Archive for the 'Health & Wellness' Category

Nutritional considerations for children with Crohn’s disease

child holding bowl of berries

For children with Crohn’s disease, good nutrition is important to allow them to grow and develop at a healthy rate. What your child eats or is able to eat can depend greatly on whether their Crohn’s is in remission (not active) and experiencing few symptoms or if it is active and causing increased inflammation of the digestive tract.

When your child’s disease is in remission, the goal is to maintain a well-balanced diet featuring a wide variety of nutrient-dense foods. These foods include: protein (meats, fish, poultry, dairy products, beans and legumes), carbohydrates (whole grain cereals and breads, vegetables, fruit), and fats (monounsaturated and polyunsaturated oils, avocado, nut spreads). A well-balanced diet can help make sure that your child gets enough calories, protein and vitamins/minerals.

When the disease is active and your child is experiencing more symptoms, the goal is to make sure your child is consuming sufficient calories and nutrients. Your child’s health care provider may suggest a modified diet that may be helpful during this time such as a low fiber/low residue diet or a lactose-free diet. Changes to your child’s diet are recommended mainly to help with any discomfort or unpleasant symptoms your child may be having.

Low fiber/low residue diet

Fiber is the part of food that cannot be digested; it is also known as bulk and roughage. Fiber helps the body move food through the digestive tract. Eating foods high in fiber — such as fresh vegetables and fruit, whole grains, nuts and popcorn — when your child’s disease is active may increase diarrhea, increase pain and discomfort with bowel movements, and increase bleeding. A low-fiber diet can help to “rest” the intestines.

If your child’s doctor recommends a low-fiber low/residue diet, this article might be a useful reference for appropriate foods on a low-residue diet. In addition, a multivitamin or vitamin supplements may be recommended in order to add nutrients normally found in fruits and vegetables.

Remember to always check with your child’s health care provider before beginning a new diet.

Lactose-free diet

Lactose is the carbohydrate portion of milk. Children may experience lactose intolerance, especially with the disease in the small intestine. Symptoms include nausea, bloating, increased burping, increased gas, stomach pain and diarrhea. These symptoms can decrease or go away completely when milk and other dairy products, such as cheese, ice cream and yogurt, are removed from the diet.

Because milk and dairy products are very important sources of calcium and vitamin D for a growing child, your health care provider may suggest switching to lactose-free milk or fortified soy milk/almond milk/rice milk, or recommend your child take a lactase supplement when eating milk products.

Consult your health care provider before taking dairy products out of your child’s diet. A dietitian can also make suggestions that will help to lessen symptoms and keep up the amount of calcium and vitamin D in your child’s diet.

Supplements

Children with Crohn’s disease may benefit from vitamin and mineral supplementation of calcium, iron, B12, magnesium and/or phosphorus due to a variety of reasons including location of disease within the GI tract, poor absorption, surgical resections or poor food intake due to decreased appetite. Do not start supplementation without consulting your child’s medical health provider.

There is not one set diet that is applicable to every child with Crohn’s disease. Keeping a daily food journal can help identify foods that may trigger symptoms and avoiding these foods, especially when your child’s disease is active, may help lessen symptoms. It can be helpful to consult with a dietitian who can help develop a specific dietary plan for your child. A dietitian can also review your food journal to see if there are any patterns in your child’s diet in relation to his/her symptoms.

Mary Ligotti-Hitch, R.D., is a registered dietitian with the Beaumont Health Center’s Weight Control Center.

Resources:

Dysphoric Milk Ejection Reflex

mom breastfeeding baby

Cropped image. Cheryl, Flickr. CC license.

What is Dysphoric Milk Ejection Reflex (D-MER)?

D-MER is a condition affecting lactating women that is just recently been recognized. It is characterized by abrupt dysphoria, or negative emotions, that occur just before milk release. This reaction to letdown may occur when pumping, breastfeeding or when experiencing spontaneous letdown (i.e., milk releasing when not breastfeeding/pumping).

Moms have used many different words to explain the feelings that take place with D-MER. Some of the most frequent descriptions are anxiety, sadness, dread, nervousness, emotional upset, irritability and hopelessness.

