Children Caffeinated: What are safe limits for kids?









Tragedy struck on April 26th when a teenager died from a caffeine-induced cardiac event after drinking three caffeinated drinks.  The article can be found here.

What are Caffeine Safe Limits for Children?

Children’s brains are developing and their bodies are growing so limiting caffeine is recommended.

Sleep is vitally important for a child’s developing brain. Since caffeine can interfere with sleep, it should be avoided.

Caffeine should be treated as any other drug and used with caution until a person understands how it interacts with his/her particular genetic make-up and health profile.  It’s also important to understand that a person’s safe limit of caffeine can change over time as a person’s health evolves over his/her lifetime.

Ages 12 and Under

Caffeine isn’t recommended for children under 12.

I may recommend caffeine for children diagnosed with ADHD, but generally, there really is no reason for children under 12 to consume caffeine.

For children 4 or older an occasional caffeinated soda or chocolate treat will likely pose no concern and around 45mg per day is recognized as a safe amount, but caffeine shouldn’t be a daily part of a child’s diet.

Ages 13-18

Teens are still developing and need 8-9 hours of sleep a night.  They should consume no more than 100mg of caffeine daily.

This is equivalent to about:

  • 1.3 shots of espresso
  • 1.25 8 fl.oz. Red Bulls
  • .5 of a 5 Hour Energy Shot
  • .6 of a 16 fl.oz. can of Monster Energy Drink
  • .2 of a Starbucks Venti brewed coffee
  • 3 12 fl.oz. Cokes

Medical Quackery, Complement or Criticism?

I was at a dinner party listening to conversations brewing around the table. Fun to hear what people will talk about after a nice dinner and wine. A seedling of a story sprouted into a deeper conversation concerning alternative medicine. Sam had just returned from Thailand and spoke about an experience at a massage center. We teased him that massage parlors in Southeast Asia don’t really give massages but “massage alternatives.” He smiled, understanding what we meant, and politely restated his interpretation of massage therapy changed his western perception of alternative medicine.

Sam had been exploring Buddhist Temples in the traditional northern city of Chiang Mai. Chiang Mai is 12 hours by train and a world apart from the more corporeal Bangkok. People from all over the world go to Chiang Mai to study massage therapy and a friend who studied there insisted he seek out a Mr. Kai for a massage saying, “Mr. Kai would change your life.”

After winding through stone alleyways and lanes he located the massage center. He was at once surprised to realize that all the massage therapists were blind.  In the open-air communal massage room he announced himself adding he was looking for Mr. Kai because a friend insisted he get a massage from him.

An old man with wispy white hair turned and said he was Mr. Kai. He had all the peace and calmness of a Buddhist master, martial arts master, or Eastern studies scholar – that’s when Sam noticed Mr. Kai was working with a middle-aged western woman. She turned to meet Sam’s gaze and Sam related that her eyes were soulful. Her eyes harbored 40 years of pain and suffering behind a glimmer of growing hope as Sam looked on. Tears started in her eyes and her body trembled. She was having a great emotional release at the hands of Mr. Kai. Sam was wonderstruck.

This woman was overcome with peace by the time the massage was over. This was no typical massage. This was a massage alternative. Mr. Kai was a healer.

Mr. Kai explained her body was re-living pain from the mind and spirit that was entangled in suffering from emotions and past experience. He was a conduit between the pain of the body and the mind-spirit. He worked with people to get them to acknowledge their pain, their responsibility in it, see need for maintenance of their pain body, and facilitated a release. Physical disease starts in the mind as energy and later manifests in the body, he said. Mr. Kai was helping restore, maintain, and promote a sense of good health and wellness.

Sam was intrigued. As a westerner he always thought of his body, mind and spirit as separate entities. To mainstream US medicine Sam was separated into organ systems and treated in parts. He thought wryly of Frankenstein’s monster where separate parts do not make a whole.

At this point in the dinner conversation the more rational and logical voices began to question the credibility of such claims. How do you make the jump from massage to healer? At the worst, this man must certainly be milking these sad saps for all their worth, or at best these are anecdotal tales without rigorous science to back up such claims.

