Food Ingredients – PediaCast 227

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Dr DJ Scherzer and Dr Amber Patterson join Dr Mike in the Pediacast Studio to discuss some controversial food ingredients. Topics include high fructose corn syrup, trans fat, food colorings and dyes, natural and artificial flavors, aluminum, and bovine growth hormone. Do you have a food-related question? If so, let us know, and we’ll get it answered the next time our “Foodies” drop by!

Topics

• Food Ingredients
• High Fructose Corn Syrup
• Trans Fat
• Food Colorings and Dyes
• Natural and Artificial Flavors
• Aluminum
• Bovine Growth Hormone

Guests

• Dr DJ Scherzer
  Section of Emergency Medicine
  Nationwide Children’s Hospital

• Dr Amber Patterson
  Section of Allergy and Immunology
  Nationwide Children’s Hospital

Links

• Concussion ToolKit (for athletes, parents, coaches, educators)
• Froot Loops Comparison: UK vs USA
• Definition of Artificial and Natural Flavors (Code of Federal Regulations)
• Lauric Acid (saturated fatty acid)
• Arachidonic Acid (CIS unsaturated fatty acid)
• Vaccenic Acid (TRANS unsaturated fatty acid)

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children’s, here is your host, Dr. Mike!

Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast, a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children’s Hospital in Columbus. I’d like to welcome everyone to the program. It is episode 227 for September 19th 2012 and we’re calling this one Food Ingredients.

Of course there are a lot of different ways that we could with that and I’m going to explain exactly what I mean by food ingredients in just a couple of minutes. First though, football season is in full swing and concussions are something lots of families will be dealing with. And to help you do that our Sports Medicine team here at Nationwide Children’s has developed a “Concussion ToolKit” with loads of information for parents, athletes, coaches, teachers and of course school administrators as well.

The resources answer lots of common questions like what are the symptoms of a concussion. What causes these symptoms? How long will they last? When can I return to play? What sort of return to play protocol should coaches institute and why are these protocols important? Also, what can teachers expect from concussed athletes in the classroom and what role do school administrators play in developing an effective concussion strategy for their school district?

So if you are a student athlete or if you parent, coach or teach student athlete you’ll definitely be interested in our Concussion ToolKit and you can find it in the Show Notes for this episode 227 over at pediacast.org.

01:58

All right. So what are we talking about today? Food ingredients. And what I thought we would do is just sort of come up with a list of controversial food ingredients, ones that you sort of hear some bad things about or maybe a lot of parents have questions about them and so I thought we would tackle some of these.

So what exactly are we talking about? High fructose corn syrup as one example, transfats, food colorings and dyes, natural and artificial flavors, things like aluminum. And what about bovine growth hormone in milk and dairy products? What kind of effects does that have? Why is it there? Those sort of questions.

And I have a couple of great studio guests to join me in the discussion, Dr. DJ Scherzer and Dr. Amber Patterson. But before we get to them I want to remind that if there’s a topic that you’d like us to talk about on PediaCast or you have a question for the program or you want to point us in the direction of a particular pediatric news story, it’s easy to get a hold of me, just go to pediacast.org and click on the Contact link. You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS. 347-404-K-I-D-S.

Also, I want to remind you the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a concern about your child’s health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org.

03:34

All right. Let’s turn our attention to our studio guests this week. And I want to preface this by saying the three are not food experts. So I did not gather a group of biochemists and food scientists to talk about ingredients. We are simply three pediatricians and consumers and parents. We’re interested in health and we’re interested in food. We are certainly knowledgeable about researching scientific information and we do eat food.

And here’s the important thing, as a mom or dad out there with questions about food you probably aren’t going to yourself in a position to ask a food scientist about controversial food ingredients. You do, however, have access to your doctor. And that got me wondering, how much do garden variety physicians really know about food ingredients? Well, off the top of their head maybe not a lot.

But physicians are lifelong learners and researchers. We know where to look. We know how to look. We have experienced separating important and relevant information from the extraneous. And we have experienced communicating that information to moms and dads and patients in a way that makes sense and can be used practically. So at the end of the day I think it’s very reasonable for three pediatricians to talk about food ingredients.

And for you clinicians out there in the crowd, doctors, nurses, nurse practitioners, I hope this discussion stimulates your interests so you can do your own research, which of course will benefit the care that you give to your patients and families.

04:59

All right. So let’s get started. I’ve decided to call our group today the ‘Foodies’ and actually we had so much fun putting this show together that I’ve already asked if they would be willing to come back in a few months to answer some of your questions about food. So as we go along, if a particular question pops into your head or a different food ingredient comes to mind, just write it down, send it in and we’ll try to get the answer the next time we meet.

So who are the Foodies? Dr. DJ Scherzer, MD, is an attending physician with the section of Emergency Medicine at Nationwide Children’s Hospital and an associate professor of pediatrics at the Ohio State University College of Medicine. Dr. Scherzer is no stranger to PediaCast. He joined us in the studio back in episode 178 to talk about anaphylaxis, just a life-threatening allergic reaction. So welcome back to PediaCast, Dr. Scherzer.

Dr. DJ Scherzer: Hey! Thanks Dr. Mike.

Dr. Mike Patrick: We really appreciate you stopping by. Also joining me in the studio is first time PediaCast guest, Dr. Amber Patterson, MD. Dr. Patterson is an assistant professor of pediatrics at the Ohio State University College of Medicine and an attending physician with the section of Allergy and Immunology here at Nationwide Children’s Hospital. So let’s offer a warm PediaCast welcome to Dr. Patterson.

Dr. Amber Patterson: Hi! Thank you for inviting me.

Dr. Mike Patrick: Thanks for stopping by. Really, really appreciate both of you taking time out of your busy schedules to talk about food. So here’s how it’s going to work, each of us researched two common and potentially controversial food-related items and we’re going to take turns asking each other questions about the topics we selected.

So first stop is me asking Amber and we’re going to dispense with the doctor titles for this particular show. I mean, if we’re going to be the Foodies, it just feels right to go less formal. You know what I mean?

Dr. Amber Patterson: Yeah. I agree.

06:42

Dr. Mike Patrick: Yeah. So I’m going to ask Amber about high-fructose corn syrup. I guess a good place to start is what exactly is high-fructose corn syrup?

