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.

Kids Earn $62.5 Billion for US in Twenty-Five Minutes

They say that a penny saved is a penny earned.  That’s exactly what children aged 8-11 could be doing for society if we permit them to play for 25 minutes a day, three days a week.  We could save $62.5 billion by averting health care expenditures and loss of productivity related to obesity according to research published by Bruce Lee on May 1st in Health Affairs.   Bruce Lee and his team from John Hopkins University Bloomberg School and the Pittsburgh Supercomputing Center at Carnegie Mellon University fed data into supercomputers with computational models to look at what would happen to obesity rates as we adjust time playing for children 8-11 years old.

The crux of this study is that even a modest increase in play would yield big bottom line results.  The national average shows us that 32% of children currently get 25 minutes of exercise a day for three days a week.  That leaves plenty of room for improvement.  If we invest today in programs that encourage physical activity we’ll have big pay-offs in the future.  We need to begin planting the seeds early because studies have shown that a high BMI at 18 will lead people to have high BMI throughout adulthood.  High BMI is associated with higher rates of diabetes, heart disease, sleep apnea, stroke, gallbladder disease, depression, and anxiety.  All of these health issues not only decrease the quality of life but inflate health care expenditures and affect productivity through absence at work.

While the study is built around many broad assumptions it still raises some important issues, like the importance of physical activity in children.  Furthermore, the billions in savings do not even begin to quantify the less tangible benefits of feeling good and happy, which will pay further dividends to society.  Still we hope studies like this will guide our decision makers and influencers to help encourage activities, programs, and resources that spur more play and physical activity in children.

16 reasonable and natural ways to save your skin and self-esteem from acne

You Have Brain Blemishes

One of my older teenage male patients complained of his acne and asked his mom to take him to the dermatologist. He wanted to go on EpiDuo for acne. I am all for treating acne but in this young man’s case his acne was mild and the EpiDuo requires repeated blood tests to check liver function. The medicine can have very serious complications. Well, two issues became apparent. The vanity of teens and the need to write about natural acne treatments.

Try these 16 reasonable and natural ways to save your skin and self-esteem from acne.


Sebaceous glands reside in the dermis, the mid-level of your skin, and produce a fatty waxy oil called sebum. There are on average 5,000,000 of these glands covering your whole body, except for the palms of your hands and bottoms of your feet. One gland exists for each hair follicle if you wish to see it that way. The sebum produced by the sebaceous gland inside the mid level of the skin travels up the follicle and out of your pores to lubricate and waterproof your hair and skin. Also, dead skin cells exit the body by traveling up the follicle with the assistance of the sebum and make their way out of a pore. Sometimes these canals get jammed up by excessive sebum (thanks, hormones! and other inflammatory agents!) The body then seals off the area and bacteria like P. acnes begin to feed on the sebum and spew out inflammatory by-products. Voila! That’s when a pimple grows. Bacteria can spill over to nearby areas and acne spreads.


The essence of acne is inflammation rearing its ugly head. To manage acne we need to look at common causes of inflammation.

Dairy: Non-organic milk and dairy products contain growth hormones like IGF-1 and inflammatory substances that clog your pores and cause acne. Milk and dairy cause an insulin spike in humans that cause the liver to produce even more IGF-1, leading to even more acne. Dairy also causes excess sebum which inhibits dead skin cells from exiting the pores causing further clogging. Cow milk is good for cows and good for acne.

HACK IT: Expand your culinary limits! Try nutritional yeast sprinkled onto foods instead of Parmesan. With its rich nutty cheesy savory flavor it is a dairy substitute that could easily be in the starting line up. Explore and experiment with it. Also, try tofu with your crackers next time, or smoked tofu like a provolone on sandwiches. If you cannot give up dairy and cheese look to goat milk based products- much easier on the digestive system.

Sugar: Beware or be damned. Sugar contributes to and causes acne in two ways. Sugar in the soda we drink (who are we kidding, sugar is in everything) creates a spike in your GH-1 production and bioavailability. In short, sugar causes excess sebum and skin cells to multiply setting off a chain reaction to acne. At the same time, sugar was observed in studies to increase C-reactive protein (CRP) levels, which is regarded as one of the best measures of inflammation. Finally, sugar causes Candida to grow beyond the normal range. On the face excessive Candida growth causes inflammation, and excessive Candida growth can cause havoc in the gut which indirectly contributes to acne.

HACK IT: Opt for honey, coconut-based sweetener, or stevia-based sweeteners. If you touch the Splenda, or high fructose corn syrup, I’ll have to remove you from our Newsletter and Facebook Page.

Wheat and gluten: You probably already know that gluten is a protein found in wheat, that if you are gluten intolerant the body does not recognize gluten as food, and this causes the body to treat gluten as a foreign body like a bad bacteria or virus. Basically, your immune system fires up causing inflammation which indirectly affects acne.

