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December 29, 2016
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Caring For Your Newborn – 2014-07-24

Cuidado De Su Recién Nacido – 2014-07-24

 


I have just updated our pamphlet “Caring For Your Newborn” which we give to parents during their newborn’s stay at the hospital.  The changes from the previous version are:

  • Redesigned Cover exhibiting the Excelcare Alliance logo
  • Current office email address
  • Deletion of newborn intensive care services as part of our newborn care services as they are now provided by the neonatology department.
  • Updating of the formula name “Carnation Good Start” to “Gerber Good Start Gentle”.
  • Adding to the “routine vaccines given list” vaccines to prevent cervical cancer, genital warts and rotaviral gastroenteritis.
  • Deletion of the use of rubbing alcohol in umbilical cord care.

Should Children Receive Fluoride Supplementation

Arnold Solof, MD

By Arnold Solof, MD

Following comments I received about fluoride supplements for children on the interview published in the Times Journal, I went back and reviewed the current guidelines and recommendations and research available on the subject.   Very little of the science has changed over the past 30 years, but more recently since about 2008, the wording, interpretation, and application of the available knowledge has changed.

As before 2008, the evidence continues to clearly show that fluoride supplementation reduces the incidence of caries in children.  However, years ago, the statistics quoted were a 75% reduction in the number of cavities.  Now, they are quoting numbers in the range of 33% reduction in cavities.

In 2010, the American Dental Association published a statement “Evidence-Based Clinical Recommendations on the Prescription of Dietary Fluoride Supplements for Caries Prevention: A report of the American Dental Association Council on Scientific Affairs“.  The CDC (Center for Disease Control & Prevention) and AAP (American Academy of Pediatrics) and other expert recognized medical organizations followed their lead coming out with recommendations & guidelines consistent with the ADA statement.

In my opinion, there are serious problems with the new guidelines and I expect they will be revised at some point to deal with these problems.

Currently, more attention is being paid to the problem of fluorosis; a problem resulting from too high an intake of fluoride.  In its mild form it results in barely detectable speckling of the teeth.  In more severe forms, it can cause cosmetically noticable speckles and spots on the teeth and even weaken the tooth structure.

Total fluoride intake is the sum of one’s intake from all sources; water supply, supplements, fluoride rinses, fluoride toothpaste, food & beverages.  One can accurately control the intake from all of these sources except food & beverages.   The fluoride content from food and beverages is variable, unknown, and unlabeled.

In the past it was assumed that cases of fluorosis that appeared were the result of the excessive intake of fluoride from the unknown, unmeasured sources.  Now, there is a suggestion that “minimal” and “mild” cases are more common in recipients of fluoride supplements.  On the other hand, there is a general consensus, that the minimal and mild fluorosis cases are not clinically significant problems.

The ADA continues to strongly recommend that our community water supplies be fluoridated to prevent cavities.   They used to recommend that all children, 6 months through 16 years receive fluoride supplements if their water supplies were not optimally fluoridated.  Now, instead, they recommend that only children “at high risk for caries” whose water supply is sub-optimally fluoridated receive supplements.  Carrying out that recommendation requires accurate, quick, and easily and regularly administered screening tests to separate out the “high risk” from the “low risk” groups.  Good luck with all that.  The accuracy of these tests are debatable, their results will vary over time with changing habits, lifestyle, environments, they take time to administer, and the definition of what constitutes sufficient risk to indicate the use of supplements remains undefined.   When you analyze the “Evidence Based” statement, you see that these changes to the prior recommendations were classified as level “D”, meaning they had the weakest evidence for their basis.  The class “D” evidence consisted only of expert “opinion” and their indirect extrapolation of conclusions from better evidence, not the evidence itself.  So, in other words, there is no direct research based evidence for the recommendation to “screen” and only supplement the “high risk” group; just opinion.

The new approach appears to me to be inconsistent with itself.  How do you on one hand recommend fluoridating the water supply which supplements everybody from birth through death, and on the other hand require a screening test to determining if it is safe and acceptable to give the equivalent amount of fluoride to those who happen to live in a community that decided not to fluoridate its water?

