Food as Medicine – PediaCast 387

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  • This week we consider food as medicine. We’ll start with the basics of carbohydrates, fats and proteins. How are they beneficial? When and why are they dangerous? Then we’ll explore the use of food to prevent and treat several medical conditions. What should we do with conflicting food advice? And how can we think critically when the latest diet fad or nutritional product shows up in our news feed? Join us to find out!

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  • Food as Medicine
  • Integrative Medicine
  • Plant-Based Diets
  • Anti-Inflammatory Diets

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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 a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. 

It's Episode 387 for October 11th, 2017. We're calling this one "Food As Medicine". I want to welcome you to the program. 

Before we get started today, I want to get a quick shoutout to my wonderful daughter. She is the voice that you hear introducing me at the beginning of the program and the concluding voice at the end. And she recorded those segments a long time ago. Remember, we've been doing PediaCast for over a decade now. And we use those intros and outros that she recorded, we used them for years, really long time.

And it turns out she got married last month. Time flies. The wedding was beautiful. Really, really lovely time and yes, I feel old. And to a degree, there's some grieving at the end of my daughter's childhood. So, just think, those little kids that you care about so much, they grow up and life goes on. 

But as a wise guest on our CME program reminded me few weeks back, after the microphones were off and we were finished recording, she reminded me, this is what we want for our kids. We want them to be healthy and happy. That's why you're listening to this program right now.

0:02:05

And then, when they grow up, we want them to spend their days with someone who loves them as much as we love them. And despite the brief grief of losing that childhood, we do anticipate the future with lots and lots of excitement. And for those of you with little ones at home, trust me it flies by way too fast. 

So, just a quick shoutout of congratulations to our show announcer and her new husband, Katy and Alex, I love you both very much.

All right, let's move on. I'm actually really excited about today's program as we consider the topic — food as medicine. We've talked about various nutrition type topic over the years on PediaCast, many times. In fact, we recently covered sports nutrition and breakfast with our sport's dietitian, Jessica Buschmann.  And in the past years or so, we've covered school lunches, picky eaters, Mealtime and Playtime, which is an initiative from the Ohio chapter of the American Academy of Pediatrics.

Now, whenever we talk about food and nutrition, listener numbers, downloads usually go through the roof. And I think the reason for that is that nutrition is a topic that affects everyday living for every single American family. We all have to eat, right? And in fact, families around the world, it's not just America. And eating is something that we think about every day.

And at the same time, we frequently entertain some other thoughts about eating. First, in the back of our minds we know we can do better. And we also to a degree know what we need to do in general. 

We need to decrease those calories in, increase our energy out through exercise. We need to increase our consumption of vegetables and fruits and decrease our intake of processed foods and simple sugars and unhealthy fats. 

0:04:08

So, we know what we need to do. We don't always know why or the science behind why those changes need to be there. So, we want to kind of explore that today.

And then, also just how do you do it? It's really difficult to make changes. And sometimes, it's easier to make a little change at a time and then, over the course of a few years, you made some big changes. But when you try to make a big change too quickly, it can be difficult, and we fail. 

We still want to enjoy life and there's so many things that we have to do and eating is something that is enjoyable. And so, we kind of get into our patterns of what we eat and how we eat, who we eat with whether it's on the run. It's just these patterns. And there's so many complex things in life that it can be difficult to make those changes and yet, we know that making those changes is important.

The second thing I want to mention is we also hear a lot of claims. We hear claims of what food can do and what it cannot do. We hear those claims from lots of different sources and directions especially on the Internet. And you begin to wonder what's true and what's not true. 

And then, you start to hear conflicting information. And if you're like me at some point, you tend to just shut down and go back to doing what you usually do with regard to diet and exercise. Until you step on the scale and you visit your doctor or you read the latest nutrition-related article on the Internet. And then, those nagging thoughts start coming back and you try to do better. Then, you get all confused again. 

And the thing is at the end of the day, it is important to get this right. Not only for our own health but as we feed our kids and be an example to them and establish a habit and boundaries, ones we hope will continue throughout their lives. 

0:06:01

So, my goal today is really just to take a step back and sort of to start fresh. What do we know about food? How does food affect our health? And, of course, if food has a positive effect on our health, we can start thinking about it as medicine. Of course, food is much more than medicine. It's often a part of our culture, we socialize around it, we enjoy the taste. We celebrate with food. We give each other the gift of food. Lots of great food on my daughter's wedding.

So, food is many things. But as we think about health outcomes, one of those things is food is medicine. Because we can prevent many disease conditions and even treat disease conditions when we alter our diet. 

Now on the other hand, if food can be medicine, it can also be poison. Food can harm us. And thinking about food in these terms, medicine, poison, it's an interesting perspective, I think. And it's one that arose from the world of alternative medicine, which is really becoming integrative medicine as we sort of marry holistic ideas with traditional medicine in our pursuit of the best health outcomes for ourselves, our children and our family.

So, we're going to start with the basics today — what are carbohydrates and fats and proteins? How are they beneficial? How they harmful? And then, we'll move on to some specific disease states related to the foods we eat, things like obesity and diabetes and heart disease, also asthma, depression, ADHD, even some cancers. 

We'll talk about how to approach conflicting information about food that you may come across and how to think critically before you buy in to the latest diet fad — the one that seems too good to be true, probably is. Most certainly, it is. Or an expensive nutritional product or supplement with the wild claims that you hope for true but you know, they simply can't be true. And you know the ones I'm talking about. 

At the end of the day, or at the end to the episode as the case may be, my goal is just to do a sort of a reset on everything you thought you knew about food and hopefully provide some practical clarity as we think about that everyday task of eating.

0:08:09

And to help me do that, I have a couple of fantastic studio guests joining me. Dr. Maria Mascarenhas is a pediatric gastroenterologist at Children's Hospital of Philadelphia, also known as CHOP. And she is director of their Integrated Health Program. And Dr. Ala Shaikhkhalil is a pediatric gastroenterologist and nutrition expert here at Nationwide Children's Hospital. 

Before we get to them, I do want to remind you that if there's a topic that you'd like us to talk about, you have a suggestion for the program, you want to point me in the direction of a news article or journal article, or you have a question, it's easy to get in touch. Just head over to PediaCast.org and click on the Contact link. 
                  
Also, I want to remind you, the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to 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. 

So, let's take a quick break, we'll get our guest settled into the studio and I will be back to talk more about food as medicine, it's coming up right after this.

[Music]

Dr. Mike Patrick: Welcome back to the program. Dr. Maria Mascarenhas is a pediatric gastroenterologist at Children's Hospital of Philadelphia and an associate professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. She serves a section chief of Nutrition at CHOP and director of their Integrative Health Program, which plays as special emphasis on the topics we are discussing today — food is medicine. 

