Sports Nutrition – PediaCast 325

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Show Notes

DESCRIPTION
Welcome to another sports medicine edition of PediaCast. Dr Eric Bowman joins Dr Mike as Co-Host along with guest Jessica Buschmann, clinical dietician with sports medicine. Our topic is sports nutrition and includes details on powering student athletes with optimum fuel. We cover meals & snacks, supplements & energy drinks, fluid intake and general nutrition guidelines. We’d love to have you join us!

TOPICS

• Sports Nutrition
• Fueling Student Athletes
• Meals & Snacks
• Supplements & Energy Drinks
• Fluid Intake
• General Nutrition Guidelines

CO-HOST
Dr Eric Bowman
Sports Medicine
Nationwide Children’s Hospital

GUEST
Jessica Buschmann
Clinical Dietitian
Sports Medicine
Nationwide Children’s Hospital

LINKS

• 700 Children’s Blog
• Pediatrics Nationwide
• PediaCast CME – pediatric podcasts for providers
• Sports Medicine at Nationwide Children’s
• Female Athlete Triad – PediaCast 285
• ChooseMyPlate.gov
• EatRight.org
• KidsEatRight.org
• Sports, Cardiovascular, and Wellness Nutrition
• DrugFreeSport.com
• Taylor Hooton Foundation
• MomsTEAM.com

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. It's pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital from Columbus, Ohio. It is Episode 325 for August 5th, 2015. We're calling this one "Sports Nutrition".

I want to welcome everyone to the program.

So a couple of weeks back, we had a show focused on a variety of baby problems. During to the introduction of the program, I made no apology for the fact that we were exclusively catering to parents and caregivers of infants. In fact, I mentioned that the rest of you might want to find a different episode to listen to. Of course, I mentioned it'd be great if you could share the baby show with friends, families and co-workers, ones who might benefit. But, as for you, if you don't have a baby at home or take care of babies in one capacity or another, then that particular episode might not really be one you want to invest your time with.

Well, today, what comes around goes around, because this program has nothing to do with babies. In fact, if your only child is an infant, or you take care of infants and only infants, then it may be your time to skip an episode. But we sure would like for you to share it with folks you know who have or care for older kids, particularly if those older kids are student athletes, because today, we're going to cover sports nutrition.

This is a great time of the year to cover these topics as summer conditioning and try-outs and practice get underway for the fall sports season. Now, if you have an older child at home who is not involved with organized sports, that's OK, stick around because the most important aspects of sports nutrition really affect all active kids. Of course, we want to encourage all kids to be active. Whether that activity is part of organized sports or just running around like crazy, you still want the best fuel for your children, and that's where the principles of sports nutrition spill over into just great information for kids in general.

0:02:30

So again, stick around if you have school-aged children and/or teenagers in the house because I promise you'll get a few great nuggets of useful information regardless of the degree to which your child participates in sports.

To help us to cover the topic today, guest co-host, Dr. Eric Bowman, returns to the PediaCast studio, along with Jessica Buschmann, a clinical dietitian who is also no stranger to the program. She joined us back in Episode 285 when we covered the female athlete triad. Dr. Eric and Jessica are both key players in our sport medicine program here at Nationwide Children's.

Dr. Eric will take the reins with hosting duties after the break.

First though, I do want to remind you about our 700 Children's Blog. It's been awhile since we talked about it. For those of you who are new to the program, 700 Children's is our sibling blog for parents. You can find it at 700Childrens.org. Rather than having one author, we pool from the collective expertise of our entire institutions at Nationwide Children's and cover a variety of topics of interest to parents.

Why do we call it 700 Children's? It's a great question, and the answer comes down to a little bit of local history. The address of this hospital has been 700 Children's Drive for about as long as anyone can remember. So, if you live in Central Ohio, and in particular, if you're one of the thousands of staff who call Nationwide Children's home or one of the millions of children we treat and families we support, for you, the term 700 Children's mean something, but it's a phrase that may not be as clear to those outside of Central Ohio. But now you know.

0:04:06
So what are some of the recent topics on the blog? We're still in the throes of summer, so you'll find articles on water safety and drowning prevention tips. Another one on dry drowning and secondary drowning. This one written by yours truly. What exactly is dry drowning and secondary drowning? What causes these conditions? What are the symptoms? How long following a submersion event should you worry? And what do you do if symptoms develop? So check out my article to find out.

Other recent topics include the importance of the Vitamin K shot for newborns, noisy breathing in kids, tips for raising multiples, including twins, triplets and more. We also have throwing guidelines for baseball player, how to talk to your kids about puberty, doctors take on essential oils — it's another one I wrote and sure to generate controversy — preventing skin infections and wrestling, sleep apnea, the effects of weight-related bullying. So, lots of great content for moms and dads. Again, you can find these stories and more on the 700 Children's blog over at 700Childrens.org.

For the providers in the crowd, we also have articles for you at PediatricsNationwide.org. I'll include links to both of these sites, 700 Children's and Pediatrics Nationwide in the Show Notes for this episode, 325, over at PediaCast.org.

Recent topics at Pediatrics Nationwide include confronting and eliminating racism in the delivery of pediatric healthcare, obesity prevention that steers clear of overly restrictive feeding practices, reducing practice variations in pediatrics, designing a center for collaborative care and talking to adolescent patients about marijuana. We also have an article on cancer virotherapy; another on psychiatric telemedicine. Many, many more, so lots of great content for pediatric providers at PediatricsNationwide.org.

If you like what you hear on PediaCast and PediaCast CME, which is our podcast for providers at PediaCastCME.org, then be sure to check out the written word from Nationwide Children's — the 700 Children's Blog and Pediatrics Nationwide. Again, I'll provide the links to these resources in the Show Notes, for this episode, 325, at PediaCast.org.

0:06:17

One more reminder, this is your show. So if there's a topic you like us to talk about, you have a question for me, you want to point me in the direction of a news article or a journal article, it's really easy to get in touch. Just head over to PediaCast.org and click on the Contact link. You can also call the voice line and leave a message that way, 347-404-KIDS, 347-404-5437.

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.

All right, let's take a quick break, and then Dr. Eric Bowman will be back to take over hosting duties as we talk sports nutrition. That's coming up right after this.

[Music]

Dr. Eric Bowman: All right, Dr. Mike, I just want to say thanks again for having me. I really appreciate it.