Now, playing the Devil’s advocate, the ADA had a reason for this change in the guidelines.  They are trying to strike a balance between preventing cavities using supplementation with fluoride and avoidance of fluorosis by attempting to use only as much fluoride as needed in as few individuals as possible to achieve this end. But, for the reasons stated, I think they are fooling themselves if they think this approach is going to work.  In the past, the guidelines were straightforward and clear.  Even with clear guidelines it has been difficult to get parents to consistently give fluoride supplements day after day, year after year.   What do you think is going to happen to the level of compliance with guidelines that are confusing, inconsistent and equivocal?

I am going to make a prediction.   The application of the new guidelines will result in fewer children receiving the supplements.  The result of that will be a big jump in the incidence of caries in communities with unfluoridated water supplies.  10 – 15 years from now when that becomes apparent, they will reword the guidelines so that all children in unfluoridated communities can again enjoy the benefit of this prevention strategy.

December 29, 2016
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Arnold Solof, MD

Vitamins – Times Journal Interview

I was interviewed by Regina Schaffer the other day for an article on vitamins she was writing for the Times Journal.  She was writing on whether or not routine vitamin supplementation was necessary or desirable.   Here is the link to the article.

http://www.thedailyjournal.com/apps/pbcs.dll/article?AID=2014301130009&nclick_check=1

December 29, 2016
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Arnold Solof, MD

By Arnold Solof, MD

I developed this spreadsheet as a motivational tool to help me stick to a weight loss diet.  Due to requests from some patients I posted it on our website.   http://www.asolof.com/vpeds/clinical/calorie-tracker.xlsx.  It is in Excel Spreadsheet Format.  It will calculate how many calories you ate over or under the amount of calories you burn each day.  It will also total the calories consumed each week and the weekly difference between what you ate and burned.  You can also use it to determine how many calories per day you burn based on your weekly rate of weight loss.  You enter a daily calories burned amount that yields the predicted weekly weight loss that matches your actual weight loss.   You should exclude the weight loss of the 1st week since it includes fluid shift weight changes that occur when starting a diet.

If you find yourself “slipping”; that is, not exactly sticking to the calorie limits you set for yourself, try this spreadsheet.  Make yourself fill it out for every meal and snack.  By measuring and tracking your exact calorie intake you will avoid “sticking your head in the sand” and being oblivious to what you are really doing, and subsequently being surprised about the outcome.

December 29, 2016
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By Arnold Solof, M.D.

The purpose of the diet is to reduce/eliminate excess body fat. As a result, one can expect improved health and improved sense of well being. This will also result in improved appearance and better athletic performance.

Set Your Goal

Determine Your Target Weight (pounds):

There are several ways to set a dieting goal. The most consistent, reproducible, and easily measurable method however is by using body weight. You first need to determine what weight you want to be. Subtracting that from your current weight you determine how many pounds you need to lose to achieve that weight.

Determine When You Want to Reach Your Target Weight (date):

You next need to determine when you want to achieve your target weight (in other words your target rate of weight loss). Realistic weight loss goals vary from 1/2 to 3 pounds per week. The stricter the diet, the more rapid the weight loss. Your doctor can help you select an appropriate target weight and safe rate of weight loss.

Fat is a storage form of energy from the food we eat. When you consume more calories than your body uses, the excess is stored as fat. On the other hand, if you consume fewer calories than your body uses, your body burns stored fat for the needed energy. There are 3500 calories in one pound of body fat. Therefore, to lose 1 pound of body fat we must eat 3500 less calories than our body burns.