D-MER presents itself with slight variations depending on the mother experiencing it, but it has one common characteristic: a wave of negative emotion just prior to letdown. This emotional response is the consistent key component in D-MER. The breastfeeding mother experiences a surge of negative emotions 30 to 90 seconds prior to her milk release when breastfeeding, pumping, or with spontaneous letdown.  It can last for a few seconds at the beginning of a feeding or it can happen repeatedly with multiple letdowns in the same feeding.

For some mothers D-MER is gone by the time the baby is 3 months old, but for other moms it lasts until weaning.

What is the cause of D-MER?

Before discussing what it is, it is important to discuss what it is not.

  • It is not a psychological response to breastfeeding.
  • It is not postpartum depression or postpartum mood disorder.
  • It is not general dislike of breastfeeding.
  • It is not breastfeeding “aversion”.
  • It is not due to a history of depression, a history of physical/sexual abuse.
  • It is not related to the mother’s birthing experience.
  • It is not because she doesn’t love her baby enough or because she’s a bad mother.

Other important things to note:

  • Mothers themselves cannot cause D-MER. It is a hormonal problem.
  • The feelings a mom experiences with D-MER are not real. They are her hormones are fooling her and even though it feels like it’s in her head, it’s not.
  • Mom did nothing to cause it, and she cannot make herself snap out of it

Research tells us that D-MER is physiological not psychological. This means that hormones in the mom’s body, not past experiences or repressed memories, that are causing the condition.

Preliminary studies found that D-MER is the result of the drop in dopamine levels at letdown. This drop must occur to allow the prolactin (milk-making hormone) level to increase. This happens to all mothers, but in women with D-MER, the dopamine level drops too far or too fast in the central nervous system. This results in a wave of negative emotions.

What treatment is available?

For mothers with mild to moderate D-MER, education may be the best treatment. Many women find their symptoms are more easily managed once they are aware it is a medical problem and not an emotional one. Tracking symptoms in a log and learning what makes them better or worse is helpful for many moms.

Mothers with more severe D-MER are encouraged to visit their health care provider. Together, they can determine the best way to treat this condition effectively. So far, it has been proven that medications that increase dopamine levels in a mother can treat D-MER effectively. The best way to receive the proper treatment is to let your doctor know exactly what is happening when you experience these feelings.

Education

D-MER is not a new condition, but until recently, little was known about it. Many mothers were embarrassed to talk about this; they thought they were the only ones struggling with the feelings they had during letdown. If they did speak of it, many times a mother’s feelings were dismissed. We are just discovering how widespread this is. As more people continue to speak up about this condition and awareness increases, progress will continue to be made in the education, support and treatment of D-MER.

– Pat Ashley, RN, IBCLC, Beaumont Hospital, Grosse Pointe

Summer salads to bring to your next BBQ

chopped vegetable confetti salad

image credit: fooddonelight

With summer right around the corner, what better way to celebrate than with some fresh vegetables? As one of the dietetic interns at Beaumont, I wanted to share two of my favorite salad recipes with you. I love to eat salad, especially in the summer time and with so many delicious vegetables to choose from, I like making a different salad every day and trying new recipes. There are so many temptations in summer from graduation parties, holidays, and birthday parties, but bringing a salad to one of your social events will keep you full, on track, and it’s sure to be a hit at the festivity.

Chopped Vegetable Confetti Salad (pictured above)

Ingredients:

  • 4 cups cauliflower, roughly chopped
  • 4 cups broccoli, roughly chopped
  • 2 cups carrot, roughly chopped
  • 2 cups celery, roughly chopped
  • 1 red pepper, roughly chopped
  • 1 cup onion, roughly chopped
  • 2 cloves garlic, minced
  • ½ cup fat-free Italian dressing
  • Fresh ground black pepper to taste
  • *Note: To save time buy your vegetables pre-cut at your local grocery store

Directions:

  1. Place cauliflower into a food processor and pulse until cauliflower is very finely diced. Pour into a large bowl.
  2. Repeat with broccoli and remaining vegetables, one at a time.
  3. Add the minced garlic to other vegetables.
  4. Pour dressing over vegetables and toss well and season with pepper.
  5. Refrigerate for an hour and serve. (Counts as low starch vegetables.)

