February 2020 Newsletter 
Does Cow's Milk Increase Mucus?
Most of us have our own opinion on this age-old adage.

Michael Greger MD, a staunch advocate of plant-based diets, cites portions of an in vitro study that suggest that a subset of the population, when exposed to A1 milk (that is the subject of another newsletter!) could get increased phlegm.  

Moreover, in a paper published by doctors from NYU in 1991, pulmonary function declined after milk consumption in a group of asthmatics.

On the other hand, other studies have  failed to show a decline  in lung function in atopic patients after milk consumption.   Another study from Australia, published in 1997 likewise failed to find a response to milk in asthmatics.

In fact, a review titled Milk Mucus & Myths published last year by Dr Ian M Balfour-Lynn from The Royal Brompton Hospital in London, concluded that "The milk-mucus myth needs to be rebutted firmly by healthcare workers."
So, what is a parent to do with this controversy? This may be a situation for an "N of 1" experiment. If your child has a cold with nasal congestion / cough, try keeping them off dairy (i.e. cow's milk, ice cream) for a day and see how they do. Give herbal teas, soups, fresh juices, coconut water, etc.

The following day add in the cow's milk and note the response.  [Note that this does not apply to nursing infants. Moreover, raw milk may yield different results]. Share your experience with us on Facebook here.  
Reverse Opiate Crisis for Kids?
In 2017, The FDA advised practitioners that codeine and tramadol (a synthetic first cousin) may not be prescribed to children under age 12 or nursing mothers. This restriction came, not so much in response to the opiate crisis but to reports some children (so-called rapid metabolizers) who received these drugs had life-threatening respiratory depression and even death.
The following year, the FDA further restricted use of codeine cough syrups to adults age 18 and old. They determined that the risks of difficult breathing, misuse, abuse, addiction, overdose, and death with these medicines outweigh their benefits in pediatric patients.
These were thoughtful actions; safety comes first. But to the parent of a child with a badly-fractured extremity, extensive burn, or major surgery - the alternatives for pain-control are sadly lacking. Ibuprofen and acetaminophen have limited efficacy and their own safety concerns with multiple daily dosing.
We share the frustrations. Some suggestions:
  • Ask us about a shot of Toradol, a first cousin of ibuprofen. May be helpful for a child writhing in pain from a bad ear infection or toothache - pain that we expect to be short-lived. There is an oral form as well.
  • Consider topical agents such as viscous lidocaine for an earache or canker sore, clove oil for dental pain, or an ice pack for a bad bruise.
  • Cannabidiol (CBD) may be helpful for chronic pain, especially if it is inflammatory in nature. Safety and efficacy, however, are still being worked out.
  • Low level laser therapy (available in our office) -- helpful in both acute and chronic conditions.
Rapamycin:  A Remarkable Antibiotic
Easter Island, a 63 square-mile remote dot of land in the southeastern Pacific, is most well know for the moai, monumental human figures carved out of stone by the Rapa Nui people - weighing in at up to 90 tons.

It was there in 1964 that a Canadian microbiologist Georges Nogrady gathered soil samples from some five dozen sites. Nogrady passed the samples on to Ayerst Labs.  
In one of the samples, a novel bacterium dubbed Streptomyces hygroscopicus was discovered in 1972 by Suren Sehgal to produce a substance he called rapamycin (now also called sirolimus) which had potent anti-fungal properties. In fact, he used it to clear a neighbor's stubborn rash. Soon after, however, the lab closed - and he brought the bacterium home and stored it in his freezer.
Some years later, when working at Wyeth, his work resumed on rapamycin -- eventually spearheaded by David Sabatini at MIT. Those efforts led to the discovery of a nutrient sensing protein kinase that was named mTOR - short for mammalian (or mechanistic, as it is found in all eucaryotes) target of rapamycin.
mTOR is activated by free amino acids, insulin, and growth factors. This puts cells in growth-mode, something that is important in children. Fasting turns it down. It is blocked by rapamycin.  Cycling mTOR off and on seems to be important for health.

Rapamycin went on to become primarily used as an immune-suppressive drug, but it more recently been found to have anti-cancer and anti-aging properties. Mice given rapamycin have a 60% increase in lifespan, for instance.  Topical rapamycin reduces wrinkles and can shrink some types of growths, such as those found in children with tuberous sclerosis .    
Preparing for Corona-Virus
Will coronavirus hit the Hudson Valley hard in the next few weeks? We just don't know. It has already eclipsed SARS, a cousin that made headlines back in 2002-3.

Moreover, many of us will recall the rapid spread of the H1N1 swine flu bug in 2009 from rural Veracruz, Mexico to upstate New York in a matter of weeks.
How should a family prepare? According to the NYS Department of Health, there is not much one can do. Wash your hands, keeps some Advil in the house, and hope for the best....
On the other hand, parent raising their children with an integrative mindset contend with such an array of options that one's head can start spinning!
Here are a few practical suggestions:
  1. Optimize your family's immune defenses now. It's been a rough flu season already for many households. Those that have been through flu B, flu A, RSV, etc know what we mean. Daily vitamin D3, cod liver oil, and a probiotic is a good baseline. For those that need additional support, add a medicinal mushroom such as reishi and some astragalus.
  2. Keep a temporal artery thermometer that gives reliable readings in the house.
  3. Have a supply of vitamin C on hand. Liposomal is the strongest (but least affordable) form. It needs to be a form that your child will actually take - as hourly dosing may be needed during a fever; gummy-form would be last resort.
  4. An anti-viral agent such as elderberry should be on hand. Garlic, echinacea, and other herbs may be helpful as well.
  5. For those that may need extra support, a glutathione booster such as ProImmune, NAC, or liposomal glutathione.
  6. There may be something to the old home remedy of Alka-Seltzer.  Baking soda (sodium bicarbonate) has recently been shown to have an anti-inflammatory effect.  It is often an out-of-hand inflammatory response that leads to trouble in the first hours and days of a viral infection.
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