner every night and eggs/spam for breakfast.  Having more than 1 dish available for dinner was a sign of success.   Having the best cut of beef for parties was living large.  That was when eating large volumes of steak was the way to "get big" if you were a guy and girls only did 'aerobics' to burn off the calories.   Creatine and protein came into vogue in the 90's, 'steroid stacks' were sold in the gym at the millennium.  Now we have complex bodybuilding "herbs", TRT (testosterone replacement therapy), epo, steroid hiding drugs all abound in sports because of endorsement deals and social media spotlight.  So the urgency to be the best has trickled down to grade school levels.  Training hours per week have surpassed what a division I crew team would be going through on full boat scholarships.  The problem arises in those little joints that haven't stopped growing yet.  Placing excessive leverage on a tween joints can pull growth plates off long bone causing things like shoulder dislocations, little league elbow, chondromalacia, osgood schlatter and severs disease of the heels.  

Once you find an activity of interest, be aware of how the coach treats his/her team.   It is habit to want to drop off for practice and do some errands but invest some initial time in observing and make sure coach sees you.  Tag team with other parents as well.  I trust that most coaches have good intention especially if their own kid is on the team but don't assume.  Observe the dynamics of how aggressive training is, how the ultimate concern is the experience of working with others and self improvement.  Now comes the meat and potatoes of what my sister was asking.  

Supplements are a good idea for an average American diet.  Dr Agus was recently on a DrOz episode and brought up his perspective on no vitamins.  I don't agree, average family eats OK, but usually has fast food mixed in 25% of the week (usually at school!).  Just to balance the trips to any place where you cant be in the kitchen to check the type of cooking oil or choice of meat, I feel a multivitamin will "supplement" the basic building blocks for maintenance, repair and growth.  I hope that with the other 75% of weekly intake coming from cooked meals at home, you may get some nutrient from the whole foods purchased from the periphery of the grocery.  No no no......soil today doesn't have the same nutrients as 2-3 decades ago, more pesticides are used, more GMO seed is used, distance of shipping has been solved with airfreight so you may be getting fruits and veggies picked before ripening over 2000 miles away that never had the opportunity to complete life cycle and consequently spoil much faster on your counter.  Anything that looks or feels a few hours over ripened will have degraded its nutrient content days before.  May not be getting appropriate vit K, magnesium or iron especially if parents are choosing a semi vegetarian lifestyle.  I don't feel we will see overt rickets, pellagra or beriberi in our schools but I do believe there will be (and already is) an abundance of unusual adult diseases popping up in childhood (reflux, depression, bipolar, diabetes type II, hypertension, high cholesterol, irritable bowel...) that were unheard of for kids in the 80's and 90's.   All diseases are multi factorial and no time to discuss here but going back to basic suggestions......a multivitamin would be a start.   More important for my young patients is to begin a habit of 'ritual' where the kid gets used to taking a tablet, capsule or liquid every morning.  Even if the cheap kid vitamin with inferior binders just ends up in the toilet, that young person has now ingrained the idea of always taking a vitamin daily.  If you try to start at teen years....get ready for resistance and failure.  So for me the habit is important and starting early is important.  If the little guy/girl has a medical problem then we should probably not just stick with cheap Walgreen's brand.....I would spend for higher grade vit's or get them compounded.   I remember in one of the ER's I worked at there was a stark contrast in home nutrition; had a very calm easy going patient care tech that spent her whole paycheck on organic for all the kids/then her counterpart- a registered nurse who was usually stressed out and stated she attempted to feed her kids 'healthy' but it was too hard so she goes with MacDonald's and all microwave stuff because they all refused.  It does take patience, planning but pays off in the long run.  If it is too stressful to change diet now, OK....but all that omega 6, fructose and caffeine will have an accumulative effect sooner or later-guaranteed.