HACK IT: Quinoa is a great alternative grain. Look for an ALDI grocery store for a growing selection of affordable gluten-free products.

Omega-6 fatty acids: Omega-3 and omega-6 fatty acids are needed for many functions related to growth and repair in the body. Our bodies can’t produce them, we must get them from food (or supplements). Omega-6s mostly come from plant oils like corn oil, grapeseed oil, soybean oil, and sunflower oil and the standard American diet (SAD) provides plenty of omega-6s. So when the ratio of these becomes unbalanced and heavy on the omega-6 side, which is easy for Americans, then we get inflammatory immune system responses, thus causing acne to flare up.

HACK IT: As this is about ratio and not about whole values you can look at increasing your omega-3 intake. We recommend a potent liquid fish oil, or potent soft gels if you prefer not drink your omega-3s. It’s that simple.

Alcohol: It is part of our work hard culture and here is how it affects our acne. Alcohol causes a spike in insulin, if you are drinking it with a sweet mixer then you can account for a greater spike. Alcohol also affects our hormones and can reduce our quality of sleep. If we are drinking to take the edge off, then we are also probably dealing with some stress which further aggravates acne. Finally, alcohol can lead to dehydration which inhibits our ability to flush toxins from our body.

HACK IT: Drink in moderation. Stick to red wine or clean spirits, if needed.

Stress: Picture someone feeling tired, anxious and stressed out. How is their complexion? Science tells us that stress doesn’t necessarily create acne, but it does make an existing case worse. Stress throws us into an inflammatory response that causes walls of pores to break therefore enabling the spread of acne-causing bacteria. Stress throws the adrenal gland into overdrive. Androgens (male hormones) increase. Higher levels of androgens lead to more acne, and this is especially true for women because they produce a larger percentage of their androgens in the adrenal gland.

HACK IT: It starts with an appreciative and positive mindset. Surround yourself with other positive and appreciative people. Take time to yourself so that you are in prime health and wellness. Finally, breathe, be in the moment, let feelings wash over you and let them go.

Exercise: This may sound contrarian but exercise can be quite good for your skin. Exercise increases circulation and promotes sweat which helps the body rids itself of toxins and pushes impurities out of pores. We can also mediate our stress levels in a healthy manner through exercise. Exercise also helps us produce endorphins which create a sense of happiness, calm, and well-being. This may have an anti-inflammatory effect which is really what we should all be after.

HACK IT: Leave the lycra at home in favor of natural materials to prevent body acne. Leave the makeup off to permit your body to sweat cleanly. Gently wash your face with cool water after exercise.

Hygiene: Wash your hands frequently with gentle soap. Avoid touching your face, or anyone else’s for that matter. Wash your face twice a day. Washing it more will dry out your skin and promote sebum production. You can use water based face moisturizer. Tea tree oil and aloe are good products for the face. Tea tree oil has antiseptic qualities, and aloe has a soothing moisturizing effect. Avoid toners with alcohol. Wash right after exercising to prevent heat and moisture buildup, which become bacterial breeding grounds. And wash your pillow, and pillow cases frequently.


If you have had acne then you have probably tried one or all of the following; medicating it, meditating it out, hoping it goes away, praying it goes away, harsh soaps, gentle soaps, alcohol, oils, clays, masks, changing your diet, and maybe some voodoo. What really works?

Here are some natural approaches to attenuate acne and cultivate a healthy glowing radiant skin.

Exfoliation: Do it the right way and with the right frequency. Exfoliation helps the body with the natural process of desquamation, showing our older skin cells to the door. As we age our body does this less efficiently. Exfoliation can give your skin a youthful glow, but if done too stringently it can leave you red blotchy and more susceptible to infection. Ever think about using natural baking soda? Use about a tablespoon and gently rub in circles. You can make a paste with sea salt lavender essential oil, or another of your favorite essential oils. Finely ground oatmeal is ideal for sensitive skin. You can buy or make your own Kefir for use as a face wash. Kefir is loaded with good bacteria and pH balancing properties. Honey can be used alone or with any of the other treatments mentioned. Honey is antibacterial, antiviral, and antifungal. It reduces inflammation and hydrates. Gentle is key, we aren’t sanding a reclaimed wooden desk.

Organic Apple Cider Vinegar: Tried and true apple cider vinegar is a powerful antibacterial and antifungal agent.
Dabbing blemishes with a cotton swab twice a day will keep bacteria in check and soothe skin. Also, taking 1 tablespoon with purified water can work internally to alkalize and detox the body. This will help to ease inflammatory processes.

Tea Tree Oil (Melaleuca oil): This oil is a traditional topical antiseptic, antifungal remedy, and it is an extremely effective acne treatment. This remedy is particularly good for those with oily skin. You can add it to your favorite moisturizer, too.