So let's give a warm PediaCast welcome to Dr. Maria Mascarenhas. Thanks so much for joining us today.

0:10:20

Dr. Maria Mascarenhas: Thank you. It's my pleasure to be here with you.

Dr. Mike Patrick: Really, really appreciate you taking the time to be with us. 

We also have Dr. Ala Shaikhkhalil in the studio. She is also a pediatric gastroneurologist and nutrition expert here at Nationwide Children's Hospital and an assistant professor of Pediatrics at the Ohio State University College of Medicine. So, a warm welcome for you as well, thanks for being here with us.

Dr. Ala Shaikhkhalil: Thank you for having me.

Dr. Mike Patrick: Yeah. Let's start with Dr. Mascarenhas, what is meant by this phrase food is medicine?

Dr. Maria Mascarenhas: So, food we know is very important and food is all the foods that we eat, and medicine we take when we're sick. And so now, what food is medicine is how do we take food and harness or utilize the properties that it has to use it to make us feel well. 

And this is really key not just for treating disease, but also disease prevention. So, how can we eat the right foods and use them and use special properties that they have to make sure we are healthy and don't get sick? And if we do get sick, how can we use them to make us get better?

Dr. Mike Patrick: Yeah, absolutely. So, at the end of the day, food is really chemicals that are put together just like medicine are chemicals. And when we ingest them, they get absorbed and broken down by the body unto individual chemicals which interact with the body. And so, there's going to have good effects and bad effects. So I suspect the food can be medicine, it can also be poison.

Dr. Maria Mascarenhas: This is correct.

Dr. Mike Patrick: And I think another good place to start is just a review of what the different food categories are? And so, parents, you hear about carbohydrates and fats and proteins. And we're going to be talking about which one of those you want to emphasize and what are good ones and bad ones to some degree. Because you can really get into the weeds here and you can do an hour just on carbohydrates, right?

0:12:11

Dr. Maria Mascarenhas: Exactly. 

Dr. Mike Patrick: But let's just sort of do an overview of what these nutrients are and sort of what benefit but also what problems could come up. I think carbohydrates would be a good one to start. 

Dr. Shaikhkhalil, just run us through what a carbohydrate is?

Dr. Ala Shaikhkhalil: Yeah. So, carbohydrates, proteins, and fats are the building blocks of our major components of the diet. And as you said, there's a lot to be said about them and some can be good and some can be bad. And the information can be confusing. 

But carbohydrates are foods that consist of starches. So, you think your grains, your wheat, your pasta, bread, rice, some legumes like beans and lentils. Those are the foods that we mean by when we say carbohydrates. And generally, they have fiber, they have starches, they have sugar in them in that the three combinations.

And when we talk about carbohydrates and the content of, either the words complex carbohydrates come up and what that does really mean, and then there's enriched, and there's whole grain. All these concepts that come up with that. 

And the idea is that there are end production of carbohydrates is sugar. When it is broken down, it's broken into glucose and we absorb it. However some carbohydrates also contain fiber, which is not broken down and doesn't get to become sugar.

So, when we say complex carbohydrates, it's the carbohydrates that our body needs to work on in order to break it down to become the sugar components of it. Whereas, the carbohydrates that have a lot of so called simple sugars are ones that directly get absorbed into the bloodstream. And those are the ones that we worry about.

Dr. Mike Patrick: And the purpose of carbohydrates in the body really is an energy source?

Dr. Ala Shaikhkhalil: Absolutely. It is a main energy source. And especially for teenagers and growing children, their main energy source should be from carbohydrates. Sometimes up to 50 or 60% of our caloric requirements should come from carbohydrates. But again, that includes legumes and whole grains and things like that.

0:14:09

Dr. Mike Patrick: Sure. And then if you ingest too many carbohydrates and your body doesn't need all that energy, it's going to save the energy for later. Because if we were in our sort of native environment out in the wild, and we don't know what our next meals going to be, then you have to have some storage of energy for later kind of to take advantage at meal. So tell us how that come then run into some problems?

Dr. Ala Shaikhkhalil: Yeah. So, when you are ingesting more than you need, your body will start first into short-term energy in the liver as an immediate sugar source. However, after that, whatever was left over is converted into fat that the body stores. And eventually, if that energy intake continuously exceeds your needs, then more and more fat would build. And that can have a very negative health outcome.

Dr. Mike Patrick: The other one that you mentioned was fiber. It is a part of carbohydrates. What is the purpose of fiber?

Dr. Ala Shaikhkhalil: So, fiber is actually very, very healthy and very helpful and serves a couple of purposes. One is it helps bulk up content of the bowels, poop. So when you are eating more fiber, your poops are easier to pass. 

As a gastroneurologist, we talk about poop all the time in our clinics. And we have constipation problems that are very common. And so fiber can be use to make your poop easier to pass. And believe it or not if you have diarrhea, more fiber can also thicken up your poop and make it less liquidy. 

Also fiber is a source of nutrition for our colons. So, when the fiber hits the colon, bacteria can break that down into what's known as short-chain oligosaccharides or probiotics. So, these are the fat food the bacteria will use to make the good bacteria grow in numbers. And also, it's food for the cells of the colon.

0:16:08

Dr. Mike Patrick: So, fiber's a good thing.

Dr. Ala Shaikhkhalil: Fiber's a great thing.

Dr. Mike Patrick: Great thing. 

Dr. Ala Shaikhkhalil: Yeah. 

[Laughter]

Dr. Mike Patrick: And how can parents tell the carbohydrates that they're getting is rich in fiber? Is there something they can look on the label to tell, hey, this is a good one?

Dr. Ala Shaikhkhalil: Yeah, that's a very good question. So, yes, the label will have the fiber content per serving. I mean it's very important to look at how many servings than it is whole box of whatever it is you're eating.

Whole grains are the grains that contain three layers of the plants. So if you have the wheat, it has the germ, it has the fiber around and all these layers, and that's really helpful. Marketing-wise, many food labels will have whole grain, front and center at the label upfront. But that only means that there is some whole grain in the product. It doesn't mean that it is all whole grains. So, when you look at the back, it should tell you how many servings of whole grain is in this product and that can be helpful for parents to look at.

Dr. Mike Patrick: Yeah. And you could compare fiber content?

Dr. Ala Shaikhkhalil: Exactly.

Dr. Mike Patrick: Of two different things. They may both say whole grain but it doesn't necessarily that they have an equal amount of fiber in.

Dr. Ala Shaikhkhalil: Yes.

Dr. Mike Patrick: And we're going to talk more about processed foods in a few minutes but I think that really relates to this because when grains are processed, they're not whole anymore. And it's really the fiber and then a lot of micronutrients that also get taken out during the refinement process, which then makes it not as nutritious, right?

Dr. Ala Shaikhkhalil: Exactly. And sometimes, they put some of the micronutrients back like a folic acids or the iron. But yes, the fiber content and some of the other more subtle changes are definitely lost when the food is processed.

