Change your Oil: Fats and Cholesterol

"Eat a low-fat, low-cholesterol diet" has been the mantra for healthful eating for decades. The low-fat approach to eating may have made a difference for the occasional individual, but as a nation it hasn't helped us control weight or become healthier. I am seeing a larger number (even very thin) patients with high cholesterol and triglycerides.  Why hasn't cutting fat from the diet paid off as expected? Detailed research—much of it done at Harvard—shows that the total amount of fat in the diet isn't really linked with weight or disease.

What really matters is the type of fat in the diet.
Bad fats, meaning saturated fats, increase the risk for certain diseases.
Very bad fats, meaning trans fats,  are worse for cholesterol levels than saturated fats because they raise bad LDL and lower good HDL.
Good fats, meaning monounsaturated and polyunsaturated fats, do just the opposite. They are good for the heart and most other parts of the body. There is no good evidence that replacing saturated fat with carbohydrates will protect you against heart disease, while there is solid proof that replacing saturated fat with unsaturated fats will help. Here are three helpful tips:

1. Try to eliminate trans fats from partially hydrogenated oils. Check food labels for trans fats; avoid fried fast foods.

2. Limit your intake of saturated fats by cutting back on red meat and full-fat dairy foods. Try replacing red meat with beans, nuts, poultry, and fish whenever possible, and switching from whole milk and other full-fat dairy foods to lower fat versions.

3. In place of butter, use liquid vegetable oils rich in polyunsaturated and monounsaturated fats in cooking and at the table such as canola and olive oil.

My patients often ask, "How much fat should I eat per day"?

• It generally is figured as a percentage of your daily caloric intake, which varies with your age, sex, and activity level.
• The American Heart Association recommends limiting dietary fat to 30% of total calories, however, if you are overweight, need to lower blood cholesterol or have another medical concern, you may need less than the recommended 30%. Back to the math: for 1,600 calories diet - Limit fat to 50 grams.
• The Dietary Guidelines for Americans recommend no more than 10 percent of your total daily calories come from saturated fat (for a 2,000-calorie diet this would be about 20 grams per day), and your trans fat consumption should be as low as possible.

Safe and Sunny Summer

I have recently experienced a bad sunburn while vacationing in Florida. I know that too much sun can cause skin cancer. But I was out all day playing with my son, enjoying the water and my leisure reading on the beach. I forgot to reapply the sunscreen. By the end of the day, I was hurting. On the other hand, my son was wearing his sunshine gear: a hat, his long sleeve shirt and UPF 50+ shorts. He was safe.  This experience has reminded me of the importance of discussing sun safety with my patients.
Here are few tips to consider when having fun in the sun:

1.  Use sunscreen with SPF of 15 or higher. SPF stands for sun protection factor and determines how long that sunscreen will allow you to stay in the sun without burning. Be sure to apply enough sunscreen - about one ounce per sitting for a young adult. When it comes to sunscreen, more is more. Reapply sunscreen every two hours, or after swimming or sweating. 

2. Sunscreens containing zinc oxide or titanium dioxide create an invisible barrier to UV rays. Most sunscreens need time to react with substances in your skin before they become effective. Be sure to apply them at least 20 minutes before you go out in the sun. For tear-free formula that is quick, easy and painless to apply, try Banana boat SPF 50 or Aveeno SPF 70 spray.

3. Stay in the shade whenever possible, and limit sun exposure during the peak intensity hours - between 10 a.m. and 4 p.m. Remember that clouds offer no protection from UV rays. UV index is an indicator of how dangerous the UV rays are. If UV index is 3 or higher, protect yourself. The Environmental Protection Agency puts out a national UV index forecast map, with sun protection advice, every day. You can even put in your own zip code! Go to http://www.epa.gov/sunwise/uvindex.html.


4. The first, and best line of defense against the sun is covering up. Wear a hat with a three-inch brim or a bill facing forward, sunglasses (look for sunglasses that block 99-100% of ultraviolet rays), and cotton clothing with a tight weave. Sun-protective clothing, which has a sunscreen in the fabric, really works (but can be expensive).

5. For babies under 6 months, the two main recommendations from the AAP to prevent sunburn are to avoid sun exposure and dress infants in lightweight long clothes to prevent sunburn.

Here are few myths about sunscreen that I wanted to clarify.

"I need sun for Vitamin D."
True. You only need 15 minutes of peak sun time three times per week to help avoid vitamin D deficiency. Unless you are sunscreen applier champion, you will not be blocking vitamin D synthesis. If you are truly low on Vitamin D, consider taking supplement.