Dr. Amber Patterson: Sure. Good question. High-fructose corn syrup is a liquid sweetener made from highly processed field corn. In some countries it’s called glucose-fructose syrup – description of the mix of sugar contained in the syrup.

And there are three varieties of high-fructose corn syrup named by the percent fructose that it contains. There’s high-fructose corn syrup 90, which is 90% fructose, 10% glucose. There’s high-fructose corn syrup 42, which is 42% fructose, 53% glucose. And then there’s high-fructose corn syrup 55, which is 55% fructose and 42% glucose.

Now that 55 and 42 are the ones that are used as sweeteners and preservatives to prolong shelf life in many processed products, drinks, breads, cereals, breakfast bars, lunch meats, you name it.

Dr. Mike Patrick: So how are they made? Let’s there. How exactly do you get from corn, how do you get to high-fructose corn syrup?

Dr. Amber Patterson: It all starts with a variety of field corn known as yellow dent #2. The corn is soaked for two days that ferments it, it allows the kernels to fall apart and then the germ and the endosperm, those are two parts of the corn seed or the corn kernel, they’re ground separately, the starch is removed by washing and centrifuging and then finally it’s dried. And this yields what we know as cornstarch. So cornstarch is kind of the first ingredient to high-fructose corn syrup.

So once we get the cornstarch, it’s treated with an enzyme called alpha-amylase. This alpha-amylase is an industrially-produced enzyme made by a bacterium called bacillus. And it helps break down the starch sugars in the shorter change of sugars. So then this is treated with another enzyme called glucoamylase and this enzyme is industrially produced for us by a fungus called aspergillus. This further breaks down the corn starch sugars into glucose.

Then there’s a third enzyme called gluco-isomerase. All these big words.

09:07

Dr. Mike Patrick: Yes.

Dr. Amber Patterson: It converts some of the sugar into fructose yielding that 42 mixture, remember there is 90, 55 and 42. And then a process called liquid chromatography takes the mixture up to that high-fructose corn syrup 90, which is then back blended with the original 42 mixture to make the 55 mixture. This process also involves other acids and enzymes like hydrochloric acid and caustic soda.

Dr. Mike Patrick: So once we get then to high-fructose corn syrup, they put it in the foods, why do they do that? Why do we go to the trouble to make sweetener from corn? Why not just use cane sugar?

Dr. Amber Patterson: The bottom line is money and politics. High-fructose corn syrup has really enjoyed being the darling of the processed food industry over the last 40 years. And here is how the story went down. So back in ’57 there were two guys, Marshall and Coy, who first kind of invented high-fructose corn syrup but they didn’t really have what it took to get it mass produced. So it wasn’t until the late 60s almost a decade later that the Japanese were able to do it. And by 1975 high-fructose corn syrup was beginning to be rapidly introduced into many processed foods and softdrinks in the United States.

Now, watch the timeline here closely, because in 1975 that’s when high-fructose corn syrup was introduced into our industrial production. Then two years later, in 1977, the United States imposed the system of sugar tariffs and sugar quotas that significantly increased the cost of imported sugar. And United States producers wanted a cheaper sweetener.

On top of that, corn costs were kept low because the government employed subsidies to pay the corn growers. So between the sugar tariffs doubling the price of sugar and corn subsidies ultimately lowering the price of high-fructose corn syrup, high-fructose corn syrup sidestepped sugar as the more economical choice.

And then because of that what we’ve seen in time is consumption of fructose has paralleled the rise in obesity and metabolic syndrome, especially in kids. And recent NHIN’s data tells us that about 15% of Americans taken over a quarter of their energy in the form of added sugar. And that doesn’t count the natural sugars consumed in unprocessed foods.

Then when you look at adolescents alone, they’re the highest ingestures of sugar, period. But 20% of them consume more than a quarter of their total calories from fructose since the majority of products use that sweetener.

12:10

Dr. Mike Patrick: Yeah. So we know what’s in high-fructose corn syrup, how does that differ from just granulated cane sugar?

Dr. Amber Patterson: Now I have to say, Mike, when I looked into this I was actually surprised that there are probably more similarities between the two than differences. The main difference is that high-fructose corn syrup is much more highly processed than table sugar, so there’s the possibility for more exposure to enzymes and reagents used in that processing. But similarities abound. They both come from grasses – table sugar is made from the cane sugar plant, which is a type of grass; and high-fructose corn syrup is made from corn, which interestingly is also a grass.

Both are processed from their natural state resulting in sweet crystals in the case of table sugar and syrup in the case of high-fructose corn syrup. Chemically speaking, they have similar compositions as well – table sugar is sucrose and sucrose is fructose + glucose and it’s about half fructose and the sugar in high-fructose corn syrup is also fructose and glucose with either 42% or 55% fructose. So really both contain around 50% fructose.

Sucrose, that table sugar and high-fructose corn syrup 55 are about the same sweetness; 42 is a little less sweet; 90 is much more sweet. And they both endocrinic and metabolic effects. Now where we do see differences in how our bodies metabolize sugar is between fructose and glucose, but again both of these products contain both sugars.

Dr. Mike Patrick: So they’re really similar, it just takes more processing to get high-fructose corn syrup.

Dr. Amber Patterson: Yes.

Dr. Mike Patrick: Yeah. I guess the next question is is if they’re so similar, is there any harm in eating it?

14:11

Dr. Amber Patterson: And I guess that depends on who you ask because if you ask the Corn Refiners Association they believe their product is safe and the FDA supports that. You’ll find others who disagree and I guess this is where it gets good, folks, because let’s start with genetically-modified foods.

Most field corns are grown from a genetically-modified seed developed by a company called Monsanto. And this company single-handedly spearheaded the development of genetically-modified seeds. The majority of field corn grown in this country is genetically-modified so you can virtually guarantee that all high-fructose corn syrup is made from genetically-modified corn.

Now on top of that, two of the enzymes used in the production of high-fructose corn syrup are also genetically-modified. Alpha-amylase and glucose isomerase are genetically-modified enzymes.

Now let’s move on to mercury exposure. Several studies have come out over the last decade finding detectable mercury, a known neurotoxin, in products containing high amounts of high-fructose corn syrup indicating that maybe it’s not just the high-fructose corn syrup or the fructose itself that’s only harmful but maybe there are some reagents used in making the syrup that are also to blame.

