Oral Rehydration Solutions and Sports Drinks

Thirsty boy drinking water outdoorsThe World Health Organization (WHO) has had a recommended formulation of basically salt and glucose, to be used in the event of diarrhea since the late 1970’s.  This has been life-saving for millions of people every year. They have just recently released new recommendations for a formulation with reduced sodium: http://apps.who.int/medicinedocs/es/d/Js4950e/2.4.html  I would recommend anyone who would be traveling for an extended period to parts of the world where access to health care might be limited, carry a good supply of the WHO packets for use, and to leave there for those less fortunate than we are. Here in the USA, for severe diarrhea, especially in infants, we tend to recommend Pedialyte.  I still think for the infant with severe diarrhea this is your best option. For everyone else read on.

For sport drinks and general rehydration, there are a few choices that I think are much better than Gatorade or Powerade, though in a pinch those would do.  Water and a banana would do in a pinch also and be much better without the artificial dyes and colors, and plastic bottle exposure.  The Gatorade and Powerades have too much “sugar”, and are sweetened with high-fructose corn syrup, which you can be sure comes from genetically modified corn – a big NO NO! 

If you don’t have diarrhea, Emergen-C will do and provides a great dose of vitamin C (too much if you have diarrhea, and too much to use multiple times a day), along with other electrolytes and vitamins. Coconut water is actually a great natural rehydration drink, especially if you can get it unprocessed.  For an all-around drink before and after sports, I now carry and recommend Ultima Replenisher.  This product is GMO-free with no MSG or artificial ingredients. It’s vitamin C is not derived from corn products which could be GMO, and for sweetness, it uses Stevia, the only sweetener other than honey that we should use.  At home, use honey when you can.



Dr. Paul


Getting Your Picky Child To Eat What They Need To Or Should Be Eating

FussyEaterI recall early in my career, a mom came in with a toddler who was holding a coca-cola bottle and donut.  When I asked her why he was having that for breakfast (it was 9 am) her response was, quite mater of fact, “that’s all he will eat”.  Now most of you would agree that this is not acceptable.  Where we miss the point is that many parents are giving their children processed cereals (not much different from the donut) and store juices or drinks, not much better than the coca cola.  So many of our children, especially those with autism who most need a changed diet, are very picky and refuse all but a limited diet that is deficient in nutrients and often directly toxic to their bodies.  So how do you get a child who only wants those crackers, or bread or other “snacks” to eat meat or vegetables or fruit?  How do you get that 6-12 month old who only wants to nurse, to try a new food? 

I’m not saying it’s easy, but it is absolutely essential that you, the parent, learn how to modify their eating behavior. Their brain depends on it.  Let’s start with the nursing infant. When your baby is hungry or very upset, it is appropriate to nurse them, especially for the first 6-12 months of life. We now know it’s best to introduce solids at 4 months, and this may make it easier than waiting until 6 months when they are even more aware of likes and dislikes.  Early introduction actually reduces the chance of allergies (yes, I know that’s opposite to what we have said for decades). At some point when your infant is not upset and not particularly hungry, offer a taste of something you want them to eat.  As soon as they taste it, with lots of joy and praise, let them know with emotion that you are happy with them and give them the breast.  Repeat this until they are begging for that food so they can get the breast (I’m exaggerating – but you get the point). This is behavior modification 101.  It works on animals, it works on humans. 

For the most difficult picky eaters, the ones who can hold out for days it seems, try to find something that motivates them. Perhaps it’s the breast if you are still nursing; maybe it’s that processed cracker or other sweet food, or an iPad or favorite movie etc. When they are calm, get them to taste, or even just lick the food and immediately lavish praise and give them what they really wanted. Continue with eventually giving them a little piece to chew and swallow before they get that desired food or iPad etc.

Dr. Paul


Vitamin D- What Is It? What Are Its Main Functions?

sunshine2Vitamin D is not really a vitamin at all but a hormone made from cholesterol.  That’s right, the same stuff you have been told for years that you need to lower! 

Vitamin D1 is a blend of D2 and lumisterol and is not worth taking or thinking about.

Vitamin D2  (calciferol, ergocalcifero, oleovitaminD2) is made by plants but not very active as it needs UV light to become the active form vitamin D3.

Vitamin D3 (cholecalciferol, oleovitaminD3, 7-dehydrocholesterol).  This is the form our bodies make when sunlight hits our skin, and the form that gets converted to active 1,25-dihydroxyD3 (calcitriol).

Once Vitamin D3 (from sunlight on your skin, or a D3 supplement) gets into your blood it is transported to the liver by D-binding protein.  In the liver, a hydroxy ( -OH ) group is added at carbon number 25 to make 25-hydroxyvitamin D3 (calcidiol), the storage form of vitamin D and the major type that is circulating in the blood and thus typically measured as an indicator of your vitamin D status.

In kidney, bone, and the placenta, the 25-hydroxyvitamin D3 is activated to 1,25-hydroxyD3 by the addition of another -OH group. This is the most potent form and active form of Vitamin D.  Together with the parathyroid hormone, it controls calcium metabolism, and a host of other important functions.  In the intestines and to some extent in kidney, bone, and placenta, some 24,25-OHD3 is made that influences the uptake of calcium.