I chirped in with a historical perspective on medicine. The 1800s medicine system was an eclectic pursuit of various healing methods. There were traditional MDs, spiritual MDs, homeopathic MDs and osteopathic physicians. Today we only have traditional MDs and osteopaths.

Former Surgeon General, Dr. C. Everett Koop said, “During the 19th century, American medicine was an eclectic pursuit where a number of competing ideas and approaches thrived. Doctors were able to draw on elements from different traditions in attempting to make people well. Perhaps there is more to this older model of American medicine than we in the 20th century had been willing to example.” The most famous of all surgeon generals was noting that different people heal in various ways and one system cannot address all needs. This gave the more philosophical dinner guests something to chew on. But for the more doubting, I acknowledged the incredible advances of scientific medicine while sharing its failures to highlight my point.

The extent of alternative medicine utilization confounds proponents of western scientific medicine. In 2010, people made 202 million visits, laid out over $14 billion, and regular users were above 20 million for Oriental Medicine Doctors, Acupuncturists, Chiropractors, Naturopaths, and Massage Therapists. In some cases, the cost of good medicine is also problematic. The cost of healthcare will reach $10,000 per person for the first time this year and each year is consuming more and more of the GDP. The current medical system is cannibalizing our economy.

I went on to say that a lack of trust of the mainstream medical establishment is driving away both patients and doctors alike. We are in a bureaucratic and information healthcare crisis. Doctors want to heal but the quality of research is suspect at times and the paperwork to see a patient is too cumbersome.

John Ioannidis MD, the C.F. Rehnborg Chair in Disease Prevention at Stanford University, Professor of Medicine, Professor of Health Research and Policy, Professor (by courtesy) of Biomedical Data Science at the School of Medicine; Professor of Statistics (by courtesy) at the School of Humanities and Sciences; co-Director, Meta-Research Innovation Center at Stanford; Director of the PhD program in Epidemiology and Clinical Research and Harvard med school graduate, notes that greater than 75% of clinical research is paid for by private companies with specific interests. “We think of the scientific process as being objective, rigorous, and even ruthless in separating out what is true from what we merely wish to be true, but in fact it’s easy to manipulate results, even unintentionally or unconsciously. At every step in the process, there is room to distort results, a way to make a strong claim, or to select what is going to be concluded.” Dr. Ioannidis is widely published. JAMA and the New England Journal of Medicine accept his finding on the bias in medical research. This turns the scientific method on its head a bit.

I went on to say there are three reasons people test the waters of alternative medicine. First, someone may have been raised up in an environment where alternative medicine is already part of the repertoire for health and wellness. Second, others feel helpless after exhausting the options that modern medicine has to offer, or unsatisfied with medicating symptoms away without addressing the underlying problem. The third type to venture into alternative medicine is the one with a philosophical approach towards healing, who recognizes MD medicine is practiced differently even in advanced western countries of which the US  does rank as well in term of preventing diseases.

This last point is the reason I started to investigate alternative medicine. I listened to the parents in my practice request non-traditional treatments and researched their request. This led me to examine various respected and diverse medical systems around the world. My conclusion is medicine is a combination of science and culture.

Mainstream medicine can alleviate symptoms and make someone symptom free but this is a long way off from feeling healthy. Additionally, I believe people are looking for more natural and holistic approaches to feeling well by addressing the mind, body and spirit through personalizing factors of everyday living.

I concluded with the question, “How can one system address everyone’s needs?” We all see the world differently. Look at Lynn Payer’s book, Culture and Medicine. She outlines how Great Britain, Germany, France and the US use the same scientific literature to treat common adult illnesses but interpret the literature through a culture prism. Each country has its own take on medicine and each would be considered malpractice in the other countries. Who are we to say alternative medicine does not work? Maybe the private interests that guide 75% of the mainstream literature are not asking the right questions when they pay for the results of their studies.

The dinner conversation was lively and enjoyable. Everyone partook and walked away with a feeling of being heard and with compelling reasons to take ownership of their participation in the Road to Wellville.