The manufacturing plants that make high-fructose corn syrup are called chlor-alkali manufacturing plants. Historically, they used mercury cells for production of caustic soda and other acids involved in production of high-fructose corn syrup and this may give some explanation from where this mercury may be coming from.

Now industry representatives will argue all day long that mercury cells are outdated technology and industry doesn’t even use these methods anymore because there are mercury-free alternatives that are more energy efficient. But one study done under the direction of the FDA doesn’t quite agree with that. They sampled high-fructose corn syrup 55 and 42 from three different U.S. manufacturers and the study that they published in the journal of environmental health in 2009 shows us that they found almost half of the 20 samples that they collected from the manufacturing plants contain detectable levels of mercury.

And then another study published in the same journal by Dr. Wallinga and colleagues, they tested products right off the shelves of a grocery store. They sampled only products where high-fructose corn syrup was the number one or number two ingredient and they included a variety of different commonly purchased products from cereal bars and yoghurt to barbecue sauce and ketchup. They tested 55 samples and they found detectable mercury in 31% of them. Now many of the companies that were targeted in the study responded to note that their foods contain well below the EPA’s safe exposure level, so you have to take that into consideration as well.

And then finally, fructose. High-fructose corn syrup is about half fructose and we know that liver breakdown of fructose results in sustained elevations of triglyceride levels after meals. We also know that increased fructose consumption, especially when we’re talking about sugar-sweetened drinks, which in this country are mostly sweetened with high-fructose corn syrup, has been implicated in promoting weight gain, visceral adiposity, dyslipidemia, insulin resistance and glucose intolerance and fatty liver.

17:57

Dr. Mike Patrick: That doesn’t sound good.

Dr. Amber Patterson: It doesn’t sound good.

Dr. Mike Patrick: But some of those things, there is also fructose in table sugar.

Dr. Amber Patterson: Exactly.

Dr. Mike Patrick: There are some those risks in table sugar just not the processing, the possibility of mercury exposure kind of thing.

Dr. Amber Patterson: Exactly.

Dr. Mike Patrick: So how do parents know if a product contains high-fructose corn syrup?

Dr. Amber Patterson: You have to be a good label reader. You can look for high-fructose corn syrup in the ingredients and in this country it should say high-fructose corn syrup. But sometimes it will masquerade in the abbreviated form, so it might just have the initials H-F-C-S or it might say H-F-C-S solids. Sometimes it’ll say fructose syrup or fructose solids.

Now there was a push a couple of years back to switch the name of high-fructose corn syrup to corn sugar, you may have heard about this. The Corn Refiners Association felt that it would better represent their product and kind of rescue them from some public discontent about high-fructose corn syrup.

So in 2010, they applied to the FDA to formally make this name change and after 20 long months, this Summer, the FDA finally released their decision and they rejected the application. So thank you FDA. They felt it would be misleading to change the name and they required that they continue to promote the product as high-fructose corn syrup.

Dr. Mike Patrick: Very good. Kudos to the FDA.

Dr. Amber Patterson: Exactly. Now you can also look for foods that advertise that they’re non-GMO of non-genetically-modified because like I said earlier most field corns used to make high-fructose corn syrup is genetically-modified. So if the product is claiming that they don’t contain genetically-modified ingredients then it would assure that there was no high-fructose corn syrup.

Dr. Mike Patrick: Gotcha. All right. Well I think that was a great, great presentation on high-fructose corn syrup. I’m certainly more educated about it having listened to that.

Dr. Amber Patterson: Thank you.

20:02

Dr. Mike Patrick: So next we’re going to move on to bovine growth hormone. And this time, DJ is going to ask Amber the questions.

Dr. DJ Scherzer: All right. So moving on from corn to milk. What is bovine growth hormone?

Dr. Amber Patterson: All right. Bovine growth hormone, which is also called bovine somatotropin, is a natural hormone in cattle that’s produced by the pituitary gland that helps regulate growth and milk production and it can be artificially produced and given dairy cattle to increase their milk supply.

Anybody want to take a guess as to which company is behind the development of recombinant bovine growth hormone? Any guesses?

Dr. Mike Patrick: Monsanto.

Dr. Amber Patterson: Monsanto. Again. Although they sold the business to Eli Lilly in 2008 for a cool $300 million.

Dr. DJ Scherzer: What does this hormone do in a cow’s body?

Dr. Amber Patterson: The FDA states that when injected into dairy cattle the product can increase milk production by 78 more pounds of milk per day than would be produced without the recombinant bovine growth hormone. And two different meta-analysis, which those are studies that look at multiple studies that have been done on the topic, and they’ve published that recombinant bovine growth hormone effects on bovine health include increase in milk output, which we know that’s the desired effect; but there’s also a nearly 25% increase in the risk of mastitis, which is utter infection; a 40% reduction in fertility; and a 55% increase in developing clinical science of lameness, which I did not research lameness like PediaCast. The same report said that a decrease in body condition scores for their cows were found in those that were treated with the hormone, even though there was no increase in what those cows ate.

22:15

Dr. DJ Scherzer: Does any of this hormone get into the milk that we drink?

Dr. Amber Patterson: So that’s a really good question. It doesn’t appear that there’s a great amount of bovine growth hormone that passes into the milk, but there is concern about other hormones that bovine growth hormone stimulates, as well as antibiotics because of the infections they’re getting that may be passing in to the milk.

Dr. DJ Scherzer: So the hormone may or may not get in to the milk but does it change the milk?

Dr. Amber Patterson: OK. So the overall composition of the milk including the fat, the protein, the lactose content, they do not appear to be substantially different. But in 2010, the U.S Court of Appeals Sixth Circuit found that there was a compositional difference between the milk from treated cows and untreated cows. They found that in the treated cows there were increased levels of a hormone called insulin-like growth factor 1 that’s also called IGF-1.

They also found a higher fat content, lower protein content and more of a type of cell called the somatic cell, which they claimed might make the milk turn sour more quickly. There’s also an increased risk of anti-microbial residues from the infections these cows are getting and antibiotic residue, as well as concern for antibiotic-resistant bacteria because of the use of all these antibiotics in the infected cows.

Dr. DJ Scherzer: So if I drink a lot of milk should I be concerned about drinking milk that comes from cows that were injected with BGH?

