March Newsletter
In This Issue
Cure for ADHD?
Forks Are Killing Us...
Youth Diabetes is Complicated
A Better Model of Medical Care
Dr. Niedfeldt
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I hope this newsletter finds you and your family well. I'm really getting this newsletter in barely under the wire to still be March. Although it doesn't feel like spring (c'mon, can we at least see the sun?) it's baseball time. Opening day is coming up and I'm certainly excited about our revamped roster. On the basketball side, our Bucks are the hottest team in the league and I'm looking forward to a playoff run. It will make my schedule crazy but it will certainly be worth it!

This months I have three articles looking at our diet and how it affects behavior and our health. The first article looks at the link between diet and one of the most common pediatric diagnosis, attention-deficit/hyperactivity disorder (ADHD ). Could a change in diet potentially prevent (or cure) this problem? 

For us adults, the second article shows us that a significant number of deaths annually can be directly attributed to our diet. If you want to live longer, heed this advice. 

Finally, the incident of diabetes in our young people is rising rapidly. The troubling aspect of this is that these young people seem to be more prone to complications from diabetes. This is worrisome on several different levels. 

Click on the links the the left to check out our newly redesigned  web site ...
Cure for ADHD? 
Mediterranean Diet associated with lower ADHD in children      
We have seen a huge rise in ADHD (Attention-deficit/hyperactivity disorder) in our children over the past few years. Some speculate that this is due to our new digital media culture and lower attention spans. Some feel it is antibiotics, dyes, or BPA in our food supply. Others feel it is our processed diet which is low in fruits and vegetables and high in sugar and processed starches. This study, from the journal Pediatrics, looked at a population of children in Spain. Spain has traditionally had a 'Mediterranean diet' high in vegetables, fruits, nuts, olive oil, and fatty fish but is moving toward a more 'American diet' high in processed foods, sugar (candy and soft drinks), fast food, and low in fatty fish, vegetables and fruit, and lacking in breakfast. The researchers found a link between a lower adherence to the Mediterranean diet and ADHD diagnosis. This suggests that diet plays a significant role in this diagnosis. 
  • OBJECTIVES:  Although attention-deficit/hyperactivity disorder (ADHD) has been related to nutrient deficiencies and "unhealthy" diets, to date there are no studies that examined the relationship between the Mediterranean diet and ADHD. We hypothesized that a low adherence to a Mediterranean diet would be positively associated with an increase in ADHD diagnosis.
  • METHODS: A total of 120 children and adolescents (60 with newly diagnosed ADHD and 60 controls) were studied in a sex- and age-matched case-control study. ADHD diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Energy, dietary intake, adherence to a Mediterranean diet, and familial background were measured. Logistic regression was used to determine associations between the adherence to a Mediterranean diet and ADHD. 
  • RESULTS: Lower adherence to a Mediterranean diet was associated with ADHD diagnosis (odds ratio: 7.07; 95% confidence interval: 2.65-18.84; relative risk: 2.80; 95% confidence interval: 1.54-5.25). Both remained significant after adjusting for potential confounders. Lower frequency of consuming fruit, vegetables, pasta, and rice and higher frequency of skipping breakfast and eating at fast-food restaurants were associated with ADHD diagnosis (P < .05). High consumption of sugar, candy, cola beverages, and noncola soft drinks (P < .01) and low consumption of fatty fish (P < .05) were also associated with a higher prevalence of ADHD diagnosis.
  • CONCLUSIONS: Although these cross-sectional associations do not establish causality, they raise the question of whether low adherence to a Mediterranean diet might play a role in ADHD development. Our data support the notion that not only "specific nutrients" but also the "whole diet" should be considered in ADHD.

What you eat affects how you feel. We all know this. Who feels energized after eating Thanksgiving dinner? We feel sluggish and tired. Most of us have seen the post Trick or Treating or birthday party affects of sugar on kids, and it's not good (I usually serve the cake and ice cream right before they head home - sorry parents).

ADHD and similar diagnoses are becoming more and more prevalent. Children as young as 4 years old are being given this diagnosis and started on stimulant medications! This is an important study because it shows that diet definitely affects the diagnosis of ADHD. Kids who skip breakfast, eat diets high in sugar and fast food and low in fruits and vegetables are more likely to have attention deficits. Shocker! While this seems to be common sense, unfortunately, it is all too common in our society. Talk to any teacher about what they are dealing with in class. Our next generation isn't learning because of their diet. While certainly there are other factors involved in the diagnosis, what we feed our children can profoundly affect how they act and whether they can learn. We need to give them every chance for a bright future. I hope the next study will be an intervention proving that we can make a difference in their lives through healthy food. 
Forks Are Killing Us
Poor diet blamed for 400,000 US deaths in 2015