Service is the thread that binds us

When we involve our families in community service, we reap what we sow.

It is time to flip the old adage, “What goes around comes around.” More often than not we hear this familiar expression either as a way to dissuade someone from potentially acting against another or to caution how negative experiences are impacted by karma. I prefer to interpret this through the lens of good karma. Yes, we reap what we sow; but if we sow selflessness, generosity and kindness, we’ll be justly rewarded. It is the natural order of how we humans help each other and in turn trust that others – even complete strangers – will have our back when times get tough. It is a pattern that has repeated itself since the beginning of time, each generation educating the next about the importance of giving of one’s self through their own time and resources.

As parents, we owe it to our kids to introduce them to the joy of giving. Children who volunteer are less likely to engage in destructive behaviors such as drug and alcohol use, and far more likely to act altruistically as adults. Volunteerism in childhood creates a healthy habit that will benefit kids for life; in adults it appears to lower stress levels, improve mood, increase a sense of purpose, and help people connect with the world around them. Community service gives children opportunities for independent work which can strengthen independence and leadership skills, build self-esteem, and provide valuable initial work experience. Community service has even been shown to be an effective tool in school dropout prevention. A study in the Journal of Early Adolescence concluded that serving the community helps kids make a connection between school and the real world that in turn boosts self-esteem, reduces problem behaviors, and reduces depressive mood.

So, how do we teach our children to want to give of themselves? It starts at home as we model selfless acts for our kids – and most of us already are doing this. Taking a meal to an ailing friend, helping an elderly neighbor carry in groceries, or even picking up a piece of litter as it cartwheels across our path. Every day we do little things that help our communities. Being mindful of these acts and recruiting our kids to take part in them is a start. In fact, it is sometimes the only way to involve busy older children who can’t devote the time for a Saturday beach cleanup but can spare a few minutes to deliver a casserole next door.

We are all more likely to volunteer, and to enjoy the experience if we work with someone – and community service presents a perfect opportunity for meaningful family time. Most facilities that care for the elderly encourage volunteers of all ages to visit with residents, deliver flowers, or stroll with those in wheelchairs. Parks departments always welcome organized litter-pickup initiatives, and schools might be happy to take your family’s landscaping help. Train together and run or walk in a charity 5K event, or serve a meal in a soup kitchen.

There are many service activities that can easily include even young children. With a little assistance, they can assemble care bags with fruit and granola bars for the homeless and deliver them in person or to a local outreach organization. Kids can help plan a neighborhood canned good drive for a food bank, create greeting cards for hospital patients or veterans, or make rope pet toys to deliver to a local shelter. The CEngagorporation for National and Community Service showcases service opportunities broken down by age group (

On April 22 thousands of people across the country will work in local initiatives to recognize Earth Day, which has galvanized and educated millions of volunteers since the inaugural celebration 47 years ago. This year Earth Day will focus on environmental education and climate literacy in “March for Science” gatherings throughout America ( A broader initiative that weekend is Youth Service America’s Global Youth Service Day (April 21-23), which celebrates the selfless achievements of children and teens working to improve communities in more than 100 countries ( On its website, YSA gives dozens of service ideas organized by categories to match kids with their interests: health, environment, poverty and hunger, education, human rights, and community building. Youth can register their service projects to gain local support and possibly international recognition.

We all have different priorities, but a common thread that weaves together our global society is the desire to make a difference. This time-honored ritual of lending a hand is passed down from parents to kids and builds on our instinctive needs to be useful and have a sense of purpose. Parents that work side-by-side with their kids to better the community realize their role in perpetuating the natural cycle of helping others, paying forward good deeds. After all, what goes around comes around.

Six Steps to a Natural ADHD Approach

add_sign_smallADHD is a religious experience and there are believers and nonbelievers. Different places have different approaches, and these are based on many factors, such as the country’s general cultural belief about children and learning or the economic system that supports healthcare or limits access to healthcare.