Dr. Mike Patrick: Yeah, absolutely.

Dr. Eric Bowman: So we had a lot of fun a couple of months ago when we were here doing a show on back pain and athletes.

Dr. Mike Patrick: Yes.

Dr. Eric Bowman: So, this is something that we're hoping to really be able to continue and move forward. So we really appreciate you allowing us to come on and share some great information in sports medicine.

Dr. Mike Patrick: Yeah, this is great. And I love being able to sit back and learn something.

Dr. Eric Bowman: Good. Well, that's what we're hoping to do for everybody here today. So we've brought in another great member of our staff in our Sports Medicine Division here at Nationwide Children's Hospital.

Today, we've got Jess Buschmann with us, and as you've already said she's a clinical dietitian for sports medicine here. She's an extremely valuable member of our team. We count on her a lot for a lot of great, valuable information and helping our student athletes and even some of the staff and our co-workers out as well. So, it's really good.

0:08:34

I know that today we're going to be taking a look at the broader area of sports nutrition. As you alluded to earlier, she's been on discussing the female athlete triad, which is a really important topic that I recommend people take a listen to and learn about, but there's more in sports nutrition than just that. So, we wanted to bring Jess on today to really get a chance to talk about all those variety of topics and those sort of things.

So today, we're really going to try and dive in and find out what we can do to maximize our potential, how to be healthier overall and find out some of the pitfalls that are made when it comes to exercise and nutrition. So, Jess is going to chat with us about a lot of great topics — eating around, exercising, supplements, how to stay hydrated and what we should do overall and eat overall to help us stay healthy.

So Jess, thanks so much for coming and joining us today.

Jessica Buschmann: You're very welcome. Thanks for having me.

Dr. Eric Bowman: Absolutely. So just to kind of start off, just to ask you, so nutrition, it's a vital part of sports, right?

Jessica Buschmann: Totally is. And I think it's one of the areas that's undervalued. We're so quick to make sure that we stretch, and we do all these different things to be proactive but we have to look at what goes into our body to make sure we're fueling from the inside out, and making sure we're being preventive of that way too.

Dr. Eric Bowman: You're right. You always hear, "Warm up" and "Cool down" and that sort of stuff, but it's everything else that what builds our body, what makes our body what it is.

Jessica Buschmann: And I mean, that's fuel for exercise. You would never not put gas in your car to make it go. So you have to make sure that your body has the proper energy to make sure you yield the result you want for sports performance.

Dr. Eric Bowman: Excellent. Awesome.

I know Dr. Mike mentioned earlier that we aren't diagnosing anything here, but I just wanted to throw out there for clarification, what we're talking about today is general sports nutrition guidelines. If someone has a medical condition like diabetes or something like that, it's really important for them to talk to their doctor, maybe get a specific plan with it, with a nutritionist and something like that, right?

Jessica Buschmann: Correct. Yeah, so they're got to make sure we're doing that. These things that generally work and things that I would practice in clinic but, of course, cater to every athlete individually.

0:10:33

Dr. Eric Bowman: Awesome. Well, let's go ahead and dive in here. So one of the big things I think that I get asked a lot when it comes to exercise and athletes and performance and things like that are, What should I eat before I exercise? What should I do to get my body ready to be the best it can be?

Jessica Buschmann: So, having a meal three to four hours — yes, I said three to four hours — before competition would be ideal. Now, for early morning practices, like I have an athlete just this morning that had the 7AM practice, I'm not going to ask you to wake up at three, to eat breakfast. But at the same respect, skipping breakfast is not the answer either.

So how do we make that work? So maybe one and a half to two hours before would be a better option. And then, if you do adhere to that three to four hours meal before, make sure you have a small snack, 30 to 60 minutes beforehand to boost their energy. So that would be officially after school. Make sure that you're having lunch, let's say around noon and you have practice at 3:30 or 4, that you're having that snack like right around 2:30, 3:00, to make sure that you're not just like walking on the field eating your granola bar or whatever it is.

Dr. Eric Bowman: So, big on Friday night, football's coming up here soon, right?

Jessica Buschmann: Oh, yes. Yes.

Dr. Eric Bowman: So making sure we get the nutrition for that. So three to four hours. Are you saying somebody should have a meal right after school's out to kind of be able to fuel the body for that 7, 7:30 kind of start time?

Jessica Buschmann: And you know, not having chipotle at like 6PM. Maybe not a good idea.

[Laughter]

Jessica Buschmann: But at the same point, yes. So having something right after school that's easy for parents to coordinate boosters, things like that, like that right-after-school meal, that way you make sure that everyone's getting the fuel they need.

Dr. Eric Bowman: Awesome. All right, is there anything that we should avoid in those meal. I mean you said not chipotle. Why not chipotle? Why not something like that? Is there a reason?

0:12:29

Jessica Buschmann: Yeah, chipotle, great. It has a place in the diet. I'm not dissing chipotle, I promise, but at the same point, we want to make sure that we're avoiding those really high-fat food items right before. Really high-fat meals take a long time to digest.

The big one is we want to make sure that we're not causing stomach discomfort. I have treated athletes in the past that either eat too close to exercise, or a meal too high in fat and they had adverse effects from that. So we want to make sure…

Dr. Mike Patrick: Plus, you eat a big meal and your circulation goes to the GI tract. You want it to go on to your muscles.

Jessica Buschmann: Exactly. Correct. And that will cause all kinds of abdominal discomfort. We just want you to play the game and have fun and focus on that.

Dr. Eric Bowman: So, I've had my practice. I ate like I was supposed to. I did everything right, practice is over. What should I do now?

Jessica Buschmann: Now it's time to eat again.

Dr. Eric Bowman: This is a great thing. I love this.

Jessica Buschmann: I know, right? That's what I tell my athlete, "You just got to eat all the time." But making good choices is very important. So you should eat something 15 to 60 minutes after exercise. That is the ideal time frame. Now, let's say mom has to run to the grocery store right after, or some other errands. And you know that, and that's usually what happens, bring a snack with you to eat right after exercise and then go home and have a meal within one to two hours afterwards.

So I know it kind of gets tough with meal planning right after practice and things like that. So be proactive and kind of think ahead with your day.