Second on my list is omega 3 oil......fish or cod liver OK!  (just watch for piggy back vit A mixed in with some cod liver oils.   (preformed vit A can be a problem with acting as a proinflammaotry)  Again building on the idea that average kid has 50% or more of their weekly intake from fast food high in omega 6.  Too much omega 6 and too little omega 3 turns on inflammation- arthritis, bowel disease, skin disease, depression......short of cooking with EVOO, eating more fish less red meat, taking the omega 3 daily will re-balance away from 'standard American diet' and more to 'mediteranean diet/antiinflammatory diet'.  (in basic soccer-parent terms: given a choice of 3 days of knee pain vs 2 weeks of knee pain-diet can make the difference)  Kids are sensitive to burping smells so free the capsule (the tiny one are great, call the company to inquire about if they check for mercury in product regularly)   Liquid omega 3 can taste nasty.....although at the Arizona Integrative Medicine Fellowship, I sampled Barlean's pina colada omega 3 6 9 and it was yummy!  (children average about 700-1200mg daily)

Last is vit D3.  Due to melanoma scares, we sun-block the hell out of our kids which is good for skin cancer but bad for maintaining vit d levels in the body.  Most Americans are low on vit D, there is new conflicting evidence for pro's and con's on using supplement but for the last 10 + years low levels have been associated with diseases like cardiovascular disease, asthma and certain cancers.  The data on vit D toxicity(overdosing) is lacking so even if future studies say it doesn't help to keep blood levels high, it aint gonna hurt either.  Until NIH and the Cochrane show anything different.....please take vit D3 for yourself and your kids.   (children average about 400IU daily to be taken with healthy fat/food/oil)

So it seems like I am pushing alot of pills on kids and yes, if diet is lacking, don't wait until later.  Always, always change the diet first.  If you cant, then add the multivitamin and make it a habit.  If there is a medical disease, clear it with the doc and add the omega 3 and D3 at the least.....other things depending on the presentation.  (ie...zinc for adhd, inositol for anxiety, magnesium for dysmenorrhea, probiotics for irritable bowel, turmeric for muscle aches, licorice for reflux...)  Wedge in some healthy snacks and meals into daily nutrition and hopefully they become accommodated to always seeing a fruit, veggie, or fiber source thus take it with them to adulthood. Maintain a meatless Monday and fish Friday to cut down overall sources of red meat (high omega 6 and cholesterol) and experiment with non redmeat dishes to see if they catch on.   Even if training is 2 hours a day, 5 days a week (that is time consuming right in the middle of the day! God bless our parents!)  the antiinflammatory diet is the gold standard for keeping a healthy injury free athlete.   Eat Drink Weigh Less by Walter Willet, The Mediterranean Diet Cookbook by Harmon Jenkins (nice pics), John LaPuma's Big Book or his website for free recipes www.drjohnlapuma.com and of course my guru Andy Weil and his multiple books and informative website www.drweil.com .

(For my parents.)

Cold and Flu Herbal "Go Bag"

     I feel my chances are high regarding getting sick from a contagious patient.  Not so much at First Health Associates where I see complicated chronic conditions.  More at the immediate care centers where I "moonlight" for Alexian Brothers.  I get the occasional cough or stuffy nose but the last time I touched an antibiotic was 2003-2004 for a sinus infection after which I proceeded to come down with the rare psuedomembranous colitis from antibiotic over dose (this was after the first day!!!)   Note: this is when I was sleeping less, drinking a large coffee from McDonalds with 10 packs of sugar and a steak egg and cheeze bagel/hash browns every morning, beer with dinner which was mostly Filipino feast foods and the occasional 1 pound hamburger from Fuddruckers.  Oh...almost forgot the dozen warm cripsy cream donuts "for the staff" on fridays.  
     Those days are far behind me but the point is I try to stay healthy and set and example for friends, family and patients but still get a little cough, stuffy nose now and then.   I have confidently developed my "go bag" of herbal supplements that have truncated any/all infections my body is trying to express.  As in most integrative treatments, use is based on factual studies.  The higher the degree of disease presentation/complication, the more RCT's (randomized controlled trials) or Cochrane Reviews are necessary before making recommendations.  (This is the ultimate reason for putting myself through 2 years of fellowship study- outside the normal training set by the state and fed in order to practice medicine.)   I have adapted a few things to make sure natureal healing is maximized when homeostasis becomes imbalanced with infection.  