"You don't need to wear sunscreen if you have dark skin." 
False. Any skin color can get skin cancer. Everyone needs sunscreen.

"I read somewhere that sunscreen can expire."
True. The active ingredients in sunscreen can lose their potency. Check the expiration date. To be safe, toss them after a year.

"I heard there is a detergent that helps your clothes protect you from sunshine."
True. Washing your clothes in RIT's SunGuard can add an equivalent of SPF 30 to your clothes.

Even if you haven't always been sun protection conscious, it's time to start now. Instead of dwelling on the past sunburns, get your sunscreen regimen today. Looking for a rule of thumb? Apply early and often. I am speaking from experience. Have a good day, sunshine.

E is for Exercise

“If there is one single thing you can do to improve your health, there is no doubt it is exercise,” said Robert E. Sallis, M.D., immediate past-president and Chair of the Exercise is Medicine initiative. Regular physical activity is so powerful in maintaining and improving health that it should be prescribed, just as medicine or any drug would be. During aerobic exercise, the heart beats faster and a person breathes harder. When done regularly and for continuous periods of time, aerobic activity strengthens the heart and improves the body's ability to deliver oxygen to all its cells. This idea deserves the attention of the month of May.


My family has recently been on a weekend trip to a beach. My husband and I scheduled early morning walks to make sure we were active during our mini-vacation. When most adults think of exercise, we envision a structured activity. But for kids, exercise means playing and being physically active. Exercise is fun. We should engage in variety of activities to include the three elements of fitness: endurance, strength and flexibility. This task can be very simple. For example, I have watched my son run after the birds on the beach (endurance), throw rocks in the water (strength) and bend down to dig the sand (flexibility).

How does physical activity help?

Center for Disease Control and Prevention (CDC) reviewed studies about the role of physical activity and health. Substantial evidence suggests that kids who are active will:

• Builds strong bones and muscles

• Decreases the likelihood of developing obesity and risk factors for disease like type 2 diabetes and heart disease

• May reduce anxiety and depression and promote positive mental health

• Positively affects classroom behavior and can help improve their concentration and memory

How much physical activity do youth need?

• All children age 2 and older should participate in at least 60 minutes (1 hour) of enjoyable, moderate-intensity physical activities every day that are developmentally appropriate and varied.

• If your child or children don't have a full 60-minute activity break each day, try to provide at least two 15-minute periods or three 10-minute periods in which they can engage in vigorous activities appropriate to their age, gender and stage of physical and emotional development.


How can I get my child to be more physically active?

It is important that physical activity be a regular part of family life. Studies have shown that lifestyles learned as children are much more likely to stay with a person into adulthood. If sports and physical activities are a family priority, they will provide children and parents with a strong foundation for a lifetime of health.


Parents can play a key role in helping their child become more physically active. Younger children like to move between short bursts of activity followed by short periods of rest. Adolescents do more structured and longer activities than younger children. Following are 3 ways to get started:

1. Turn off the TV. Limit television watching and computer use. The American Academy of Pediatrics recommends no more than 1 to 2 hours of total screen time, including TV, videos, and computers and video games, each day. Use the free time for more physical activities.

2. Make time for a fun activity. Help your child find a sport that she enjoys. The more she enjoys the activity, the more likely it is that she will continue. Get the entire family involved. It is a great way to spend time together.

3. Choose an activity that is developmentally appropriate. For example, a 7- or 8-year-old child is not ready for weight lifting or a 3-mile run, but soccer, bicycle riding, and swimming are all appropriate activities.

What kinds of activities are appropriate for my child?

Children should have several opportunities to be active throughout the week and year round.

Here are some suggestions:

1. Outdoor activities can be enjoyed in a variety of locations and are often less expensive, more accessible, and can foster life-long activity. This week, take your child to a local park or playground.

2. Encourage your children to be active with their friends by playing tag, basketball, or by riding bikes.

3. Give your children toys that encourage physical activity like balls, kites and jump ropes

4. Take a walk after dinner

5. Find out what physical activities are offered at your child’s school


We hope people will pledge to be a little more active this month to gain that positive impact on their health. Just a modest amount of activity can impact cardiovascular health and enhance strength and flexibility. Be Active and Play, 60 MINUTES, Every Day!!!

Tips to Promote Social-Emotional Health Among Young Children

Thursday, May 6 is National Children's Mental Health Awareness Day. The AAP is a co-sponsor of this event, an initiative of the Substance Abuse and Mental Health Services Administration (SAMHSA). 
The theme, "positive mental health is essential to a child" healthy development from birth,” focuses on making sure that the promotion of mental health is considered when children are young. 
To support this event, please read the list of tips that the AAP developed for parents, early childhood educators, and pediatricians. 