Dr. Mike Patrick: Let's move on to fats. So, what are fats? And what are their benefits and problems?

Dr. Ala Shaikhkhalil: So, fats are also a very important source of calories. And you think of fat, you think it's oils and the butters and things like in dairy. There's also different breakdowns of fat. It should be around 30% or so of what we eat, calorie-wise, for the energies.

It's very important for growth and children. It's important for their brain development. It's important for many cellular functions around our body. 

0:18:19

And then, when you think about fat, it's broken down into, you hear the terms 'saturated fat', 'unsaturated fat', 'transfat'. And all these terms are also can be very confusing to our families. And so, a little bit of maybe an easy way to look at it is saturated fat is the fat that's going to be solid at room temperature — so butter, whole cream, whip cream and also the fat in milk and dairy. 

Unsaturated fat tends to be liquid at room temperature. So olive oil and these ones. And then, also the fats that's in nuts is unsaturated. 
Transfat is almost entirely as synthetic fat and it became very popular, I would say, few decades ago with the margarines and things like that increase the shelf life of certain products like oil. 

And when we quickly discovered as the medical community that it really has very deleterious health care outcomes, and recently the labels are now require to tell how much transfat is in certain food. And since that, the government mandated that the content of transfat in food in general has dropped quite dramatically.

Dr. Mike Patrick: So, transfats are the worst of all of them. And then, we kind of it seems go back and forth sometimes in terms of recommendations that you hear with different types of fats. And again, we could do a whole program just on that.

Dr. Ala Shaikhkhalil: Yeah.

Dr. Mike Patrick: But in general, are the liquid fats healthier would you say than the solid fats just as a general rule? Or no? Is that oversimplifying it?

Dr. Ala Shaikhkhalil: I think as a general rule, yes, but into some degree, there is a bit of oversimplification on that because you still want some of the different fat profiles. Because with fat, the main component is something called fatty acids which is a biochemical structure that has a carbon and a hydrogen atom. And it has various lengths and various amounts of double bonds in it. And not to get too much into the biochemistry of that, but depending on how long that molecule is, your body will use it differently. 

0:20:22

And there are certain fatty acids that we call essential because our body cannot make them on its own. And there are ones that are non-essential, meaning that if we get the essential ones, we'll make anything else from that. 

And then, there's also this whole concept of what Dr. Mascarenhas is talking about in grand rounds today, the anti-inflammatory diet. And some fatty acids tend to have a pro inflammatory effect, which means increasing just the general level of inflammation in our bodies. And we now know that inflammations affect our health in many different ways.

Dr. Mike Patrick: True.

Dr. Ala Shaikhkhalil: So, looking at the pro versus anti-inflammatory component of these fats can be quite important as well.

Dr. Mike Patrick: Yeah, yeah. In addition to inflammation and that possibility with sort the wrong mix of fatty acids, what other concerns are there with fat intake?

Dr. Ala Shaikhkhalil: Fat is a very efficient energy source. And that means it has a lot of calories. And despite the fact that it has important benefits to us, if you eat more of that, it's very easy to gain excessive weight. And that is the main concern. 

And then depending on long-term, if you look at that risk associated with high weight including cardiovascular disease, diabetes, all the other diseases.

Dr. Mike Patrick: Like high blood pressure all that goes along hand in hand.

Dr. Ala Shaikhkhalil: Exactly.

Dr. Mike Patrick: So, let's move on to proteins, what are proteins and sort of what's their purpose in the body and what concerns could there be with those?

Dr. Ala Shaikhkhalil: Yes, so proteins are also building blocks in our diet and they consist of something called amino acids. And our body takes the protein and breaks that into its building blocks, amino acids, and then uses those to build their own protein in muscles, hormones, different things around the cell. So it really helps in building our bodies. 

0:22:17

And as children grow, they need even more of the building blocks. And so you will notice that your protein requirements in infancy are much higher than when we get older. And one of the main issue that we see with protein is that it's very well known that you need protein. And many parents worry that their children aren't getting enough protein and they want to focus on these sources of protein. 

And when we look at the typical American child and adult, we almost always get more protein than we need for our building blocks. And so, what you don't use for building becomes the source of calories. And then, again the problem becomes that excessive can cause weight problems. And it also can have long-term outcomes on calcium metabolism and kidney issues and things like that when you get too much protein.

Dr. Mike Patrick: You also kind of have to consider the fat with the protein because depending on what source of protein you're getting, there may be some fat coming along. And so that's where we talk about red meat versus lean meat. And it's really that fat content that's different. What about animal-based proteins versus plant-based proteins? Is there a difference between those in any way?

Dr. Ala Shaikhkhalil: I'll let Dr. Mascarenhas answer your question.

[Laughter]  

Dr. Mike Patrick: Yeah, absolutely.

Dr. Maria Mascarenhas: So, there is a difference between animal-based proteins and plant-based proteins. Typically, as Dr. Shaikhkhalil says, you'll get fat with the protein as it comes in. And there are studies suggesting that the plant-based proteins are probably healthier for you than the animal-based proteins. Again, from the inflammation standpoint. 

And so, what you'd really want is more plant-based proteins in your diet. And you do need animal-based protein but probably less of that than the plant-based proteins. And in life, everything is a balance. So, you need to balance everything. And above all, make sure your food is tasty.

0:24:12

Dr. Mike Patrick: Yes, yes, very important. And the moderation thing, too. So, if you look at different, some foods are higher in calories some lower in calories. But if you decrease the total amount, you're going to get decreased calories regardless of which ones that you're eating.

Let's then talk about processed foods. What is a processed food? I think we kind of hinted at it when we talked about with the whole grains versus refined grains. Why do we refine to begin with and what effect did this have in our health?

Dr. Ala Shaikhkhalil: Yes, so processed food is essentially any food that's been in a factory and come in a package, if you want to look at it simply. And food is processed for a variety of reasons. Sometimes, it increase its palatability. Sometimes, it increase its shelf life, make it less likely to spoil faster and that kind of thing.

So it increases the access to foods in a certain way. But because of that processing and the effort that the factories or the food industries makes in making it more palatable, you almost always have more sugar add in. 

And the refined grains, meaning that you take these outer layers out. It does make it taste different. Especially for children, they tend to accept that taste a lot more than they would for non-processed food, if that's the only thing they're introduced to. And that's the main concern that we have with processed foods.

Whereas, the whole foods is the food that is minimally processed. You think of a piece of fruit, you think of a piece of vegetable, a grain that has been collected and harvested, meat that has not been processed or cured or smoked and that kind of thing.

Dr. Mike Patrick: So, the further you get from the food sort of natural state in general, it's not going to be quite as healthy for you as if you eat it the way that it came.

