Vitamin D, Cigars, Mozart – PediaCast 198
Join Dr Mike as he covers news parents can use and adds three scientific studies to our research round-up. Topics this week include Vitamin D and its link to depression, dissolvable tobacco and nicotine (bad!), flavored cigars (also bad!), milk consumption and colon cancer, food marketing (an update), folic acid and language development, Mozart and epilepsy, and differences between boys and girls when it comes to concussion symptoms.
- Vitamin D and Depression
- Dissolvable Tobacco and Nicotine
- Flavored Cigars
- Milk Consumption and Colon Cancer
- Food Marketing Update
- Folic Acid and Language Development
- Mozart and Epilepsy
- Boys vs Girls: Differences in Concussion Symptoms
- Cleft Lip and Palate Center at Nationwide Children's Hospital (Facebook)
- Snap Crackle Pop – PediaCast 163
- Folic Acid Supplements in Pregnancy and Severe Language Delay in Children (PubMed)
- The Long-Term Effect of Listening to Mozart in Children with Epilepsy (PubMed)
- Sex Differences in Concussion Symptoms of High School Athletes (PubMed)
- All About Concussions – PediaCast 177
Announcer 1: This is PediaCast.
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!
Mike Patrick: Hello everyone! And welcome once again to PediaCast, a pediatric podcast for Moms and Dads. Also for clinicians too. We have a growing number of physicians and nurses in the audience. We would like to welcome all of you to the show too.
We really try to keep things in a language that parents can understand, but provide enough depth for the rest of you as well. And hopefully we're doing a good job with that. If you have suggestions for the show of course we are always open to them.
We are coming to you from the campus of Nationwide Children's Hospital in Columbus, Ohio. And it is February 8th, 2012. We're calling this when Vitamin D, cigars, and Mozart. We'll talk a little bit more about exactly what's coming your way and because there's always more topics.
And just what we've mentioned in the intro here, especially for our news. And actually this is not going to be a listener's show, we're doing a research round up today. We haven't done one of those in a couple of months. So, wanted to get back to some research topics which are pertinent for moms and dads. So, I think you'll find them interesting. And we'll put them again in the terms that you can understand pretty easily.
Before we get started with that though, it is our one year anniversary here at Nationwide Children's Hospital. So, we used to do PediaCast in Orlando, Florida. And we moved up North, thought we're going to have some really cold winters.
This is not turning to be one of them. Although last February I know we were greeted to a couple of ice storms right off the bat. So, that was trying, but this year we really had a mild winter, I think yesterdays high was almost 60 degrees which is unheard of in this neck of the woods. So, we're enjoying the warmer weather.
I mean, you kind of miss the snow a little. I don't the ice, don't miss the ice at all. But I have miss having a couple of snow storms. We live in Ohio before we moved to Florida for many many years. And so, we are used to Ohio winters. Anyway, I guess I was hoping for one good snow storm this year and we haven't really had it. So, now I just want spring to get here. At this point we're being teased with a nicer weather.
Also, this is kind of cool, we have another brand new Facebook page for you, that's affiliated with Nationwide Children's. We're really tying to build more specialized Facebook pages so that we have communities around specific topics. And I mentioned a couple shows ago that we had launched our sports medicine Facebook page.
And that we've launched another one, this one is for cleft lip and cleft palate. So, if you have a child or someone you love, or no who has cleft lip or cleft palate, you could either join that Facebook page or let others know about the resource.
So, it's not just about the happenings in the cleft lip and cleft palate center here at Nationwide Children's, we really wanted it to be an entire support community of folks who are dealing with cleft lip and cleft palate. And so, even if you aren't in Central Ohio, you may have a voice on that page and can help other people who are threading the path that you have once trod. So, make sure you check that out, just go to Facebook, do a search for Nationwide Children's Hospital cleft lip and palate center.
And if you want a real easy way to do it, just go to the show notes for this episode 198 and we'll have link for you to the cleft lip and palate center the Facebook page here at Nationwide Children's Hospital.