Dr. Amber Patterson: I guess the cause for concern from the human health perspective would be the issues that I just mentioned. Let’s look at IGF-1. It’s a hormone stimulated by a bovine growth hormone and this increases the growth in milk production in the cows. Now humans also make this IGF-1 and it’s identical in amino acids sequence and nearly identical in biological activity to the bovine form. So we have this naturally occurring in the milk of humans and cows and it’s circulating in our blood.

The difference comes to play when you talk about having abnormally high levels of circulating IGF-1 because that has been correlated with development in growth of human cancers. So that’s the concern with that hormone. Now to allay those concerns about the matter, the FDA did a study that indicated the IGF-1 levels in milk from these bovine growth hormone treated cows is actually within the physiologic range found in human breast milk.

In other studies showed that even if the IGF-1 in the cow’s milk was not destroyed by pasteurization that the minimal extra that may have gotten into a batch of milk would not affect the organism that ingested it because it would get denatured in the stomach. So I guess you can choose who to trust on that matter.

25:41

Dr. DJ Scherzer: How do I know if the milk I’m buying comes from a BGH-injected cow?

Dr. Amber Patterson: Really, unless the milk you buy is labeled recombinant bovine growth hormone-free or it’ll often say those initials RBGH-free, unless it says that it may have been treated with the hormone. There is no other really good way to know. I guess at a minimum this can help you make an informed decision at the grocery store. But this is also another place to give a good plug to those local farmers because if you’re buying from local farmers you may have a better idea of what you’re getting.

Dr. Mike Patrick: Great. Excellent. So I feel more educated about bovine growth hormone as well. We’re going to turn now to DJ and the next food-related item we’re going to talk about is aluminum. And Amber you have some questions for DJ regarding aluminum.

Dr. Amber Patterson: I do DJ. I’ve seen baking powder, pancake mixes, even antiperspirant that specifically advertise that they’re aluminum-free. What’s the big deal with that?

Dr. DJ Scherzer: Well, it’s a big deal to a lot of people and I think it stems from the decades-old association between aluminum and Alzheimer’s disease. In the 1960s, investigators injected aluminum directly into the spinal fluid of rabbits and those rabbits developed lesions that looked like the ones in people who had Alzheimer’s disease. I don’t know why they were doing that in the first place but I’m sure they had hypothesis.

And these findings connection between aluminum and these lesions became an anchor for hundreds of subsequent studies. My feeling is that too much of anything is bad and if you inject something directly into the spinal fluid that’s too much. But these findings were supported by real aluminum-induced disease in real people. Particularly, in the 1970s and 80s, there were patients with chronic renal failure who are on dialysis, some of which was contaminated with aluminum and these patients suffered cortical dialysis dementia. Some of them also had these neurofibrillary tangles that characteristic lesion of Alzheimer’s.

Now later, with advance electron microscopy and histochemical techniques it was found that there are ultrastructural and histochemical variations in different types of neurofibrillary tangles. So the ideology can vary but nevertheless, this combination of a serious disease and a common element was a recipe for a very durable idea.

28:27

Dr. Amber Patterson: So what do these associations mean for day-to-day living in generally healthy people?

Dr. DJ Scherzer: Aluminum is very common in our environment. It’s the third most common element in the earth’s crust. The first two are oxygen and silicon, both of which are essential for life. So far, it seems that aluminum is not essential for life but it does get into life’s path. It finds its way into water, soil and the food chain. It’s in our food whether we know it is or not.

It does appear that if you are exposed to aluminum gastrointestinally, in other words you eat it, it probably doesn’t get absorbed, at least for the most part. For aluminum to get into your brain it has to get pass three barriers. It has to get pass your GI tract, your kidneys and then the blood brain barrier. The capillaries that go through your brain actually have pretty tight junctions so only special molecules can get through. And for the most part, aluminum-based molecules aren’t that special.

But nevertheless, there is this exposure and to date it remains unclear what the meaning of that exposure is. I likened it to background radiation. It’s there, there’s nothing we can do about it, we’re not sure what it means.

Dr. Amber Patterson: Why do they add aluminum to food?

Dr. DJ Scherzer: So aluminum gets into food in a few ways, one – naturally, two – via human processes, unintentionally and also intentionally. So it’s gets in there unintentionally through the food processing system simply because there’s so much contact with aluminum-made containers and transport medium. And also the processing system does tend to acidify food a little bit, which then promotes some leaching of aluminum from its containers. And sometimes, aluminum is used as a catalyst to reduce the amount of time and energy needed for chemical reactions that process food.

It’s also added deliberately because it can facilitate the emulsification of food, so it can take a lot of time and energy to mix a variety of ingredients, so aluminum makes that easier. And it also facilitates the baking process. It speeds it up and reduces the amount of heat that’s necessary and it can help fluff up some breaded products.

31:03

Dr. Amber Patterson: Is it difficult to avoid foods with additional aluminum?

Dr. DJ Scherzer: So there are these “aluminum-free products” and what that means is there’s no intentionally added aluminum that was intended to be an ingredient. It’s still there and I don’t think it’ll ever be quite clear as to how much aluminum is naturally there, how much gets in there accidentally. But in terms of those three means of getting in there, you can reduce your exposure to the foods to which aluminum was intentionally added.

So there’s a lot of products that are out there that have it. Mostly baked goods, that includes your pancakes, waffles, muffins, tortillas, also chicken nuggets and chicken fries, that kind of stuff that tastes really, really good.

For almost every product that has aluminum in it, you can find a similar product, usually on the same shelf, for about the same price that doesn’t have it. In fact, a lot of these products have calcium-based baking facilitated as opposed to aluminum. So throughout there you can find them. You can’t avoid aluminum all together, but if you want to, you can read ingredients and you can avoid some of these products.

Dr. Amber Patterson: What about aluminum pots, pans, cans, detoxifiers?

Dr. DJ Scherzer: Well, if you choose to change your pots and pans and drink out of plastic bottles instead soda cans, you’ll diversify your exposures and diversification is probably good. I’ve also found that whenever there’s a perceived problem, there’s going to be a product. I was curious to see what’s selling so I Googled aluminum detox and I got 2,330,000 hits in 0.18 seconds.

Dr. Mike Patrick: Wow!

Dr. DJ Scherzer: So there are all kinds of products out there and they range from vitamin therapies, herbal remedies, minerals, magnetic clay, which is interesting because clay has a lot of aluminum in it, I don’t think it’s magnetic, and also infrared therapies.