0:14:00

Dr. Eric Bowman: Now, is there anything in particular we should eat right after that practice, that 15 to 60 minute window? Should we eat something really fatty? What's the best thing to eat there?

Jessica Buschmann: The best thing is a blend of carbohydrates and protein. I think protein is really well-known. I get asked that question very commonly in clinic.

After exercise, you need on average, 20 to 35 grams of protein, which can easily be obtained through food. We'll talk about supplements a little bit later, but that can easily be received in food.

Carbohydrates, right afterwards too because you use carbohydrates as your energy for exercise and you need to replace that. Because you're going to go right back the next day and do the same thing, so you need to have those carbs available.

Dr. Eric Bowman: Now, I've heard out there, and I just wanted to ask if this is true. I've always heard that chocolate milk is actually a decent post-workout drink. Is that something's that's true or is that just a rumor?

Jessica Buschmann: Yeah, it is. I recommend chocolate milk a lot for my athletes right after exercise.

Dr. Eric Bowman: So, you're giving us permission to be a kid and drink chocolate milk?

Jessica Buschmann: Correct. Go for it.

Dr. Mike Patrick: Does that go for adult athletes as well?

Jessica Buschmann: Yeah, absolutely, it does.

Dr. Eric Bowman: Better. I love it.

Jessica Buschmann: It has an ideal ratio of carbohydrates-to-protein, and so I recommend it all the time. When I get that rare athlete that doesn't like chocolate milk, I say that's fine. Go right for the weight. That's fine.

Dr. Eric Bowman: Now, you're not necessarily saying you should drink chocolate milk all the time?

Jessica Buschmann: Right. Please hear me when I say that. It's really ideal for right-after-exercise, especially. So I did not say five glasses a day everyone.

Dr. Eric Bowman: I just wanted to clarify.

Jessica Buschmann: I thank you.

Dr. Eric Bowman: Just to make sure.

And then, as far as activities and things like that, I know we talked about refilling afterwards, should you go right back into another workout right after a previous workout? Or, do you need to give your body a chance to rest? Or, what should we do there?

Jessica Buschmann: Yes. Please give your body some time to rest. Recovery, of course, the hydration, nutrition is important, but that rest is really what shuts your body down and gives you that recovery that you need.

0:16:03

A lot of my athletes are, like I said, student athletes, so I know completing homework is challenging, having practice and then packing a lunch for the next day, and the list goes on and on. But, at the same point, if you invest in it now, you'll have better success later.

So ideally, seven to eight hours of sleep at night would be great. Upwards of, even my younger athletes, they need nine and a half hours of sleep at night. So, that is challenging to get in today's society, but I promise it's worth it.

Dr. Eric Bowman: Sleep's important. I mean we need it. Our body needs it to rebuild itself and rejuvenate itself, so staying up late and getting up early for practice is not necessarily the best practice, is it?

Jessica Buschmann: No, it's not ideal. It's summertime right now, so unfortunately, a lot of my patients are going to bed at midnight and 1AM and then, they wonder why they don't want to wake up at 7AM for practice. Yeah, I don't know.

Dr. Eric Bowman: So, it's important. Sleep's something that we all need for sure. I agree. That's something we really have to make sure that we're getting our athletes and active individuals in general.

Jessica Buschmann: Yup.

Dr. Eric Bowman: Awesome. Well, you said earlier, let's say mom has to run to the grocery store. You don't have time to eat a full meal. Let's grab some healthy snacks maybe, right? Do you have some examples what maybe some of the healthy snacks people might be able to have.

Jessica Buschmann: Absolutely, I do. I think the important thing that I want to emphasize here is that it doesn't have to be anything crazy. It can be something very simple, like a peanut butter sandwich, or yogurt with granola. Watching, making sure when I say yogurt with granola, I did not say like the yogurt with the M&M's and the chocolate chips.

I always say, I'm a dietitian. I kill dreams for a living sometimes when I say that, but it's true. Yogurt with granola, whole grain cereal with milk, a granola bar. Also watching what's with the granola — chocolate is chocolate — if they are covered in a chocolate coating, that doesn't make it necessarily sometimes healthier than a Snickers bar or something like that. So you have to watch that, or other candy bars.

0:18:06

Trail mix, good rule of thumb, if you're making your own at home, aim for at least a nut and a dried fruit and maybe one sweet item. Sometimes they have the potential to have three, four different sweet items and we think, Oh, it's trail mix, but it might not necessarily have the most healthy variety in there.

Pretzels with string cheese. My personal favorite, I actually had it today was a rice cake with apple sauce and peanut butter. I love it. Give it a shot, sounds a little weird, but I promise it's worth it.

And then, maybe a hard-boiled eggs and some crackers. Doesn't have to be anything crazy, you can make like a dozen hard-boiled eggs early in the week and just kind of eat from them all week long.

Dr. Eric Bowman: All right, well, that sounds like some great options that we have there.

So, I think the next thing, you talked about, it doesn't have to be crazy – the snack and everything else. I think a lot of people go, "Yeah, but what about all these supplement bars and these other supplements that are out there?" There are a lot of different ones that people have — caffeine, energy drinks, whey protein, creatine, all these other workout supplements that are available.

This is a huge topic. I know it's something that you feel pretty passionately about, and I think that we need to discuss because it's something that I think a lot of young athletes have a lot of access to. And, there's not a lot of great information out there necessarily.

So I guess what's your thoughts? I mean, can you talk us through supplements in general and just kind of what the deal is there?

Jessica Buschmann: Sure. So my overall thought is that food first, always. Food first, and then if you need something additional, then maybe we can look at supplements. There are some companies that are doing it the right way. But the August 2005 edition of Pediatrics, the scientific publication of the American Academy of Pediatrics reports that 8% of girls, and 12% of boys surveyed admitted to using supplements in an effort to enhance their physique. The results suggest that girls may use unhealthy means to achieve low body weight, whereas boys may use unhealthy ways to improve muscle and mass strength.

0:20:05

Athletes are prime targets, unfortunately, for nutrition fraud and other use of these products, and that's associated with a variety of factors. Athletes are young. They're impressionable, often concerned with body image and easily influenced by the media. A lot of that media's campaign is directed directly at adolescents. If they are dissatisfied with their body, they may turn to different supplements to alter their body composition.