0:26:11

Dr. Ala Shaikhkhalil: Exactly.

Dr. Mike Patrick: Got you, yes.

Dr. Maria Mascarenhas: The other thing in processed food is the additives that are put into it, so the preservatives and the chemicals. So not all them are good for you. And as we learn more about how important the bacteria in our intestines are, these bacteria maybe responding to changes in those chemicals. And so, we're beginning to now understand the long-term effects of that. And for some of them, it could be actually inducing inflammation in your intestines. 

So there are many things that come along with processed food. The convenience is there but there also other things that come along with.

Dr. Mike Patrick: Yeah. I want to take that term 'inflammation'. First, explain for parents what exactly is inflammation and how is it that food contributes to it?

Dr. Maria Mascarenhas: That's a tough one — how to explain inflammation in a simple way. Inflammation is a reaction in your body where chemicals are released. And you can have two kinds of these reactions, the good inflammation and the bad inflammation. The good inflammation is when you get a cut in your skin and the white blood cells come then along with chemicals to heal it. And so, that's where you want inflammation. It's a good inflammation. 

But when you have a bad inflammation, it's when these chemicals are released. And this happens more over time and they damage a body in different ways. So a lot of western diseases are linked to the bad inflammation like obesity, heart disease, hypolipidemia, diabetes. So, these are all linked to bad inflammation.

And so, we do know that stress in the body along with diet and many other factors can lead to these inflammation. And so, how diet contributes to that is the key thing.

Dr. Mike Patrick: Yeah. And one of the ways and please correct me if I'm wrong because I'm certainly not a gastroenterologist or a nutrition expert, there's this concept of the microbiome that we have covered here on PediaCast before. So the microorganisms that you have growing in your intestine, do those contribute to the amount of inflammation in your body? And then, do foods that you eat have an effect on which mix of organisms are in your microbiome?

0:28:22

Dr. Maria Mascarenhas: It's a very complex ecosystem. There are actually more bacteria in your intestines than you have cells in your body, so it's very complex. 

And there's more and more evidence linking the food with the bacteria? And it's just not bacteria, it's viruses and fungi and other things. But it's also how they talk to each other and then the chemicals they produce. And based on how the interaction happens between the food, the bacteria, how they crosstalk, the chemical they produce, you actually produce inflammation in the intestine. 

So a good example is something called carrageenan. Carrageenan is used in a lot of almond milks, that's where you might find it. And carrageenan has been used in an animal model in the lab to induce colitis.

So, it's very important how you eat the food and then how the food also causes the inflammation.

Dr. Mike Patrick: Yeah. Now, we're going to kind of move toward talking about how diet can decrease inflammation, which then could in fact sort to be used as a medicine. Because if inflammation is related to specific disease processes — and asthma would be another one of those and allergies — then if we manipulate diet in a certain way to create less inflammation, then that may help prevent or even treat diseases, correct? 

Dr. Maria Mascarenhas: Absolutely, absolutely. 

Dr. Mike Patrick: So, let's start with just the American diet. What is the description would say of just your typical American diet in terms of the amounts of the different types of foods that we've been talking about?

Dr. Maria Mascarenhas: So, I'm going to start up by saying that often when we do lectures, what you hear is a Standard American Diet. So, it's S for standard, A for American, D for diet. So, it's SAD.

[Laughter]

0:30:09

Dr. Maria Mascarenhas: So, often people will put S-A-D that it's like, okay, Standard American diet. But the typical American diet is one that's rich in red meat, dairy products, has lot of unhealthy fats, refined sugars, processed foods, artificial sweetened foods and also genetically modified foods. There's not much fruit, vegetables, fish, legumes, the whole grains. It's the typical one. And then, it's about 50% carbs, 15% protein and about 35% fat.

Dr. Mike Patrick: Okay.

Dr. Maria Mascarenhas: That's probably the typical diet.

Dr. Mike Patrick: Sure.  So that being the typical American diet, and then we look at the incidents of inflammatory related diseases, the ones that we've talked about — obesity, heart disease, diabetes, high-blood pressure, asthma, inflammatory bowel disease, all of these sorts of things. But then we look at maybe an area of the world where they have a different diet and much less of those things.

Now certainly, there are other factors that possibly could be involved. But one of those areas is a little island near Japan, Okinawa. Tell us about their diet and sort of the disease panel. What do those diseases look like in that population?
 
Dr. Maria Mascarenhas: Okay, so we learned about the Okinawan diet several couple decades ago. And the reason people focus on that is because they have elders there who lived a long life. They were pretty healthy. They didn't have any of those Western diseases. And they also didn't have much cognitive decline or depression. 

So when people saw that they were like, "What's different about their diet?" So, their diet is high end green and yellow vegetables. Root vegetables primarily sweet potatoes, soya beans, base fruits and other plants. 

Many of them have medicinal properties. So they take foods that have these medicinal properties like seaweed or turmeric or sweet potatoes and their leaves. And they incorporate into the recipes and what they have on a day-to-day basis to harness those really important effects. 
They also don't have much meat in them. It's a lot of seafood and fish. And they use spices to flavor their food but also to bring out the goodness or to promote the good chemicals in the food and the good reactions in your intestine.

0:32:29

Jasmine tea is also something that they drink as beverage. So there's not much dairy then and it's also quite low-fat.

Dr. Mike Patrick: One thing I found interesting, because you could say well, maybe genetically, these folks are healthier and it's not really their diet. But there have been some observations of when folks moved to another place and changed their diet, then you do start to see those diseases which make you think maybe it is the food that's involved.

Dr. Maria Mascarenhas: That's correct. There was a study done in China, in partnership with the University of Oxford and our own Cornell University. And they looked at 6,000 to 7,000 Chinese people who lived in different counties. And they found that when the people moved from one county to another, they got the diseases, Western type diseases. They change the diet they picked up. 

So, things changed. So it's not like you're genetically born with something. It's what you eat influence the appearance of Western disease in that population. And they studied these patients over several years, so they will be able to get very good accurate record of what was happening.

Dr. Mike Patrick: There's another area in the world where you can look and see that those diseases also have decreased incidence. And you look at what we would say the Mediterranean diet? Tell us about that one.

Dr. Maria Mascarenhas: Okay. The Mediterranean diet really is not a specific diet but it's more of a pattern of eating. And it's seen in the countries around the Mediterranean sea — so Spain, Southern France, Italy, Greece, parts of the Middle East. And it's really a plant-based diet again. 

0:34:04

So, regular ingestion of vegetables, fruits, whole grains, cereals, legumes, nuts, a lot of olive oil. And the oil really comes from the nuts and the seeds. There's a moderate amount of low-fat dairy products like yogurt, cheese and butter. 

So, this is different from the Okinawan diet where there is not much dairy. Here, there is dairy but it's low-fat and again a moderate amount. There's moderate amount of ingestion of fish and shellfish. The meat is really white meat, not so much red meat. And there are eggs in the diet as well.