What Parents of Young Children Can Do:

• Catch your child being good!  Praise your child often for even small accomplishments like playing nicely with brothers or sisters, helping to pick up toys, waiting her turn, or being a good sport.
• Find ways to play with your child that you both enjoy every day. Talk with your child, tell stories, sing, and make rhymes together. It is especially important to try and reconnect for a few minutes after separations.  Include some type of regular physical activity such as a walk or bike ride around the neighborhood.
• Seek ways for your child to play with other children of the same age. Make sure they are watched by a trusted adult.
• Read with your child every day as part of a special family routine.  Turn off the television before the evening meal, have conversations with your children during the meal, get baths/showers after the meal, and read books with your children in preparation for bedtime.  This will help children to settle down and sleep well at the end of the day.
• Limit screen time to no more than two hours daily for children 2 and older.  The AAP does not recommend any screen time for children younger than 2 years of age.  Never put a TV in a child's bedroom.  Parents should watch along with older children and try to put the right spin on what their children are seeing. Young children should not be exposed to violence on TV, including on the news.   TV should not become a babysitter.
• Make time for a routine that includes regular family meals when parents and children can sit and talk about their day together. Play the "high-low" game by taking turns sharing the best and not-so-good parts of the day. 
• Provide regular bedtime routines to promote healthy sleep.  This time of day can become an oasis of calm and togetherness in the day for parents and children.
• Model behaviors that you want to see in your child.  Parents are their child’s first and most important teachers, and what they do can be much more important than what they say. Be especially careful of criticizing teachers or other trusted adults in front of the child.
• Everyone experiences anger and stress! Help your child to find acceptable ways of working through these feelings. It is okay to be mad but never okay to hit or destroy property.
• Listen to and respect your child. Remind your child that he or she can always come to you to discuss concerns, fears, and thoughts. Calmly discuss the issues and talk to your child's pediatrician with any concerns you might have as a result.

What Early Education and Child Care Providers Can Do:

• Greet each child warmly. Smile, make eye contact, and use a positive tone of voice that says you are happy to see the child.
• Be friendly and affectionate with each child. Warmth and affection can be shown through your expression, laughter, voice, and words.
• Look for each child's strengths. Make sure that your words and interactions with children are more positive than negative.
• Show children how to talk to other children and build friendships. Teach children how to handle problems with others and to ask for help when they need it.
• Teach children how to follow directions, including listening, asking questions, and finishing tasks.
• Reinforce desirable behaviors by ignoring things that are trivial, providing frequent praise when you see positive behaviors start to emerge, and modeling respectful communication.
• Provide children with opportunities to make choices when possible and help them to learn to understand the consequences of their actions.
• Talk to a child's parents early on if you observe problem behaviors.
• Some child care facilities and schools provide mental health services on site; others can help students connect with community resources and providers of these services.
• Promoting positive staff morale among child care workers can help to minimize staff turnover.  To the extent possible, maintain the same staff members for the same children.

What Pediatricians Can Do:

• Often doctors are the first people families turn to for concerns about behaviors or emotions. Recognize that the trusting relationship you have with your patients and parents can encourage parents to share concerns.  Be alert to the signs and symptoms of emotional and behavioral problems among young children as well as mental health concerns among parents. Include questions about family violence, substance abuse, and mental health history in your assessments.
• Promote the "5 Rs" of early education to families.
• Reading together as a daily family activity.
• Rhyming, playing, and cuddling together often.
• Routines and regular times for meals, play, and sleeping, which help children know what they can expect and what is expected from them.
• Rewarding everyday successes with praise.
• Reciprocal and nurturing relationships, which are the foundations of healthy child development.
• Integrate literacy promotion into practice.
• Talk with families about child care and school. Promote a 3-way partnership among the pediatrician, family, and caregivers.
• Help your patients and parents focus on the child’s assets or strengths.
• Discuss the importance of a support system and appropriate coping strategies when parents feel tired, overwhelmed, or frustrated.
• If you see signs of depression in a parent, encourage interventions and support. Remind parents that they have to take care of themselves before they can take care of their child. Depression may impair the parent’s responsiveness to the child.
• Know what resources are available in your community so that you can refer families who need support. Make connections with mental health service providers and referral sources, and have information available in the office about mental health services.

A Final Thought:
As adults, one of the greatest things we can do for our children is to make them feel good about themselves and to equip them with a wide repertoire of positive coping strategies. They learn these strategies best when they see them modeled by the important adults in their lives. 