Also, want to remind you this is sort of new, we are doing transcriptions now of all of our shows. So, if you go to the show notes, we have all the topics lined up, the guest, but then we also followed that up with a transcript -a written transcript of the show. So, if you don't have time to listen, you can interact with it at the website.
Also make it more searchable in terms of finding topics that we talked about that weren't necessarily included in the title of the show or in our topic list that just kind of came up because I decided of the cup to talk about it. It will make things a little easier to search for each episode. So, we're excited about that.
OK. So, what we're going to talk about this particular episode Vitamin D and depression is a possible that Vitamin D supplementation could increase your mood and cause less depression symptoms, we're going to talk about that. Also dissolvable tobacco and nicotine products, not good things. And flavored cigars aren't good things either. We're going to talk about those.
What about milk and colon cancer. Can milk intake whether it be increased or decreased, have an effect on colon cancer later in life. We're talking about milk drink during childhood. How much you drink, does that cause more colon cancer or less colon cancer down the road?
Food marketing update, we talked about a few episodes ago the death, the potential death of our beloved cereal box characters. So, Tookie and Sam, and Snap, Crackle, and Pop, and the like, Lucky the leprechaun, Tony the tiger, OK, you get the picture here. We're going to have a little update for you on the food marketing debate that is going on on Capitol Hill.
Also, folic acid and language development, what's the relationship? How about Mozart and epilepsy, is there a relationship between listening to Mozart and better control of epilepsy? That's an interesting idea.
And then, boys versus girls, the differences in concussion symptoms. So, all of these things are coming up your way. I want to remind you if there's a topic that you'd like us to talk about, it's easy to get a hold of me, just head over to pediacast.org, and click on the contact link. You can also email firstname.lastname@example.org, that's another way to get a hold of us, or call the voice line at 347-404-KIDS, that 347-404-K-I-D-S.
And finally, 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. If you have a concern about your child's health, make sure you call your doctor and arrange a face to face interview and along with the hands on physical examination, it's very important.
All right. We all know that Vitamin D is important for calcium absorption in the gi tract, that's why it's added to milk. Vitamin d helps transport the calcium from the milk across the intestinal wall, and into the body where the calcium is used for growing bones.
But Vitamin D may have a mood altering effect as well. Researchers at Bristol University in the United Kingdom looked at Vitamin D levels in 2,700 children between the ages of nine and thirteen. T
hey found those with the lowest levels of Vitamin D, were the most likely to suffer from depression symptoms and those with the highest level of Vitamin D were the least likely.
The study investigated two forms of Vitamin D, D2, and D3, and found the strongest anti depressant link came from the D3 variety. Now, milk isn't the only source of Vitamin D it's also found in oily fish, and the skin produces Vitamin D when it's exposed to sunlight.
This relationship may contribute to seasonal effective disorders, since long bouts of cloudy days leads to less sun exposures which leads to less skin production of Vitamin D. Of course too much sun exposure is also bad with sunburns and an increased risk of skin cancer, very real possibilities.
And researchers warn, it's not time to change recommendations regarding daily Vitamin D allowance quite yet, until additional studies confirm this findings and establish safe levels of supplementation. So, Vitamin D has been sort of touted as a wonder drug lately in the realms of alternative medicine.
You see it on magazines, you know, if you're shopping at the store and you're in the grocery, check out line, you'll see something about Vitamin D and how it's important, and it'll change your life. And I guess, this study does give its possible mood altering effect some legs, but I do want to throw in a warning here.
Vitamin D is a fat soluble vitamin, and that mean that if you get too much of it, you can't simply pee out the excess. So, you know other vitamins, like Vitamin C for instance, you take too much of it, and the extra you just pee it out. But that's not the case with the fat soluble vitamins like Vitamin D.
And that means if you take too much, it get stored in your body for a long time. And too much Vitamin D does come with its own set of problems like fatigue, irritability, muscle weakness, vomiting, decreased appetite, dehydration, constipation, high blood pressure, kidney stones, Polyuria which is peeing too much, and Polydipsia which is being thirsty all the time. So if you want to supplement Vitamin D for your kids, be sure to consult with your doctor regarding a safe way to do it.
