Healthy Kids Healthy Drinks

Recently four major health organizations came together to support the first-ever consensus recommendation about healthy drinks for kids. There are so many drinks available in stores these days, and many of them are advertised as kid's drinks. Unfortunately, many drinks that are advertised for kids are not actually healthy for kids. I know it was always a challenge for me as a parent, trying to combat the advertisements, as well as the availability of unhealthy drinks at every turn, from restaurants to soccer games. But it is important that we as parents make good choices for our children who are too young to make these choices for themselves.

Which organizations formed the consensus?

• Academy of Nutrition and Dietetics
• American Academy of Pediatric Dentists
• American Academy of Pediatrics
• American Heart Association

Why are these new recommendations important?

The beverages that kids drink during the first few years of their lives are a significant source of calories and nutrients, and can have a large impact on their health, not only during childhood, but throughout adulthood as well. Early childhood is the ideal time to start shaping nutrition habits and promoting healthy nutritional choices, and this is just as important for beverages as it is for foods.

What are the new recommendations?

The recommendations are divided by age, from birth through age five. You can follow the link at the bottom of the page to read the full recommendations, but I can give you a summary here.

0-6 month old babies should drink:

• Breast milk
• Infant formula

6-12 month old babies should drink:

• Breast milk
• Infant formula
• A few sips of water during meal times with solid foods

12-24 month old babies should drink:

• Water - 1-4 cups of water daily, depending on the weather and how active they are
• Milk - Plain, pasteurized whole milk provides lots of nutrients which their growing bodies need. They should get 2-3 cups of whole milk per day.

2-3 years toddlers should drink:

• Water - 1-4 cups per day which varies depending on the weather and how active they are
• Milk - At this age, children should transition to low fat milk, either 1% milk or skim milk, about 2 cups per day.
• Very limited amount of 100% fruit juice - Only ½ cup (4 ounces) per day. You can add water to fruit juice in order to make a little bit go further. Instead of drinking fruit juice, children should be eating fruit (fresh, canned, or frozen) with NO added sugar. Even 100% fruit juice can cause dental cavities and unwanted weight gain.

4-5 year old kids should drink:

• Water - 1.5 to 5 cups of water a day, again depending on weather and activity level.
• Milk - Plain, pasteurized, low-fat milk, up to 2 ½ cups a day
• Very limited amount of 100% fruit juice - No more than ½ to ¾ cups (4-6 ounces) per day. Again, kids should be eating fruit without added sugars, rather than drinking juice.

For all age groups, kids should not drink anything that is not on the list of recommended drinks for their age, this includes:

• Flavored milks, like chocolate or strawberry milk
• Transition formulas, sometimes called toddler formulas or follow up formulas
• Plant-based milks such as almond milk, soy milk, rice milk, oat milk
• Drinks with caffeine, such as sodas, coffee, tea, energy drinks
• Carbonated drinks, such as sodas
• Sugar-sweetened drinks, or drinks sweetened with low-calorie sweeteners, such as sodas, fruit drinks, fruit-ades, sweetened waters, etc.
• Sports drinks or energy drinks - No kids should drink sports drinks, even if they are playing sports.

I would encourage you to read the full recommendations by following this link:
https://healthydrinkshealthykids.org/ 

If you have any questions about healthy drinks for kids, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Gout Part II - Diagnosis and Treatment

Last week, we talked about the symptoms and causes of gout.  This week, we'll talk about the diagnosis and treatment of gout, including dietary changes.  My husband has had gout for many years, so I am very familiar with the dietary triggers for gout flares!

If you have symptoms, how is the diagnosis of gout made?

• There are several tests that can help make the diagnosis.  Not all of them are necessary for all patients.
• Blood test - A test that measures the uric acid level in the blood can be helpful.  However, this test is not diagnostic for some patients.
• Joint fluid test - Your doctor can use a needle to remove fluid from the affected joint.  If urate crystals are seen under the microscope, that provides the diagnosis.  
• X-ray - An X-ray of the affected joint may be helpful to rule out other conditions.
• Ultrasound - An ultrasound can often detect the urate crystals in a joint or gout nodule.

What are the possible complications of gout?

• Recurrent gout flares may cause erosion and destructive changes within affected joints.
• Untreated gout may also cause deposition of urate crystals under the skin, causing gout nodules called tophi (tophi is pleural, tophus is singular).
• Urate crystals may also build up in the kidneys, causing kidney stones.  

If you have gout, what lifestyle changes can you make to decrease your risk of flare-ups and complications?