D is for Discipline

“He is out of control, doctor,” said a mother of a 3-year-old boy who was scheduled to see me for his asthma. I looked around the room and mom’s wallet, lipstick and cell phone were all on the floor. The paper that once covered the exam table lay in crinkled pieces all over the floor. “No! No! No! Don’t throw my cell phone!” the mother screamed. “Do you see what he is doing?! He drives me crazy!” she proclaimed.

I can sympathize with my patient’s mother. I am always running after my son, Ibrahim, who wants to touch, feel, press, push and pound everything that he sees. I am constantly saying, “No, Ibrahim, don’t go there." "Don’t do that." "Don’t touch that.” However, I am not proud of saying No to a child who is just exploring his environment. Children don’t always do what we want them to do, so I make a daily promise to myself that I will work hard to be a positive, loving and supportive parent.  

It is our job as parents to show good behavior and discipline our children.

Effective Parenting

There are different styles and approaches to parenting. An effective parent raises a child who is self-reliant, self-controlled and positively curious. Research shows that parents who are too strict and who over-use punishment as well as permissive parents who rarely use punishment are NOT effective parents. Effective parents respect and trust their child to do the right thing according to the child's age and understanding. Effective parents use clear rules and explain why these rules are important.

For example, the first time your 3-year-old uses crayons to "decorate" the living room wall, discuss why that's not allowed and what will happen if he or she does it again. You can say, “Crayons are for the paper only. If you write on the wall, you will not be able to use the crayons all day." 

-Instead of saying "Don't color on the wall." use a positive sentence: "Crayons are for paper only."

-Let them know the cost of misbehaving. When you tell them the cost of misbehaving you are both making an agreement to accept the consequences. Your child is agreeing to accept their punishment (which may not really happen) and you are agreeing to enforce the punishment (which must always happen if you want your discipline to be taken seriously). Instead of using empty threats like "I won't ever let you use crayons again!" give them a realistic punishment that you will fulfill: "If you write on the wall, you will not be able to use the crayons all day."

-Follow through and be consistent. If the wall gets colored again a few days later, remind your child that crayons are for paper only and then remove the crayons from their usual location to a safe place your child can not reach. Kids are very smart and remember well. If you don't follow through on something you said you would do, they will remember and will not believe you anymore.

Children learn from experience. Having natural and logical consequences for misbehavior helps children learn that they are accountable for their actions. A natural consequence occurs when a parent does not intervene in a situation but allows the situation to teach the child. The technique is based on the old saying that “Every generation must learn that the stove is hot.” A teenager who stays up too late may suffer the natural consequences of being tired the next day. When my son emptied the whole box of crackers, he soon learned that there were none there left to eat. When you use this method, don’t give in and rescue your child (by giving another him another box of crackers like I almost did).

This was the time when my husband and I had to talk about and agree on the disciplining consequences we would use when our son misbehaved. Parents should establish the rules and be consistent. Consistency and predictability are the cornerstones of discipline. You must follow through with the punishment you and your child have agreed upon every time in order to be an effective parent. If you give in your child’s tantrum by rescuing him with a cookie, you will be buying a lot of cookies for the rest of your life.

Consequences need to be logically connected to the misbehavior or mistake. “Do not warn, threaten or moralize” says Dr. Ken West, the author of The Shelbys Need Help: A Choose-Your-Own-Solutions Guidebook for Parents. The secret of a good consequence is its logical connection to the misbehavior. If a child writes on the wall with the crayons, it is not logical for him or her to lose television rights or endure a speech. None of these responses are related to the misbehavior. Having him/her help you clean the wall, however, is both logical and educational. Some experts call this method “fix-up”. If children damage something, they need to help in fixing it or in cleaning up.

Effective guidance and discipline focuses on the development of the child.
Here are some age-appropriate methods for discipline:

Ages 0 to 2 Years

Eliminate temptations and redirect. Babies and toddlers will naturally go after jewelry and cleaning supplies left on the coffee table.Telling them No will not be effective just remove the temptation (jewelry, crayons, cleaning supplies) to a place they can't access.

Ages 2 to 5 Years

Time-Out. This is a technique that works well when a specific rule has been broken. Once your child can sit quietly, choose a time-out spot. Set a timer so that she will know when the time-out is over. When giving a time out, be calm and firm. One minute for each year of the child's age is appropriate.

Ages 5 to 8 Years

Withholding privilege. When you tell your child that if she does not cooperate, she will have to give something up she likes. If a child breaks the rule about where they can go on their bike, take away the bike for a few days.

