The Latest on Children’s Health

Here’s a question for you. What’s the best way to live a longer, healthier life? Diet? Exercise? Both—eating healthy while doing jumping jacks? Welcome to the Nutrition Facts Podcast. I’m your host Dr. Michael Greger and I’m here to help you answer that question. We have tremendous power over our health destiny and longevity. The vast majority of premature death and disability is preventable with a healthy enough diet and lifestyle. And, I’m here to bring you the latest peer-reviewed research to give you the tools to put it into practice.

On today’s show we bring you some peer reviewed research on children’s health.  And our first story is eye opening.  Did you know that by age 10, nearly all kids raised on the standard American diet already have fatty streaks in their arteries. This is the first sign of atherosclerosis, the leading cause of death in the United States. So the question for most of us is not whether we should eat healthy to prevent heart disease, but whether we want to reverse the heart disease we may already have.

A landmark study, published in 1953, radically changed our view about the development of heart disease forever. A series of 300 autopsies performed on U.S. battle casualties of the Korean War, average age 22. 22 years old, but 77% of their hearts had “gross evidence”—meaning visible-to-the-eye evidence—of coronary atherosclerosis, hardening of their arteries. Some of them had vessels that were clogged off 90% or more.

As an editorial in the Journal of the American Medical Association concluded, “This widely cited publication dramatically showed that atherosclerotic changes appear in the coronary arteries years and decades before the age at which coronary heart disease becomes a clinically recognized problem”—before symptoms arise. Follow-up studies on the hearts of thousands more soldiers over the subsequent years confirmed their results.

How young does it go? Fatty streaks, the first stage of atherosclerosis was found in the arteries of 100% of kids by age ten. What’s accounting for this buildup of plaque, even in childhood? In the 80s, we got our first clue, with the now-famous Bogalusa heart study, looking at autopsies of those dying between the ages of 3 years old to age 26, and the #1 risk factor was cholesterol.

You could see the stepwise increase in the amount of their arteries covered in fatty streaks as the level of bad cholesterol in the blood increased. As powerful as this was, this was only looking at 30 kids. So, they decided to study three thousand—3,000 accidental death victims, ages 15 through 34.

After thousands of autopsies, they were able to produce a scoring system, able to predict advanced atherosclerotic lesions in the coronary arteries of young people. The higher your score, the higher the likelihood you have these lesions growing in your heart.

So, if you’re in your teens, twenties, early thirties, and you smoke, your risk goes up a point. If you have high blood pressure at such a young age, that’s four points. If you’re an obese male; six points. But, high cholesterol was the worst. If your non-HDL cholesterol (meaning your total cholesterol minus your good cholesterol) is above, like, 220, that’s like eight times worse than smoking.

So, let’s say you’re a young woman with relatively high cholesterol, but you don’t smoke, you’re not overweight, your blood pressure and blood sugars are fine. At your sweet sixteen, there’s just a few percent chance you already have an advanced atherosclerotic lesion in your heart. But, if you don’t improve your diet, by your 30th birthday, there may be like a one in five chance you have some serious heart disease. And, if you have really high cholesterol, it could be closer to one in three.

Bringing your cholesterol down to even just that of a lacto-ovo vegetarian, and you’re down to here. And, if you exercise to boost your HDL, you can extrapolate down a little further. So, what this shows us is that: “Even in 15- to 19-year-olds, atherosclerosis has begun in a substantial number of individuals, and this observation suggests beginning primary prevention at least by the late teenage years, to ameliorate every stage of atherosclerosis and to prevent or retard progression to more advanced lesions.”

You start kids out on a low-saturated fat diet, and you may see a significant improvement in their arterial function by 11 years old. “Exposure to high serum cholesterol even in childhood may accelerate the development of atherosclerosis. Consequently, the long-term prevention of atherosclerosis might be most effective when initiated early in life”—as in seven months of age.

Atherosclerosis, hardening of the arteries begins in childhood.  Remember, by age 10, nearly all kids have fatty streaks, the first stage of the disease. Then, the plaques start forming in our 20s, get worse in our 30s, and then can start killing us off. In our hearts, it’s a heart attack. In our brains, it’s a stroke. In our extremities, it can mean gangrene. In our aorta, an aneurism.

The choice likely isn’t whether or not to eat healthy to prevent heart disease; it’s whether or not you want to reverse the heart disease you already have.

Ornish and Esselstyn proved you can reverse heart disease with a plant-based diet. But we don’t have to wait until our first heart attack to reverse the clogging of our arteries. We can start reversing our heart disease right now. We can start reversing heart disease in our kids, tonight.

In our next story we look at the prevalence of prediabetes in children.  Prediabetes is a disease in and of itself, associated with early damage to the eyes, kidneys, and heart. The explosion of diabetes in children is a result of our epidemic of childhood obesity. A plant-based diet may help, given that vegetarian kids may grow up not only taller, but thinner.