According to a study presented at the the American Heart Association's Epidemiology and Prevention/Lifestyle and Cardiometabolic Health 2017 Scientific Session, eating an unhealthy diet contributed to over 400,000 premature US deaths from cardiovascular disease in 2015. Low intake of nuts, seeds, vegetables, whole grains and too much salt were the main contributors. Nearly half of cardiovascular disease deaths could be prevented through dietary improvement. 
  • Eating a diet lacking in healthy foods and/or high in unhealthy foods was linked to more than 400,000 deaths from heart and blood vessel diseases in 2015, according to an analysis presented at the American Heart Association's Epidemiology and Prevention / Lifestyle and Cardiometabolic Health 2017 Scientific Sessions.
    Eating more heart healthy foods, and less foods with high amounts of salt and trans fats, could save tens of thousands of lives in the United States each year, researchers said.
    "Low intake of healthy foods such as nuts, vegetables, whole grains and fruits combined with higher intake of unhealthy dietary components, such as salt and trans-fat, is a major contributor to deaths from cardiovascular disease in the UnitedStates," said Ashkan Afshin, M.D., M.P.H., M.Sc., Sc.D., lead study author and acting assistant professor of global health at the University of Washington's Institute for Health Metrics and Evaluation in Seattle. The institute is home of the Global Burden of Diseases, Injuries, and Risk Factors Study , which conducted the new analysis. "Our results show that nearly half of cardiovascular disease deaths in the United States can be prevented by improving diet."
    The new analysis was designed to pinpoint how diet impacts heart and blood vessel disease; it relied on 1990-2012 data from the National Health and Nutrition Examination Survey, food availability data from the Food and Agriculture Organization of the United Nations as well as other sources.
    Looking at U.S. cardiovascular deaths in 2015, researchers found less-than-ideal dietary choices - both a lack of healthier foods and an excess of less healthy foods - played a role in the deaths of an estimated 222,100 men and 193,400 women. Researchers also evaluated the degree to which leading dietary risk factors were linked to cardiovascular disease deaths:
    • low intake of nuts and seeds (11.6 percent);
    • low intake of vegetables (11.5 percent);
    • low intake of whole grains (10.4 percent); and
    • excess salt (9 percent).
      The team's systematic approach in quantifying how diet can contribute heart disease deaths, and in defining the healthiest diet to prevent it, are the research's key strengths, Afshin said.

What we are eating is literally killing us. Over 15% of overall deaths in the US in 2015 were directly due to our diet. Just think, that only includes heart disease deaths due to diet. It doesn't include increased rates of diabetes and its complications, cancer, and dementia which have all been linked to poor diet. These conditions account for 57% of overall deaths. 
We can prevent at least half of these cardiovascular deaths by improving our diet. How much can we improve the overall death rate with dietary changes
Youth Diabetes is Complicated
Increased risk of complications in young Type 2 diabetics 
fast food kids
This study, recently published in JAMA, found that teenagers and young adults diagnosed with type 2 diabetes (often referred to as adult onset diabetes) had significantly more complications than those diagnosed with type 1 diabetes. Type 1 diabetics don't make insulin so they need to take insulin. Type 2 diabetes is due to insulin resistance. The type 2 group had higher rates of kidney disease, retinopathy (eye disease), and peripheral neuropathy (nerve disease) than the type 1 group regardless of glucose control, weight and blood pressure. A total of 32% with type 1 diabetes and 72% of those with type 2 diabetes had at least one complication or comorbidity by age of 21. 
  • Importance: The burden and determinants of complications and comorbidities in contemporary youth-onset diabetes are unknown.
  • Objective: To determine the prevalence of and risk factors for complications related to type 1 diabetes vs type 2 diabetes among teenagers and young adults who had been diagnosed with diabetes during childhood and adolescence. Design, Setting, and Participants
    Observational study from 2002 to 2015 in 5 US locations, including 2018 participants with type 1 and type 2 diabetes diagnosed at younger than 20 years, with single outcome measures between 2011 and 2015.
  • Exposures:  Type 1 and type 2 diabetes and established risk factors (hemoglobin A1c level, body mass index, waist-height ratio, and mean arterial blood pressure).
  • Main Outcomes and Measures: Diabetic kidney disease, retinopathy, peripheral neuropathy, cardiovascular autonomic neuropathy, arterial stiffness, and hypertension.
  • Results: Of 2,018 participants, 1,746 had type 1 diabetes (mean age, 17.9 years [SD, 4.1]; 1,327 non-Hispanic white [76.0%]; 867 female patients [49.7%]), and 272 had type 2 (mean age, 22.1 years [SD, 3.5]; 72 non-Hispanic white [26.5%]; 181 female patients [66.5%]). Mean diabetes duration was 7.9 years (both groups). Patients with type 2 diabetes vs those with type 1 had higher age-adjusted prevalence of diabetic kidney disease (19.9% vs 5.8%), retinopathy (9.1% vs 5.6%), peripheral neuropathy (17.7% vs 8.5%), arterial stiffness (47.4% vs 11.6%), and hypertension (21.6% vs 10.1%), but not cardiovascular autonomic neuropathy (15.7% vs 14.4%). After adjustment for established risk factors measured over time, participants with type 2 diabetes vs those with type 1 had significantly higher odds of diabetic kidney disease (odds ratio [OR], 2.58), retinopathy (OR, 2.24), and peripheral neuropathy (OR, 2.52), but no significant difference in the odds of arterial stiffness (OR, 1.07) and hypertension (OR, 0.85).
  • Conclusions and Relevance: Among teenagers and young adults who had been diagnosed with diabetes during childhood or adolescence, the prevalence of complications and comorbidities was higher among those with type 2 diabetes compared with type 1, but frequent in both groups. These findings support early monitoring of youth with diabetes for development of complications.
Diabetes diagnosed at a young age leads to a very high rate of lifetime complications. At this point, type 1 diabetes is most likely autoimmune. However, we are seeing more and more young people, even children being diagnosied with type 2 diabetes which is due to insulin resistance. Studies have shown insulin resistance in children as young as age 5! This is a huge problem. Currently, 30% of children are obese. This will lead to more insulin resistance and more type 2 diabetes developing at a young age. These young people have extremely high rates of complications (over 72%), especially kidney disease. Our conventional treatments are not effective. We need to intervene before this happens. And perhaps, look at treatments besides medications. A radical change in diet is likely necessary.  
Thank you for taking the time to read through this newsletter. I hope you have found this information useful as we work together to optimize your health. 


As always, if you have questions about anything in this newsletter or have topics you would like me to address, please feel free to contact me by email , phone, or just stop by! 

To Your Good Health,
Mark Niedfeldt, M.D.