Vitamin D has its main traditional role in the balance of calcium that must be kept in a narrow range for normal brain function, bone growth, and indeed cell function.  If calcium levels are dropping too low the parathyroid gland (sits on top of the thyroid gland in your neck), will secrete more PTH (parathyroid hormone).  PTH stimulates 1-hydroxylase enzyme in the kidney to make more active D3 (calcitriol).  Increased active D3 does three things to raise blood calcium:

1.  It increases intestinal absorption of calcium (this is a D3 dependent step).

2.  It increases calcium movement from bone to the blood stream (also requires PTH).

3.  It increases the kidney retention (reabsorbing) of calcium so it’s not lost in urine (also require PTH).

Notice that without enough active D3, you will not absorb the calcium from your diet, and all the milk or calcium supplements in the world will not help you! Lack of calcium in its most severe form is known as rickets (bowed weak bones in infants) and osteomalacia (soft painful bones) in adults.

Because Vitamin D Receptors (VDR) have been found in most cells and in our immune cells (T-lymphocytes), adequate Vitamin D seems necessary for good immunity and large doses may actually be beneficial in those with autoimmune disorders.



Dr. Paul

B-12 Deficiency: How Common Is It? Why Is It Missed?

CouldItBeB12B-12 Deficiency, sadly, is usually unrecognized by doctors and every one of us. For a child, this could result in developmental delays, speech challenges, loss of IQ, poor focus, autism, depression, anxiety, seizures, low tone, or visual problems. For the adult patients, add to the list confusion and dementia, strokes and heart attacks, cancer, fertility troubles, leg numbness and tingling or abnormal sensations, balance issues, sleep problems, irritability, personality changes, weakness, and symptoms mimicking Parkinson’s and Multiple Sclerosis. Since most cases of B-12 deficiency are the result of poor absorption rather than inadequate dietary intake, it’s no wonder it is not on the radar for doctors.  


The process of getting B-12 from the food you eat (shellfish, fish, meat, eggs, dairy) into your blood stream in a usable form is a complex journey.  The first critical step involves having enough hydrochloric acid from the stomach.  This can be impaired if you have stomach issues (autoimmune destruction of intrinsic factor-  as in pernicious anemia) or atrophy for other reasons such as by-pass surgery. For so many who take acid blocking medicines or antacids, this treatment for stomach ulcers, peptic ulcers (PUD), or reflux (Gastroesophageal Reflux), blocks the acid and will reduce the process of unbinding B-12 from the animal protein.  The enzyme pepsin, from the small intestine, along with the acid helps to free B-12 from the animal protein. R-binder proteins carry the B-12 in the intestine where intrinsic factor (that also came from the stomach) latches onto the B-12 to carry it to the ileum where receptors can bind the B-12 and get it into the blood stream.  In the blood stream another protein, Transcobalamin II, carries the B-12 to all the cells of the body and to the liver for storage.


The other reason doctors rarely think of B-12 deficiency is that we are trained in medical school that this is rare, and presents with megaloblastic anemia (unusually large red blood cells), which often is not the case. The other reason this deficiency is missed has to do with our lab results and what is considered “normal”.  

Many deficient people have “normal” serum B-12 levels.  This is due to the arbitrary designation of normal that likely is based on a population that is itself deficient in B-12.  Most labs will list B-12 deficiency at levels below 180-200 pg/ml and borderline at 200-450 pg/ml.  The so-called “Normals” might be listed from as low as 180 to over 1000 pg/ml. The authors of the book “Could it be B-12?” write that serum B-12 should be greater than 550 pg/ml and that for brain and prevention of disease levels should be maintained near or above 1000 pg/ml.


In the following article http://www.ars.usda.gov/is/pr/2000/000802.htm, Judy McBride writes  that 39% were found to be in the low normal range, and 16% had levels below 185. She acknowledges that people are having symptoms who are in the low normal range. In 2009, the CDC reported B-12 deficiency found in 1/31 people over the age of 50 with levels below 200pg/ml. 50% of vegetarians and 80% of vegans show evidence of B-12 deficiency.  


Given the magnitude of illness and disability that is possible with B-12 deficiency, this is one situation where doctors would be wise to treat the patient’s symptoms and not rely on a “normal” lab result from a serum B-12 blood test. I suspect it would be prudent that all of us keep our B-12 levels above 550 pg/ml and aim to be near 1000 pg/ml.  I also use a test by Spectracell that measures the relative amount of B-12 inside the white blood cells, as a way to get an idea of how much is actually available at the cellular level. B-12 is one of those vitamins that I feel we all should supplement. And add folate to that while you are at it, as the two work together in the key methylation cycle reaction that converts homocysteine to methionine.  If you are suffering from symptoms that might be related to B-12 deficiency, then I recommend you get your levels tested and find a physician who can order Methyl B-12 injections. 


Dr. Paul


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