Prediabetes is not just a high risk state for the development of diabetes–prediabetes can be a disease itself. People with prediabetes may already have damage to their eyes, kidneys, blood vessels, and heart.

Evidence from numerous studies suggests that the chronic complications of type 2 diabetes start to develop during the prediabetic state. So by the time we have prediabetes, it may already too late to prevent organ damage, so best to prevent prediabetes in the first place, and the earlier the better.

Thirty years ago, virtually all diabetes in young individuals was thought to be autoimmune type 1 diabetes. But since the mid-90s we started to see an increase in type 2 diabetes among our youth, particularly in the United States. Indeed, the term adult-onset diabetes has now been scrapped and replaced with “Type 2” because children as young as eight are now developing the disease. And the effects can be devastating. A fifteen-year follow-up of children diagnosed with Type 2 diabetes found an alarming rate in young adults of blindness, amputation, kidney failure, and death in young adulthood.

Why the dramatic rise in childhood diabetes? Because of the dramatic rise in childhood obesity. During the past 30 years, the number of children diagnosed as being overweight has increased by more than 100%. Once an obese child reaches age 6, it’s likely they’ll stay that way. And even if they don’t, being overweight in our youth predicts adult disease and death regardless of adult body weight, even if we lose it.

Being an overweight teen may predict disease risk 55 years later. Twice the risk of dying from heart attack, more cancer, gout, arthritis. In fact being overweight as a teen was a more powerful predictor of these risks then being overweight in adulthood. This underscores the importance of focusing on preventing childhood obesity.

So how do we do it? From the official American Academy of Pediatrics clinical practice guidelines, the problem appears to be kids eating too much fat, and added sugars, and not eating enough fruits and vegetables.

Doctors, at every occasion beginning soon after a child’s birth, should endeavor to give sound advice regarding nutrition and growth so that obesity and its complications may be curtailed. What might sound advice sound like?

The chair of the nutrition department at Loma Linda University published a paper suggesting not eating meat at all might be an effective strategy. Population studies have consistently shown that vegetarians are thinner than comparable non-vegetarians. This is from the largest such study to date.

A body mass index over 30 is considered obese, 25 to 30 overweight, and under 25 ideal weight. The non-vegetarians were up at 28.8, the average meat eater in the U.S. is significantly overweight. As one gets more and more plant based the average BMI drops. But even the average vegetarian in the U.S. is overweight. The only dietary group that was, on average, ideal weight, were those eating strictly plant-based. So that comes out to be a 33-pound difference between the vegans and the meateaters.

Vegetarian children grow up not only thinner, but taller. Vegetarian kids grow to be about an inch taller than other kids. Apparently meat intake is somehow negatively associated with height.

I can just hear the dairy council now saying it’s because all the milk the veggie kids must be drinking, no. The veg kids consumed significantly less dairy, and much lower animal protein intake overall.

Meat intake is apparently associated with growing wider, though. In school-aged children, the consumption of animal foods (meats, dairy, or eggs) is associated with an increased risk of overweight, whereas plant-based equivalents like veggie burgers, veggie dogs, veggie cold cuts were not, and the whole plant foods like grains, beans, and nuts were found to be protective.

This may be because plant-based diets are low in energy density and high in starch, fiber, and water, which may increase feelings of fullness and resting energy expenditure, meaning resting metabolic rate. Eating plant-based appears to boost metabolism, such that you just burn more calories at rest, even when you’re sleeping. However, we’re not sure how much of the benefits are due to increased consumption of plant foods versus decreased consumption of meat.

Either way, plant-based diets should be encouraged and promoted for optimal health. Local, national, and international food policies are warranted to support social marketing messages and to reduce the social, cultural, economic, and political forces that make it difficult to promote such diets.

For example, although the advice to consume a plant-based diet is sound, questions arise concerning the relatively high price of produce. Yes we could reduce the burden of childhood obesity, prevent the further spread of the disease, but we need to ensure that plant foods are affordable and accessible to children of all income levels.

Fruits and vegetables may not fit on the Dollar Menu, but our kids are worth it. Getting diabetes in childhood cuts nearly 20 years of their life. Who among us wouldn’t go to the ends of the Earth to enable our kids to live 20 years longer?

We would love it if you could share with us your stories about reinventing your health through evidence-based nutrition. Go to NutritionFacts.org/testimonials. We may be able to share it on our social media to help inspire others. To see any graphs charts, graphics, images or studies mentioned here, please go to the Nutrition Facts Podcast landing page. There you’ll find all the detailed information you need plus links to all of the sources we cite for each of these topics.

NutritionFacts.org is a nonprofit, science-based public service, where you can sign up for free daily updates on the latest in nutrition research via bite-sized videos and articles. Everything on the website is free. There’s no ads, no corporate sponsorship. It’s strictly non-commercial. I’m not selling anything. I just put it up as a public service, as a labor of love, as a tribute to my grandmother –whose own life was saved with evidence-based nutrition. Thanks for listening to Nutrition Facts. I’m your host, Dr. Michael Greger.