There's lots of water and moderate ingestion of wine. Not that we're telling our children to drink red wine but wine is part of that diet. Again, wine has a very important chemical called resveratrol, which has been shown to be anti-inflammatory as well. 

So, the other part of this diet is that to use wide variety of foods. They're eaten in season. So we're not eating food that's typical is in season. So, now with fall, it would be you're eating  pumpkins. So, they eat foods that are in season, that is locally grown. So, again, it reflects what's around you.

So, it's not coming from a distance. So if it's come from a distance it's probably preserved, fumigated, altered in some way, processed in some way, as Dr. Shaikhkhalil said. So, it's locally grows, it's fresh, it's in season. And this actually maximize its nutrition content because the longer you keep your food, the more chemicals and preservatives you put into it, the nutritional value does go down.

Dr. Mike Patrick: And these folks also in addition to eating different foods, they sort of eat in a different way, too, don't they?

Dr. Maria Mascarenhas: Absolutely. So, they eat with families. They work together. They take time eating their food. And so, food becomes not just the way to eat and put nutrition but it becomes a way of living. So, you have dining as suppose to eating. And I think that's key. You're kind of paying attention to what you eat. And you're in a happy atmosphere with your loved ones and your family.

Dr. Mike Patrick: Yeah. And there's something to be said for that in terms of mental health for sure.

Dr. Maria Mascarenhas: Absolutely.

Dr. Mike Patrick: And having meals together and talking. Because we really eat on the run a lot here on the United States. And so, we could learn something certainly from that culture.

0:36:15

So then, this really been soon termed anti-inflammatory diets because this way of eating and this mix of foods results in fewer of these inflammatory associated diseases. So I guess the next question would be how can we, here in the United States, best alter our diets to really mimic this anti-inflammatory diet? And is there any evidence that if we do that that it does make a difference?

Dr. Maria Mascarenhas: So, there is a lot of evidence from studies that have looked at the Mediterranean diet which show that you can definitely change a risk. For example, there was a study done in France called the Lyon Heart Study, where they took patients on a heart attack. They put them on the Mediterranean diet and they were able to reduce the chance of getting a second heart attack dramatically. It was so dramatic they stopped the study when they found this. So that all patients would benefit from the study. 

But to go back to your question about what should a diet look like. I think the diet should really be primarily a plant-based diet. So, it should contain vegetables and fruits. Again, more fruit than vegetables.

Dr. Mike Patrick: Or more vegetables than fruit.

Dr. Maria Mascarenhas: Sorry. Thank you, thank you. More vegetables than fruit.

Dr. Mike Patrick: I remember that because I didn't like that.

[Laughter]

Dr. Maria Mascarenhas: Yes. It's a very hard shift, you know. But I made it. So, if I can do it, I think other people can because I really love my fruit. But I think it's vegetables and fruit. More vegetables than fat, very important point.

Again, using the whole grain that Dr. Shaikhkhalil talked about. Beans, legumes are very important because again you're getting the complex carbohydrates, you're getting some protein in there. Also beans and legumes are good for fermentation in your intestines. So again, that's good for the microbiome. Pasta, absolutely. Pasta, maybe two or three times a week if that's what you like. 

0:38:11

And what's nice in Italy, they have the pasta what they call 'al dente', means it's not too soft. Because when your pasta is not too soft when it's just a little bit firm, then actually, your body has to work a little bit harder digesting it. So, again you burn more calories eating it. So, I love pasta. So, enjoy your pasta. But your body is working a little bit harder, so you tend to store less calories.

Dr. Mike Patrick: You just not cook it quite as long?

Dr. Maria Mascarenhas: Correct. And if you look at the box, they'll say how to make it aldente, as well as how to make it the regular way, yeah. So, if you want aldente, you'll see a minute or two less in boiling water.

Dr. Mike Patrick: Yeah, that's good for you. That's a simple little change that folks could make that could make a difference.

Dr. Maria Mascarenhas: Absolutely. The other thing I would do is to make sure you're getting healthy fats. And healthy fats really coming from extra virgin olive oil, or nuts and seeds. Walnuts are really good. Avocado's very good. 

Again, in general, as Dr. Shaikhkhalil said, the vegetable-based oils are healthier than animal-based oil. But you need a balance of everything which is why if you look at this diet there is a balance. They're not all vegetarian but there's a balance. Of course, if you want to be on a vegetarian diet, you can have a very healthy diet. But there's a balance in all these things, yeah. 

And then, I think other source of protein are good. People talk about omega-3 enriched eggs because what happens is if the chickens eat a diet that's healthy, then that reflects the kind of fats in the eggs. And so, if the chickens are eating a lot of corn, then the fats in the eggs reflect that balance. And then your body reflects what you're putting it.

So, it's important to pay attention to foods that you're eating. And the last thing I want to mention is very small amount of sweets. It should be set sparingly. So, the change we made in our family is instead of having dessert of pie or cake or a cookie, we eat fruit for dessert.

0:40:09

Dr. Mike Patrick: Yeah, very good, great suggestions. So, if we have to sum it up, it's going to be you want more vegetables for sure. You'll still want dairy and fats but less of them than fruits and vegetables, heavy on the vegetables. You still need a variety of meats but less of them than what we're used to. And then, the processed sweet stuff, I mean just special occasions, right?

[Laughter]

Dr. Maria Mascarenhas: And a little bit of fish thrown in. If you can, wild fish would be great. 

Dr. Mike Patrick: Yeah. And really a little bit of everything in moderation, but go heavy on the vegetables and the fruits. So, how do you get kids to eat more vegetables? This is the million dollar-question, right?

Dr. Ala Shaikhkhalil: Yeah. That is definitely the million-dollar question. And I don't know that there is one universal trick for that. One of the things that I think maybe could help is shifting the thinking and the culture about children should eat differently than adults. Once you are a  toddler and able to process table foods from the developmental standpoint eat and swallow foods, there's nothing that says that children need to eat off the kids menu. They can certainly try and eat all the foods that adults eat. 

And as parents, we must model healthy behaviors for our children. And you would be surprised at how much children notice about what their parents are eating, what their teachers are eating and everybody else. And so, that is an important shift maybe in how we think. 

I grew up in the Middle East and in my family, you ate what the parents ate. And if you didn't like that, well then, you didn't really get much of a choice. But the vegetables were there and they were placed on your plate and you eat them. And most parents know that their children should eat more vegetables, and they definitely try to do that but it is a challenge to do it. 

0:42:11

So some of the things about shifting the culture and incorporating the food for everybody. Everybody's going to eat this vegetable today, place it on the plate. If the child doesn't eat it, don't make it too much of a fuss or comment. You can take it away, try again later, and keep incorporating it in the diet. 