These over-the-counter supplements are often found in nutrition stores and online. They are not regulated in the same way as other pharmaceuticals by the FDA, so there's less strict regulation and adherence that they have to follow. Therefore, they are not responsible for the accuracy of the label and the contents of this product.

These supplements include products — all of it you mentioned before, Eric — is that there's just this mega doses that we need to watch out for, always focusing on food first rather than turning right to the supplement, even though it caters to a lot of our American lifestyle. That they're quick. They're easy. We'd rather invest time than making a protein shake than making a peanut butter sandwich because it takes 30 seconds more time.

Dr. Mike Patrick: People sit around marketing conference room tables to try to figure out how to get families and teenagers to buy this stuff.

Jessica Buschmann: Yes.

Dr. Eric Bowman: Absolutely, and they know exactly who they want to go after for sure, yeah.

Jessica Buschmann: Like I said, the unfortunate reality of it is that most people don't… They look at the label, they look at the price, and then they buy it. There's a lot of trust in those companies…

Dr. Eric Bowman: You assume it's safe.

Jessica Buschmann: Right. It's on the shelf. It's going to be perfectly safe, but unfortunately, especially in the world of supplements, that's not the way that it is. I've had a lot of athletes in clinic who have had a lot of adverse reactions to some of these products. Then, once I teach them how to do it through food, they have a lot better, greater success.

Dr. Eric Bowman: And I know the thing, even above and beyond what you're saying is that there had been studies that have come out that have shown that there are actually things in a supplement that aren't even on the label. There had been studies that have shown that some of these creatine supplements, protein supplements actually have trace levels of steroid in them, have trace levels of testosterone, have other issues that are bigger than just "Is it the best way to fuel my body?" There's a lot of risk that goes with that, and I think that's important for people to understand as well.

0:22:25

Jessica Buschmann: Yes, especially for the athletes who are looking to go into college. The NCAA highly regulates those supplements use and does different testing methods and things like that, so you really have to watch it. And it's hard to always think that extra step ahead but it will come back to bite you. They will find out.

Dr. Eric Bowman: And I think that's hard too is that, again, supplements, as you mentioned before, don't have the FDA regulation, and therefore they don't have to prove their effectiveness, correct?

Jessica Buschmann: Correct. Yeah. So, you know, different pharmaceuticals are tested and tested and tested until they're deemed safe by the FDA, and then they're released to the public for our consumption. Sports supplements, vitamin and minerals supplements alike, they are not that way. They are put on the store shelves first, and then once there are adverse reactions, and things are reported and all these indications keep coming back that these products might not be safe, that's when we're taking a second look at them. So it's kind of backwards, and it's a scary reality, so you just need to watch it.

Dr. Eric Bowman: Are there any third parties out there? Anybody like that who does test the efficacy of supplements? Is there anybody you can "trust" out there to look into this for you? Or, is it really just kind of "You're out there on your own, good luck"?

Jessica Buschmann: Yes. There are third-party companies that do test for quality impurity, meaning, they will take a supplement off the shelves themselves or have the company send them the product itself and then test it, and then slat their label on it that says this product is indeed correct what is on the label. But looking for those companies, it takes an education process, too.

Dr. Eric Bowman: So, I guess, if you have to leave parents and athletes with just a final thought on supplements, one line that you would really want them to kind of get in their head, what would you say? What's the one line? What's the sports dietitian approach to supplements?

Jessica Buschmann: Be critical. And take a look at your diet first before investing your time in supplements.

0:24:38

Dr. Eric Bowman: Awesome. I think that's absolutely great.

All right, moving on to another topic here that's incredibly important — hydration. Water, water, water, just water and that kind of an idea. You know, I get this question all the time, especially this time of the year, summer, hot, people are really being active. And so, people would say "Hey, doc, how much should I drink to stay hydrated for sports?" "How much should I drink beforehand, and during, and after?" And, "Does it matter?" that kind of thing.

So, as far as volume, things like that, what would you recommend for people if they were coming to you to ask you that question?

Jessica Buschmann: So before competition, we want to look at drinking — about two hours before activity — about six to eight ounces of cold water. So when I say cold water, it just depends on your personal preference. Some people prefer room temperature. It's not necessarily the temperature that matters. And then, about 30 minutes before activity, if your stomach can handle it, 8 to 12 ounces beforehand.

Also, looking at, if you know that you're a heavy sweater — and when I say this most athletes know that they're "Yes, I am a heavy sweater." I have the white ductlets on my face and I can taste it," and things like that — you might even need more than that. So, especially for a heavy sweater, eat a pre-exercise meal with a little extra sodium. Most Americans don't have trouble getting plenty of sodium in their diet.

[Laughter]

Jessica Buschmann: However, just thinking a little bit ahead, if you can salt your food a little extra, that might be a good thing to do in the summer. But, just again, general regulations. Then, during, it's important, too.

Dr. Eric Bowman: As far as during a competition, so I'm there during my soccer game, my football game, my basketball game, whatever it may be, how much water should I drink during those events, like I'm actually out there competing?

0:26:24

Jessica Buschmann: Yes. So some guidelines will say, every time you come off the field, drink 8 to 12 ounces of water for every 15 to 20 minutes. I will be perfectly honest, I have yet to find an athlete that's able to achieve that recommendation. So what I say is make sure that you're utilizing those breaks, like every 15 to 20 minutes, whenever you're coming off the field, when coach calls the timeout or whatever it is, make sure that you are taking at least a healthy swig of water. Then, aiming for a sports drink as well during exercise.

I want everyone to say it with me — during exercise, after 60 minutes of physical activity.

Dr. Eric Bowman: So that's not okay with breakfast, is what you're saying?

Jessica Buschmann: Yeah, or lunch or things like that. Sports drink, when I say sports drink, I mean like PowerAde and Gatorade. You can even make your own home-made at home if you're interested, but you're making sure that we're focusing on water every other times.

Sports drink is meant to be, designed to be used during exercise, but again, like I said, just making sure that you're taking advantage of those timeouts and those water breaks as you can during exercise because I know it's hard to drink a lot for a lot of athletes during.

Dr. Mike Patrick: You drink too much and you got to take timeout to go to the bathroom during the game.

Jessica Buschmann: Exactly. Oh my goodness, yes.

[Laughter]

Dr. Eric Bowman: Coach is never happy about that one.

Dr. Mike Patrick: Yeah, right.

