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Dr. M’s SPA Newsletter Volume 15 Issue 25 – Tough Conversations

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Speaking Truth in Love: The Weight of Avoidance in Pediatric Metabolic Health

After completing the second round of our Asthma and Obesity Metabolic Pilot Program at Salisbury Pediatrics, I left the clinic reflecting deeply on what I witnessed. It crystallized a truth that is uncomfortable but undeniable: the greatest health threats to our children today are not infectious or accidental, they are metabolic. Diseases once reserved for adulthood: insulin resistance, fatty liver, hypertension, early vascular aging are now appearing in children who should be free to run, play, and thrive.

In modern society, conversations about weight and metabolic dysfunction have become relatively taboo. This is not to say that children of normal or low weight are immune; they, too, can be at risk. However, the excess-weight group carries the highest statistical burden. Too often, clinicians hesitate to speak truth to families for fear of offending, shaming, or overstepping. In doing so, we risk silence becoming complicity and allowing preventable disease to take root in the very children we are charged to protect.

Much of this epidemic is not born of individual failure but of systemic neglect. Government-funded, poor-quality school meals, cheap processed foods, and relentless marketing of sugar and refined carbohydrates have built an environment where metabolic injury is almost inevitable. When a child’s daily fuel is engineered for shelf life instead of cell life, the outcome is not accidental, it is predictable. Our pilot program lab results are a painful window into that truth…. and a literature review on eczema and anaphylaxis.

Enjoy Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 22/23/24 – Acetaminophen and Autism

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Review Part III – after the Attia Podcast

After completing the interview with Dr. William Parker and now listening to Peter Attia’s analysis, let us look again at this question. I repeat that the initial question has not changed for me. The first and most fundamental question to ask is this: What is the true value of acetaminophen in health compared with the potential risk if the associated findings are indeed correct?

My response to this question has been altered by the analysis so far.

I love this from Dr. Attia: “Some people might be wondering, why did you just take so long to explain all this to us? Why don’t you just give us the answer? I just want the sound bite, man

Peter’s reply, “If you just want sound bites, you’re never going to learn.”

Honestly, if you just want sound bites, this isn’t the podcast for you. But if you actually want to be able to learn to think for yourself, then that’s what we’re here to do. And that’s the reason we killed ourselves over the past week to put together the most thorough gathering of all the data we could find and the most intense night-weekend analysis possible. “

I agree! I believe that the science and data are key. So here goes – round three!…..

Dr. M

 

Dr. M’s SPA Newsletter Volume 15 Issue 20/21

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Flu season is around the corner and we should take a look at the virus for preparation purposes.

Influenza

Every few years, I revisit this virus in my writing, not only to keep it on your radar in preparation, but also because of the significant illness and death it continues to cause. It’s never wise to dismiss its potential impact. Influenza reliably returns each year, difficult to escape even with strict isolation.

The flu is different from the common cold in many ways as the flu has:

1) Rapid onset with high spiking fevers

2) Muscle and headaches

3) Little to not sneezing and sore throat

4) Rapid and robust cough onset

Influenza season is beginning in the United States this fall. Who gets sick? In short, people of all ages. Seasonal influenza has a reproductive rate of just over one, meaning that each infected person typically spreads the virus to one or two others through coughing or sneezing in close proximity. The virus also survives on surfaces for up to 24 hours, creating another common route of transmission, especially in children. Young kids frequently touch surfaces and each other, then touch their faces, providing the perfect pathway for infection. Because of this, schools remain a major hub for flu transmission across the country.

Preventing the virus from taking root in your body is the key to avoiding a bad outcome.

Things that I think of as critical to avoiding or preventing this infection:

1) Keeping your vitamin D level greater than 50 ng/ml is an important way to prevent influenza infections. Get tested and supplement accordingly. As always the sun is your natural route to normal D levels

2) Get adequate sleep based on your age to keep your immune system in great shape. Sleep is very important for immune health…… and more on asthma driving mental health issues.
Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 19

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For parents of special needs children, I honor you today.

I witness your strength every day in clinic.

You rise to meet challenges that many cannot begin to imagine, truly. You navigate medical appointments, therapy sessions, school meetings, and the unpredictable rhythms that come with raising a child with special needs.

Often without pause, without adequate rest, and without the recognition you deserve. For those single parents carrying this day to day reality, a double level of gratitude for you.

I want to pause for a moment and say what is too rarely said: you are extraordinary. Truly extraordinary.

Your love is not passive, it is an active force. It shows up at 2 AM when a child can’t sleep, in the quiet patience during a meltdown, in the persistence to advocate for services in a dysfunctional system requiring resilience summoned when the system says “no” but you know your child needs a “yes.”…. and a discussion of nutritional dark matter.