Yield:

10 servings

Recipe adapted from https://fooddonelight.com/chopped-vegetable-confetti-salad/#_a5y_p=1560257

Creamy Tomato and Cucumber Salad

Ingredients:

creamy cucumber and tomato salad

image credit: Natasha’s Kitchen

  • 3 medium tomatoes
  • 2 medium cucumbers
  • ½ medium onion
  • 1 large garlic clove
  • 3 tablespoons fat-free mayo
  • 2 tablespoons fat-free sour cream or plain Greek yogurt
  • ⅛ teaspoon pepper
  • Salt to taste

Directions:

  1. Cut tomatoes into 1-inch pieces.
  2. Cut cucumbers in half and slice, then thinly slice the onion.
  3. Combine all the prepared vegetables in a medium bowl.
  4. In a small bowl, combine mayo, sour cream or plain Greek yogurt, garlic, and pepper. Mix well.  Mix the dressing into the vegetables.
  5. Add salt to taste just before serving. (Counts as low starch vegetables.)

Yield:

6 servings

Recipe adapted from http://natashaskitchen.com/2010/08/16/creamy-cucumber-and-tomato-salad/

– Chelsea Bono is dietetic intern going through the Beaumont Dietetic Internship program.

Breaking digital addictions

girl holding smartphone while looking out window

Did you see the recent study from Harvard noting that increases in Facebook use correlated with decreases in well-being, even after controlling for baseline levels of use? This was the case even when the study participants were “liking” and posting, rather than merely “lurking” on social media. The authors conclude:

“The full story when it comes to online social media use is surely complex. Exposure to the carefully curated images from others’ lives leads to negative self-comparison, and the sheer quantity of social media interaction may detract from more meaningful real-life experiences. What seems quite clear, however, is that online social interactions are no substitute for the real thing.” – Shakya & Christakis, 2017 (emphasis is mine)

In previous posts, Phubbers and the iPhone Effect and Stuck in Cyberspace: The hidden dangers of Internet addiction, we discussed the power of technology to pull us out of our everyday lives and even put our relationships at risk.

Nonetheless, we all see the benefits of using computers and smartphones, and even television and video games can have valued uses. Ideally we want a balanced relationship with our technological gadgets. Remember that overuse of technology is a habit, and like all habits, it can be hard to break. Also, we often handle social anxiety by retreating into our digital worlds; this doesn’t help us build relationships or deal with discomfort.

This HelpGuide.org resource lists key features of smartphone addiction, includes an online quiz, and offers tips to help break digital addictions. Here are some of the highlights, along with a few tidbits I’ve learned through working on my own smartphone use:

  • Make technology your servant, not your master.
  • Goal is to cut back to healthy levels of use.
  • Think before you automatically pick up phone.
  • Turn off notifications on apps and games.
  • Review responses before sending.
  • Make “good habits” easier and “bad habits” harder. Remove apps or move icons off home screen
  • Keep phone away from bed (light filter).
  • Read “real” books in bed. Also, e-readers that do not emit light should not disrupt sleep.
  • Buy an alarm clock.
  • Adjust your settings to silence your phone at night. The timer/alarm will still go off and certain contacts can still call through for emergencies.
  • Realize: You don’t get those minutes back that you spent aimlessly drifting through the internet.
  • Set goals for when you can use your smartphone and use a timer to keep yourself honest.
  • Turn off your phone at certain times of the day.
  • Replace your smartphone use with healthier activities (e.g., physical activity, talking to others, reading, etc.).
  • Spending time with other smartphone addicts? Play the “phone stack” game: Everyone stacks their phones in a location out of arm’s reach, and just interacts with each other.
  • Limit “checks” of your phone. Wean yourself off compulsive checking.
  • Maybe most importantly, curb your fear of missing out, and tune in to what is going on around you. You may really be amazed at what you see and who you talk to when your face is not stuck in a screen!

– Lori Warner, Ph.D., LP, BCBA-D, Director, HOPE Center at Beaumont Children’s

Stuck in cyberspace? The hidden dangers of internet addiction

We are surrounded by cyberspace! Computers connect and help us in so many ways. We often take for granted all of the resources at our fingertips, at least until the power goes out! I’m enjoying the wonders of technology right now as I write this post on my computer and technology will allow you to read it. Technology is an amazing tool.

However, any tool can be used as a weapon. This same technology can be used for cyberattacks, cyberbullying, and even increased depression and anxiety resulting from too much negative news consumption. Too much screen time can horribly impact our relationships, health and mood.

How does this happen?