The American Journal of Psychiatry reports that the geographic difference is due to collection methods by the researchers rather than true geographical differences. Here is an example of the cultural divide and disparate approaches to prescribing ADHD medications:

Germany requires that parents who are concerned about the possibility of ADHD in their children must try to learn parent-training strategies before the doctors start writing prescriptions for medicine. In contrast, the US health economy is biased toward medication use and we don’t do that much counseling — parent training is not an element that is culturally validated by parents or practitioners.

Almost 11% of children ages 4 to 17 years in the US have been diagnosed with ADHD per a 2012 CDC report while the general worldwide incidence per the American Journal of Psychiatry is 5.29%. Why is there a two-fold difference in the number of children diagnosed with ADHD in the United States compared to the rest of the world? This is an important question since the annual societal ‘‘cost of illness’’ for ADHD in the US is estimated to be between $36 and $52 billion in 2005 dollars or between $12,005 and $17,458 annually per individual, according to the Journal of Pediatric Psychology.

I have been in private practice for 11 years and in two very distinct practice settings. When I worked in a traditional insurance-based office and saw 30-50 children a day, I wrote many prescriptions for Ritalin, Concerta and Strattera.  Once I switched to concierge medicine where I see six to ten kids a day, I had time to educate parents, work on parenting techniques, focus on diet as well as natural supplementation. As a result I have only had to place one child on ADHD medication over the past eight years.

Here is a list of natural approaches that have worked well:

1. Minimize Food Additives. A 2007 study of nearly 300 kids ages 3 to 8, published in The Lancet, found that those given drinks containing artificial dye showed significantly higher hyperactivity within a few hours. The British government now requires labels warning that children’s products containing dye may impair attention.

2. Consider an Elimination Diet. A first-of-its-kind 2011 study, also in The Lancet, showed that when 50 kids with ADHD were put on restrictive hypoallergenic diets free of allergens like gluten and dairy for five weeks, their symptoms improved far more than those in the control group. When the eliminated foods were reintroduced, symptoms returned in 63 percent of the children. Deichert says that ADHD patients with digestive problems, recurring ear infections or skin problems— all symptoms of possible food sensitivities—are particularly good candidates for elimination diets.

3. Reduce Electronic Media and Replace with Exercise. Very large studies have associated TV and video game use with a worsening of ADHD symptoms.

4. Buy Organic Foods. A 2010 study of 1,100 children, published in the journalPediatrics, found that the more pesticide residue children had in their urine, the more likely they were to be diagnosed with ADHD.

5. Check Iron Levels. Studies in the Archive of Pediatrics & Adolescent Medicineand elsewhere have shown that children diagnosed with ADHD are more likely to have lower iron levels, and when those that are deficient take iron supplements, their symptoms either subside with- out medication or they react better to lower doses of medications.

6. Safe Supplements. Clinical research is still inconclusive but in my practice ADHD patients have benefited from zinc, ginkgo biloba, acetyl-carnitine and omega-3 supplements.

The diagnosis and treatment of ADHD is a result of cultural bias. Use a therapeutic prism to illuminate the different options available to you. The first step is to find a practitioner that is willing to invest time in your child and explore all the options available under the rainbow.

What do Subway, Pillsbury, Sara Lee, Shoprite, Safeway, Smucker’s, Fleischman’s, Jimmy Dean, Kroger, Little Debbie, Tyson and Wonder have in common?

sub-sandwichAzodicarbonamide – a chemical used to make yoga mats and baked into your bread.

“ADA” is used in the plastics industry as a “foaming agent” and in the food industry as a dough conditioner for the convenience of industrial bakers.

In the plastics industry, it is mixed into polymer plastic gel to generate tiny gas bubbles, something like champagne for plastics. The results are materials that are strong, light, spongy and malleable. In many commercial baked goods, ADA is used as a “dough conditioner” that renders large batches of dough easier to handle and makes the finished products puffier and tough enough to withstand shipping and storage.

Food should be food – not contain chemical foaming agents.

Click here to add your name to EWG’s petition demanding that major brands stop using azodicarbonamide!