Sample target rates of weight loss:

Calorie deficit/day X 7 days = weekly calorie deficit

Weekly calorie deficit / 3500 calories = pounds per week lost

250  calorie deficit X 7= 1750 calories = 1/2 pound per week  
500  calorie deficit X 7= 3500 calories =  1 pound per week
1000 calorie deficit X 7= 7000 calories =  2 pounds per week
1500 calorie deficit X 7=10500 calories =  3 pounds per week 

Average calories burned per day based on lean body weight (what you would weigh
if you were not fat):

Weight (Pounds)     Daily Calories
66                  1700
88                  1900
110                 2100
132                 2300
154                 2500
176                 2700

These numbers are averages and may +/- up to 25% depending upon general level of physical activity and genetic predisposition and age. Based on your actual weight loss at a given calorie intake, you can recalculate the actual number of calories your body burns each day. For example, if you found that while eating 1000 calories per day for 6 weeks your weight loss averaged 2 pounds per week, and from the table above you know that 2 pounds per week weight loss occurs with a 1000 calorie per day deficit, then you know that your body burns 2000 calories per day. Since diets restricting caloric intake to less than one half of your calories burned per day promote muscle loss, they should be avoided.

Self Hypnosis:

This is not referring to hocus-pocus. It goes by many names and refers to techniques one uses in focusing on and achieving personal long term goals. Using these techniques, the seemingly impossible can become readily achievable. This is the most important part of the diet plan. You MUST succeed with this to succeed in reaching your diet goals. Therefore you should understand and begin practicing this BEFORE you start your diet.

You need to close your eyes and visualize in your head where you want to be when you reach your goal. Picture how you will look and feel and things you will be able to do having reached the goal. Keep this image vividly in your mind. You CAN do this. I know you CAN do this. But what matters is YOU must BELIEVE you can too. Depending upon the amount of weight you will be losing, this can take from weeks to months. You must be able to frequently and instantly retrieve this image in your mind of having reached the goal so you never lose sight of the direction you are moving in and why you are doing it. At EVERY mealtime you have to picture this and ask yourself, is what I am about to do going to move me in the direction of my goal? This is an exercise you will need to repeat frequently, many times a day for the duration of your diet. It may feel “awkward” at first, but in time it will become effortless and automatic.

As part of this, you will manipulate your environment to keep you on target. You need to keep the necessary “tools” and diet foods available and avoid situations that needlessly make it difficult to stay on your diet. Essentially, with your focus clearly on your goal, you will systematically proceed in the direction of achieving this goal. You will be proceeding in countless tiny steps, which by themselves do not appear all that important, but collectively, over time, will achieve your goal.

Diet:

The diet I recommend for losing weight is a low calorie diet. From the above tables (and perhaps past experience) you should know how many calories you burn per day. You have already determined what your target weight is and how quickly you wish to reach it. Fill in this form.

Current Weight: _____________

Target Weight:  _____________

Target Date:    _____________      (When you want to reach your target weight)

Calories Burned _____________      (Per day)

Diet calories   _____________      (Per day)

Calorie Deficit _____________      (How much less eaten than burned per day)

Target Rate:    _____________      (Pounds per week you expect to lose)
Click Here for my Calorie Tracker Spreadsheet

Diet Tools:

To help you implement the diet, you should obtain a calorie counter book (or smartphone app) in which you can look up the calorie contents of foods. Many foods have these already listed on the product packaging. In addition, you should get a 4″ X 6″ card and make a quick reference list of the foods you eat frequently and their calorie content. We are creatures of habit and generally eat the same foods each day. With this card, you will not need to look up many foods a second time. You should get a diet food scale, measuring cups and measuring spoons to measure food portions.  Uou will also need an accurate bathroom scale.

Meal Calorie Goals:

It is generally too cumbersome to try to remember and track everything one eats for an entire day. On the other hand, it is relatively easy to do the same one meal at a time. You should divide your diet calories (the amount of calories you are allowed to eat on your diet in one day) into meal calorie goals. Once these goals are set, you only need to remember the meal calories limit, and not exceed that, one meal at a time. You should space these meals and distribute the calories in a way that will fit best with your life style and minimize hunger.

Sample meal calorie goals:

     1500 calorie diet:
          Breakfast 300 calories
          Lunch     400 
          Dinner    500
          Snack (pm)     300

     1000 calorie diet:
          Breakfast 100 calories
          Lunch     300 
          Dinner    500
          Snack (pm)     100

Premeasured Meals:

After you have set your meal calorie goals and you have been on the diet for a short while, you will find that your meals tend to repeat themselves during the week. That is, you will tend to eat the same amounts of the same foods at the same meals. Your personalized collection of premeasured meals which stay within each meal’s calorie limits, will greatly simplify the task of  “counting calories”, since everything has been pre-counted.