• Drink plenty of fluids, especially water
• Limit or avoid alcohol, especially beer
• Limit your intake of high-fructose corn syrup, especially soft drinks
• Limit your intake of meat, fish, and poultry, but especially red meat and organ meats
• Limit the amount of seafood in your diet, such as shrimp
• Get more of your protein from low-fat dairy products, which seem to have a protective effect
• Maintain a desirable body weight - If you are overweight, losing weight may decrease your uric acid levels.  However, fasting, or losing weight rapidly may temporarily increase uric acid levels.
• Maintain a regular exercise program

What are the other treatment options for patients with gout?

• Some people manage very well with lifestyle changes alone, at least for a while.  Medications can be used to treat acute attacks, to prevent future attacks, or to decrease the risk of complications.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) - NSAIDs include over-the-counter and prescription medications, such as ibuprofen, naproxen sodium, indomethacin, and others.  Your doctor may recommend that you take a higher dose during an acute attack, then a lower dose to help prevent flares.  Side effects include an increased risk of bleeding and ulcers.
• Colchicine - This is a prescription medication that works effectively to relieve gout pain.  It may be taken in higher doses to help with an acute flare, and then in lower doses to help prevent recurrent flare-ups. It can have side effects (primarily gastrointestinal symptoms), especially if taken in large doses.  
• Corticosteroids - This includes medications such as Prednisone.  They may be given in pill form, or as a shot.  We usually don't use these medications unless a patient cannot take NSAIDs or colchicine, primarily because of the risk of adverse effects associated with these drugs.
• Medications that block uric acid production - These medications would be taken daily to try to prevent gout flares and complications.  They include allopurinol and febuxostat.  By blocking uric acid production, they can lower your blood level of uric acid.  Side effects are not uncommon.  
• Medications that improve the removal of uric acid by the kidneys - This includes probenecid and lesinurad, which are taken daily.  They do help prevent joint flares and complications, but they increase the level of uric acid in the kidney, so they can increase your risk for kidney stones.  They can have other side effects as well.  
• The decision about taking medications for gout should be discussed with your doctor, weighing the risk of side effects against the potential benefits of decreasing gout flares and complications.  

For more information about a low-purine diet, follow this link:
https://www.drugs.com/cg/low-purine-diet.html

Dr. Anita Bennett MD - Health Tip Content Editor

Gout

Gout is a complex form of arthritis.  It typically causes sudden, severe attacks of pain, swelling, redness, and tenderness in the joints.  The most common joint affected is the base of the big toe.  Most patients will have episodic flares, with little or no symptoms between flares.  There are ways to manage this condition and decrease or even prevent symptoms.  Today we'll talk about the symptoms and causes of gout, and next week we will talk more about the diagnosis and treatment of gout.

What are the symptoms of gout?

• Intense joint pain - The onset of pain is sudden and severe, often waking you up from sleep.  The pain is most severe within the first 4-12 hours, and is often described as feeling like your big toe is on fire.  The most common joint affected is the base of the big toe, but other commonly affected joints include the ankles, knees, elbows, wrists, and fingers.  
• Persistent discomfort - After the initial severe pain, some discomfort may last for days to weeks.  The longer a patient has gout, the longer the persistent discomfort may last, and the more joints may be involved.
• Redness, swelling, tenderness - Affected joints may be so tender that even the weight of the bed sheet may seem intolerable.
• Limited motion of joints - With repeated flares, affected joints may lose the ability to move as easily as they should.

What causes gout?

Gout happens because urate crystals accumulate in your joint which occurs when you have high levels of uric acid in your blood.  Urate crystals are sharp, and needle-like, and when they develop inside a joint, they cause the inflammation and swelling associated with gout.

Uric acid is produced by the body when it breaks down substances called purines.  Uric acid is normally dissolved in your blood and is eliminated by passing into the urine through the kidneys.

    

High levels of uric acid in the blood can be caused by the body either producing too much uric acid, or by the kidneys not getting rid of enough uric acid. 

What are the risk factors for gout?

• Family history - If family members have had gout, you are more likely to develop it.
• Age and sex - Men are more likely to develop gout because women tend to have lower uric acid levels.  However, after menopause, uric acid levels in women increase and approach those of men.  Men are more likely to develop gout when they are younger (between 30-50 years of age), but women are more likely to develop gout after menopause.
• Diet - Eating a diet rich in foods containing high levels of purines will increase uric acid levels.  High purine foods include red meats, organ meats, seafood, and some others.  Other foods that increase levels of uric acid include high-fructose foods or drinks and alcohol, especially beer.
• Obesity - When you are overweight, your body produces more uric acid, and your kidneys have more trouble eliminating it.
• Medical conditions and certain medications - Conditions such as diabetes, untreated high blood pressure, heart disease, and kidney disease increase your risk of gout.  Some medications increase uric acid levels, such as certain diuretics, aspirin, and some others.

We'll talk more about gout next week.  If you have any questions about gout, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor