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An Open Letter To Pediatricians (An Opportunity To Reclaim What Once Was Ours)

We recently reached over 100,000 views worldwide! It is certainly a wonderful milestone to reflect on. As a Pediatrician managing a large practice and a wonderful family at home, the viewership statistics have far exceeded my expectations when I originally started my blog. My sincere gratitude to those who follow and have supported lowcarbpediatrician.com. It is exciting to watch the paradigm shift in nutritional science take shape and I strongly believe that the information should be available to all of our children.

The job of teaching children to eat Real Food in order to achieve optimum health falls squarely on the shoulders of pediatricians. Years ago, I thought it was a job that someone else would handle or take care of. As a pediatrician, this was a poor mentality and I know now that I was dead wrong. Don’t let this be you. The job is ours and we need to lead the way. Nutritionists, physician extenders, and nurses will look to us to provide this information.

Make no mistake, the scientific answers are clear.

Since starting my blog, there is one other book that I HIGHLY recommend. Published just this past year, it is called “The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet” by Nina Teicholz. I won’t go into a full review – if you are interested, here are a few of my favorites: Diet Doctor, Protein Power, and Former British Medical Journal Editor Richard Smith. The book contains over 60 pages of references and, as Smith puts it,

“… the forensic demolition of the hypothesis that saturated fat is the cause of cardiovascular disease is impressive. Indeed, the book is deeply disturbing in showing how overenthusiastic scientists, massive conflicts of interest, and politically driven policy makers can make deeply damaging mistakes. Over 40 years I’ve come to recognize which I might have known from the beginning – that science is a human activity with the error, self-deception, grandiosity, bias, self-interest, cruelty, fraud, and theft that is inherent in all human activities (together with some saintliness), but this book shook me.”

The most interesting part of the book, for me as a pediatrician, was Chapter 6. Teicholz does a wonderful job revealing the pediatricians’ response to the low-fat diet. Prior to the low-fat dogma, pediatricians felt whole milk, butter, eggs, cheese and meat (along with fruits and veggies) should be the backbone of a child’s healthy diet. Many scientific bodies, including the American Academy of Pediatrics (AAP) fought the low-fat recommendations for children based on lack of scientific merit. It should disturb practicing pediatricians to know that the AAP fought the guidelines before finally consenting, in 1998, under a wave of pressure from non-pediatric institutions such as the USDA, AHA, NIH, NHLBI, and even parents – despite a lack of data stating low-fat diets were safe for growth and development. The two studies that are highlighted as supporting the low-fat diet in children (DISC or Dietary Intervention Study in Children and STRIP – Special Turku Coronary Risk Factor Intervention Project) are significantly flawed in both methodology and outcomes. Teicholz discusses both in detail.

As pediatricians we need to look at ourselves in the mirror and make the decision to pass on this critical nutrition information to the families who place their trust in us. At a global level, we are failing to do this. No one else is going to take on this responsibility. Childhood obesity/metabolic syndrome/dyslipidemia (and all comorbidities) will not be solved at the institutional level. As many of you know, pediatrics is not a significant source of revenue for most institutions and only the most basic services are provided (generalizing). Hence the need for fundraisers such as Children’s Miracle Network, etc. Nor will school systems, allied health services, or parents (who themselves were raised with incorrect nutritional advice) be able to correct the crisis without our help. We are in charge of providing comprehensive healthcare to children. Healthcare as we know it hangs in the balance.

For a variety of reasons, our profession gave up control of one of the most basic of childhood needs – making sure families are knowledgable about Real Food. They must know what that encompasses so they can make their own healthy choices. We MUST regain control of this nutritional crisis at the grassroots level. Ultimately, we have no choice. I believe we can do this. It starts with one pediatrician at a time and one family at a time. If you are a pediatrician, it starts with you! Make this decision today!

Start in your office. Today. One patient/family. Take it from there. They will be grateful.

Finally, I wanted to share an inspiring message from Dr. Harlan Krumholz in “A Note to My Younger Colleagues… Be Brave”:

“In some ways, our best hope to reveal our follies lies with those new to the field. It is your fresh eyes, unbridled enthusiasm, optimism about what is possible, and commitment to the highest ideals of the profession that can reveal what those who have longer tenure in medicine may have trouble discerning. And yet, to be effective and make use of those insights, you must be brave. Surely, you must also be judicious and prudent in expressing yourself, making sure that your opinions are informed and grounded in science. But when there is an opportunity to speak truth to power, I hope you will consider doing it.

Unfortunately, our profession does not often reward those who question dogma. In fact, there are many episodes throughout the history of medicine and science in which truth was resisted and dogmatic beliefs, however poorly supported by evidence, were imposed by those in a position to do so. If we are to accelerate innovation in medicine, eliminate wasteful practices, and improve the depth and effectiveness of how we care for patients, then there must be room to question traditional approaches and to introduce new and better ways of prevention, diagnosis, and treatment. We are now at that critical juncture.

When I entered medicine, I did not realize that there was such intense pressure to conform. But we learn early on that there is a decorum to medicine, a politeness. A hidden curriculum teaches us not to disturb the status quo. We are trained to defer to authority, not to question it. We depend on powerful individuals and organizations and are taught that success does not often come to those who ask uncomfortable questions or suggest new ways of providing care.

…..

I have grown to appreciate those who will stand up despite the risks or in the face of efforts to silence them. Promoting the best science and the best advocacy for patients and the public sometimes entails risk. Change does not come easily to a system and there is resistance to those who may seek to make the system safer, more effective, and more patient-centered through new ideas or the articulation of uncomfortable truths.

If you take the path toward clarity, I guarantee that you will occasionally find people who will disparage you. They may seek to undermine you, find ways to marginalize you, and try to incriminate you. They may come from directions that surprise you. Powerful ideas often attract attacks that focus more on individuals than ideas. If you raise inconvenient truths or voice uncomfortable opinions, particularly if they threaten someone’s comfortable status quo, then you will discover much about the character of those with whom you disagree. But always take the high road, engage in dialogue about ideas and evidence, and be motivated by the opportunity to best serve patients and the public. You will not regret it.

Ultimately, our success as a profession will depend on our ability to engage in debate, acknowledge different opinions, and seek answers through science. The more we depart from the evidence, the more difficult it is to resolve differences. It is critical that we seek truth through science and be humble enough to acknowledge uncertainty. Dogma based on opinion must be reduced from a position of infallibility to one of supposition.

Defining moments can occur when you least expect them. Are you prepared to respond in a way that will bring honor to you and our profession? If you are prepared to let science lead you to your conclusions, then your work and your ideas will find a venue in these pages. Patient-centered improvement will require such a commitment from all corners of our profession. Be brave.”

– Dr. Krumholz

And let it be noted that there is no more delicate matter to take in hand, nor more dangerous to conduct, nor more doubtful in its success, than to set up as a leader in the introduction of changes. For he who innovates will have for his enemies all those who are well off under the existing order of things, and only the lukewarm supporters in those who might be better off under the new. This lukewarm temper arises partly from the fear of adversaries who have the laws on their side and partly from the incredulity of mankind, who will never admit the merit of anything new, until they have seen it proved by the event.

—Machiavelli, 1532

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Historic Time Cover

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If you have not seen it yet, here is the recent cover of Time Magazine! The historic paradigm shift in nutritional awareness continues thanks to a better understanding of what constitutes Real Food. The article discusses the mistakes that were made when the USDA adopted the low-fat guidelines over 30 years ago. For example, clinical trials were never conducted before low-fat recommendations were made public. Also, the observational studies that were used were of extremely poor quality. The low-fat theory is no longer scientifically or morally defensible as our children now suffer from metabolic diseases (diabetes, dyslipidemia, hypertension, obesity, etc.) at a pandemic rate. These problems were non-existent in this age group decades ago. Below is the Time Magazine cover from 30 years ago in 1984. I am very happy to see the correction. However, the low-fat hypothesis still has a firm grip on the medical community and is firmly entrenched in Western dietary culture. Without a doubt, it is the most devastating scientific/political blunder in the course of modern civilization with far reaching consequences worldwide.

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New Cookbooks

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As my collection of cookbooks continues to grow, let me pass on a couple of new additions. First, Michelle Tam has published Nom Nom Paleo: Food for Humans (She has a blog by the same name and it happens to be one of my favorites). I pre-ordered this cookbook 6 months ago and it was well worth the wait. Friendly for both young people and adults, she walks you through the entire Paleo experience with bright, colorful, vibrant illustrations (when it comes to cookbooks, for me, the more pictures the better). Recipes include building block basics, kid friendly paleo lunches, quick snacks, delicious dinners and tasty treats.

Kate Evans Scott has published another valuable kid friendly cookbook that enables our youngsters to eat real food. Add it to our growing list of low carb/paleo cookbooks for children. It’s called The Paleo Kid Lunch Box. It includes 27 recipes designed to deliver where our school-provided lunches fail. Check it out!

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Happy Holidays!

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Our Failure to Slow the Diabetes Epidemic

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The month of November is Diabetes Awareness Month and we are losing the battle. The number of cases, worldwide, has risen to 382 million. The majority of these cases are Type II diabetics and, unfortunately, a large number of these people (175 million) are walking around undiagnosed. There are over 5 million deaths attributed to the disease every year – approximately 1 death every 6 seconds. Annual costs worldwide are estimated at $548 billion. In the year 2035, it is estimated that 592 million people will suffer from the disease. Aside from premature death, the long list of complications will lead to long-term disability for many.

The rise in Type 2 diabetic patients is, of course, not limited to the adult patient population. Children and adolescents are increasingly at risk. Alarming given that Type 2 diabetes was essentially nonexistent in children a century ago.

The statistics are grim. The predictions are horrific. The costs are horrendous. For the sake of future generations, we need to denounce the advice that we know has failed . Instead, we need to utilize science in order to provide sound public health advice. The Swedish recommendations follow a literature review of sixteen thousand studies. Sixteen thousand studies later, we are on the same course. Let’s change that!

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Parenting Strategies and Other People’s Food (Part 2)

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Here is a link to Robin Strathdee’s wonderful 2 part series on how to handle a myriad of situations involving our children and other people’s food.

How To Find Real Food

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Parenting Strategies and Other People’s Food (Part 1)

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Halloween is around the corner and it provides an opportune time to discuss a topic that comes up frequently when I counsel parents and kids about eating real food. What should we, as parents, do when it comes to holidays, birthday parties, grandparent outings, and similar events? After all, much time and energy has been spent on learning which foods are meant to nourish our bodies and which “foods” can harm us. Maybe we’ve spent some time with an educated low-carb health professional or we’ve done our own research on the internet or in the bookstore. We’ve successfully implemented nutritional change at home and eliminated refined sugar, corn and wheat. What strategy should we take when our children are offered refined high-carb food outside the home? In the event of a food allergy, certainly, 100% avoidance should be instituted. If we are following LCHF for overall health and well-being, however, there is more wiggle room. As parents, we can still attempt strict dietary control. Many (including my wife and me), are willing to let the kids take part in outings and celebrations without restriction. Although we often allow the kids to enjoy these foods during the event, we often take control of the situation afterwards. In the end, I don’t feel there is a right or wrong answer. Robin Strathdee writes about this very topic in Part 1 of an article at
whole9life.com. I encourage you to read through and ponder this so you can make a decision that is right for you and your children.

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Time to Reflect…

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I’ve decided to go ahead and take a sabbatical of sorts.  Another break from blogging to focus on my “day job” which consists of managing my patient practice.  In addition, our newest son Ezra, is 6 months old and I am happily shifting more focus/energy at home where it should be.  The blog will remain as is, in it’s current state for your review.  I would like parents, teens and children to continue to educate themselves – I believe that is our best hope at curbing the rapid increase in the number of obese children in our population.  Also, my hope is that fellow pediatricians are motivated to question nutritional dogma and take the time to learn basic nutritional science that is largely left out of medical school curriculum.

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