Ages 9 to 12 Years

Natural consequences. For example, if your fifth grader's homework isn't done before bedtime, don’t make him stay up all night. If homework is incomplete, your child will go to school the next day without it and suffer the resulting bad grade.

Ages 13 Years and up

Set limits and boundaries. Give your teenage more control and freedom but still provide guidance.

If you invest your time in listening to your child, setting limits and teaching responsible attitudes though a firm but gentle disciplining approach, it will be a worth your effort. Dr. Brazelton a renowned child development expert, states that children actually look for limits and this journey you take with your child can build a foundation for the rest of their lives. Positive guidance and discipline are crucial because they promote self-control and help children make thoughtful choices. Children need our help navigating their way toward independence.

Next time I saw my patient for a follow up appointment, his asthma and his behavior had improved. He had his own toy cell phone with fun music tones. He was playing with the numbers on the phone instead of pushing mom's buttons.

This morning when my son took out all the salad dressing bottles from the side of the fridge, I got down on my knees. I started shaking the bottles and teaching him how to put them back. Discipline can be an opportunity to strengthen the child-parent bond. According to numerous studies, nurturing your child while you teach and discipline them is extremely important.  Everyday I dedicate myself to be a warm, understanding and supportive parent and pediatrician- the kind of person I want my son to become.

Study: Heavy children are at risk for bad arterties

In the last post, we discussed the importance of maintaining good cholesterol. I also wanted to point out that overweight and sedentary children are even at a higher risk of having heart disease as adults.

US researchers found that children with more body fat and less endurance than their fitter, leaner counterparts have stiffer arteries at a young age. Stiff arteries are a hallmark of atherosclerosis, a typically adult condition in which blood vessels become clogged. Identifying these children early will help us implement preventive measures.

Next time you visit your pediatrician, make sure you talk about heart health.

Read more: Study: Heavy children at risk for bad arteries - Atlanta Business Chronicle (4/16/2010)

C is for Cholesterol

My husband is an interventional cardiologist who is on-call for Howard County Hospital’s Heart Attack Team every Tuesday evening. We often get wake-up calls in the middle of the night about a patient with chest pain. My husband rushes to the hospital when there is a heart attack. Time is critical when it comes to opening up the clogged arteries that bring blood to the heart. It’s a true emergency. Someone in America dies every 37 seconds from some form of cardiovascular disease.


Since I am also awoken in the middle of the night, I wonder, “What has caused that patient’s arteries to clog?” My goal is to get to the root of the problem before it has time to grow. I want my patients to grow up healthy and never have to be faced with a heart attack.

Thanks to many studies and thousands of patients, researchers have found certain risk factors that play an important role in a person's chances of developing heart disease. Some risk factors can be changed, treated, or modified, and some cannot. One of those risk factors for having heart disease is having high cholesterol.

What is cholesterol?

Cholesterol is a fat-like substance (lipid) that is found in all body cells. Your liver makes cholesterol. We also can get cholesterol from the foods we eat such as meat, fish, eggs, butter, cheese and milk. We need some cholesterol to help our brain, skin, and other organs grow and do their jobs well. There are two main types of cholesterol: HDL and LDL.

LDL cholesterol is more likely to clog blood vessels because it carries the cholesterol away from the liver into the bloodstream, where it can stick to the blood vessels. LDL is also known as “lousy cholesterol”. 

HDL cholesterol, on the other hand, carries the cholesterol back to the liver where it is broken down. HDL is know as "healthy cholesterol". When your HDL cholesterol is high, it's actually good for your health.


When should children have their cholesterol checked?

Screening should take place after age two but no later than age 10, if your child is at risk.

The American Academy of Pediatrics (AAP) considers the problem serious enough to have issued recommendations to help parents and physicians identify children potentially at risk for problems with high cholesterol. The recommendations target children and adolescents who have:

• a family history of premature cardiovascular disease

• at least one parent with a high blood cholesterol level

• other factors for heart disease including obesity, high blood pressure or diabetes

Like most things, cholesterol levels are different for kids, so make sure you discuss those numbers with your pediatrician.

Helpful Tips

If you don’t know your family’s health history, have the child’s cholesterol level checked between 2-10 years of age.

If a child's fasting cholesterol profile is normal, then it should be repeated every three to five years.

If a child is found to have high cholesterol, his or her physician will likely recommend treating the problem with a combination of diet management and physical activity. If a problem is severe enough, medications may be used to lower the cholesterol.

To help your family have healthy cholesterol levels, have a Heart Healthy Diet, one that is low in cholesterol and saturated fat.


Let’s help our children stay away as far as possible from heart disease: keep their blood flowing freely through their arteries by having a Heart Healthy Diet and staying physically active together.