I think it’s easy to kind of get sold on a problem and have people play on your fears and it might be tempting to buy somebody else’s obsession, but I think that it’s probably better to keep it simple and if anything probably just read ingredients and decide for yourself how important you think this issue is.

Dr. Mike Patrick: And let your body naturally detoxify yourself.

Dr. DJ Scherzer: Yeah. Aluminum is a big part of our natural environment and life flourishes here, so it can’t be that bad. But one of the concerns though is that human industry has turned it up quite a bit. But we’re pretty complex and that actually is part of our resiliency.

33:48

Dr. Mike Patrick: Yeah. All right. We’re going to move to colorings and dyes in food. So I’ve seen like dye-free products out there, especially like children’s medicines – acetaminophen, ibuprofen, Benadryl – out on the shelves. What’s the concern with dyes?

Dr. DJ Scherzer: A lot of concern that these dyes, which were originally made from coal tar and now from petroleum, can be carcinogenic and I think an even more popular concern is that they may facilitate or contribute to problems with attention deficit disorder or other behavioral difficulties. Actually in the 1970s, there was an allergist named Dr. Feingold who found that when he eliminated some food colorings from some children’s diet that their behavior actually improved. And there have been quite a number of studies since then trying to either confirm or deny these suspicions.

Dr. Mike Patrick: So you said petroleum-based, so food colorings are made of petroleum?

Dr. DJ Scherzer: Well, food coloring can come from vegetables, minerals, animals, predictably certain insects, and also from petroleum. The petroleum-based products are the ones that the FDA certifies and names with a number like red 40, yellow 5, yellow 6.

Dr. Mike Patrick: So petroleum like what you use to make gasoline with?

Dr. DJ Scherzer: Yeah. You can color your food or you can degrease your engine.

[Laughter]

Dr. Mike Patrick: OK. So why do we color food in the first place? Why not just let it be its natural color?

Dr. DJ Scherzer: Well, essentially just to make something look better than it really is. We’re naturally attracted to colors, maybe it’s even instinctual, maybe it’s part of how we identify nutrient-rich foods. But food colorings are kind of fun, they’re rich, they’re bright, they’re vibrant and they sell well.

35:47

Dr. Mike Patrick: So are there any studies to support real concern with food coloring?

Dr. DJ Scherzer: There are a lot of studies and it’s a difficult thing to study. For the most part, the evidence is pretty weak but there’s something there. Recently, relatively recently, in 2007 the Lancet, which is a very well-known medical journal, it’s known now worldwide, published a study in which about 260 were studied over a period of several weeks. And these kids had been given three different concoctions of fruit drinks and they were indistinguishable from each other by appearance or by taste. And all of the children kind of rotated through which drink they got.

One of the drinks was a placebo, it was actually pure fruit juice. And their behaviors were rated using a standardized scale by parents and teachers. And this was a double-blinded trial, in other words, nobody knew who was getting what drink.

And in the end, when the results were decoded, when they found out which child was drinking what and correlated them with what their test scores were at that time, they found that there actually was a significant different in children’s behaviors as a group, wasn’t for every child but for a group of children.

There was a significance difference in how children were rated on hyperactivity scales when they were drinking the concoction with the highest amount of food coloring versus the one with the medium amount and the one with none. And the high amount was still within the realm of what kids might typically eat.

Dr. Mike Patrick: So with studies like that out there, have regulatory agencies responded?

Dr. DJ Scherzer: Yes. So in England in Europe this is actually been a really big deal. All the countries called for a ban on these colorings and a few of them actually outright banned them. The European as a whole actually has required as of 2010 that foods with these colorings on them have a warning label saying that these particular petroleum-based dyes are associated with hyperactivity.

There are a number of American multinational food companies that have big business in Europe and they don’t want these labels on their products which can scare away consumers. And interestingly, they actually did change their ingredients. So Kraft, Kellogg’s, McDonald’s, Nestlé’s, Mars (the company that makes M&M’s), they actually make their products with vegetable-based food colorings in Europe and in England because of this. That has all occurred in the last few years.

38:37

Dr. Mike Patrick: That’s maybe coming here. Possible.

Dr. DJ Scherzer: Maybe. Maybe. The FDA’s stand and just to paraphrase them is that findings from relevant clinical trials indicate that the effects on behavior appear to be due to unique individual intolerances rather than any inherent neurotoxic properties of these substances. That has been their stand. There are some indications that they’re going to look at this a bit differently, but we’ll see.

Dr. Mike Patrick: Yeah. So it may not be that the FDA rules against it but maybe the consumer if we start looking at does it have those numbers so they are the petroleum-based ones. I mean if the consumer push maybe away from that possibly.

Dr. DJ Scherzer: Yeah. It’s an interesting issue. One can make a very reasonable argument that the evidence is weak or weak to moderate. But everything we do is a matter of benefit versus risk. So perhaps the evidence for risk is weak, but on the other hand, the benefits are also weak. So if there’s something that has a high benefit you’re willing to accept the high risk. If something has little or no benefit you should probably accept no risk.

39.53

Dr. Mike Patrick: Yeah. Yeah. Well I think a natural flow from colors and dyes is going to be to natural and artificial flavors and so I’m in the hot seat now for the next couple. DJ, you have some questions for me about natural and artificial flavors.

Dr. DJ Scherzer: Yeah. Let’s start off with what are they?

Dr. Mike Patrick: They are food ingredients and so if you look at the ingredient label on just about every food you’re going to see listed as an ingredient natural and artificial flavor. So what exactly does that mean? Well according to the FDA and it’s spelled out in the Code of Federal Regulations Title 21 Chapter 1 Subchapter B Section 101.22 and I have to link to it in the Show Notes just to prove that this really exists.

Dr. Amber Patterson: Can you say that three times fast?

Dr. Mike Patrick: Well I can but only because I have it written in front of me.

[Laughter]

So what is a natural flavor? Well the term natural flavor or natural flavoring means the essential oil, oleoresin, essence or extractive, protein hydrolysate, distillate or any product of roasting, heating or enzymolysis, which contains the flavoring constituents derived from a spice fruit or fruit juice, vegetable or vegetable juice, edible yeast, herb, bark, bud, root, leaf or similar plant material, meat, seafood, poultry, eggs, dairy products or fermentation products thereof, whose significant function in food is flavoring rather than nutritional.