Now here is something that's not safe for kids or adults for that matter. The Food and Drug Administrations tobacco product scientific advisory committee is meeting now to discuss dissolvable tobacco products. These new products looked like candy, and contain enough nicotine to cause quick addiction and possibly deadly overdose of an entire packages consumed.
The FDA will look at composition of these products, also characteristics used trans health effects and current product marketing. Then they'll send their report to the Secretary of Health and Human Services next month. In the meantime moms and dads, be aware that they are out there, know what your kids and teens are doing, and be sure to keep them far away from this potentially dangerous products.
And parents you should stay away from them as well. Just no good can come of dissolvable tobacco products.
While we're on the topic of tobacco, flavored cigars are the new darling of the smoking industry. Manufacturers are using candy like flavorings to lure kids, teens, and adults to their products. Of course the sweet tasting cancer sticks contain the same toxic chemicals as any other cigar or cigarette.
So, again steer clear. A group of U.S. senators is urging the FDA to ban the flavored cigars and the cigars industry in typical form is fighting back. The International Premium Cigar and Pipe Retailers Association is circulating a petition warning that the FDA should not regulate this because by regulating flavored cigars, this would devastate local stores across the country.
Of course, never mind the devastation the local stores are causing on families, who see moms and dads and other loved ones to die because they are addicted to their products that they're selling.
Look folks, I'm a capitalist, and if you're in the business of selling dangerous and addictive substances, I think it's time to diversify your product offerings.
I mean, it's only going to be a matter of time before Uncle Sam is going to step in whether you like it or not, and regulate these things. So, you might want to get on a different product program while you still can. And of course in the meantime, consumers can have the final say by not buying the products.
All right, enough about tobacco and cigars, let's talk milk and colon cancer. Researcher in New Zealand looked at 571 adults between the ages of 30 and 69, they looked back at their milk intake as children, and then they looked ahead at their adult frequency of colon cancer to see if there was a relationship. The results recently published in the American Journal of Epidemiology, revealed that those who drink the most milk had the least chance of developing colon cancer later on.
Now, before you get too excited about this, it's a retrospective study, right? So, we're looking back, and in fact we're looking way back and relying on a person's memory regarding their milk intake as school kids, which may have been as many as 50 years ago.
Well, it's not exactly true, over 1,000 people were studied and half of those went to schools that when they were kids had a free milk program, while the other half did not. And back at that time, milk is not routinely given in schools, so the fact was the adults who when they were kids went to schools that had the free milk program that they would have had more milk intake than the other groups.
So, all together they studied 1,000 people and those in the free milk program when they were kids who we think drink more milk, that group had 30% fewer cases of colon cancer cancer compared to the group that were not part of the free milk program when they went to school a long time ago.
But here's the real kicker, previous studies have suggested that increased calcium intake actually increases the risk of colon cancer. So, researchers aren't sure why their study shows the opposite effect. They plan to return to their labs in an attempt to figure out why.
So, bottom line here moms and dads, keep giving your kids milk, it's a great source of calcium and Vitamin D, and maybe just maybe they will decrease your child's risk of colon cancer down the road, but the verdict is still out on that one. Now, how much milk should your child be drinking?
That's an answer that really differs from kid to kid. And the best way of knowing is to check in with your doctor on a yearly basis, see how they're looking on their growth chart, talk about their diet, and go from there. And finally in our, 'news parents can use', an update on marketing food for kids.
Now, if you recall back in episode 163, and I actually entitled that one 'Snap, Crackle, and Pop. And in that particular episode we discussed food companies and their marketing techniques toward children. Health experts have been lobbying Congress to pass laws that prevent companies from marketing directly to kids unless the food in question can meet a healthy standard.
Passage of such a law would in effect kill beloved food mascots such as Tony the tiger, Tookie and Sam, and Lucky the leprechaun, and others.
And we've talked about all of them at length in that episode 163. Unless the products they represent undergo major ingredient changes to push them below that healthy threshold. Well, the update is this, Congress isn't buying it, or shall I say they aren't passing it until the proposal undergoes a rigorous cost benefit analysis.