Jessica Buschmann: And they get like the bubble guts, like sloshing around in your stomach.

Dr. Mike Patrick: You got to be reasonable with it, too.

Jessica Buschmann: Right, exactly.

Dr. Eric Bowman: So, I've had my practice, I had my game. I did everything you said. I drink beforehand, I drink during. I'm a good athlete, right? Now, what do I need to do afterwards?

0:28:00

Jessica Buschmann: Especially during two-a-days, so we have two-a-days for football and soccer, sometimes even cross country coming up. It is my hope, athletic trainers out there kind of taking the lead on this and some coaching staffs too, that you should be weighing your athletes before exercise and then again after exercise. For each pound that is lost, you should be replacing with 16 to 24 ounces of water, for each pound that was lost. So simple multiplication problem.

The reason for that is I think dehydration is one of the key sources of poor performance in the summer that we don't really invest as much value in.

Now, during the year, as it's not as hot and there's not-two-a-days and things like that, ways to tell if you're getting enough water, just looking at your general urine color.

Your urine, as I was saying to my athletes, now should be the color of water to light yellow, so lemonade. If your urine looks like apple juice or ice tea, you need to get to drink in. In the mornings, sometimes, our urine is a little more concentrated because we've been asleep all night and things like that, haven't been to the restroom. But generally, throughout the day, your urine should be like that, light lemonade color.

Dr. Eric Bowman: And I think it's really important for athletes and parents to understand, you talked about how dehydration is really important just from a performance standpoint, but it doesn't take a lot. I think a lot of people are like, "Oh, yeah, I got to have that dry, tacky mouth and not sweating before I'm dehydrated," but isn't it true, it's just as little as 1 to 2% affects sports performance?

Jessica Buschmann: Absolutely, it does, yeah. And drinking water proactively, all throughout the day, not just at practice. A lot of my athletes will say, "Well, I'm drinking during practice." Well, about with breakfast? Did you have water? How many bottles of water did you have throughout the day? Really looking at that, you don't want to wait until you're thirsty. That's almost too late. So making sure that you're drinking water all throughout the day is key.

0:30:01

Dr. Eric Bowman: Yeah, I think it's really important. Hydration is one of those things that can't be achieved at the last minute. It's planning. You have to make sure that you're staying ahead of it, even days in advance and just really maintaining good hydration overall.

Jessica Buschmann: And your muscles rely on it. Your muscles are up to 70% water. So it needs it just for your basic physiological processes to keep you healthy in that way. So then, even more so, you're putting that physical activity demand on it, and you're sweating and your heart rate's going up, and your muscles are working harder. We need water for all of those things, too.

Dr. Eric Bowman: Now, you talked about hydration and hydration during and after. We mentioned the Gatorades and the Powerades and things like that with 60 minutes of more of activity really to replace it. Obviously, water is a great option as well. Are there any drinks that you say maybe we shouldn't use as our hydration?

Jessica Buschmann: Yes, absolutely.

Dr. Eric Bowman: Yeah? What kind of things should we probably avoid as a source of hydration?

Jessica Buschmann: Soda is a big one. I have athletes that would say, "What do you mean soda isn't a good replacement? I just did all that exercise. It's OK, right?" No, not quite.

Coffee just like at baseline, plain, black, anything, or any of those coffee drinks that we like to get. They call them Fufu coffee drinks with the whipped creams and things like that.

Dr. Eric Bowman: The fun ones.

Jessica Buschmann: The tea, and energy drinks is another big one too. So, energy drinks, sometimes they'll say, "Well, after exercise, you need B vitamin," or something like that. Well, don't worry, you can get those through meat and all kinds of other healthy foods. So you don't need energy drinks to give that to you.

Dr. Eric Bowman: Awesome. All right. So, water.

Jessica Buschmann: Water.

Dr. Eric Bowman: It's what I have.

Jessica Buschmann: Go for that water.

Dr. Eric Bowman: I love it.

Jessica Buschmann: Try home-made sports drink. Do it.

Dr. Eric Bowman: Yeah? Is there a way people can know how to do that?

Jessica Buschmann: Oh, yeah. I can provide a recipe.

Dr. Eric Bowman: Absolutely. We can post a recipe here as part of the show links, and people will be able to find out and they can make their own sports drink with it as well.

Jessica Buschmann: It's easy. It's only a couple of ingredients — water, sugar, salt, 100% fruit juice.

Dr. Eric Bowman: And the nice thing is you know for the most part where everything is coming from.

Jessica Buschmann: Absolutely.

0:32:04

Dr. Eric Bowman: Good. Nice. OK. Awesome.

All right, so we've talked a lot about competition and practices and events and games and things like that. Let's kind of I think just go overall.

Overall, eating well, right? We all need to probably hear about this a little bit more, and myself included in that one, and, obviously, our athletes and our active children and parents out there for that matter, too. What are some good guidelines for eating well? Is there a way we can know what is a good way to eat well?

Jessica Buschmann: Yeah. I think we hear this time and time and again, but putting it into practice is really tough, but balance is key. One good rule overall is I like to say, and I teach my patients in clinic is that eat close to the earth. The closer that it looks to like it came off the tree or out of the ground is better. So a good comparison I like to use is look at the strawberry, and then look at strawberry fruits snack. How many steps were there to get to that strawberry fruit snack?

Dr. Eric Bowman: Right along that line, I've also heard another phrase I think that's also very helpful, "If it comes from a plant, as in the earth, it's great; but if it's made in a plant, you probably want to avoid it."

[Laughter]

Dr. Mike Patrick: That's good.

Dr. Eric Bowman: That's one way, you know.

Jessica Buschmann: It's true.

Dr. Eric Bowman: It's the same concept. The more natural, the better, right?

Jessica Buschmann: Exactly. Healthy eating is healthy eating, but looking at for an athlete in sports nutrition perspective, our athletes can eat even more. I'm still not telling them to eat more cheeseburgers and french fries and milk shakes and things like that.

Dr. Eric Bowman: The good stuff.

Jessica Buschmann: Right. You eat the good stuff.

Dr. Eric Bowman: Good stuff. All right. Well, some of the good stuff's the grains, the carbohydrates, right?

Jessica Buschmann: Yes, definitely.

Dr. Eric Bowman: But there can also be bad in there too, right?

Jessica Buschmann: Yes.