And the term artificial flavor or artificial flavoring means any substance the function of which is to impart flavor which is not derived from a spice fruit or fruit juice, vegetable or vegetable juice, edible yeast, herb, bark, bud, root, leaf or similar plant material, meat, seafood, poultry, eggs, dairy products or fermentation products thereof.

So basically, a natural or artificial flavor is any substance included in the food to give the food a specific taste.

Dr. DJ Scherzer: So how are they made?

41:49

Dr. Mike Patrick: Well they are created in a food lab by a flavor company. And some examples of flavor companies include Bell Flavors, Cargill, McCormick, Quest International, Wild Flavors, Inc. And the process is very secretive with the employees subject to prosecution if they divulge any actual ingredients or recipes for these flavors.

So the flavors are created with pretty much any food item that’s approved for human consumption by the FDA. And then the flavor companies sell it to food companies who buy a license for exclusive use of a specific flavor which results in a specific taste for their food product.

So the ingredients that make up a flavor, again, can be any item approved for human consumption but the ingredients of that item are simply summed up on the label as an artificial or natural flavor depending on their specific make-up.

Dr. DJ Scherzer: Why does the food industry use this flavors?

Dr. Mike Patrick: Well the food industry use proprietary flavorings to create a brand taste. So that’s what makes a Quarter Pounder tastes different than a Whopper. It makes McDonald’s fries taste different than Wendy’s fries. Coke tastes different than Pepsi. It’s what makes Doritos take like Doritos. It’s what makes Froot Loops taste like Froot Loops. Pretty much any food you can think of that has a distinctive flavor tastes the way that it does because of artificial and natural flavors that are cooked up by a flavor company and sold to food manufacturers.

Dr. DJ Scherzer: It’s interesting that you mentioned Froot Loops. I just happened to look up the ingredients of Froot Loops in the U.S. versus U.K. and I’ll put it in the Show Notes, but I think people will be pretty surprised at how different the ingredients are on one side of the ocean versus the other. What are the health concerns associated with these flavors?

Dr. Mike Patrick: The biggest concern is for people with allergies or sensitivities to trace amounts of any food product. Of course the food industry wants to keep the ingredient secret otherwise they couldn’t use taste to compete with one another. But it is possible for folks to have an allergy or sensitivity to a particular food due to a component of the flavoring without knowing what component is really in there.

Just an example, a flavoring could contain a nut product or dairy product or MSG, so a person with a food sensitivity to one of those items may diligently examine the label and they don’t see the item they’re sensitive to so they eat it only to experience a reaction because the product is in the food but it’s in there as a flavor.

Food companies do recognize that there is some liability with this situation and so you may see a disclaimer like ‘may contain traces of peanuts’ or ‘this product is manufactured in a facility that also deals with peanuts’. So for the big well-known dangerous type of allergens, they’re likely going to let you know some are on the label that it could be in there, but they don’t have to let you know and the vast majority of flavoring and ingredients are not divulged.

44:47

Dr. DJ Scherzer: Are these products regulated?

Dr. Mike Patrick: Well all items used in the creation of a flavor have to be approved for human consumption by the FDA, so in that sense they’re regulated. But again, what specific ingredients are in the flavor do not have to be disclosed on the item label.

Dr. DJ Scherzer: Is there any way to find out what these flavorings are made of?

Dr. Mike Patrick: You can ask. You can always ask the food company what’s in it. Most of the time they won’t tell you. Flavor ingredients are usually closely guarded secrets. However, flavor ingredients have led to some lawsuits which have a little bit changed the way that some companies handle this request.

And just as an example, in 2001, McDonald’s was sued by two Hindus in Seattle who charged the company with violating their religious beliefs by not disclosing that the natural flavoring of their French fries contains a beef product. The suit was settled out of court and now if asked, McDonald’s will specify the source of a natural flavor as dairy, meat or vegetable, but they still won’t disclose the specific ingredients.

So this may actually be an issue for vegans out there as well. I mean, here’s a potato product fried in vegetable oil and it still has an animal product in the flavoring and truth be told McDonald’s fries aren’t alone. Really any food or drink may contain any food item, animal or otherwise, in the flavoring. So it’s definitely something to think about.

46:09

Dr. Amber Patterson: Wow! It’s surprising.

Dr. Mike Patrick: Yeah. So we’re going to move on to trans fat. And this one, Amber, you’re going to ask the questions.

Dr. Amber Patterson: Can you define trans fat?

Dr. Mike Patrick: Yes. If you weren’t a chemistry major, you’re going to have to sort of close your eyes and just take this little journey with me to really kind of visualize what this is, because you really got to get in to the biochemistry to understand what a trans fat is and why it’s bad.

I’m going to have some links in the Show Notes with pictures of the molecules. So actually, if you’re in a position right now to kind of pause the podcast and go the Show Notes, it would be helpful to see what these molecules actually look like because you have to understand the shape of the molecules too.

So let’s define a trans fat. First of all, I’ll start with the fatty acid and in chemistry terms a fatty acid is a carboxylic acid, carb means carbon, oxy means oxygen, so a carbolyxic acid contains carbon and oxygen. And there’s one more molecule we have to consider and that is hydrogen. So we got these three elements to think about – carbon, oxygen and hydrogen.

Now all fatty acids also are composed of a head and a tail. The head of every fatty acid is the same, so it’s only the tails that are going to be different. Let’s talk a little bit about the fatty acid head only because it doesn’t really make a difference but we can start to understand some of these terms by talking about it.

So the fatty acid, we start with an atom of carbon and every carbon has four bonding sites where it can bond to other atoms or molecules. So in the head of a fatty acid site 1 is bound to what’s called a hydroxyl group, which is an oxygen and a hydrogen that’s together, so those are bound to site 1.

Site 2 and 3 are strongly bound to a single oxygen atom that’s why we call it double bond. So the oxygen is connected to that carbon at two of the bonding sites of the four. And this concept of a double bond will be important as we move on. And then site 4 is attached to the tail. So that’s the head of the fatty acid.

48:28

So let’s move to the tail. The fatty acid tail is basically a long string of carbon atoms that are attached to the head, basically end to end to end to end. So it’s just a long string of carbon. Now remember carbon has four bonding sites so that means that each carbon in a string is attached to two other carbons, one on either side until you get to the end of the string and then the end is just attached to one carbon.