The immediate gratification from computers and mobile devices create a powerful reward loop that works something like this:

feel bored or unhappy → tap into internet or game → feel entertained/better

The reward pathways that light up in our brains when we use the internet are the same pathways that light up when we use alcohol, nicotine, or other drugs. Wow! Whether we use technology to escape bad feelings or just in a habitual way, risk factors for significant problems.

Taken to extremes, people can actually become addicted to the internet. There is scientific debate whether it’s truly considered a “mental disorder,” but we do know that psychological and social problems occur. Both China and South Korea identify internet addiction as a significant public health issue, and the United States is starting to take this issue more seriously as well.

How do you know if you or someone you love is addicted to the internet? A recent study describes signs, and you should consult a professional if you see:

  • “changes in mood,
  • preoccupation with the Internet and digital media,
  • the inability to control the amount of time spent interfacing with digital technology,
  • the need for more time or a new game to achieve a desired mood,
  • withdrawal symptoms when not engaged,
  • continuation of the behavior despite family conflict, a diminishing social life and adverse work or academic consequences” (Cash et al., 2012).

Parents know that kids need reduced screen time and lots of face-to-face, active interactions to thrive and grow. But at the same time, screens are all around us and the constant pull of notifications from emails, text messages, games and apps can leave us distracted and scattered. So how do we balance the benefit of technology with the hidden dangers of these amazing machines?

First and foremost, practice what you preach! If your phone is your constant companion, start being more mindful of how and when you use it. Specific tips for breaking digital addiction in our next post, so stay tuned!

– Dr. Lori Warner, Ph.D., LP, BCBA-D, Director, HOPE Center at Beaumont Children’s

Plain soap and water

mom and son washing hands

Cropped image. Cade Martin and Dawn Arlott, PIXNIO. CC license.

How many times a day do doctors wash their hands? Dozens, perhaps. And they encourage us to follow effective hand-washing techniques as well.

“But, the conversation shouldn’t end there”, according to Dr. Paula Kim, M.D. with Beaumont Health, clinical professor at Wayne State University’s School of Medicine, and associate professor at Oakland University William Beaumont School of Medicine. She says, “The next questions are: What type of soap is used at home? Is it an antibacterial? Or is it plain soap and water?”

The Centers for Disease Control, American Medical Association, U.S. Food and Drug Administration, and others overwhelmingly encourage people to use non-antibacterial (plain) soap and warm water, and to rub hands together for a minimum of 20 to 30 seconds.

Why plain soap? Isn’t an antibacterial product more effective? Surprisingly, no. In 2013 the FDA challenged manufacturers of over-the-counter antibacterial hand and body soaps to prove that their products are more effective at killing germs than plain soap and water. And they couldn’t do it.

“There’s no data demonstrating that these drugs provide additional protection from diseases and infections. Using these products might give people a false sense of security,” says Theresa M. Michele, M.D., of the FDA’s Division of Nonprescription Drug Products.

Due to health risks, including bacterial resistance, the FDA banned manufacturers from using almost all antibacterial chemicals, including the widely used triclosan. Manufacturers of hand and body soaps (soaps intended to be used with water) have until September 2017 to switch their formulations. The new rule affects most of the liquid hand soaps and bar soaps currently on the market. It does not affect hand sanitizers or hand wipes.

Health risks

The FDA is heeding the warning of research showing that the use of triclosan can lead to bacteria that are resistant to antibiotics, making them ineffective. The agency also expressed concern over triclosan’s potential hormonal effects. According to the FDA, “…recent studies have demonstrated that triclosan showed effects on the thyroid, estrogen, and testosterone systems in several animal species, including mammals, the implications of which on human health, especially for children, are still not well understood.”

Other organizations, such as the Canadian Environmental Law Association (CELA), have found — in addition to concerns about endocrine activity — triclosan carries risks for the reproductive system and brain development.

Exposure

We likely use at least one product every day that contains triclosan. Antibacterial chemicals are added to thousands of products, including household cleaners, cosmetics (including deodorant, toothpaste and mouthwash), clothing, furniture, lunchboxes, backpacks, food packaging, kitchen utensils, children’s toys and more. But the chemical doesn’t simply stay in those products. Researchers found triclosan in household dust, in streams and other waterways, in wildlife, in human plasma and breast milk, and in drinking water.