The plan is already been in the works for over a year and a half, and this latest blow could keep it from becoming a law. If you're interested, my opinion on the whole food marketing to kids issue, I'm not going to rehash it here, because really, it would take up the rest of our time together.
But if you really want to know my thoughts, check out PediaCast 163, again it's called "Snap, Crackle, Pop", and to make it easy for you, we'll put a link in the show notes for this episode back to episode 163, so you can find it pretty easily. All right. Well, that wraps up our 'News parents can use' and we'll be back to do our research round up right after this.
All right. We are back and this is our research round up that we're up to now. And this one is as interesting, I think we have some good studies for you. The first one comes out of the Norwegian Institute of Public Health, and it was published in the Journal of the American Medical Association, October 2011.
And we have a link to -we're just going to talk about three studies here, and we'll have a link to all three of them in the show notes. So, when you look at the -there's a place on the internet called PubMed where you can look at the abstracts and then they have some other links if you want to see the full text.
Some of them you have to purchase to see the entire text because the articles owned by a journal, unless you're affiliated with an academic institution and then you can probably get a hold of it at no cost. But there's links available, so in the show notes for this particular show there will be links to the study that we're talking about at PubMed.
So, if you want to go check it out yourself you're more than welcome to do that and it will be easy to do just by heading over to the show notes page. OK. So, this first one was a study looking at prenatal folic acid and language development. The institution is the Norwegian Institute of Public Health and this was published in the Journal of the American Medical Association, October 2011.
The question before the researchers, among children aged three years, what is the association between mothers use of prenatal folic acid and the risk of language delay. So this was a prospective study, it involved 40,000 children.
So, this is a huge sample size, and you know we've talked in the past that prospective studies are better controlled and really just sort of better quality studies compared to retrospective studies where you take a group of people and then looked backwards.
So, these are cases where you're going to enroll people in the study and follow them forward, and it's easier to control your variables that way. And in this case they looked at 40,000 kids. So, they actually started when the children's mothers were expecting for them and enrolled expectant mothers between 1999 and 2007, and they enrolled them when they were 17 weeks gestation.
And they asked the moms, 'did you take folic acid supplements during the time period of four weeks before conception through eight weeks after conception?'. So, in the month before and the two months after you conceived, so very very pregnancy, were you taking a folic acid supplementation?
And based on the answer to that question, the women were placed into four categories, those with no supplements whatsoever, so no vitamins of any kind, they did take a vitamin, but not folic acid, that would be group two. Group three is they took folic acid and other supplements, so multivitamin plus extra folic acid. And the fourth group they took folic acid only.
Now I want to point out that this study was done in Norway, and there is no folic acid supplementation in the food in Norway. So, if you try to do this study in the United States, you also would have to control for the mother's diet because they'd be getting folic acid that way. But in Norway there's no folic acid supplementation in the food, so the only source of folic acid would have been through this extra supplementation.
OK. So, they enrolled in that way, and kind of divide them into those groups depending on their folic acid exposure. And they waited for the kids to be born, and at age three they assess their language skills. And they did this base on a questionnaire completed by the mothers.
And based on the answer to that questionnaire, or the answers the children were categorized into a language category, one of three language categories. Either their language was one word, one word phrases, or unintelligible. And those kids were considered to have a severe language delay at age three.
If they could do two to three word phrases, they were considered to have a moderate language delay, and if they could do fairly complete sentences, then they had no language delay. OK.
So, once they've divided these kids into severe language delay versus moderate language delay, versus no language delay, then they calculated odds ratios for each group of women based on their folic acid supplementation status at the time of conception and they compared that to the resulting language category of each particular child at age three.
And these resulted in a lot of numbers. And so, I'm going to boil it down to you. The statistically significant results was this; the mothers who had folic acid supplementation whether it was by itself or in addition to other supplements, had a decreased risk of having children with severe and moderate speech delay at age three.