1 Avoid all dairy

product for 10-14 days (even organic) I would really cut out all processed food (no matter how much you crave it), complex/big meals, alcohol, excessive caffeine-if you cut out all caffeine now you will have a withdrawal headache ontop of the viral/flu/sinusitis headache.  The opposite is true if you starve yourself down to 1000cal daily, the immune system will "hit the wall".  If you want to keep at a minimum of food intake....the old way Bananas Rice Apple sauce Toast is ok for 24-48 hours but push fluids:
2 Make sure the minimal fluid

intake per day is 3 liters per day (13 cups) try to make the morning warm fluid and cool it down as the day goes on.....cold water is more palatable.   Ayurveda practice is to start with warm fluid as to not cool the fire (solar plexus chakra) that starts the day.  I also like using Airborne fizz tablets in the water to insure taste helps it go down.  There is argument as to whether Airborne has any healing properties at all....I just want it to taste better without adding sugar. 
3 Elderberry

has been studied to shorten the days of illness in children with viral symptoms.  The dark berry is surmized to accentuate white blood cell killing power.  For kids-Sambucus is a nice formulation with echinacea.  For adults I suggest New Chapter Sinus Take Care or Garden of Life Immunity Sinus usually at Whole Foods Market or Fruitful Yield.  All about 4-5 times daily for 5 -7 days. 
4 Astragalus

 a fantastic root that is known as an "adaptogen".  This category responds to stress with "boosting" to calm the stress response of white blood cells but also allow to unleash hell to bacterial and viral invaders.  Think of the professional boxer-cool, collected knows a strategy that works and is focused on getting a job done in the ring.  Compare to a drunk brawler who may have adrenaline but no control of emotion, decision making even if he has the same tools as the boxer.  Now think of a while blood cell that is focused on work vs a white blood cell that is over stimultated.  The overstimulated will either attack the wrong thing (a friendly knee cell in Rheumatoid Arthritis or an intestinal cell in Inflammatory Bowel Disease) or it wont fight the true invading bacteria/virus leading to infection after infection.  There have been small studies showing benefit of astragalus daily use in asthmatic patients during cold and flu season to decrease infection rates.  If you are lucky, your local herb shop will have astragalus tongue depressors, think slivers of the root you chop up and place in tea or soup if you dont mind the taste of bark.  (Whole Foods Market brand, Nature's Way-purple top, Now Foods from Fruitful Yield)
5 Neti Pot nasal irrigation

2-3 times daily followed by over the counter or prescription meds to decrease nasal swelling (if congestion or cough is part of the picture).  I like Nasacrom that can be purchased anywhere no script needed-I relied on it heavily 2 decades ago when it was only prescription and worked well then and still works now (albeit the otc dose is smaller than back in the day).  Some people dont like putting things in their nose......a spray form is probably ok but can irritate the ostia (hole) the sinus uses to drain discharge into the nose and out the nostrils.  Irritate the ostia too much and it may cause a nasty facial headache.  I do not believe the viral story that went out about a neti pot being the cause of a parasite killing someones brain-neti pots have been used for more than 2500 years even before antibiotics/antiparasitics where invented, those were times when infection and parasites were true life enders.  If there was a high association with brain absess formation, 2500 years would have shown a relationship of all the people in India dying of massive brain absess outbreaks.  Purchase at any herbal store, vitamin shop, most pharmacies.
Link to DrOz Oprah demo of neti pot

