Day: 03/05/2013

The What, Why, and How of Baby-Led Weaning .

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blw

Most people take it for granted that when a baby starts on solid food he will be spoon fed baby rice or mush, one taste at a time, in a schedule decided by his parents. And although most parents hope their child will turn out to be a ‘good eater,’ the reality is often very different.

The path to relaxed and healthy family meals turns out to be far more difficult than it should be for many families. Mealtime battles, food phobias and fussy eating are just some of the things that parents can face when they start to introduce their little ones to solid food. Many children end up with a limited diet – often based on soft, processed foods – and childhood obesity is on the rise.

In response, a growing number of parents are rejecting the conventions of spoon feeding, turning instead to an approach called baby-led weaning (BLW), which is fast gaining a reputation as a better way to establish long-term healthy attitudes to food in children.

Weaning is used in its fullest sense here – the gradual move away from a milk-only diet, starting with the baby’s first taste of solid food through to the last breast or formula feeding, and taking anything from six months to several years. With baby-led weaning there’s no hurry, and no spoon feeding or baby food. Instead, this is what happens:

  • Babies are allowed to join in with nutritious family meals and feed themselves ‘real’ food with their fingers as soon as they are ready.
  • They choose what to eat, how much and how quickly.
  • There is no pressure for the baby to eat a set amount of food or any particular food group – the emphasis is on allowing him to explore and discover a range of healthy food in his own time.
  • The baby sets the pace for progress with solid foods and decides how quickly he cuts down his milk feedings.

The result is a slower and more enjoyable transition than has been the case for many babies in the past, avoiding many of the common mealtime challenges faced by families, and with potentially healthier outcomes for the infant.

How Does Baby-Led Weaning Work?

Baby-led weaning is based on how babies develop in their first year. It starts when the baby shows signs of being ready to pick up food. This is usually at around six months of age, when he is able to sit upright with little or no support and reach out accurately to grab things with his hands. At this age, most objects get taken to the mouth automatically, as part of the baby’s exploratory play – baby-led weaning extends this natural curiosity to the discovery of food.

Research shows that around six months is also the age that babies’ gastrointestinal and immune systems become able to cope with food other than breastmilk or formula, and their ability to move things around their mouth is mature enough to deal with non-liquids. This is why it’s the age recommended by the World Health Organization and the American Academy of Pediatrics as the optimum time for solids to begin.

However, the research so far has focused almost exclusively on when to introduce solids, rather than how. Baby-led weaning questions the common assumptions about how babies should be fed.

Spoon feeding babies of six months and older mashed or pureed food has no research to support it. It’s simply left over from when solid foods were given to babies when they were much younger, before they were really ready. Spoon feeding is unnecessary for healthy babies of six months – they are able to feed themselves.

The physiological readiness of babies for solid foods coincides with their developing abilities to take food to their mouths and begin to chew. If they have the opportunity, many babies will show their parents they are ready simply by helping themselves to food from someone’s plate.The benefits of allowing a child to follow their instincts for this important part of development may be considerable.

The potential advantages include:

  • Healthy food choices – babies are allowed to explore the tastes, textures and smells of nutritious family food, rather than the blandness and combined flavours associated with baby foods. Some research suggests children who have done BLW as babies make healthier food choices. Most parents report that BLW babies are adventurous, non-fussy eaters.
  • Less obesity – babies are allowed to eat according to their appetite. They can stop eating when they are no longer hungry and are not encouraged to eat more quickly than they want to, have ‘one more spoonful’ or ‘make a clean plate’. Many non-BLW babies have their natural appetite recognition overridden and are encouraged to eat more than they need from the earliest age. Research suggests lower BMI in children age 2-6 years who have done BLW.
  • Natural jaw development – babies experience a range of textures from the start, allowing chewing skills to develop naturally. This may facilitate speech development and help to reduce the need for orthodontic treatment later. And, because food that requires chewing spends longer being mixed with saliva in the mouth, BLW may promote enhanced digestion.
  • Improved hand-eye coordination and dexterity – BLW babies have lots of practice exploring different shapes and textures in food, learning how to grip them and get them to their mouth, and later how to manage silverware.
  • Confidence and enjoyment at mealtimes – No pressure to eat means no mealtime battles, making eating as a family more relaxed and enjoyable. Shared mealtimes also allow babies to copy siblings and parents, learning to share and take turns, and developing social skills.