Dr. Eric Bowman: So what's the difference there?

Jessica Buschmann: So looking at… We want to… You know the principles of MyPlate, Choose MyPlate from USDA, is making sure that half your grain each day come from whole grain sources. You know these things like whole wheat bread, whole wheat pasta, whole wheat flour when you're cooking, oatmeal, brown rice.

I teach a lot about grains, like quinoa, bulger, teff. There's some of you who might be like, "Huh? What are you saying over there?" But look them up. I promise, there's lots of fun ways to prepare them.

0:34:16

Then, avoiding more so like the refined grains. So that's more looking at our white flour, or white pasta, or white bread, white rice.

Those whole grains offer you more benefit. They offer you more nutrition. They help with digestion, more vitamins and minerals. They help keep you fuller longer. I guess, we're talking about it earlier, they're more natural source compared to those white products which are stripped of most of those nutrients and things like that.

Dr. Mike Patrick: Why do they process those grains? If they're so good, why do we have processed grains to begin with?

Jessica Buschmann: Right. They taste better. Well, that's just a matter of opinion. But the theory, they taste better, and they are cheaper to sell and to consume, unfortunately. I wish that we didn't have to offer them at all. They do take some degree of getting used to.

Then, sometimes, some people are not able to process the whole wheat and the whole grain and things like that. So having both options available is a must.

Dr. Eric Bowman: And I feel like a recipe out there too, and things like that, especially baking, calls for a lot of enriched flour or refined flours, or refined sugars. So, you're dealing with a lot of history there, too, I think. It's probably a part of it.

Jessica Buschmann: Told you, I'm a dream killer. Told you.

[Laughter]

Dr. Eric Bowman: But you told us, we could have chocolate milk right after exercise.

Jessica Buschmann: I know. But it balances out.

Dr. Eric Bowman: So you're keeping the kid alive. So, that's right.

All right, what about calcium? Is calcium important.

Jessica Buschmann: Calcium is so important, so very important. Dairy products nowadays are not the only way to get it. It is the most abundant source naturally that we can find calcium.

But looking at, choosing sources that are natural, things like yogurt, cheese, milk, now we can look at alternative milk products or dairy products like there are soy milks, almond milk, coconut milk. All of these products are fortified with calcium, so what that means is that these sources don't naturally have calcium. So the companies put calcium in it for you, so you're not missing out on that if you're not able to consume dairy products or other milk products.

0:36:35

Looking at also…

Dr. Mike Patrick: Is it important for Vitamin D to be part of that mixture when you're getting calcium in?

Jessica Buschmann: Absolutely. Calcium and Vitamin D have a great relationship, and when they're paired together, they absorb into the bone the best together, like best as a pair. When I'm talking to my younger patients, I say they're besties. Calcium and Vitamin D are besties. They like to go into the bone together to make it nice and strong for stress fracture prevention and things like that down the road, too.

Dr. Eric Bowman: Now, all the things you mentioned, the almond milk and the rice milk and the soy milk, calcium fortification, are they also fortified with vitamin D usually to go right along with it?

Jessica Buschmann: Yes, they are. Good point.

Dr. Eric Bowman: All right, calcium, it's super important for our bones and to help us grow and everything else, and there are a lot of other resources out there and place where we can find it.

What about those fruits and veggies?

Jessica Buschmann: Eat those fruits and veggies, my friend. Eat them up.

Dr. Eric Bowman: That's just the simple answer, right? Just eat them.

Jessica Buschmann: Yeah, just eat them. Make half your plate fruits and vegetables, especially when you're watching out for fruit. You want to make sure that you're avoiding the syrups, the fruit cups and things like that. There are ways to get in a 100% fruit juice now.

Going back, when I said make sure that it looks like how it came off the tree or out of the ground, the closer that you can get to eating the whole fruit or the whole vegetable, the better, because you're getting good fiber from the skin of that, all the benefits and minerals, all the benefits of it. Because when they're in a cup or there's an extra degree of processing, some of those healthy nutrients are lost.

So, especially, never limit you on vegetables. Eat as many vegetables as you want all the time.

0:38:22

Dr. Mike Patrick: What about the folks who package vegetables into a pill?

[Laughter]

Dr. Mike Patrick: I won't mention any particular company names, but what's your opinion on that?

Jessica Buschmann: Just eat real food.

[Laughter]

Jessica Buschmann: I feel like I say that 20 times a day, but yeah, just eat real food. I know veggies aren't as fun to eat, but there's lots of fun ways to hide vegetables for those picky eaters and make vegetables fun and delicious and things like that. I feel that's such a standard dietitian answer, like here she is trying to make vegetables fun, but that's what I do.

Dr. Eric Bowman: But I think it's important, most people are probably really familiar with the concept. Maybe a little peanut butter, which can be a healthy kind of fat, mixed with celery.

Jessica Buschmann: Yeah, go for it.

Dr. Eric Bowman: Celery is.. It can be boring, let's be honest.

Jessica Buschmann: It can be boring.

Dr. Eric Bowman: But something like a peanut butter or almond butter or something like that can help add some flavor in it.

Jessica Buschmann: Add some raisins to it.

Dr. Eric Bowman: Excellent.

Jessica Buschmann: There we go.

Dr. Mike Patrick: And you get the crunch.

Jessica Buschmann: Right.

Dr. Mike Patrick: It's great.

Jessica Buschmann: Yeah. And that's why I just had, like I said, a patient just before, I recommended that to him. He's older adolescent. He was over the moon over it.

Dr. Eric Bowman: Excellent. Well, I mentioned peanut butter, almond butter like a potential protein source, correct?

Jessica Buschmann: Yeah.

Dr. Eric Bowman: Are there other good sources of protein, natural protein, non-supplement protein out there maybe?

Jessica Buschmann: Yes, oh, there's plenty. Let's talk about it. There is meat sources. Of course, let's look at our lean protein sources first of all — so chicken, turkey, lean beef. Watching, also looking at that fat, if there's visible pieces of fat on there, you can trim that off. You don't necessarily have to eat it.

Other protein sources include those nuts, nut butters. When I say nut butters, as we're talking about before — peanut butter, almond butter, cashew butter. Hazelnut butter such as Nutella does not count as a nut butter.

[Laughter]

0:40:23

Dr. Mike Patrick: You're a dream killer again. That's all I know.