Indeed the multitude of exposure paths was a driving factor behind the FDA’s original inquiry. According to a September 2016 FDA Consumer Update factsheet, Antibacterials? You Can Skip It – Use Plain Soap and Water, “…people’s long-term exposure to triclosan is higher than previously thought, raising concerns about the potential risks associated with the use of this ingredient over a lifetime.”

Consumers

Many people use antibacterial soaps without knowing they are using an OTC drug. Shoppers should watch out for the word “antibacterial” or the phrase “kills germs”. Generally, we find these words and phrases reassuring. But remember that it isn’t necessary to kill all the germs, but to simply remove them with plain soap and water. Then wash them down the drain. A drug facts label on a soap or body wash is a sign a product contains antibacterial ingredients. As Dr. Kim always encourages her patients, “Read the label on anything you buy. Read what’s in it!”

More information

You don’t have to settle for toxic triclosan in your household cleaners either. Dr. Kim suggests her patients to “use natural things if possible, such as vinegar and water.” White vinegar is a food-grade anti-microbial that can kill germs on surfaces. Or look for Clean Well brand soaps and sanitizers, which use thyme oil as the active ingredient to kill germs. Some of the Seventh Generation brand cleaning products include the Clean Well technology also.

– Melissa Sargent, Environmental Health Educator with LocalMotionGreen at Ecology Center. For more information, you can email her at melissas@ecocenter.org or visit http://www.ecocenter.org/lmg.

Childproofing your home

Toddler opening a cabinet

Unaltered image. Jed De La Cruz, Flickr. CC license.

As a parent, it is our job to keep our children safe. So how do you know when to start childproofing and where to start? This can be an overwhelming process for many parents. Have you ever just stood in the safety section at your local baby store? There is an entire wall chock full of products with a variety of door handle covers, outlet covers, drawer and cabinet locks, and other items that you never even knew existed. Here is some advice on how to make sure your home is safe for your baby.

  • Get down on the floor at baby’s level. The world looks a whole lot different from there. Pay attention to what baby can see and reach.
  • When should I start? The sooner the better, however once baby is able to start rolling (typically 4 to 6 months), you want to make sure you’ve started your childproofing.
  • Know your baby. Some babies are much more mobile and curious than others. Some babies need to climb and get into everything. For these children, you may need to be much more thorough.
  • Keep all medications, chemicals, soaps, and detergents away from baby. Make sure these items are in locked cupboards or above baby’s reach in the kitchen and bathrooms.
  • All items that fit within a toilet paper tube pose a choking hazard to baby. Anything that fits inside should be kept away from baby, especially small items like coins.
  • Make sure you have the number for poison control in your cell phone and a central location in your home (800) 222-1222. You can also download an app to your phone.
  • Register for the Consumer Product Safety Recall list to be alerted for recalled items.

Recommended safety items

  1. Outlet covers
    1. Babies are very curious and the outlets seem to attract little fingers.
    2. If you don’t like the outlet covers, you can swap out all of your outlets with ones that have covers built into them.
    3. When traveling to a relative or friend’s home, bring an extra pack of outlet covers to keep your baby safe.
  2. Gates
    • You must use gates mounted with hardware at the top and bottom of stairs.
    • Pressure-mounted gates can be used in hallways and doorways.
    • Some gates have extension pieces to make sure they fit your space properly.
    • If you need to mount your gate to the banister, you can purchase a kit that lets you install the gate without drilling holes into your banister.
  3. Furniture straps
    • All furniture (including dressers and book cases) should be strapped to wall in rooms that baby will be in. These help to prevent furniture from falling on top of baby.
  4. Door locks/handles
    • Make sure you have the correct type of door lock for the correct door:
      • Bi-fold door locks
      • Sliding door locks
      • Universal locks
      • Appliance locks (e.g., refrigerator, drawer under oven/washing machine, dishwasher, etc.)
      • Door latches are very inexpensive and perfect for basement doors.
      • Toilet locks keep children from “playing” in toilet.
  1. Drawer and cabinet locks
    • Plastic locks that screw into the inside of cabinets or drawers.
    • Magnetic locks are less visible, but more expensive).
  2. Cord protectors
    • Mini blind cord protectors
    • Power strip protectors
  3. Thermometer for bathtime
    • Ensures water is not too hot or cold for baby

– Amy Weiss, MPT  Supervisor of Outpatient Physical Therapy at Beaumont Physical Therapy Berkley

 


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