Friday, August 24, 2012

School Lunch

Lunch is an important part of the school day – almost as important as recess! Many children brown bag their lunches, but many more depend on the school lunch (and breakfast) for a substantial portion of their daily nutrition.

In the past, school lunch programs have depended upon contributions of excess food from USDA programs – the idea was that farmers would have a ready market for their wares and that school children would benefit eating farm-fresh products. Well, we all know how that turned out! For the first time in fifteen years the USDA has raised the standards of the school lunch program. This will have a direct impact on the thirty-two million children who participate in the school meals program every day.

The final standards make the same kinds of practical changes that many parents are already encouraging at home, including offering students both fruits and vegetables every day of the week, substantially increasing offerings of whole grain-rich foods, offering only fat-free or low-fat milk varieties, and increasing the focus on reducing the amounts of saturated fat, trans fats and sodium.
For the first time, calories are limited based on the age of the children. Under the old plan, the regulations stated a minimum number of calories; faced with increasing obesity we need to reeducate ourselves about proper portion size. It’s challenging for adults to regulate intake. It’s unreasonable for beginning readers to scan a nutrition label to see that a granola bar is actually two portions or for a thirsty adolescent to know that a bottle of juice drink is four servings.
Parents play an important role in supporting the school lunch program. Don’t sabotage the healthy meal initiatives by criticizing the food. If you are not satisfied, contact the school and offer help. Don’t allow children to have additional sweets or beverages other than water. Contact the school if your child is truly hungry after finishing the school breakfast or lunch.
Bon appetit.

Sunday, August 12, 2012

The Nocebo Effect

Just knowing that a drug can have side effects may increase your risk of suffering them. This is the nocebo effect: the patient’s expectation that a drug will do harm. An excellent summary of this appears in the New York Times review pages.

Side effects from medications are real and can be harmful. Even so, the benefits may still outweigh the potential risks. A recent study confirmed that certain cholesterol medications might lead to diabetes in susceptible patients. However, the reduction in cardiovascular disease with lowering the blood cholesterol is real – and even more important in patients with diabetes. Certain patients (and we have a good idea who they might be) can have terrible effects from osteoporosis medications. This doesn’t mean that other patients at high risk for hip and vertebral fractures shouldn’t take them.

I believe that direct to consumer pharmaceutical advertisements do greater harm than good. Mind you, only expensive medications have the budgets needed to buy television commercials. The ads rarely get down and dirty to discuss the actual disease but show idyllic vacations scenes or silly cartoons, ending with a sonorous litany of terrible outcomes (rash, headache, liver failure, depression and/or death).

Starting a medication should be a shared decision. Usually the physician is more knowledgeable party but the patient is the one that actually decides whether to take the medicine. No decision is written in stone – treatment plans can be (and often are) revised. These discussions are best done face to face; the discussions are of a higher quality when the patient is prepared with questions and concerns. 

Sunday, August 5, 2012


As people age, there is some decline is short-term memory. However, when memory becomes so poor that there is an impact on the activities of daily living, it is no longer simple forgetfulness but may be dementia. The most common causes of dementia are cerebrovascular disease and Alzheimer’s disease. In Alzheimer disease, build-up of abnormal proteins damages brain cells. In cerebrovascular disease, low blood flow to the brain damages brain cells. While there is no cure for dementia, there are several medications that may be helpful in slowing the progression of disease.

The medications that are currently approved for dementia have shown small improvements in measurements of memory and thinking, but there is no data that show important improvement in behavior and quality of life.

Patients with dementia are less able to make clinical decisions and are less able to cooperate with treatment plans; caregivers play a large role in determining plans of care. Behavioral disturbances (delusions, aggression, depression) can have a profound effect on those around the patient. Inadequate nutrition is common. Exercise program and occupational therapy have been shown to improve everyday life without the side effects seen with many medications.

Caregivers of patients with dementia can suffer significant stress, particularly as cognitive function declines. Respite care and support groups are available in most areas, often through the local agency on aging.
For more information:
Alzheimer's Association at 1-800-272-3900 or on-line.