And also, I would love for the schools and day care centers to incorporate the culture of fruit as dessert. You wouldn't believe the number of times where there's cupcake day and bake sales, and all these things. And it becomes part of the kids' everyday life to eat these things and that's what's normal for them. 

But if we made birthday apples or cucumbers or whatever the case maybe. And children will have fun with that. They'll play with, they are very…

Dr. Mike Patrick: Especially if everyone else is doing it.

Dr. Ala Shaikhkhalil: Exactly.

Dr. Mike Patrick: And I think the earlier you start this, the easier it is, right?

Dr. Ala Shaikhkhalil: Absolutely.

Dr. Mike Patrick: Because like my son, not a big vegetable eater. And once you're a teenager, it's really hard to change those habits, isn't it?

Dr. Ala Shaikhkhalil: Yes, yes.

Dr. Mike Patrick: And another thing I've heard is having your kids go shopping with you and help pick up out the vegetables, and then help in the kitchen and help preparing them. So they're kind of invested in this meal and maybe they're more likely to accept it and eat it.

Dr. Ala Shaikhkhalil: Yes, exactly.

Dr. Maria Mascarenhas: You've mentioned earlier, I want to raise a point of how early can you start this? There's actually studies saying that what a mother eats when she's pregnant actually can influence the taste preference of the baby. So, it's important to start eating this healthy diet even if you're contemplating getting pregnant or while you're pregnant with your baby.

Dr. Mike Patrick: Yeah.

Dr. Ala Shaikhkhalil: Breastfeeding as well.

Dr. Mike Patrick: Yeah, very good point. So, eat well, eat more veggies during pregnancy and while you're breastfeeding. And when you do have that the kids who really are having difficulty with it, or let's say you're thinking. "My kid's 12 years old. They don't want to eat any vegetables at all. Is it too late? Did I make a mistake?" 

But you can make little adjustments, right? It doesn't have to be, "Okay, we're going to change your diet completely. And now, all you're getting is vegetables." I mean, that's going to create some problems.

Dr. Ala Shaikhkhalil: Yes.

0:44:25

Dr. Mike Patrick: So what is the better way to sneak some things in there and change things slowly?

Dr. Ala Shaikhkhalil: Yeah. So there are different ways to add vegetables into food. For example, one of the things that we've been doing with our pediatrics residents here is a culinary medicine course, where we teach residents how to cook healthy foods. 

And we have this one class where we make spaghetti and meatballs. And we make them in four different variations. One is a traditional spaghetti and meatballs. The other one, we take half the meat out and we put mushrooms instead. And then, the other version is we put even less meat, more mushrooms. And the fourth version is completely vegan with just lentils and vegetables. 

And we have the residents taste all four. Some of the residents would say, "Well, my husband wouldn't really go for that." But when we tried the half meat – half mushrooms, they said, "Yeah, they'll definitely eat that." 

And so, making gradual adjustments and adding things to the normal day-to-day foods. So the kids would recognize their Mac and cheese but maybe now, there's some broccoli in it. And as you advance in that and your palate adjusts to the texture and the taste, you can certainly start increasing things there. 

And certainly, don't present it as punishment. Don't present it as here's your vegetable, you must eat this before you can do anything else. Having the positive light of, "Look how colorful this is. This looks like enjoyable." And that can help, too. 

Dr. Mike Patrick: Yeah, yeah. And why is this only offered to the residents? I think we need a culinary medicine class for all of the faculty, too.

Dr. Ala Shaikhkhalil: That's our hope. This is still a pilot implementation. So, our hope is to expand it to everybody and offer even a CME type of course. It's really fun to do.

Dr. Mike Patrick: Absolutely. That sounds great.

0:46:10

Dr. Maria Mascarenhas: The other thing that parent should know when you're trying to introduce foods into your diet that are good for them is that it may take between 15 and 17 tries. So just because they don't take it the first time or the second time, that there's research saying that it may take multiple times. And that ultimately, they will take it. So be patient and you'll probably be able to achieve something.

Dr. Mike Patrick: Do they have to take a bite of it? Or is it just enough that it's on their plate?

Dr. Maria Mascarenhas: I think on your plate, lick, a small teaspoon, little bit and slowly they'll get used to it, yeah.

Dr. Mike Patrick: Now, one question then that I would have is, are there any disadvantages to this sort of diet, anti-inflammatory diet with much more vegetables and less meat, less dairy, certainly less sweets? Could you be missing some nutrients by switching to this sort of diet?

Dr. Maria Mascarenhas: Actually, they've studied this, the nutrient adequacy of this diet in adults and children and there are no nutrient deficiencies. They've actually shown that children who are on this diet have better intake of lot of important nutrients — so fiber, calcium, iron, magnesium, potassium, phosphorous. 

They've also shown that when the calcium is ingested in this food, there's actually better absorption retention. So, think about that. So, you're eating these foods and your bones are getting healthier as well. 

And there also really good, some early data looking at improvements in asthma, school performance, fatty liver. If a child is obese, et cetera. And then ADHD, also there's some associations saying that this Okinawa diet or the Mediterranean diet maybe actually healthier for you.

Dr. Mike Patrick: And so this is evidence-based, in terms of this sort of diet really being able to help things like obesity, heart disease, high-blood pressure, and also asthma.

0:48:09

Dr. Maria Mascarenhas: There are a lot of evidence. And even in the elderly, cognitive decline, depression, they're linking it also, diet with mental illness now. 

What we do know is that — and this might be to the microbiome — there's a very nice body of literature talking about your brain, your gut function, your immune function, and your endocrine function. And think about it, if these systems are all connected, they're probably connected to the microbiome and the metabolon as we call it, which are the chemicals of the bacteria the microbiome make. And diet is one thing that influences all these because you're putting food directly in the intestine.

Dr. Mike Patrick: Now, one thing that a concern that sort of comes up in my mind is that people may want to take this information and profit from it in some way. And so, maybe someone says, I have this special diet and you have to pay for a specific supplement that's going to make the diet better. How can parents sort of protect themselves from those who would try to profit from this information?

Dr. Ala Shaikhkhalil: I mean, I would say first, as healthcare providers, we should know more about diet and nutrition, so that way we can provide good counseling for our patients and they don't fall prey or victim to what's out there on the Internet and things like that. The good wisdom of if it sounds too good to be true, it probably is. I would say that parents should apply that if they tell you take this one pill and all your problems are gone, this sounds like a scam. 

And then, again moderation, if you look at dietary research over the last say decade or 50 years, nutrition research is difficult to do because you have so many variables — genetic variable like you said, variables in nutrition. People don't remember what they eat and so if you ask them, they don't really know. 

And that's some of the reasons why we have come up as a medical community with different recommendations over the years. We said no eggs. Now, it's eggs are okay, less fat, less sugar, no, do this. And so, I understand sometimes the public can be a little skeptical of the recommendation because they keep changing. 