Flexibility

We are not machines but living beings with feelings and moods. Sometimes we “feel” like eating more or less. You can “borrow” calories provided you pay back your “calorie debt”. So for example, if you are going out to dinner, you might eat 200 calories less at other times during the day so that you can eat 200 calories more at dinner. Likewise, you might want to eat 200 calories more one day, which is OK provided you eat 200 calories less another day to “pay back” the calorie debt. This will allow you flexibility in your day to day life without exceeding your long term allowed calorie intake. Given your obligation to pay back the calorie debt, it is up to you to decide how much and how often you want to borrow calories.

Balanced Nutrition:

Since you will be significantly restricting the amount of food you will be eating, it is especially important to eat foods with a high nutritional value and to avoid junk foods. You should attempt to achieve a reasonably balanced diet. You should strive to maintain a high protein intake to prevent muscle loss.

PROTEIN REQUIREMENTS:

Infants: 2 gm/kg (0.9 gm/lb) body weight daily

Children: 1.3 gm/kg (0.6 gm/lb)

Adolescents/adults: 0.8 gm/kg (0.36 gm/lb)

So a 150 lb adolescent or adult needs about 54 grams of protein per day. This requirement can be as much as doubled if the individual is in intense athletic training.

These protein requirements should be met regardless of how much you are decreasing your daily caloric intake. This will allow you to prevent loss of lean body mass (non-fat tissue), and even make gains in strength and endurance if exercising comparable to those you would make if you were not restricting your caloric intake.

Vitamin deficiency is common on low calorie diets so a daily multivitamin is also recommended.

FAT content of low calorie diets is usually low. However, zero fat or extremely fat deficient diets should be avoided because they can result in essential fatty acid deficiency.

Preventing Hunger:

In order to sustain your diet over the long run it is important to avoid hunger. To do this, 3 to 4 small meals spaced evenly over the day will avoid prolonged fasting. Limit your carbohydrate intake, especially sugar. This is to avoid rebound low blood sugar (and hunger) which follows sugar consumption. To satisfy the urge to eat, allow large portions of very low calorie bulk foods (like lettuce) which allow you to spend time eating without consuming many calories. Allow yourself large quantities of low calorie beverages which will distend your stomach, giving you a sense of fullness, without the calories.

Monitoring the Diet:

You should weigh yourself once per week and record the results on a chart and on a graph. Since daily fluid shifts and intermittent bathroom trips (the weight of urine and feces) will obscure small day to day weight changes, more frequent measurements should not be recorded. The record should be conspicuously displayed for you so you will see it every day and see exactly how you are progressing toward your goal.

     |
     |
     |
     |
Wt   |
     |
     |
     |
     |
       -----------------------------------------------------------------------
         1  2  3  4  5  6  7  8  9  10 11 12 13 14 15 16 17 18 19 20
                              Week

Other methods of monitoring your progress are by using a tape measure on your waist, changes in which belt hole fits, and the change in fit of your other clothes. But as stated before, weight change is the most reliable, reproducible, and objective measure so you should rely mainly on that. The other parameters will change with the weight change.

During the first week, you will probably lose more weight than subsequent weeks, even with the same daily calorie deficit. This is because there is frequently an initial  fluid shift (1 to 3 pounds) which results in some loss of body fluid weight (not fat). When the diet is ended, the fluid shift may reverse and this amount of weight may be regained. Therefore take this into consideration in interpreting the weight changes you measure when you start and end your diet.

During the course of a diet that extends longer than one month and involves the loss of greater than 5% of your body weight, your metabolism will tend to slow slightly, so that your body is burning fewer calories per day than it was at the start of the diet. This will slow your weight loss, unless you either further decrease your calorie intake or increase your exercise. As an alternative, you could reset your target rate of weight loss, therefore reaching your target weight at a later date than originally planned.