Colloidal Silver: A suspension of submicroscopic metallic silver particles in a colloidal base. Colloidal silver can be used topically for its antibacterial, antifungal, and antiviral properties. We recommend talking with a healthcare professional before ingesting colloidal silver because it can have adverse events.

Bentonite Clay: This is a favorite holistic acne/skin treatment of many natural moms and health/beauty practitioners. Perhaps a gift of Pele the Hawaiian Fire Goddess and goddess of volcanoes and lightning. Bentonite clay is derived from volcanic ash and produces an electrical charge when hydrated. It is a healing clay used across many ancient cultures. Bentonite Clay pulls excess hydrogen from the skin and allows oxygen to take its place. The clay absorbs toxins and releases healthy minerals for the body to use. Bentonite can be used topically and internally. Baths, masks, washes, and powders are all possible with Bentonite Clay.

Omega-3s: Studies have shown that using fish oil supplements for the intake of omega-3s heal acne faster. The positive effects of omega-3s are difficult to overstate. This is one of the supplements we recommend for everyone along with, Vitamin D3, and a quality probiotic.

Zinc: Zinc plays an important role in cell division and regrowth. Few foods are rich and zinc, therefore, many of us are zinc deficient. Zinc also has anti-inflammatory effects which can also help with acne. Take a zinc taste test to learn if you are deficient.

Probiotic: The contrarian approach to the typical dermatologist that prescribes an antibiotic. By maintaining a healthy gut with good bacteria you will better absorb nutrients from food and reduce immune system inflammatory responses. This is a force multiplier for great health and wellness.

Try These Eight Safe, Natural and Effective ADHD Treatments

Prevailing ADHD therapy is not suitable for all children.  If you are looking for natural, safe, and effective alternatives to treat (beat) ADHD, then try these 8 natural supplements readily available in most places supplements are sold.  Turning to a powerful nootropic like Ritalin is not my first choice for treating ADHD because these stimulants can have adverse effects on our children’s reward system that can have lasting effects.


Zinc is an important cofactor to dopamine, which affects our responses to emotions and reward-seeking behavior.  Zinc deficiency is further correlated to low melatonin and serotonin which is associated with decreases in ability to process information.  Zinc is naturally occurring in certain foods and added to others.  Oysters have the highest zinc per serving of all foods, but poultry and beef account for most zinc in the American diet.  Many people do not get enough zinc in their daily diet because of our society’s eating habits.  A fun test is to drink a liquid zinc supplement and see what it tastes like.  If you are zinc deficient it will have no taste, but if you have enough zinc it will taste bitter to you.


Carnitine is believed to improve brain cell functioning by facilitating the burning of fatty acids, which helps brain and nerve cells to preserve their membranes.  Carnitine has been demonstrated to improve symptoms of hyperactivity and social behavior and is considered by some as a safe alternative to stimulant drugs.


Serine in a non-essential amino acid important in metabolism and is a precursor to several amino acids including tryptophan.  When administered with omega 3 fatty acids it improved ADHD symptoms significantly better than omega 3 fatty acids alone, suggesting a synergistic effect.  Phosphatidylserine also increases dopamine levels.


Glutamine is a precursor to the calming neurotransmitter GABA (gamma-aminobutyric acid) that affects mood, focus, and hyperactivity; Disruption of the glutamine-containing neurotransmission system may cause ADHD.


Choline is an essential nutrient that is a precursor to the neurotransmitter acetylcholine, which regulates memory focus and muscle control (hyperactivity).  Acetylcholine is especially important to normal brain function.  Dr. Axe explains, “Choline is important for liver function, normal brain development, nerve function, muscle movement, supporting energy levels and maintaining a healthy metabolism.”


Folate is a B Vitamin and low folate levels in pregnancy are linked to hyperactivity in children: People with MTHFR (methyltetrahydrofolate reductase) gene are predisposed to folate deficiency and more likely to have ADHD.

Vitamin B6

Vitamin B6 is a water-soluble vitamin. Evidence suggests high dose supplementation of B6 is as effective as Ritalin for ADHD, probably due to its role in raising serotonin levels.  Dr. Weil explains that “Vitamin B6 supports adrenal function, helps calm and maintain a healthy nervous system, and is necessary for key metabolic processes. Vitamin B6 acts as a coenzyme in the breakdown and utilization of carbohydrates, fats and proteins.”


Magnesium deficiency is linked to poor function of the neurotransmitters that control emotion, social reactions, hyperactivity and attention: Synergistic effect with Vitamin B6.  Literature with the National Institute of Health supports the fact that magnesium supplementation in children with ADHD improved hyperactivity.


If you are the parent, guardian, or an advocate for a loved one then I encourage you to begin a dialogue with your pediatrician about the safety and efficacy of these natural supplements for treating ADHD.  We all want to see our children have the best chance they can to grow into well adjusted happy adults, and ADHD can certain make that journey more difficult.  Stimulants may seem like a quick fix, but you should know that natural, safe, and effective alternatives do exist.