0:50:15

So, we definitely want everybody to keep an open mind and as long as we have this moderation and continually adding healthier food to our diet, then I think we'll be on the right track. And looking at lifestyle in general because we not only want a healthy diet, we want a healthy weight. We want emotional resilience. We want mindfulness. And all these things are kind is kind of part of a healthier, more quiet lifestyle that we advocate for our patients.

Dr. Mike Patrick: And this is better done in the grocery store than it is in a bottle of pills that you may get in the mail, that has all these nutrients kind of packed in that you can just swallow.

Dr. Ala Shaikhkhalil: 100%.

Dr. Mike Patrick: It's really better to do this in terms of whole foods in the grocery stores, right?

Dr. Maria Mascarenhas: Absolutely, absolutely. I mean we can take an example of a vitamin like Vitamin A. Vitamin A is very important for a lot of things — eyes, skin, immune system. But when you take it as a supplement by itself, and you take high doses for a long period of time, you can actually have severe liver damage. You can have major damage to your bodies. 

So, again if you take a nutrient out of its natural form and ingest high amounts in their supplement form, first of all, you could be getting some other toxins in that supplement. But then, you actually, you're running into more problems. 

Whereas, if it's taken in the food, your body is this exquisite machine that knows how to take what you need and leave what you don't need and how to utilize it. Because again, the food is also interacting with other food groups in your intestine and the bacteria, and your body knows exactly what to do. 

So, you're right, whole food is better than taking a supplement. And whenever things come out, like this is the best thing, this is the best diet, just wait because sometimes, something else will come along which says that it may not be that good for you. So, I think to go back to plant-based diet from whole foods is probably the best.

0:52:11

Dr. Mike Patrick: Some of these supplements, they'll show you, "Okay, we did a study and it shows that this really is helpful. Maybe that's something that parents should take to their doctor and say, "Hey, can you look at this and tell me is this good science? Or is this maybe not so good science and other conflicts of interest? And who's funding the study? And is it really well designed?" 

And because that can be I think confusing for parents. You hear someone just says, "Oh, this study showed that this is helpful." I mean because we use evidence to say this is what we think is important, and the reason that you should change behaviors or do a certain intervention. And so, when someone else says that, but we all know that some studies are better than others.

So, I think just to push or put a plug in that if your having questions about this, talk to your doctor.

Dr. Ala Shaikhkhalil: Yes, and the National Institute of Health has a website which I could give to you later. You could maybe incorporate in the Show Notes if you would like because it has a list of all of the supplements, some of the evidence behind them, and the pros and cons. Because again, remember, these are chemicals. Some are good, some may have downside and poison. So even though it's natural, it may still have downsides in how it interacts with our foods and medications. 

So, it's really important to run these things by your healthcare provider and make sure that they know. Even if you will end up to taking these thing anyway, it's better for your doctor to know that you're taking it rather than take it and not tell anybody about it.

Dr. Mike Patrick: Yeah, let's definitely get that link and I'll make sure gets in the Show Notes. So I think that'll be extremely helpful for folks. 

One last thing that I wanted to talk about is irritable bowel syndrome. So, I think you hear this a lot, and there are different symptoms. The sets of symptoms of irritable bowel may be different from one person to another. So, could you just give a sort of an overview of what is irritable bowel syndrome and then how does it relate to food?

Dr. Ala Shaikhkhalil: Yeah. So, irritable bowel syndrome is a very common condition and being a gastroenterologist, I see that pretty much on a daily basis. I think we have about 20 to 30 million Americans who have irritable bowel syndrome. And I tell my patients if you talk to ten people with irritable bowel syndrome, you can get 11 sets of symptoms of what they have. 

0:54:19

So, it's a very variable condition in how it affects the body. It can cause abdominal pain, abdominal cramping, constipation, diarrhea, going back and forth between constipation and diarrhea, bloating, increase gas, discomfort and any combination of these symptoms.

The good news is irritable bowel syndrome is not a dangerous condition. Meaning, it does not cause you to develop serious long-term outcomes that we know of. But it's a very annoying condition. And it really affects the quality of life for children, adolescents, and adults that have it. 

And we do know that the symptoms, the progression, the severity of the symptoms have a lot to do with what we eat, our stress level, and how the microbiome, the stress level and what we eat interact altogether.

Dr. Mike Patrick: Yeah. And it's not necessarily a food allergy, right? Because you can't do a blood test and say, "Oh, these are the foods that you should avoid." At least that's not going to be a guaranteed sort of thing. Because it has a lot of trial and error and figuring out for an individual person what is going to help them get better or not get better. 

And sometimes, that mindfulness comes into play in terms of thinking about how we feel after we eat and trying to may be do  a food diary. And it can be confusing too because then you read things on the Internet from good sources that would say, "Oh, there's no evidence that this particular food causes this problem." But you really just have to think about your own body and be mindful of how food is affecting you because your microbiome maybe different than someone else's.

Dr. Ala Shaikhkhalil: Yeah, exactly. And I think that this degree of food intolerance, like you said, varies from person to person. And it's important for patients to discuss that with their doctors. And we can help them develop a fully represented diet that's rich in all the vitamin and nutrients while still eliminating the food that bothers them. But it does takes trial and error. 

0:56:23

One of the things I find myself is very helpful is getting rid of sugary beverages and artificial sweeteners in the diet as much as possible because they do seem to cause by-products of the bacteria when they take these sugars and artificial sweeteners. That gives you more gas, more bloating, more cramping and you're going to feel it even more when you have irritable bowel syndrome. 

So, this is something I ask every patient I see about juice, sweetened tea, even diet drinks are important. And these are relatively simple food group to take out and change your habits with regarding to IBS. And also other conditions really.

Dr. Mike Patrick: This is not good news for me because I drink diet soda more than I should. If my wife is listening now, she will be like, "See, I told you, you should not be drinking this diet soda." So, but I need a caffeine, so what's a better way for me to — coffee, tea, basically?

Dr. Ala Shaikhkhalil: Yeah. The coffee actually does have some health advantages and it seems to go well…  
           
Dr. Mike Patrick: And this is good news.

Dr. Ala Shaikhkhalil: It seems to go beyond the caffeine itself. When they compare coffee drinkers to, say, soda drinkers, even if their caffeine intake is similar, health outcomes can be different. And I think there's antioxidants in coffee beans that are helpful. 

I don't think we touched down antioxidants here on the diet. And it has a lot to do with anti-inflammatory diets. And so, anytime we make metabolism in our body, we make oxidants. And these oxidants are naturally everywhere and then our body as well but they damage our cells. 

So these anti-oxidants are just like what they sound. They're these food groups that come in and take these oxidants and protect ourselves from the damage that happen with them. And that is an important component of the anti-inflammatory diet. And they're present in fruits and vegetables. The more colorful they are, the more of the antioxidants we have.