Role of Exercise:

My grandfather always used to say (no, I’m not Forest Gump), “the best exercise is” … and he would gesture a pushing away motion … “while you are at the kitchen table”. I think he was exactly right. Heavy exercise stimulates your appetite. The number of calories one burns during hours of vigorous exercise can be consumed in minutes at the kitchen table. Exercise, without an accompanying diet, usually fails to result in weight loss. On the other hand, for every 250 extra calories you burn a day, if you don’t eat more, you will lose an extra 1/2 pound per week. Also, remember the purpose of the diet is to lose/eliminate excess body fat. If you are on a low calorie diet, and you do not do any exercise (strength training), some of the weight you lose will be muscle, and this is HIGHLY undesirable and counter productive. In fact, if one were to maintain a constant body weight while increasing muscle mass with strength training, it would be at the expense of body fat and would be moving in the direction you want to go.

So, be sure to get regular exercise, including strength training during your diet so as to preserve your muscle mass while you are losing fat and to maintain an optimal state of physical fitness.

“Ending the Diet”

Since you had to go on a diet, your “normal life style” probably leads you to gain weight over time. If you simply stop the diet and forget about it you have a very high probability of regaining the weight you just lost. At this point it is best to go on a “maintenance diet”. As its name implies, its purpose is to maintain your weight within a specified range. You need to set the upper and lower limits of this range. For example, if your target weight were 140 pounds, you could set a maintenance range of 138 – 142 pounds. Your “diet calories” for the maintenance diet are equal to the calories you burn per day. You should recalculate your meal calorie goals for your maintenance diet. You monitor your weight weekly. If you exceed 142 lb, you must go back on a diet until you hit your target weight (140 lb) again. If your weight drops below your maintenance range, you are alerted to increase your calorie intake temporarily until you re-enter your maintenance range (eg, at least 138 lb in the above example). After weeks and months of this, you will eventually develop new habits of eating and excercise (a new life style). The new eating habits will become automatic, and no longer feel like a diet.

“Diet Gems”

Below is a list of some foods that are helpful in maintaining a reduced calorie diet:

Food                                    Calorie content
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Non-fat yogurt                          90 - 100  per 8 oz.
Fat free frozen yogurt                  90 per 4 oz (varies with flavor)
Fat free no sugar added ice cream      100 per 4 oz (varies with flavor)
Kraft Free "Singles" (cheese)           30 per 2/3 oz slice
Philadelphia Free cream cheese          25 per oz.
Promise Ultra fat free margerine         5 per Tbsp.
Promise Extra margerine                 50 per Tbsp.
Hormel 97% fat free hot dogs            45 per hot dog
Oscar Meyer "Free" hot dogs             40 per hot dog
Weight Watchers chocolate mousse        35 per ice cream popsicle
"Light" bread                           40 per slice
Lettuce (iceberg)                       15 per 1/4 head
Green Peppers                           15 per 1/2 pepper
Seasoned salt-instead of salad dressing  0
Kraft Free Italian dressing             10 per 2 Tbsp
Peach (medium)                          35 per peach
Boullion                                10 per cup
Ham (many lean cuts)                    30 per oz.
Turkey breast                           30 per oz.
Chicken breast                          30 per oz. 
Tuna in water (white)                   30 per oz. (150 per 6 oz can drained)
Pink salmon in water                    30 per oz. (150 per 6 oz can drained)
Turkey burgers                         170 per 4 oz. burger
Egg Beaters (1 egg = 2 oz)              25 per "egg"
Healthy Choice spaghetti sauce          50 per 4 oz.
Mustard (French's Yellow)                0 per Tsp.
Diet soda                                0

“Other Foods (not diet gems)”

Below is a list of other foods and their estimated calorie contents:

Food                                    Calorie content
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Pizza                                   75 per oz.
Shrimp (breaded)                        60 per oz.
Beef/steak                              80 per oz.
Sardines (in olive oil - drained)       80 per oz.
American cheese                        100 per oz.
Fried chicken                           80 per oz.
Spare ribs                             110 per oz.
Pasta (cooked)                         200 per cup
Corn (on the cob)                       80 per ear