Jessica Buschmann: I know. Just add it to the list. I got all these notches.

Then, also, looking at soy products, beans and eggs, as well as other even plant-based sources of protein.

Dr. Eric Bowman: And I think what you just mentioned there is really important to understand because there are probably members of our audience who are saying, "That's great, I don't eat meat. So I need to find that source of protein in a non-meat way." So you're saying, that's definitely an option.

Jessica Buschmann: It's definitely an option, and it's completely feasible. I have a vegan athletes in clinic. It is a little more challenging, of course, but it's completely feasible and obtainable to make sure that you're getting enough protein in your diet.

Honestly, protein is not as hard to achieve as sometimes we think it is. It's actually pretty easy. Carbohydrates should make up a majority of the diet even if you're a non-athlete. Even more so, if you are an athlete, but protein is pretty easy to obtain. It's more about timing.

Dr. Mike Patrick: What about fish?

Jessica Buschmann: Fish, yeah, I forgot about fish. That's great, yeah.

Dr. Mike Patrick: It's still good protein.

Jessica Buschmann: It is good protein. Thank you for that.

[Laughter]

Dr. Eric Bowman: We're here to help you.

Dr. Mike Patrick: I just wanted to make sure.

Jessica Buschmann: I appreciate it. Oh, yeah. Hey, you never know, things are changing every day.

Dr. Mike Patrick: Yeah. Right.

Dr. Eric Bowman: And then, the last I think kind of like food group, food concept we'll talk about, some of the fats, the oils, those sort of things. Are those on the naughty list?

Dr. Mike Patrick: Sure are.

Jessica Buschmann: No.

Dr. Eric Bowman: No?

Jessica Buschmann: No. I say, poor fat. It gets a bad reputation in the diet, but at the same point, we need it. We actually, percentage-wise, need more healthy fat in our diet than we do protein.

Dr. Eric Bowman: Really?

Jessica Buschmann: Promise. Yeah.

Dr. Eric Bowman: So you said healthy fat. That's the key right? Healthy?

Jessica Buschmann: That is the key. Right. It's huge.

0:42:09

Dr. Mike Patrick: What do our bodies do with that? With the fat? Why do we need healthy fat?

Jessica Buschmann: We need lots of healthy fat for our brain health, our neurological health. We need do some degree, especially for women, we have a higher percentage of lean fat mass for thing like reproduction and all those things that we… Menstruation, healthy menstruation, things like that are very poor incentives sometimes from my young female athletes, but at the same point, it's crucial for your health overall.

Also, like those healthy fats, looking at that, avoiding things… I'm not saying that you can never have them, but avoiding things like the lard and fried food items, and even butter, high-fat like creamy sauces and salad dressings. Like ready, dream killer, ranch dressing, Alfredo sauce, things like that.

Again, not saying you can't have it in your diet. We just have to watch how much we have it. Those healthy fats are more about oils. The oils that we use for cooking are in salad dressings, avocado. Those nuts and nut butter also have healthy fats, looking at things like that, more so than those other poor sources.

Dr. Mike Patrick: Pizza is a pretty high calorie dense food, but it seems like a lot of student athletes after a big competition, "Let's go out and get a pizza," but doing that every time may not be such a good idea.

Jessica Buschmann: Right. Exactly. Going to the moderation, what does that mean, and balance and all that. It means, yeah, not having pizza after every single competition is not the best idea. Where it has its place in the diet, it's not the best source for recovery after exercise, so looking at that is important.

Dr. Eric Bowman: Well, you've mentioned a couple of times the term moderation, and you're saying not every time with the pizza. So it sounds to me that you're saying that maybe, sometimes, you could have a pizza, or not a whole pizza, a slice of pizza. But is there any kind of guideline, any kind of a rule that in general you can follow to say? If I follow obviously, the healthy sources of nutrition that we talked about, the more natural sources, is there any kind of a guideline or a rule that we can follow to help us say we're probably doing OK or at least staying within some level of balance here?

0:44:36

Jessica Buschmann: Yeah. One thing I really like to help my patients with just to kind of give them, like a rule like you said Dr. Bowman, is the 80/20 Rule. Eighty percent of the time, you're doing what you should; 20% of the time, having those indulgences and things that maybe aren't the best choices day in and day out, you're doing pretty good.

If looking at, like your week is seven days, as long as it's five days a week, you're doing pretty good. You ideally want more than that, yes, absolutely. But if you're young, you're a young athlete, you have to be eating well most days of the week to see that performance benefit. By the time you're eating well, the day of competition where that is, yes, it's very, very important, don't get me wrong there, but at the same point, if you're eating poorly all week and then just decide to eat healthy the day of the competition, that's not going to help you get the benefits that you are hoping to achieve.

Dr. Eric Bowman: So it sounds like keep it good most of the time, and every now and then, it's OK to…

Jessica Buschmann: Right, have those indulgences.

Dr. Mike Patrick: See, you're not killing every dream.

Dr. Eric Bowman: That's right.

Jessica Buschmann: No, not every dream.

Dr. Mike Patrick: Now, you're redeeming yourself.

Dr. Eric Bowman: That's right. …back.

[Laughter]

Dr. Eric Bowman: I guess one of the questions I might have is, you have people out there who are slightly pickier eaters. They might not like certain things. Or they may not want to eat this or that. I mean, wow, what do you do in those situations? You have a way to try to help those picky eaters to be able to be great athletes or just in general?

0:46:11

Jessica Buschmann: Yeah, I'm always encouraging the athletes and my patients in general in saying, "When was the last time you had broccoli?" And they say, "Uhm, 14 years ago."

[Laughter]

Jessica Buschmann: Like, "OK, so let's try it again, and here is lots of fun ways. You look macaroni and cheese? All right, let's make a roasted vegetable macaroni and cheese. Let's chop up some broccoli into finer pieces, get it in there, see if you like it that way. Have you ever had it roasted or braised or grilled with a bunch of meat and oil and veggies and spices and things like that?"

Introducing food in different ways is a key way, even for the adolescent athlete.

Then, also — I hate to try the word like 'sneaking' but we'll say it — sneaking vegetables in. Another great way is marinara sauce with pastas or anything like that, lasagna, spaghetti, any of the above. Chopping up vegetables into those fine pieces and mixing it in the sauce, or mixing it in eggs, or putting spinach leaves in between those lasagna layers. Anyway we can try to get it in.