So, the authors conclude that the maternal use of folic acid supplements four weeks before to eight weeks post conception was associated with the reduced risk of severe and moderate language delay in children at age three years. So, this is a well designed large sample size prospective study, and it provides another good reason for mothers to get plenty of folic acid during the very early stages of fetal development. And for those of you expecting or soon to be expecting, be sure to talk to your obstetrician about getting the right amount of folic acid.
All right. Moving on to Mozart and epilepsy. This is an interesting study done at Kaohsiung Medical University in Taiwan and it was published in the Journal Epilepsy Behavior in August 2011.
So, the question before the researchers, among children with epilepsy, does listening regularly to the Mozart K448 Sonata affect frequency of epileptiform discharges. So, what is this all about? OK. And by the way -I'm really sorry about this. I'm not sure now that I looked at it. I actually wrote this down in two different ways.
Is the Sonata 488 or 448? I'm not sure, so don't quote me on that part of it, sorry about that. I think it was 448, for some reason I wrote 488 and half my script and 448 to the other. So anyway, does Mozart Sonata affect epileptiform discharges? The researchers looked at 18 children, 10 girls and eight boys, and they range and age from seven months to 14 years.
The mean age was seven years and 10 months, and all of them had a diagnosis of epilepsy for at least six months with persistent epileptiform discharges on their EEG, but they are well controlled with anti convulsant medication.
So, I used a lot of big words there. So these were all kids who had epilepsy or seizure disorder for the past six months. They are all well controlled on their medicine, so they're not actively having seizures, but if you do an EEG where you put the electrodes up to their brain and do get the tracings, they do still have some abnormalities on their EEG, they're just not having active seizures with those abnormalities.
But they are having those discharges which would let you know that if you stop their anti convulsant medicine they probably would have a seizure again. I also want to mention that none of the kids that they looked at had musical genic seizures, so they didn't want to do a study involving music and kids in whom music might be the initiating factor of their seizure.
So, none of these had music related seizures. Also, of the 18, 16 of them have focal seizures, so it wasn't whole body seizures, although that was the case in two of the kids they looked at.
But in 16 of them, they had a history of focal seizures meaning that the epileptiform discharges that you picked up on EEG, the abnormal wave forms were just originating from one particular part of the brain. And that would only make there be a certain abnormality associated with that part of the brain with regard to their seizure, that could be a motor seizure where just like their arm shakes, or it could be in a different form -a different part of the brain which can cause different types of seizures.
So, these are mostly kids with focal seizures although two of the kids they looked at did have generalized epilepsy. OK. So, what did they do then? They actually had all of these kids listen to the Mozart K either 488 or 448, sorry. I will get to the bottom of that Sonata for eight minutes before bedtime for six months.
And they performed EEGs at one month, two months, and six months after they started doing this. And the results are pretty impressive. At one month, the epileptiform discharges, so again the abnormal waveforms they see on the EEG decreased by 53.2%, at two months, they decreased by 64.4%, and at six months, they decreased by 71.6%.
So, now those were the results if you looked at the group as a whole. However, if you took out the kids with focal occipital discharges, so that means their abnormal brain waves were occurring at the back of the brain. So, if you took out those kids because those kids that didn't work very well.
At six months, the only saw a decrease of 3.7% in their discharges if the abnormal waves on the EEG, just when you put the electrodes up to the head, they only had saw 3.7% decreased.
Now, for those who had focal seizures in the front, so they had frontal focal seizures, they saw 100% decrease in their epileptiform -abnormal epileptiform waves. If it was a central focus, they saw a decrease of 99.1%, and if it was in the temporal lobe on either side it was 96.6% decrease in the amount of epileptiform discharges, and if they had generalized -so, the two kids who had generalized seizure where the abnormal brain waves are everywhere, they actually saw a 97.2% decrease in their abnormal brain activity.
So, this is pretty impressive, and by the way there was no relationship with age or gender. So, if you then mixed up all the kids and separated them by age, or by gender, there was no difference that would be accounted for by their age or their gender, just base on the location of where their abnormal discharges were located.
So, the authors conclude that long term listening to the Mozart K448 Sonata may decrease epileptiform discharges. And by the way, I did looked at up it is 448 not 488, I don't know why I wrote 488, I just confused myself and confused all of you. But it is the Mozart K448 Sonata.
So, it is pretty impressive, now we do have a small sample size and only of the studies had kids with generalized seizures. So, I definitely would not stop your child's anti convulsant medication in favor of Mozart, at least not without talking to your neurologist first. All right. And finally up in our research round up, boys versus girls, differences in concussion symptoms.
So, this is a study that came out of three universities including the Ohio State University here in Columbus, also the University of California, and the University of Virginia. It was published in the Journal of Athletic Training in January and February 2011.
And the question before the investigators for this one was among male and female high school athletes with sports related concussion whether the difference is in symptoms, symptom resolution time, and time to return to their sport. They looked at 100 high schools, and all the schools had at least one certified athletic trainer on staff. Schools were also divided into eight categories based on geographic location and school size.
And athletic trainers reported head injury exposure to the researchers each week. Now, in order to be qualified as an injury event, the head injury had to take place during an official practice or competition,had to require the attention of the team's certifies athletic trainer at the time of injury, and they had to result in play restriction for at least one day.
They looked at nine different sports, boy's sports included football, soccer, basketball, wrestling, and baseball. And for the girls they looked at soccer, volleyball, basketball, and softball.
And by the way the study was done during the 2005-2006, and 2006-2007 sports seasons. For each injury occurrence the athletic trainers recorded the child's symptoms, the time it took for the symptoms to resolve, and the time it took for the child to return to play. A total of 812 concussion were studied, 610 of them were in boys, and 202 of them were in girls.
So, what they find? Well, the result showed that headache was the most common symptom for boys and girls, but boys were more likely to have amnesia, confusion, and disorientation, while girls were more likely to have drowsiness and noise sensitivity. When you looked at boys versus girls, there was no difference in the number of symptoms reported, and with regard to symptom resolution time for the boys 72.2% had their symptoms resolved within three days of the injury, and for girls 66.7% have symptoms resolved within three days of the injury.
However, that difference was not statistically significant, but still about 70% on average of the boys and girls have symptom resolution of their concussion within three days after the injury.
Now, what about how long it took to return to play, well for boys 63% had returned to play by nine days post injury, and for the girls 66% had returned to play by nine days post injury. So, they were out for about a week and a half, and it was not statistically significant with regard to boys versus girls when you looked at their time it took to return to playing.
So, the authors conclude that after sports related concussion, male and female high school student athletes present with different types of symptoms with males reporting more cognitive symptoms, and females reporting more neuro behavioral and somatic symptoms. Symptom resolution time and return to play time however did not differ between the sexes.
So, again boys are more likely to have disorientation, confusion, amnesia, along with their headache, whereas girls are more likely to have drowsiness, and noise sensitivity along with their headaches. So, it's interesting that the concussion symptoms is a little bit different when you look at boys versus girls.
So, these are some interesting observation regarding concussions, but I do want to point out to parents it is important that we take concussion seriously. It's important that your child have a period of rest from sports, gym, and sometimes academics following a concussion. And it's also very important that your child is recheck and cleared by your doctor before they return to play.
And if you want to know lots more about concussions from why they occur to a comprehensive list of symptoms and long term risks,, be sure to check out PediaCast number 177, that one was an entire episode devoted to concussions.
And PediaCast friend and Chief of Sports Medicine here at Nationwide Children's Hospital Dr. Tom Pommering, and certified athletic trainer Steevie Carzoo, they both stopped by the PediaCast studio to discuss All things concussion, and you can find the link to episode 177 in today's show notes.
All right. That wraps up our research round up and we're going to come back and wrap up the rest of the show, right after this break.
OK. We are back and I'd like to thank all of you for joining us for the program today, really appreciate it. I want to remind you that iTunes reviews are very helpful, so if you found us through iTunes, I bet you look at the reviews in order to decide that you wanted to take part in the PediaCast community.
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All right. And until next time this is Dr. Mike saying, stay safe, stay healthy, and stay involved with your kids. So long everybody.
Announcer 2: This program is a production of Nationwide Children's. Thanks for listening! We'll see you next time on PediaCast.