Sport Drinks Not Needed

A recent expose from 538 explains why sports drinks are unnecessary.

538: You Don’t Need Sport Drinks to Stay Hydrated

Key points:

  • Though sports drinks are highly marketed, there is little scientific evidence behind their claims
  • Water is generally better for most people
  • Hyponatremia can be provoked by drinking too much fluids

A few excerpts:

  • “As it turns out, if you apply evidence-based methods, 40 years of sports drinks research does not seemingly add up to much,” Carl Heneghan and his colleagues at the University of Oxford’s Centre for Evidence-Based Medicine wrote in a 2012 analysis published in the British medical journal BMJ. ..
  • There has never been a case of a runner dying of dehydration on a marathon course, but since 1993, at least five marathoners have died from hyponatremia they developed during a race.  At the 2002 Boston Marathon, researchers from Harvard Medical School took blood samples from 488 marathoners after the finish. The samples showed that 13 percent of the runners had diagnosable hyponatremia…Athletes who develop hyponatremia during exercise usually get there by drinking too much because they’ve been conditioned to think they need to drink beyond thirst

My take: Drink when you are thirsty.  Exceptional talent and hard work, not sports drinks, are the key if you want to “Be Like Mike.”

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Encouraging Healthy Eating in Hospitalized Children

Full Text (from J Peds twitter feed): All Aboard Meal Train: Can Child-Friendly Menu Labeling Promote Healthier Choices in Hospitals?  S Basak et al. J Pediatr 2019; 204: 59-65

Conclusion: “The combination of menu labeling techniques targeted to children in the inpatient hospital setting was an effective short-term tool for increasing the intake of healthier foods, although the effect of labeling waned over time.”

From the discussion: “Our findings in this study show a significantly higher odds of ordering green-light healthier option foods and lower odds of ordering red-light foods when exposed to child-friendly menu labeling. This effect waned over time, such that after 8 meals, proportions of red-light and green-light choices were similar with both menus…

Although most children’s hospital food environments include food items that have low nutritional value, this study highlights that nutrition education using menu labeling can be successfully implemented and can encourage children and their families to make healthier choices. It is our hope that labeling may also encourage hospital food providers to improve food quality at the hospital by decreasing red-light foods and increasing healthy food options at every meal. More research is needed to determine optimal techniques for various age ranges and develop menus that are age-appropriate and tailored for specific patient populations.”

My take: 1. This study from Sick Children’s is important.  We can determine more effective healthy eating strategies on a ‘captive’ audience.  2. I remember several years ago when one of my partners ruffled some feathers by asking the hospital to reconsider promoting sugar-sweetened beverages while at the same time posting billboards of obese children.

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Briefly Noted: Breastfeeding and Microbiome Diversity

A recent study (JH Savage et al J Pediatr 2018; 203: 47-54) examined the impact of breastfeeding compared with formula on microbiome diversity in 323 infants; this included 95 exclusively breastfed, 169 exclusively formula fed at time of stool collection.

Breastfed infants were more likely to have been born vaginally (74% vs 62%) and less likely to be African-American (11% vs. 36% for hispanic infants, and 52% for caucasian).

Key finding:

  • Breastfeeding was independently associated with infant intestinal microbiome diversity at age 3-6 months
  • Maternal diet during pregnancy and solid food introduction were less associated with infant gut microbiome changes than breastfeeding status

My take: We still don’t understand the long-term implications of these differences in microbiome alterations between breastfeeding and formula.  That being said, the development/evolution of breastmilk has taken place over thousands of years and it is likely that formula, while an important substitute, will never replicate all of the useful components.

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NASPGHAN Toolbox App -Review

To all my colleagues and to others who follow this blog, I wish you a happy new year.  Thank you to all of you, especially to those who provide feedback to help improve the content and usefulness.

Recently NASPGHAN released an App, titled NASPGHAN Toolbox.  There are some very useful features but also some areas where more work is needed.

Work in progress: Many of the algorithms that are listed are dated and no longer accurate.  To list a few examples:

  • The UC Algorithm suggests holding off on anti-TNF therapy in severe disease for 7-14 days
  • The EoE Algorithm lists only diet treatments and topical steroids and does not list PPIs as a treatment option
  • The GERD guidelines are from 2001 rather than more recent recommendations

Also, this ‘algorithms’ section should probably be renamed into ‘algorithms and tables’ as a large amount of the information is not algorithmic.

What I Like:

  • Scores and Calculators for items like MELD score, PUCAI score, Mayo score
  • Extensive patient education handouts and image atlas -this could facilitate “airdrop”ing or messaging of these items to families.  (To be picky –the normal esophagus image could be better)
  • Formula charts –though the lists for infants and older children could be more comprehensive
  • Bristol charts (especially children version) -listed in algorithm section

My take: This is a very good start and a very helpful toolbox for pediatric gastroenterologists but I would not rely on the algorithms.


My Favorite Posts from the Past Year

Recently, I listed the posts that had the most views in the past year –some dating back to 2012.  The following list includes less viewed but some of my favorite posts from 2018:





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Most Popular Posts 2011-2018

Since this blog’s inception, there are now more than 2500 posts; these are the most popular (most views):

Most of these posts are referenced in more recent posts on the same or similar subjects.

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