0:58:17

Dr. Mike Patrick: And we  haven't really talked about cancer. But there's advantages for prevention and then ongoing treatment with cancer in terms of this sort of diet too, right? 

Dr. Maria Mascarenhas: Yes, there is data looking at in the Mediterranean diet and actually colon and breast cancer, and from the China study I mentioned, that clearly the Western diet was associated with breast and colon cancer. And eating more of the Asian diet or the Mediterranean was more associated with less of that. So, there's no question that eating well will prevent you or put you at less risk for getting this disease.   

Dr. Mike Patrick: Yeah, and I also want to point out, we've not really touched on this. This is really complementary to traditional medicines. So, if the kid has asthma, you're not going to treat their asthma just with dietary changes. I mean there's a role for medicine but this is going to help the medicine work better. Is that a fair way to say it?

Dr. Ala Shaikhkhalil: Yeah, I would say yes, definitely. Food can complement the medicine but in and of itself alone, it does not treat disease or prevent it completely. But part of a healthy lifestyle and with asthma there's not typical asthma diet that we know of. There's certain foods  that people can be allergic to, that can make their asthma worse. 

So, taking that out of the diet and talking to your provider about it can be helpful. Then more antioxidants seem to be associated with better asthma control in some studies. But again, that's not alone.

Dr. Mike Patrick: Yeah, you still need your rescue inhaler.

Dr. Ala Shaikhkhalil: You definitely need your rescue inhaler.

Dr. Mike Patrick: You still need your daily maintenance medicine if you need that.

Dr. Ala Shaikhkhalil: Yes.

Dr. Mike Patrick: Fantastic. And then, we have a lot of healthy providers who listen to this program, pediatricians, family practice doctors, nurse practitioners. How can healthcare providers really effectively use these information and truly prescribe food as medicine to their families?

1:00:06

Dr. Maria Mascarenhas: I think the one thing we need to do as healthcare providers is to be aware of the knowledge. And to stay current. So, to really look at the literature, go to your national organizations, learn. And then work with your dietitians, work with your colleagues at your institutions. Work with your patients to educate them.

The other thing is to have an open environment, so that if your patient's learning or reading about something, they should feel comfortable to come and discuss this with you. If you know about it, discuss it. If you don't, read about it and set up time to go back and say, "I looked at the article you sent me." Or, "I look at the website and these are the things I think are great. And these are the things that I don't think are great. And these are the cautions that I would, if you're going to follow this, these are the things I would tell you to be careful of." 

So, I think the education is key, the dialogue is key. And then, what I found personally is to make some of these changes in my life and for me to recognize its benefits have been so powerful. Because I can tell you, I stopped drinking Diet Coke and I feel so much better. Or I now don't eat dessert at home, I eat fruit instead.

And it's better, and my husband says that. Because you don't live in isolation. You live with the family. So, whatever you do impacts the other members. So, he's lost weight now and he feels better. His knee doesn't hurt as much. So, I think setting the examples is also key. 

Dr. Mike Patrick: And it's so much more personable, too, when you tell your stories and you connect with people. And it's something that's great for healthcare providers to do with their patients and families, anyway. So, fantastic. 

Well, we're going to have a lot of resources that providers and parents could use in the Show Notes for this episode 387 over at PediaCast.org. Actually, the American Academy of Pediatrics has a site called Healthy Children. And they a really large number of nutrition topics. As I was going through it, I was just amazed how many great articles that were there. Not only for parents, but for providers to look at as well. 

Just some examples, Five Great Reasons to Cook with Your Kids, Avoiding Food Traps, Choosing Healthy Snacks for Children, Energy In Versus Energy Out, and Daily Physical Activity Recommendations. Because we didn't talked about physical activity and sleep, but those really go hand in hand, right, with good nutrition? 

Dr. Ala Shaikhkhalil: Yes.

1:02:19

Dr. Mike Patrick: Make sure that you're getting eight to ten hours of sleep for kids and probably for adults, too and plenty of exercise as well. 
There's one on Kids Need Fiber, Here's Why and How, How to Get More in There, portion and serving sizes as we talk about moderation and decreasing overall calories in, whole grain, so just lots of great information. 

And then, we'll also put that site you had said from, was it National Institute Health?

Dr. Ala Shaikhkhalil: Yeah.

Dr. Mike Patrick: Okay, we'll put that in the Show Notes as well again, 387, over at PediaCast.org.

All right, so Dr. Maria Mascarenhas from Children's Hospital of Philadelphia and Dr. Ala Shaikhkhalil from here at Nationwide's Children's, thanks both of you so much for stopping by and chatting with us today.

Dr. Maria Mascarenhas: Thank you. It's really been a pleasure.

Dr. Ala Shaikhkhalil: Thank you.

[Music]  

Dr. Mike Patrick: All right, that wraps up our time together. I want to thank each and everyone of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.       
     
Also thanks to our two guests, Dr. Maria Mascarenhas and Dr. Ala Shaikhkhalil. Appreciate them coming on the program and sharing their expertise with all of us.

Don't forget, you can find PediaCast in all sorts of places. We are in iTunes, Google Play, iHeart Radio, Stitcher, TuneIn and most mobile podcast apps.

1:04:06

Also, we have a landing site with all of our past programs, 387 of them. Also Show Notes, transcripts of the program if you'd rather read the information. Our Terms of Use Agreement and, of course, that contact page if you'd like to suggest the topic or ask a question. 

We're also in the Parents On Demand Network at parentsondemand.com. It's a collection of podcasts that are really geared toward parents. So we're proud to have our content located there as well. 

We're also on social media. Now you can find PediaCast on Facebook, Twitter, Google+, even Pinterest, LinkedIn. And we really just appreciate it when you share the show with your own online audience. So that more parents can take advantage of our evidence-based pediatric podcast to hopefully improve the health of their children and family.

And of course, we also appreciate that when you tell others face to face — family, friends, neighbors, co-workers, babysitters, daycare workers, grandparents, anyone who has kids or take care of kids. That will include your child's doctor. Really we don't have a big advertising budget here. So, just we depend on word of mouth and getting the information out there that this program is available. And by telling your child's doctor, then they can share the show with their other families and kids that they take care of.

While you talking to your child's doctor about PediaCast, let them know we have a program for them as well. It's called PediaCast CME, which stand for Continuing Medical Education. It's similar to this program, we turn up the science a couple of notches and we do offer free Category 1 Continuing Medical Education Credit which all physicians need. Shows and details are available at the landing site which is PediaCastCME.org. 

Those shows are also available in the places where you can find PediaCast. So iTunes, Google Play, iHeart Radio, and most mobile podcasting apps.

1:06:01

All right, I want to thank you all again for stopping by 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.  

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