6 Aroma Therapy

is a technique of getting the proposed strength of a plant into the body via the nose and lungs.  Like asthmatics and their inhalers/nebulizers, so to can an ultrasonic nebulizer "shake up" plant oils to make a vapor for you to inhale/sniff.   There is some research saying it works it works to induce a relaxation response in the brain.  I havent seen specific reproducible data showing head to head trials vs prescription drugs but who cares?   If the potential side effects to the treatment are minimal (breathing in nice smells) then the treatment doesnt need multimillion dollar randomized control trials for me to have a patient use it.  (....and it has to be affordable since being broke is a side effect)  I experimented with Young Living Thieves.....used it in my office for people coming in with flu symptoms and they did feel very "different" with fewer symptoms.  If you are really lucky, there will be an herbalist or "aromatherapy blender" who can find the exact combination of essential oils to help change your mind body response.  Jenn from JennScents first introduced me to aromatherapy and herbal medicine- fantastic blends!  Or try Olabas Oil found at Whole Foods Market or Fruitful Yield in the water of steam bath or steam cave - link to my Flu Lecture

7 Medical Acupuncture

is a fantastic tool that improves normal functioning during the infection.  Although the data is still being studied, if an asthmatic cant breath and a few needles helps-positive response!   If a gastritis sufferer gets control of nausea with one single acpuncture needles-postive response!  I have used it with many different patients and at the least, it makes the patient feel empowered and helps get through the crisis.  (Used it for my mom when she was suffering from the abdominal pains from her pancreatic cancer......doesnt matter if it was placebo-she got relief.  Only in America to scientist minimalize the placebo effect.  In my heart, if it works, causes no harm, is affordable/free.....do it!  No such thing as "false hope")  See Dr Zhu in my office, Dr Leon Chen in Lombard, Frank Grill in Naperville.
8 Massage

from an energy healer/massage therapist to chest and facial acupressure points feels good.   It also is a way to stimulate the acupuncture points that heal if the patient doesnt like needles.  Using essential oils like Eucalyptus to the lung points in a bronchitis sufferer or along acupuncture meridias that help drain sinus infections help my average patient get through the infectious process with less drugs.  Only problem is finding a credible acupuncturist.  I studied 1000 hours from UCLA and I rate myself as"ok".  There are far better docs than me and this is where I send my patients.  Have to research where the acupuncturist went to school, how long in practice and what is their sole means of economic survival.  If it is a practitioner that only does needles and they have been around 10 years with training from China-probably good.  If a person that does alot of different things but also does needles and studied for 6 weeks to get a diploma-run for your life.  Most states have a credentialing board overseeing non MD's, then there is the American Academy of Medical Acupuncture certification for MD/DO's.  Don't forget your spouse.
9 Mushrooms

have great medicinal value and have been used for centuries in Asia.   Good studies regarding using only them to intervene with fighting infections.  The problem is which companies do we trust?  As is the problem with all the above where do we buy our herbs.  Regarding mushroom, I like GAIA brand "Throat Shield"  peppermint flavored.  Cant tell if its the alcohol/cinnamon or the mushroom that helps sore throats.......but it doesnt matter as the cost is little more than chloraseptic throat spray.  2 sprays every 2 hours or before bed helps get through a day or night with less drugs.  Also helps calm a throat so you can eat if strept throat or tonsillitis is the problem.  
10 RICOLAAA!!!

I like any throat lozenge for soothing if it has elderberry, eucalyptus, echinacea......and not too much sugar.  Comfort is important otherwise you wont eat or drink and be in pain all day.  If number 9 is too expensive.

And there is my "go bag" of winter illness rescue.  I have a few extra things like high dose D3, magnesium, zinc, high dose vit C, colloidal silver, homepathic Boiron products....but just with the 10 things above, people get discouraged when there are too many choices.  Even if an antibiotic is needed, I still do all the above plus a probiotic for 30 days to rebuild the gut flora I destroyed with the antibioic.  Shopping a Whole Foods Market causes a spasm in my wallet but speaking from personal experience, I have not touched an antibiotic for almost 10 years and I am sitting 2 feet away from people that are being seen with strept, bronchitis, pneumonia, MRSA, sinusitis and infectious diarrhea.   Make you own judgement but dont just keep on taking antibiotic after antibiotic thinking you have no other choices.

Link to a slideshare.net lecture on Colds Coughs and Capsules
Link to a video on my influenza experience