So what’s connected to the other two bonding sites on each carbon in that string or the remaining three bonding sites if we’re talking about the final carbon in the string? And the answer is hydrogen atoms are there.

When all of those empty bonding sites are filled up with hydrogen we have a saturated fat. It’s saturated with hydrogen atoms. And the length of the tail determines which saturated fat that we have. Now remember back at the head, we said that we have an oxygen atom that’s held to the carbon with the double bond. Well in the tail of the fatty acid we could take two adjacent carbon atoms and pluck off a hydrogen atom from each one and then join the two carbon atoms together somewhere in the tail with the double bond.

And if we do that, the fatty acid isn’t saturated anymore because we’ve taken off a couple of hydrogen atoms and now we have these double bonds between carbons. And if we do that it’s now called an unsaturated fat because it’s no longer saturated with hydrogen atoms and we now have these double bonds in there. If we have that in one location it’s called a monounsaturated fat and if we have that in more than one place then it’s a polyunsaturated fat.

So what does all of this have to do with trans fats? Well, a trans fat is a special type of unsaturated fatty acid. And to determine if a fatty acid is a trans fat we have to look at the adjacent carbon atoms involved in the double bond. And specifically, we have to look at the hydrogen atoms coming off of each of those carbons because they only one hydrogen now coming off of each one because they’re attached to each other through the double bond and then to another carbon on either side with the single bond. So there’s only one hydrogen bound to each of these carbons.

50:38

And we have to look at the arrangement. If the hydrogens come off on the same side of the fatty acid molecule, we call the fatty acid a cis fat, c-i-s, it’s a cis fat. If they’re on opposite sides of the fatty acid molecule then we call it a trans fat.

So a cis fat and this is going to be important as we go on is an unsaturated fatty acid with the double bond between carbon atoms somewhere in the tail at one or more locations and where the hydrogen atoms coming off of adjacent double bound carbons come off the molecule on the same side. And this gives the molecule a bend away from the side where the two hydrogens come off. So cis fats have a bend or kink in them at that site where the double bond is and again this will be important as we go on and talk about why trans fats are dangerous.

So a trans fat then is an unsaturated fatty acid where one or more double bonds between carbon atoms exist in the tail and with the hydrogen atoms coming off of the adjacent double bound carbons, come off the molecule on opposite sides and this allows the fat to maintain a straight structure, without the bend or the kink that a cis fat would have.

So I know I’ve said these things kind of over and over because I know we have a lot of listeners who aren’t chemistry majors, but I’m hoping that in your mind you can kind of picture what these look like.

52:03

Dr. Amber Patterson: Now as complicated as that sounds, how would you make that and why would anyone go to the trouble of trying to make a trans fat?

Dr. Mike Patrick: Excellent question. We have to kind of look at the properties of these different fatty acids and then we have to look at a little bit of history of why we started to do this. So let’s talk about the properties of these different fatty acids first. Saturated fats have no double bonds so they are prone to breaking down more easily than an unsaturated fat would be.

So they’re prone in natural breakdown and that’s called rancidity. So a fat becomes rancid if it starts to naturally break down into smaller components. And so saturated fats are going to be prone to natural breakdown. They also have a very low melting point because of all those single bonds, no double bonds. So saturated fats tend to be soft at room temperature.

Now cis unsaturated fats, so these are the ones with the double bond but the tail is kinked. Those are less prone to natural breakdown due to the double bonds and they have a very low melting point. In fact, they liquids at room temperature. And that’s due to the bends and kinks in the structure, so they can’t fit together tightly in an arrangement to make a solid. So because of all those kinks they stay as a liquid at room temperature.

Trans fats, so these are double bonds with the straight tail. They’re less prone to natural breakdown, so they’re not going to become rancid as easily due to those double bonds and they have a higher melting point due to the straight nature of the molecule. They can really pack together because they’re straight and so they are actually solid at room temperature.

Now from the food industry’s point of view, trans fats are great because they’re stable, they’re less prone to natural breakdown, they don’t become rancid, they stay solid at room temperature, which makes them easy to store and transport.

The problem is that trans fats don’t occur naturally in large quantities. Really they’re only found in animal fat like lard and butter and only about two to five percent of the fat in lard or butter is actually made out of trans fat; 95-97% are saturated fatty acids. And that’s why lard and butter becomes rancid easily and it’s soft at room temperature because even though there’s a little bit of trans fat in there, it’s mostly saturated fatty acids.

54:29

Plant oils, things like coconut oil, palm, cotton seed, olive, corn, sunflower, canola, these are combinations of saturated fatty acids and cis unsaturated fatty acids. Coconut and palm oil are heavy on the saturated fat content and that’s why they’re more of a solid soft kind of nature to them. They also become rancid easily because they’re mostly saturated fat.

Cotton seed, olive, corn, sunflower and canola oils are heavy on the cis unsaturated and that’s why they’re liquid or they naturally occur as a liquid, but they’re also stable and have less of a chance for it to become rancid.

Now, 1909 was a turning point in fatty acids. Around the turn of the century, a German chemist by the name of Wilhelm Normann developed a process called hydrogenation. And he took plant oils, which are cheaper and more abundant at that point that animal fats were, he took plant oils and exposed them to pressure, heat and hydrogen. And the idea of what he was trying to do was to turn the cis unsaturated fatty acid into a saturated fat. So that way the processed plant oil would behave like animal fat.

You can imagine this guy’s thinking if I can take a plant and make butter out of it in mass quantities this is going to be a great thing. The problem is the hydrogenation process did not result any saturated fat, instead it produced a partially hydrogenated fatty acid.

So some of those double bonds were broken down into a single bond and hydrogen was added, so he was able to hydrogenate some of the bonds. But some of the double bonds weren’t broken down and instead what happened was the cis configuration around that double bond was changed to a trans configuration. So instead of creating a saturated fat from the plant oil, what he really created was a partially hydrogenated trans fat.

Well this was fabulous for the food industry because the final product was less prone to becoming rancid than anything else that was available and it remained solid at room temperature. And in 1909, Procter & Gamble acquired the U.S. rights to Wilhelm Normann’s patent and they began to hydrogenate cotton seed oil and the result was Crisco.

So that’s how Crisco was first introduced into the market. And then Margarine soon followed and due to brilliant marketing schemes and company cookbooks, the public bought in to the idea that saturated animal fats were bad and partially hydrogenated trans fats were good.

