A study presented this week at the American Stroke Association International Stroke Conference (ISC) suggests a 61% increase in stroke for people who drink diet sodas regularly.  (Click here to read more.)

Does diet soda cause stroke?  Or does the association merely mean that people who choose diet soda also have other lifestyle habits that predispose to cardiovascular disease?

My view is that this study’s results are most likely due to an association with lifestyle habits.  The study authors tried to control for such associations, but that’s hard to do in a questionnaire-based study like this one.  I’d have guessed that if drinking diet soda caused stroke and heart disease, we’d have noticed it before now.  But I don’t agree with the American Beverage Association that this makes the study meaningless.

People who choose diet sodas don’t usually do so because they prefer the flavor to sugar; often they are trying to counterbalance other issues, such as obesity, which are already known to be related to stroke and heart disease.

Especially for children, my concern is that diet sodas may reinforce kids’ preference to drink other sweetened beverages, like juices, sports drinks and sugary sodas, which are clearly associated with obesity.

The best use for diet sodas for kids is probably for children whose weight is a concern, as a temporary or infrequent stepping stone to teach better lifestyle habits.  Diet sodas may not be harmful themselves, but it’s better to teach kids to drink water or milk.

The Government Accountability Office investigated commonly available supplements, and found heavy metals — including lead, mercury, cadmium and arsenic — in supplements available at drugstores and health food stores.

The FDA’s authority to regulate such supplements and treatments was rescinded during the Bush administration; since then, the sale of unregulated supplements has skyrocketed.

Sometimes I am asked about the value of various herbal or homeopathic treatments for children.  In general, there is no proof that they live up to their claims, nor is there supervision to ensure that they are free of foreign substances that might be harmful.

For my patients, I am skeptical that herbal and homeopathic supplements not regulated by the FDA are of benefit to children.  Labelling a treatment as “natural” does not assure us that it is effective, or safe.

Click here to read an article about the Congressional investigation from the New York Times.

–     David Epstein, MD

–  David Epstein, MD

Some mothers produce so much milk that their baby can’t drink it all.  Have you ever wondered how to give it away?  Perhaps there’s a baby who could really use it.

Now, there’s a way to donate it.  “MilkShare” is an organization dedicated to uniting babies in need with a breastmilk donor.  One of my patients alerted me to this resource; she has donated milk for two families, and she’s found it to be a rewarding experience.

Donors are not expected to be reimbursed for the milk itself, but you can be reimbursed for equipment and shipping costs.  (Selling the milk itself is forbidden by the site.)  The recipient is also responsible for any costs for testing the milk.

Click HERE to see the MilkShare website, and find out more.

– David Epstein, MD

Until now!  Recently, I have seen a steady stream of recent research suggesting that vitamin supplements, especially with Vitamin D, might be useful.

People with low blood levels of Vitamin D have reported 40% more frequent respiratory infections.  The association is even stronger for those with asthma or other lung diseases. (Arch Intern Med. 2009; 169:384-390.)

Teenagers with low Vitamin D levels are twice as likely likely to have high blood pressure, obesity, and high blood sugar.  They were also more likely to have cholesterol problems.  The same finding has been previously reported in adults.  Low Vitamin D levels have direct effects on blood pressure metabolism and insulin levels, and might also be a marker for poor diet.  Vitamin D tends to be drawn into fat tissue, so people with obesity probably need higher Vitamin D intake.  (Click here for the article. 1)

And, of course, Vitamin D’s relationship to bone health is well known.  This has led to universal supplementation of milk with Vitamin D, to complement milk’s calcium supply.  Kids should be happy about this; they don’t need to swallow cod liver oil any more!

Vitamin D deficiency turns out to be surprisingly common.  61% of American children have low serum Vitamin D levels, and almost 10% are frankly deficient.  Only 4% of kids take regular children’s vitamin supplements.  (Click here to see the data. 2)

As a result, the AAP now recommends Vitamin D supplements for all children, 400 IU (“International Units”) per day.  (Click here for the AAP report. 3) (Most children’s vitamin supplements provide this amount, but check the label to be certain.)  But even this may turn out to be insufficient for some kids.  Obese children, and kids taking seizure medications, might need more.

What do I recommend?

• Infants fed with breastmilk should be given a daily vitamin supplement, starting at 1 month of age (such as Tri-Vi-Sol).  (Formula already contains vitamin supplements, so infants taking more than 16 ounces of formula per day don’t need Tri-Vi-Sol.)
• For kids over 1 year, and actually into adulthood, a regular vitamin supplement (any brand) should be given daily.  Any brand should be fine; I suggest you find a brand that also provides mineral supplementation, such as iron, zinc, and even selenium.
• Unfortunately, blood testing for Vitamin D is problematic.  Some doctors recommend keeping levels above 20 ng/ml; but others recommend levels above 20 ng/ml.  Lab testing and reporting of Vitamin D levels are not yet standardized.  And Vitamin D levels vary normally with the seasons.  So I don’t recommend blood tests except under specific circumstances.

And don’t forget to check my handout on Calcium supplements (click here).

–  David Epstein, MD

1. [PEDIATRICS Vol. 124 No. 3 September 2009, pp. e371-e379]
2. [PEDIATRICS Vol. 124 No. 3 September 2009, pp. e362-e370]
3. [PEDIATRICS Vol. 122 No. 2 August 2008, pp. 398-417]

A new program to improve the nutritional quality of food, and to further promote breastfeeding, has been put in place this year.  Delaware’s Department of Health and Human Services is one of the first states to implement the new program.

Are you interested in the program? or do you think your family might qualify?  Click HERE to see Delaware’s WIC program website.  For information about the federal funding, click here.

–  David M. Epstein, MD