Another one that I love and I always have to say to my athletes, "Please, just give it a chance. Give it a chance. You can taste it. It's like a spinach or a kale smoothie." Like if that is getting chopped up, it is better just to eat it in full as we talked about before, but at the same point, trying to get them in that way, and some kids, it gets really awesome that you're drinking a green drink.

[Laughter]

Dr. Eric Bowman: So the things out there, like the Ninjas, the NutriBullets, they're OK options for some people, if that's the way…

Jessica Buschmann: Yeah, they're not bad. Sneak them in, make sure we're getting the fruits and vegetables. I know, like I said, they don't taste as good sometimes, but at the same point, there's lots of ways to make vegetables taste good especially.

0:48:02

Dr. Eric Bowman: All right, nice. You've been really helpful with us so far here as far as educating us on all the really great things that we can do to help our athletes and our active individuals and that sort of thing.

So let's say, somebody said, "You know, I really has some more questions. I need help. I have just heard everything you said, but it's just not going well at home. I need some other stuff." If somebody wanted to just come and see you, what are some common conditions that are seen by sports dietitian like yourself?

Jessica Buschmann: In general, a majority of the athletes that I see just have general poor eating habits and are looking for a nutrition consultation to help optimize their performance.

Or underfeeling for sports competition, they feel like they're just not quite eating enough but they're not really sure or maybe overfeeling as well. So just kind of making those tweaks.

I see athletes that are overweight, athletes that are underweight, athletes that are suffering from fatigue, whether it's just general fatigue throughout the day or fatigue with performance, disordered eating in athletes.

So not eating disorders., I don't see eating disorders in my clinic. We have a great clinic here at Nationwide Children's Hospital, dedicated to the care of eating disorder patients. But then, also, I have a lot of especially male athletes that come in, parents dragging them in, saying, "Will you please talk to them about sports performance supplements," and what we can do to help optimize their diet.

We tell that they can have 4,000 calories and that's a lot of food, and that's OK. You need it for sports competitions.

Other areas that might be a little more medically related that I would see is iron deficiency anemia. We have a lot of athletes that come into my clinic with low bone mineral density or stress fractures, irregular menstrual cycles, GI upset with exercise and whether that stomach cramping, actual vomiting, or diarrhea, and all those fun things, they could be potentially linked to athletic competition.

0:50:04

I see athletes with food allergies or just general food intolerances as well as athletes with serious medical conditions like diabetes or Celiac disease and the list goes on from there.

Dr. Eric Bowman: Awesome. So it sounds like there's a lot of people you can help.

Jessica Buschmann: Yes, and I love it.

Dr. Eric Bowman: Like I said in the beginning, you're extremely helpful for us too. We love utilizing Jess in our clinic. She's able to help a lot of our athletes and really do a great job.

Unfortunately, you're not available 24/7, and we don't want to give your cell phone number out to the PediaCast listeners or anything. So, having said that, are there any resources out there that parents or athletes can go to, to look up some of the things we've talked about, from general healthy eating habits to supplements, to those sort of things? Is there something that you would recommend?

Jessica Buschmann: Yeah, in general, as I was talking about the key principles of just overall healthy eating, looking at the Choose MyPlate website, especially there's a facet of it now, that's KidsEatRight.org. And it breaks it down by toddlers, infants, all the way up to adolescents and pre-teens. So looking at those tabs might be really helpful,. Now, they're even implementing stories about athletic competition and athletes and things like that. So it's been really great.

The SCAN website, so the Sports Cardiovascular And Wellness Nutrition website, and we'll make sure that we get you these links. I know it gets a little confusing right now, as I'm explaining. They have great just general information handouts on a variety of sports nutrition topics that I talked about throughout today's PediaCast. As well as the MomsTEAM has a great blog, as well as forums that you can get involved with.

Especially for sports supplement use — if you have questions about that as well as NCAA guideline and rules — is drugfreesport.com or the Taylor Hooton Foundation.

Dr. Mike Patrick: And I'll make sure I'll get all those links in the Show Notes for this episode, PediaCast 325 over at PediaCast.org, so folks will be able to find that stuff easily for you.

Dr. Eric Bowman: Wonderful.

Jessica Buschmann: Wonderful.

Dr. Eric Bowman: Excellent.

Well, Jess, I just wanted to personally thank you again so much for coming in and chatting with us here today and helping educate us, as well as everybody else out there, on good sports nutrition guidelines that we should follow and for giving us these great resources and everything. So I appreciate your time today.

Jessica Buschmann: It was my pleasure. Thank you for having me.

Dr. Eric Bowman: Absolutely. And Dr. Mike, I wanted to thank you again for the opportunity for allowing me to come back and co-host.

0:52:26

Dr. Mike Patrick: Absolutely. We'll have you back, again.

Dr. Eric Bowman: That sounds great.

Dr. Mike Patrick: We'll do some more sports related topics together.

Dr. Eric Bowman: Absolutely, and if anybody out there has anything they want to hear about, please let us know for sure. We're happy to talk about anything anybody wants.

Dr. Mike Patrick: Great.

All right, let's take one more quick break, and then we'll be back and wrap up the show after that.

[Music]

Dr. Mike Patrick: All right, we have just enough time to say thank you to all of you for making PediaCast a part of your day. I really do appreciate you stopping by.

Thanks also to our co-host, Dr. Eric Bowman, with Sports Medicine here at Nationwide Children's, and our guest, Jessica Buschmann, clinical dietitian with Sports Medicine here at Nationwide Children's. Really appreciate both of them taking time to be with us today.

That is all the time we have today. PediaCast is a production of Nationwide Children's. Don't forget, you can find PediaCast in all sorts of places. We're in iTunes and most podcasting apps for iPhone and Android, including the Apple Podcast App, Downcast, iCatcher, Podbay, Stitcher and TuneIn.

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Then, there's the landing site, PediaCast.org. You'll find an archive featuring hundreds of past episodes, transcripts of each program, in case reading suits your taste, and a handy contact page to ask questions and suggest show topics.

And as Dr. Eric said, if you have any sports medicine related topics that you like us to talk about, just throw those our way, and we'll see if we can get a show on them.

0:54:30

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Thanks again for stopping by. 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.