So those of us who grew up in the 70s and 80s we’d recall that Margarine was marketed with little hearts on the label and promised to taste like butter while being heart healthy. But then we learned the truth.

57:19

Dr. Amber Patterson: What are the health concerns associated with trans fat?

Dr. Mike Patrick: Well, we know through retrospective studies of human diets and resulting disease that increased consumption of trans fats lead to increased incidents of coronary artery disease and type 2 diabetes. So if we look at someone with coronary artery disease or type 2 diabetes and we go back and say what was your diet like, we know that there’s a relationship between increased trans fat intake and these diseases.

We aren’t certain of the mechanism of these associations but the leading theory is this – that human lipase, which is an enzyme that breaks down fatty acids, appears to work on the single carbon-carbon bonds and the cis double bonds but that lipase doesn’t appear to work on the double bonds and the transconfiguration.

And this leads to trans fats remaining in the bloodstream longer and then being deposited in fatty plaques on arterial walls, which then clogs arteries, decreases blood flow through the artery. And if that occurs to a critical degree in coronary arteries then the heart muscles can die from lack of oxygen being delivered to the muscle and then that can lead to myocardial infarction or heart attack.

We also know that trans fat consumption decreases HDLs, which are the good fats. It increases LDLs, which are the bad fats and it increases triglycerides, although the exact mechanism for that association is really not know.

And with regard to the association with type 2 diabetes, again we aren’t exactly sure of the mechanism by which trans fat increases this risk.

58:59

Dr. Amber Patterson: So Mike, what is your verdict on trans fat?

Dr. Mike Patrick: Well on the plus side, trans fats are convenient and they taste good. Still, the evidence is convincing that increased trans fat consumption increases the risk of coronary artery disease and type 2 diabetes. So I think really the verdict is really like with a lot of these things is to consume them in moderation, like be a smart consumer, make good eating decisions. You don’t have to be militant about it and say I can’t have any of it. Do it in moderation. Read the labels.

Dr. Amber Patterson: I think sometimes that’s so hard, the whole moderation thing because when it isn’t things that maybe you aren’t aware it’s just hard. So how can I tell if a food product contains trans fat?

Dr. Mike Patrick: You look for a partially hydrogenated anything. So if it says that there’s a partially hydrogenated plant oil in the ingredient list, partially hydrogenated oils are trans fats by definition.

Dr. Amber Patterson: OK. OK.

Dr. Mike Patrick: Now what about foods that proclaim to be free of trans fats? You’re going to see labels that say ‘no trans fat’, ‘zero trans fat’, ‘trans fat free’, but when you read the ingredients list you’re still going to see partially hydrogenated oil. So how can that be?

Well federal regulations allow a product to be labeled ‘zero trans fat’ as long as there is less than half a gram per serving. Of course some foods then they just make their serving size ridiculously small, so it says zero trans fat, but they can sneak less than half a gram in to each serving and of course you’re going to eat more than one serving in a setting. So you still can get a substantial exposure to trans fat. Plus also keep in mind little exposures of less than half a gram do add up over time.

Dr. Amber Patterson: Oh sure.

Dr. Mike Patrick: So don’t trust ‘zero trans fat’ proclamation. Look at the ingredient list and be on the lookout for partially hydrogenated plant oils.

1:01:01

Dr. Amber Patterson: That was really insightful. Thanks.

Dr. Mike Patrick: So again, if you are confused by all that, there are diagrams of a saturated fat and unsaturated, the cis configuration, the trans configuration, just to help kind of visualized what that looks like. All right. I really just want to thank both of you for stopping by.

Dr. Amber Patterson: Thank you! This was fun.

Dr. DJ Scherzer: It was fun.

Dr. Mike Patrick: I think so too. And I think folks out there probably have lots more food-related questions and so I’m just going to put this out there. If you have a food-related question for us or you have a particular food ingredient or maybe the genetically altered seeds caught your attention or just anything that you’re interested in that’s related to food, ask away. And we’re really trying to be objective, I think. We just want the truth to be out there, not hype. Wouldn’t you say?

Dr. Amber Patterson: Yeah. We’re trying to be balanced.

Dr. Mike Patrick: Yeah. Exactly. So if you have a question ask away, send your question, just go to the Contact page at pediacast.org and we’ll try to get your question answered the next time the ‘Foodies’ convene.

I also want to remind you in the Show Notes we’re going to have links to the Concussion ToolKit, so for athletes, parents, coaches and educators. Also definition of artificial and natural flavors per the U.S. Code of Federal Regulations. And then we’re also going to have the examples of those molecules. And then there was something, DJ?

1:02:30

Dr. DJ Scherzer: Yeah. The Froot Loop ingredients.

Dr. Mike Patrick: The Froot Loop ingredients, we’re going to add that to the Show Notes.

Dr. DJ Scherzer: One of my staples of growing up. Now that I have kids I have a different thought about it.

Dr. Mike Patrick: We don’t eat Froot Loops a lot, but when I was researching the natural and artificial flavor thing and I was using Froot Loops as an example, I opened up our cupboard and we did have a box of Froot Loops and sure enough it had natural and artificial flavors, both are actually in there.

All right. So thanks to Dr. DJ Scherzer and Dr. Amber Patterson. Of course I want to thank all of you for dropping by and taking a listen to PediaCast. Don’t forget iTunes reviews are helpful as our links on your webpages and mentions in your blogs, on Facebook, in your Tweets and on Google+. And be sure to join our community by liking PediaCast on Facebook, following us on Twitter, tweeting with hashtag #pediacast and hanging out with us over on Google+. And be sure to swing by the Show Notes at pediacast.org to add your comments on today’s show.

We also appreciate you telling your family, friends and neighbors about the PediaCast. And don’t forget to talk us up with your child’s doctor at your next well check-up or sick office visit. We also have posters you can download and hang up wherever moms and dads hang-out. And you can find them under the Resources tab at pediacast.org.

Again, if you have a question or a comment, just go to pediacast.org, click on the Contact link. You could email pediacast@gmail.com. We also have a voice line, 347-404-KIDS. 347-404- K-I-D-S.

And until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long everybody!

[Music]

Announcer 2: This program is a production of Nationwide Children’s. Thanks for listening. We’ll see you next time on PediaCast.