Enjoy,

Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 18

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Breastmilk is Dynamic

Cellular and transcriptional diversity over the course of human lactation

This recent 2022 paper in the Proceedings of the National Academy of Sciences by Dr. Nyqiust and colleagues is a site for sore eyes.

It offers a remarkable, high-resolution portrait of how the cellular landscape of human breast milk (hBM) shifts over time. The authors capture something both scientifically rich and uniquely human: the dynamic, living composition of milk as it adapts to the changing needs of mother and child.

The abstract: “Human breast milk is a dynamic fluid that contains millions of cells, but their identities and phenotypic properties are poorly understood. We generated and analyzed single-cell RNA-sequencing (scRNA-seq) data to characterize the transcriptomes of cells from hBM across lactational time from 3 to 632 d postpartum in 15 donors. We found that the majority of cells in hBM are lactocytes, a specialized epithelial subset, and that cell-type frequencies shift over the course of lactation, yielding greater epithelial diversity at later points. Analysis of lactocytes reveals a continuum of cell states characterized by transcriptional changes in hormone-, growth factor-, and milk production-related pathways. Generalized additive models suggest that one subcluster, LC1 epithelial cells, increases as a function of time postpartum, daycare attendance, and the use of hormonal birth control. We identify several subclusters of macrophages in hBM that are enriched for tolerogenic functions, possibly playing a role in protecting the mammary gland during lactation. Our description of the cellular components of breast milk, their association with maternal–infant dyad metadata, and our quantification of alterations at the gene and pathway levels provide a detailed longitudinal picture of hBM cells across lactational time. This work paves the way for future investigations of how a potential division of cellular labor and differential hormone regulation might be leveraged therapeutically to support healthy lactation and potentially aid in milk production.” (Nyquist et. al. 2022)

And more information on breastmilk immunology and a recipe.

Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 17

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Inflammaging from a Population View

In a landmark study published in Nature Aging on July 7, 2025, researchers challenge a cornerstone of modern gerontology by showing that inflammaging, chronic, age-associated low-grade inflammation, is not universal across all human populations. The abstract states the following: “Inflammaging, an age-associated increase in chronic inflammation, is considered a hallmark of aging. However, there is no consensus approach to measuring inflammaging based on circulating cytokines. Here we assessed whether an inflammaging axis detected in the Italian InCHIANTI dataset comprising 19 cytokines could be generalized to a different industrialized population (Singapore Longitudinal Aging Study) or to two indigenous, nonindustrialized populations: the Tsimane from the Bolivian Amazon and the Orang Asli from Peninsular Malaysia.

We assessed cytokine axis structure similarity and whether the inflammaging axis replicating the InCHIANTI result increased with age or was associated with health outcomes. The Singapore Longitudinal Aging Study was similar to InCHIANTI except for IL-6 and IL-1RA. The Tsimane and Orang Asli showed markedly different axis structures with little to no association with age and no association with age-related diseases. Inflammaging, as measured in this manner in these cohorts, thus appears to be largely a byproduct of industrialized lifestyles, with major variation across environments and populations.” (Franck et. al. 2025)

The research team analyzed 19 cytokines in over 2,800 individuals from four diverse populations: two industrialized cohorts: Italy’s InCHIANTI and the Singapore Longitudinal Aging Study (SLAS); two non-industrialized, Indigenous groups: the Tsimane of the Bolivian Amazon and the Orang Asli of Peninsular Malaysia.

In Italy and Singapore, the industrialized regions noted classic inflammaging signatures with inflammatory markers like IL‑6, TNF-α, and CRP increased with age, and correlated strongly with age-related chronic diseases such as cardiovascular and kidney disease….. and more on inflammaging…

Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 16

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A Rooted Approach to Modern Medicine: The Vision Forward

My emerging and chronically iterating philosophy of medicine is a rising structural entity rooted between ancient healing wisdom and modern scientific insight. It is layered with root cause immunometabolomic thinking and built upon anthropological foundations. As a pediatrician, educator, and onion peeling thinker, I believe that a medical approach grounded in compassion, prevention, and the pursuit of root causes is the way forward. Medicine is not just about treating disease but about reshaping the very terrain in which illness arises. This can and must start with our women and children.

At the heart of this vision is a belief in the power of systems biology and our deep interconnectedness. The human body cannot be understood or healed through isolated parts or siloed provider experiences. We must move beyond symptom suppression and toward an understanding of the why behind disease. Why does a child struggle with allergies, ADHD, or autoimmune illness? What factors in the environment, diet, stress response, or microbial ecosystem have altered their trajectory? Why are the governmental and NGO leaders not guiding us towards a benevolent goal of whole child health? These are the questions that shape and guide our practice….and a literature review.

Dr. M

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