• Lose the Juice: Sugary Drinks Linked to Reflux in Children

    Despite doctors informing the public that cigarette smoking causes lung and other types of cancer, and cause chronic obstructive pulmonary disease (COPD), emphysema, bronchitis, and other various health conditions, it took decades before the public finally shifted the stigma of cigarette smoking and started shedding light on the harmful effects.  As a result, cigarette packages now come with mandatory warning labels. SURGEON GENERAL’S WARNING: Smoking Causes Lung Cancer, Heart Disease, Emphysema, and May Complicate Pregnancy. There is no longer a debate. Point blank, smoking is bad for you.  It took decades to change public behavior because the effects were gradual …. but day after day, weeks after weeks, years after years…. we saw a shift in public health as a result of long term smoking.

    What the public needs to be aware of is that juice, and its excessive sugar components are equally as harmful. Why does it not come with a “Surgeon General’s Warning” label? One ought to be created that states, ““Warning: excessive sugar leads to obesity, diabetes, acid reflux, asthma, and other inflammatory diseases.” While infants, children, and young adults thankfully do not smoke, nor consume alcohol, both of which are the greatest risk factors for overall health, they are our most vulnerable when it comes to excessive sugar consumption- especially in the form of juice and all non-water sugary beverages.

    The American Academy of Pediatrics recommends NO JUICE for children under 1 year of age, limited to less than 4 ounces for children age 1-3, no more than 6 ounces in a single day for children ages 4-6. However, majority of parents, grandparents, and caretakers are either unaware or do not adhere to these recommendations. National guidelines have little chance to influence behavior when labels imply health such as “100% Organic,” “No sugar added,” “Natural,” or “Less Sugar.” Has society become so “lazy” that proper preparation and nutrition are of secondary importance?  It is common knowledge within the medical, dental community, and the public, that excessive juice consumption in children results in cavities, malnutrition or obesity, and inadequate fiber intake. What more people need to be educated on is the fact that, excessive sugar consumed through juices is a direct cause of acid reflux.  Foods and beverages that contain high sugar content are “triggers” for acid reflux for these juices are “acidic” in nature. Infants and young children consume large quantities of liquids on daily basis as a significant part of their diet – which needs to stop here and now.

    Programs such as the The National Early Care and Education Learning Collaborative (ELECE) by Nemours Children’s Health System are on the rise to help increase awareness about the necessity of cutting out juice consumption, and providing children with water as a primary beverage, and milk in accordance with national guidelines.  This program was launched in October of 2012 as a five-year, Center for Disease Control (CDC)-funded effort aligning several programs already in existence, including the Preventing Childhood Obesity in Early Care and Education Programs and “Let’s Move” campaign from Michelle Obama. In many states including Arizona, California, Florida, Indiana, Kansas, Kentucky, Missouri, New Jersey and Virginia, partners of this program are targeted at developing healthy eating, physical activity, screen time and breastfeeding support. Such programs are particularly focused on children younger than 5 years of age and have demonstrated effectiveness because they provide not only information but also policy that support healthy living for young children.

    The public is likely not aware that citric acid, while considered by U.S. FDA to be a safe natural acid in diet (500mg per day), can actually be harmful as it is used in juices, candy, sauces, and many foods to prevent food spoilage. It is an abrasive and often found in dishwashing detergents and metal polish. Citric acid causes dental enamel erosion as well as acid reflux in children and adults due to the formation of mucous membrane of the stomach and esophagus Individuals are much better off sticking with fruit.

    Through my vast medical experience of seeing infants, and toddlers, all suffering from chronic cough, runny nose, and being dubbed “sick all the time,” I have learned that most of these problems are attributed to large consumption of sugary beverages such as juice. Once addicted to sugar and juice, trying to get a child to drink only plain water is not easy, but necessary for optimal health.  The adults in their lives must be role models:  if our children watch us drink little water and mostly sugary beverages, they will unlikely grow up with healthy nutritious values. Like cigarettes, excessive sugar day after day, week after week, year after year, will lead to negative health consequences. Until the warning labels are mandatory, it is paramount for us to decrease our children’s risk of developing obesity, diabetes, acid reflux, and all other diseases secondary to each of these conditions.