Baby’s First Foods

Baby-led weaning revolves around shared mealtimes, where the whole family eats food that is nutritious, safe, and – as far as possible – free from added salt, sugar, chemicals, and other extras unsuitable for infants. Because the digestive tract of a six-month-old is ready for solid foods, there is no need to restrict the baby to one new food at a time. Almost any healthy family food is suitable, although the way it is presented may need to be adapted so that the baby can handle it easily in the early days. The exceptions are the same as for spoon feeding and include honey, raw eggs, and types of fish that may contain high levels of mercury. Any foods linked to a family history of allergy should be introduced under the guidance of a physician.

Only very small amounts of solid food are needed at first – mainly to supply additional iron and zinc – and it will usually be several weeks before there is any noticeable change to the baby’s appetite for his milk feedings. This allows the baby’s gut to adjust at a natural pace and ensures that milk feedings are not cut back too soon.

All babies are different, but most babies will not need significant amounts of solid food until they are around nine months. This means that babies naturally develop the ability to feed themselves with these foods before they begin to need them – and they are skilled at eating a range of foods by the time this need kicks in.

How to do Baby-Led Weaning:

  1. Choose a time when the baby is not tired or hungry. The baby doesn’t yet know solid food can fill his tummy – his appetite is still satisfied by the breast or bottle. Food will be just an exciting new toy at first, and he won’t be able to relax or concentrate on exploring it if he is tired or hungry.
  2. Sit the baby up to the table with everyone else. He can be either in a high chair or on an adult’s lap – supported, if necessary, so that he can use his hands and arms freely. Make sure he is sitting upright to handle food, not lying back or slumped.
  3. Dress the baby in a protective bib – or just a diaper, if the house is warm enough – and cover the area under his chair with a large clean cloth or plastic sheet, so that dropped food can be handed back. BLW can be very messy in the beginning but babies learn quickly and, with the opportunity to practice whenever anyone else is eating, they rapidly become skilled eaters and make less mess.
  4. Offer the baby a few pieces at a time of the same healthy food as everyone else (or a selection from it), in a shape and size that he can handle easily and a consistency that is firm enough to grasp while being soft enough to chew. To start with, this means sticks or strips of food but, gradually, he will show that he can manage smaller pieces and a variety of consistencies. Plates and cutlery may be distracting at first so pieces of food can be offered on the highchair tray or clean table top.
  5. Allow the baby to explore the food and to eat at his own pace (if at all). This means no hurrying or trying to persuade him to eat, and allowing him to squidge, smear and examine the food as much as he needs. Don’t expect him to eat much at first – he will eat when he is ready.
  6. Offer water in a small shot-sized cup, which will be easy for the baby to pick up, but don’t be surprised if a breastfeeding baby continues to prefer to use the breast to quench his thirst for several weeks or months after he has started to eat solid foods.
  7. Don’t allow anyone but the baby to put food in his mouth – making sure he is in control of what goes into his mouth is an important part of keeping your baby safe.
  8. Don’t offer small, hard foods – small foods, such as grapes and cherry tomatoes, should be cut in half; stones should be removed from fruits such as olives or plums. Nuts, whole or in pieces, are not suitable for babies.

Baby-led weaning works best when the focus is on opportunities for play and learning, rather than on eating. As the baby’s skills develop, he will gradually eat more at shared mealtimes and his appetite for milk will reduce. Provided the parents are responsive to the baby’s cues, the changeover from milk to family meals will happen naturally, led by the baby.

Learning to Chew and Swallow Food Naturally and Safely

Babies naturally develop eating skills in a set order (in much the same way as they always learn to sit up before they learn to walk). The normal sequence that babies follow in the period between five and seven months of age is:

Bringing things to the mouth

Biting and munching

Chewing

Purposeful swallowing

Allowing the baby to remain in control ensures that this sequence is not rushed and keeps the baby safe. Most early bites of food will fall forward, out of the baby’s mouth. This protects his airway until he is mature enough to swallow safely – and if he is not able to bite off a piece of food, he is probably not ready to chew it. This is why it is important that no one should try to ‘help’ the baby by putting pieces of food in his mouth for him.

Gagging (or retching) is common in the early stages of BLW. The gag reflex prevents food being pushed too far back without having been chewed adequately, and it is particularly sensitive between six and eight months. As the baby matures, he becomes more skilled at chewing and the point at which the gag reflex is triggered moves farther back in his mouth, so gagging occurs less often. Although gagging can appear alarming to parents, babies are rarely bothered by it, and it may be that it is an important part of helping them to learn not to overfill their mouths.

Working with Babies, Not Fighting Against Them

All healthy, able-bodied babies roll over, sit up, crawl and walk when they are developmentally ready, provided they are given the opportunity. Most people wouldn’t dream of deciding the date for a baby to start walking, and of introducing a ‘walking programme’ on that day. They would also consider it positively cruel to prevent the child from walking before this designated day arrived. Yet the conventional approach to introducing solids takes exactly this line.

Baby-led weaning is based on the understanding that most feeding difficulties and mealtime battles stem from the fact that the goals of the parent are in conflict with the instincts of the child. Now that we know there is no need to introduce solid foods until six months – and certainly no need for jars or mush – it’s time to look again at what babies can do, and accord them the respect, autonomy and ‘real’ food they deserve. The result will be happier – and healthier – shared eating experiences for all.

About the Authors

Gill Rapley and Tracey Murkett are the authors of Baby-led Weaning: The essential guide to introducing solid foods – and helping your baby to grow up a happy and confident eater and The Baby-led Weaning Cookbook: 130 recipes that will help your baby learn to eat solid foods – and that the whole family will enjoy, both published in the USA by The Experiment. Gill and Tracey are also the authors of Baby-led Breastfeeding: Follow your baby’s instincts for relaxed and easy nursing, by the same publishers. All three titles are published in the UK by Vermilion, under their original titles. You can find more information from Gill and Tracey by visiting www.baby-led.com and www.rapleyweaning.com

Source: .mercola.com

 

 

 

 

Bitter Pill—The Absurd Costs of American Health Care.

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ripoff

In Bitter Pill: Why Medical Bills are Killing Us,11 Brill dissects our profit-driven sickness management industry posing as health care. It’s a fascinating piece, and I highly recommend reading in its entirety. In it he writes, in part:

“Recchi’s bill and six others examined line by line for this article offer a closeup window into what happens when powerless buyers… meet sellers in what is the ultimate seller’s market.

The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country… the American health care market has transformed tax-exempt ‘non-profit’ hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives.

And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over $500,000 a year, including six who make over $1 million.

Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere else on earth. In the U.S., people spend almost 20% of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries. According to one of a series of exhaustive studies done by the McKinsey & Co. consulting firm, we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia.

We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more every year on artificial knees and hips than what Hollywood collects at the box office…”

General Health Checkups and Medical Screening Tests—Do You Really Need Them?

Last year I interviewed Alan Cassels, a drug policy researcher at the University of Victoria in British Columbia, and author of several books, including Seeking Sickness: Medical Screening and the Misguided Hunt for Disease, which addresses medical screening and disease prevention.

There is an enormous amount of effort and research invested in the traditional community into medical screening procedures, which conventional medicine views as “prevention.” This is a fatally flawed view since diagnostic tools, some of which are grossly inaccurate, cannot actually prevent disease from occurring. They can only help diagnose what has already occurred. Furthermore, regular screening tends to increase unnecessary use of medicines, and you may receive a diagnosis and treatment for a “condition” that might never have led to any symptoms or had any impact on your longevity…

Much like myself, Cassels research has led him to seriously question common tests like mammography for breast cancer, and the PSA test for prostate cancer. According to Cassels:

“[S]o much of what we consider to be disease in the orthodox medicine world has been created, has been shaped, and has really been molded by the pharmaceutical industry. And very much what we consider to be medicine is determined by the kinds of things that end in what the drug industry calls the ‘drug successful visit.’ Not just anything that we potentially could be sick with, but anything that any healthy person could get.

And really, screening is about looking in healthy people to find signs of disease.

I want to distinguish right off the bat that when I’m talking about screening, I’m talking about people who have no symptoms, who are otherwise healthy, and who have really no reason to consult the doctor or being told, ‘You need to be proactive. You need to seek out early signs of disease. That’s a good thing to do to keep yourself healthy.’ People that actually have symptoms – feel a lump or whatever – and then go in for a test, that’s a diagnostic test. That’s something different. I’m talking about a screening test where you’re taking otherwise healthy people and trying to find signs of disease in them.”

Natural is Better, and Less is More

The U.S. health care system surely has a lot of room for improvement. Since the United States has the highest infant mortality rate among high income countries, and ranks dead last in terms of life expectancy among 17 affluent nations, it’s obvious that money doesn’t buy health. The answer, then, to better health must be something else. When it comes to figuring out what that “something else” is, I don’t think there’s anyone in the medical community who doesn’t agree that simply changing your lifestyle can go a long way toward “fixing” a number of chronic conditions, such as diabetes. As identified by the NIH,12 five life-changing factors that can do this are:

  • Following a healthy diet
  • Maintaining an optimal body weight
  • Engaging in regular physical activity
  • Not smoking
  • Keeping alcohol use to no more than one drink per day for women, and two drinks per day for men

What Constitutes a Healthy Lifestyle?

That’s not an impossible list. The great thing about these behavior changes is that they don’t cost extra money to do – and they’re almost guaranteed to save you money in the long run. I would add a few things to this list, though. Of all the healthy lifestyle strategies I know of that can have a significant impact on your health, normalizing your insulin and leptin levels is probably the most important.

There is no question that this is an absolute necessity if you want to avoid disease and slow down your aging process. That means modifying your diet to avoid excessive amounts of fructose, grains, and other pro-inflammatory ingredients like trans fats. In addition to the items mentioned above, these additional strategies can further help you stay healthy:

  • Learn how to effectively cope with stress – Stress has a direct impact on inflammation, which in turn underlies many of the chronic diseases that kill people prematurely every day, so developing effective coping mechanisms is a major longevity-promoting factor.

Meditation, prayer, physical activity and exercise are all viable options that can help you maintain emotional and mental equilibrium. I also strongly believe in using energy psychology tools such as the Emotional Freedom Technique (EFT) to address deeper, oftentimes hidden emotional problems.

  • Optimize Your Vitamin D Levels to between 50 and 70 ng/ml, ideally by exposing enough of your skin to sunshine or a safe tanning bed.
  • High-Quality Animal based omega-3 fats – Correcting the ratio of omega-3 to healthful omega-6 fats is a strong factor in helping people live longer. This typically means increasing your intake of animal based omega-3 fats, such as krill oil, while decreasing your intake of damaged omega-6 fats (think trans fats).
  • Get most of your antioxidants from foods – Good sources include blueberries, cranberries, blackberries, raspberries, strawberries, cherries, beans, and artichokes.
  • Use coconut oil – Another excellent anti-aging food is coconut oil, known to reduce your risk of heart disease and Alzheimer’s disease, and lower your cholesterol, among other things.
  • Avoid as many chemicals, toxins, and pollutants as possible – This includes tossing out your toxic household cleaners, soaps, personal hygiene products, air fresheners, bug sprays, lawn pesticides, and insecticides, just to name a few, and replacing them with non-toxic alternatives.
  • Avoid prescription drugs – Pharmaceutical drugs kill thousands of people prematurely every year – as an expected side effect of the action of the drug. And, if you adhere to a healthy lifestyle, you most likely will never need any of them in the first place. However if you are currently taking prescription drugs it is best to work with a trained natural health care professional to help you wean off of them.

Take Control of Your Health

Incorporating these healthy lifestyle guidelines will help set you squarely on the path to optimal health and give you the best shot at living a much longer life. Remember, it’s never too late to take control of your health. And when you do go to the doctor, know that it’s OK to ask questions and opt for less medical intervention while choosing a more natural way of healing your body – you should NEVER think that you’re not supposed to, or can’t, ask questions of the person you’ve entrusted with your body and health.

Also, while it’s important to find a doctor who is willing and able to keep up with the research, it’s equally important to realize that the field of medical research has become inundated with and corrupted by the same greed guiding our health care system.

Scientific fraud occurs far more often than one might suspect, so common sense and digging a little deeper into the research is always a good idea—especially if your physical welfare is hanging in the balance. If the problem is acute, this may not be possible, but if you’re trying to address chronic, long-term health issues, I would urge you to become more personally involved in your own treatment.

Source: .mercola.com

 

Top Five Recommendations to Reduce Unnecessary Medical Expenses.

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The American Academy of Neurology provides evidence-based guidelines for practitioners and patients with the aim of reducing costs.

To reduce wasteful practices in medicine, the American Board of Internal Medicine and Consumer Reports developed the “Choosing Wisely” campaign. As a participant in the campaign, The American Academy of Neurology (AAN) selected a diverse panel with experience in evidence-based guidelines and practice parameters. The AAN sought from its members recommendations of practices that are common in neurology yet have strong evidence of lacking benefit (or causing harm) and are costly. From 178 submissions, the AAN selected 5 as having strong supporting rationales and obtained input from relevant subspecialty experts and patient advocacy groups. These practices are as follows:

  • Don’t perform electroencephalography (EEG) for headache disorders. Rationale: Clinical features have better diagnostic accuracy for primary headaches. Neuroimaging has higher sensitivity than EEG to evaluate for a mass lesion, if clinically suspected.
  • Don’t perform carotid ultrasound for syncope without other neurological symptoms. Rationale: Syncope is common, carotid disease causes focal neurological symptoms, and indiscriminate use of ultrasound results in unnecessary procedures.
  • For migraine, reserve opioids and butalbital as a last resort. Rationale: Nonopioid analgesics often work, and migraine-specific treatments are available. Opioids and butalbital increase the risk for analgesia-overuse headaches and chronic headaches. Opioids can be considered for ≤9 days per month when other treatments fail or medical comorbidity prevents use of first-line treatments.
  • Don’t prescribe disease-modifying therapies (DMTs) for those with progressive, nonrelapsing multiple sclerosis (MS). Rationale: DMTs have not shown efficacy in reducing disability in progressive MS and have potential adverse effects.
  • Don’t recommend carotid endarterectomy (CEA) for asymptomatic carotid stenosis unless the complication rate is <3%. Rationale: A benefit for asymptomatic carotid disease requires very low angiographic and surgical complication rates.

Comment: Patients have expectations for testing and treatment, and clinicians can feel obliged to reassure patients and reduce legal risk. The Choosing Wisely campaign seeks to inform patients and lend credence to clinicians to act more conservatively. Insurance providers are increasingly creating such guidelines, but guidelines created through the AAN may be more valid and accepted.

These recommendation are useful, especially the limitations on opioids for migraine. DMTs should not be started for primary or nonrelapsing, secondary progressive MS. However, some patients on a DMT long-term may have transitioned to secondary progressive MS with no relapses for 3 years, but may still relapse or worsen upon DMT withdrawal. Knowing the CEA complication rate for each surgeon in your center is a good idea, but these data are not always available, despite the long-standing recommendation that they should be.

Source: Journal Watch Neurology

 

 

 

ACE Inhibitor, ARB, or Both in Diabetic Renal Disease?

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Dual therapy with angiotensin-converting–enzyme inhibitors plus angiotensin-receptor blockers was no better than monotherapy.

Some clinicians prescribe combinations of angiotensin-converting–enzyme (ACE) inhibitors plus angiotensin-receptor blockers (ARBs) for patients with type 2 diabetes, on the premise that dual blockade of the renin–angiotensin system will slow progression of diabetic nephropathy more effectively than single-agent therapy. In this study, researchers randomized 133 type 2 diabetic patients with nephropathy to receive lisinopril (titrated to 40 mg daily), irbesartan (titrated to 600 mg daily), or combined therapy (titrated to 20 mg and 300 mg, respectively). Inclusion criteria included stage 2 or 3 kidney disease and urine protein-creatinine ratio >300 mg/g. At baseline, mean blood pressure was 153/81 mm Hg, and mean serum creatinine level was 1.5 mg/dL.

After a median follow-up of 32 months, the incidence of the primary composite endpoint (50% increase in serum creatinine level, progression to end-stage renal disease, or death) was virtually identical in the three groups ({approx}30%). Frequencies of each of the three individual endpoints and degree of blood pressure lowering also were similar in all groups.

Comment: This study, although small, suggests that combining an ACE inhibitor and an ARB confers no benefit in type 2 diabetic patients with nephropathy. Recall that, in the huge ONTARGET trial (in which enrolled patients had atherosclerotic disease or diabetes), an ACE inhibitor plus an ARB also failed to delay progression of renal dysfunction compared with an ACE inhibitor alone (JW Gen Med Sep 2 2008).

Source: Journal Watch General Medicine

Transcatheter Arterial Catheter Embolization for Hepatocellular Cancer.

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TACE, plus radiofrequency ablation, was superior to RFA alone in patients with liver-confined disease.

For patients with liver-limited, nonresectable hepatocellular cancer (HCC), treatment options include alcohol injection, radiofrequency ablation (RFA), and transcatheter arterial catheter embolization (TACE), with or without chemotherapy. However, the optimal therapy has not been clearly defined.

Now, Chinese investigators have conducted a single-institution, randomized trial to compare RFA, with or without TACE, in HCC patients with a solitary liver lesion ≤7 cm in size (or ≤3 lesions, each ≤3 cm in size), Child’s Pugh A or B liver disease, and no evidence of hepatic or portal venous invasion. All patients received RFA (up to 3 applications per session; an additional session was permitted if imaging indicated persistent viable tumor). For patients who received RFA plus TACE, hepatic artery infusion chemotherapy with carboplatin (300 mg) was followed by embolization with lipiodol (5 mL), epirubicin (50 mg), and mitomycin (8 mg) followed within 2 weeks by RFA. Of the nearly 2300 patients screened, 189 were treated. Most were male (89%) and positive for hepatitis B surface antigen (89%), and most had Child’s Pugh A liver disease (95%) and a solitary liver lesion (68%).

Recurrence rates trended lower with TACE plus RFA compared with RFA alone (35.1% and 54.7%, respectively). Overall survival (OS; the primary endpoint) was significantly better with TACE plus RFA (hazard ratio, 0.525; P=0.002; 4-year OS rates, 61.8% vs. 45.0%). Recurrence-free survival (RFS) was also significantly better with TACE plus RFA (HR 0.575; P=0.009; 4-year RFS rates, 54.8% vs. 38.9%). Complication rates were similar in the two therapy arms.

Comment: These results support the combination of RFA and chemoembolization for selected patients with liver-confined HCC. Issues remaining to be resolved include the role of chemotherapy added to embolization compared with embolization alone. The large degree of patient exclusion after screening, the relatively small number of patients treated, and the conduction of the trial at a single institution call into question the extent to which the findings can be generalized.

Source: Journal Watch Oncology and Hematology