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    Dr. Julie Wei is a pediatric otolaryngologist practicing at Nemours Children’s Hospital in Orlando, Florida. She is the Surgeon-in-Chief, as well as the Division Chief of Pediatric Otolaryngology and Professor of Otolaryngology-Head Neck Surgery at University of Central Florida College of Medicine. She has been including dietary history and modifications as a part of patient visits for the past 15 years, which has led her to observe patterns of airway and digestive symptoms as well as number of medications children are prescribed based on their eating and drinking habits.

  • Mucus, Mucus, and More Mucus

    Does your child have a runny nose all the time? Is s/he a mouth breather? Is there always snot coming out of their nose? Do you go through veritable mountains of kleenex, wiping your child’s nose continuously? The problem is too much mucus.

    You may be surprised to learn that the lining inside your child’s nose and throat is called a “mucus membranes.” Under normal circumstances, mucus acts as a protective barrier, helping prevent environmental irritants, bacteria and viruses from affecting your child’s airway. In adults, under normal circumstances, we make about a quart of mucus a day! While it is less than that amount in children, it is still enough to lubricate and protect their mucus membranes.

    The problem of too much mucus is most commonly caused by reflux and not by infections; although, infections certainly cause a flood of mucus (often distinguishable by it’s green color). When the mucus membranes are irritated by reflux, which contains acid and nasty enzymes, what do they do? They put out more mucus. If your child has a chronically runny nose and nasal congestion, you should know that reflux is the most common cause of these symptoms.

    Your child will not complain of heartburn and indigestion, common symptoms in adults. Instead, the reflux will be “silent.” That’s because, most of the time, the reflux will occur while your child is sleeping. Here are three simple fixes that don’t cost a thing:

    1. No Bedtime Snacks (You should have dinner at an early hour, then bath, television, reading, and bed. There should be an hour and a half between eating and bed).

    2. Get Soda and Juice Out of the Fridge (The best thing for your child is water).

    3. Limit Your Child’s Snacks of Sugary Sweets to Once a Day (We recommend four servings of fruits and vegetables a day).

    Acid Reflux in Children: How Healthy Eating Can Fix Your Child’s Asthma, Allergies, Obesity, Nasal Congestion, Cough & Croup was written to empower parents. With a healthy diet and lifestyle, you can quickly remedy your child’s chronic snotty nose.

  • IN or OUT? The Billion Dollar Medical Mistake (Per Week!)

    According to the Centers for Disease Control, 8% of all Americans and 17% of poor, non-white children in the U.S. have asthma. Asthma-related costs including doctors, hospitals, and medication add up to $56 billion per year. But what if doctors had it wrong? What if asthma was one of the most common misdiagnoses in America? What if the real problem was actually “silent” acid reflux and not asthma at all?

     If you or someone you know has a diagnosis of asthma, you must carefully consider this very important question: When you have trouble breathing during an “asthma” attack, do you have more difficulty getting air IN or OUT? Trouble getting air IN (during inhalation) is NEVER asthma, while trouble getting air OUT (during exhalation) is.

     How does this work? The difference between breathing IN and OUT is explained by the anatomy and physiology of the airway. With acid reflux, airway obstruction occurs at the level of the larynx (voice box). The upper part of the larynx contains acid receptors, which act like electrical switches. When triggered by exposure to acid, these receptors close the vocal chords. That results in trouble breathing IN. This type of airway obstruction is similar to that seen in children with croup or whooping cough, who may make loud, crowing sounds when breathing IN.

     The mechanism of airway obstruction in asthma is completely different. People with asthma have trouble getting air OUT, because the breathing tubes in the lungs (inside the chest cavity) are narrowed, usually due to an allergic reaction. Consequently, during exhalation (breathing OUT), the full lungs exert additional pressure on the already narrowed bronchial tubes, resulting in prolonged expiration, what we hear as wheezing.

     Decades of combined medical practice focused on patients with acid reflux, has informed three key observations: (1) Approximately 80% of patients with asthma don’t have it; (2) Silent reflux (acid reflux occurring without the obvious symptoms of heartburn or indigestion) is usually the correct diagnosis, and (3) A problem breathing IN is never asthma. Indeed, people with wrongfully diagnosed asthma, the INs, don’t respond to asthma treatments, but they do get well when their reflux is adequately controlled.

     Remember: Reflux affects the throat and causes trouble breathing IN. Asthma affects the lungs and causes trouble breathing OUT. Unfortunately, this important clinical point is not understood by most doctors. Only when everyone is aware of this fact will the over-diagnosis of asthma cease, resulting in better health for millions of people, along with overall savings in the billions of dollars.

     – Jamie Koufman, M.D.