Dr. Uma Pisharody

Uma Pisharody, MD, FAAP Interviewed by Roberta Ruggiero, Founder of the HSF

ROBERTA
I read your bio several times, and was moved by the fact that at a very early age you knew you wanted to become an advocate for children’s health.  Would you please explain the circumstances that led you to make such a decision?

DR. PISHARODY
As a child, I remember always wanting to be a pediatrician when I grew up.  It was my own pediatrician that inspired me.  I remember how gentle and kind he was, and how I would always look forward to seeing him.  In school, I loved biology and chemistry which made choosing medicine an easy choice as I entered college.  I figured that after medical school, if weren’t able to choose a career in pediatrics, I would actually consider teaching or another career path that would enable me to create a positive impact on children’s lives!  I’ve always felt that being able to help children is the biggest honor of my life.

ROBERTA
You are on the Board of Directors for the Institute for Responsible Nutrition; on the Advisory Board for the Northwest Chapter of the Crohn’s and Colitis Foundation of America and now for the Hypoglycemia Support Foundation. That’s not including being a member of the American Academy of Pediatrics, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition, the American Gastroenterological Association, and the American Society for Parenteral and Enteral Nutrition.

What drives you to be involved with all these organizations? Do they have a common cause or interest?

DR. PISHARODY
I find that being part of these organizations allows me to become a better advocate for my patients and their families. By engaging with these organizations, I am able to keep abreast of the latest scientific breakthroughs in the fields of nutrition and gastroenterology. I am also able to better network and collaborate with other specialists. These organizations combine my interests of pediatrics, gastroenterology, and nutritional science.  Those are the cornerstones of my day to day practice and the subjects about which I am most passionate.

ROBERTA
When we first meet in January 2017, I felt an immediate connection to you.  Do you have any idea why? You were the first doctor who not only accepted my work but praised it when you said… “You knew about hypoglycemia and metabolic disease before we did!” Not many doctors know about functional/reactive hypoglycemia let alone metabolic disease.  Or if they do, I’ve seldom heard them use that phrase. Why do you suppose hypoglycemia is so poorly understood in the medical community?

DR. PISHARODY
I’m afraid nutritional science is still poorly understood by most doctors. We focus on disease and medications, but tend to forget the biochemistry of metabolism. Personally, I recall learning basic metabolic pathways in the 1st and 2nd year of medical school, but not really being forced to apply these once I got into my clinical years of training.  Once I started seeing patients, I was being taught that ‘it’s all about calories” and that obesity and metabolic syndrome were from overeating,   I didn’t even fully understand the toxicity of sugar and processed foods, until I read the work of Dr. Lustig.  That’s why, when I read your book and saw how you had astutely described the relationship between processed food health decades ago, I was in awe.  Kudos to you, Roberta, for understanding and exposing the truth about the quality of food being more important that the quantity, long before most doctors had started to realize this crucial fact.

ROBERTA
The HSF is now in its 37th year.  At first, adult women got in touch with us, typically in their fifties and sixties.  Later, this was followed by a good share of men as well. Over the years, the age of those interested in hypoglycemia dropped to mid-thirties, then twenties and then we heard from increasing numbers of young adolescents and teenagers. It became especially worrisome when we started to hear from parents of very young children, one to three years of age, being diagnosed with hypoglycemia.  The trend has increased alarmingly, and in response to the growing epidemic, we created the first ever website for children with hypoglycemia at www.hypoglycemiaKIDS.org.

I am so impressed that because of your education and advocacy efforts, Swedish Hospital is the first hospital in the country to ban juices on the pediatric menu. Please share what and how you managed to accomplish this – and why this issue is important for other hospital care systems to consider.

DR. PISHARODY
When I started working at Swedish Medical Center, fruit juice was being routinely offered and served to children following medical procedures and tests. One day, a patient of mine with metabolic syndrome was admitted for a liver biopsy. As was the protocol, he was automatically offered a glass of juice, as soon as he woke-up following his procedure.  His mother was puzzled, as I had been advising him to strictly restrict juice (and sugar sweetened beverages), and asked me about it.  The incident prompted me to write to hospital administrators about changing our hospital policy.  I was asked to review the scientific literature and present my findings to our hospital’s pediatric quality improvement committee.  I’m very grateful that this committee agreed with my recommendations and went on change the policy.  I’m proud to say that the hospital no longer routinely offers juice to children who are admitted here.  It is made available when medically necessary, or if the parents specifically request it, but it’s no longer the standard drink that they are served following medical procedures.

This is an example of a simple change that hospitals can make to educate families on the dangers of excessive intake of sugar.  Hospitals should lead by example, serving healthy foods and beverages.  This starts with educating families on why juice is not a healthy option for most kids.

ROBERTA
In an article about your achievement of getting juice off the pediatric menu at Swedish Hospital, you stated “The most common liver disease in childhood is something called Non-Alcoholic Fatty Liver Disease (NAFLD). It’s the exact same fatty liver condition you see in alcoholics, but we call it ‘non’ because it’s in kids.” Dr. Robert Lustig talks about sugar being “the alcohol of the child.” It is my sense that few parents realize that fatty liver disease is one of the fastest growing chronic diseases on earth. Please explain why sugary beverages, including juice, make fat in the liver?  Why is fat in the liver harmful? Also, since we can’t see fat in the liver, and this condition affects the non-obese as well as the obese, are there warning signs that parents can look out for – or is it a completely hidden threat, only preventable by proper diet?

DR. PISHARODY
Sugar (sucrose) is made up of two molecules; glucose and fructose. While glucose provides energy to every cell in the human body, only liver cells can metabolize fructose. This means that when consumed in large quantities, fructose can burden the liver. Overwhelmed by excessive intake of sugar, liver cells start to convert some of the fructose into fat. But over time, the increasing amount of fat overwhelms the system, and fat droplets get stuck within the liver, causing the cells to become swollen and sick. This can lead to cirrhosis and liver failure. Did you know that under the microscope, there is no way to distinguish the sick, swollen, and dying liver cells from a child who has been consuming too much sugar from the liver cells of an adult who has been a chronic alcoholic?! This is why Dr. Lustig calls sugar (including juice and sugary beverages) the “alcohol of the child!”

When children drink a glass of juice, the amount of fructose being absorbed into the liver far exceeds the amount they would get if they were to consume whole fruit instead.  Remember that when ingested in naturally occurring, small quantities, especially in combination with fiber (as would be the case when fruits are eaten in their unprocessed form), fructose wouldn’t be toxic to the liver.

Roberta, you are correct. In U.S. children, NAFLD is now the leading cause of chronic liver disease. Unfortunately, many children aren’t diagnosed until the disease has progressed.  This is because it’s hard to diagnose NAFLD, using routine tests. Once warning signs of liver disease and metabolic syndrome do show-up on a physical exam, or with medical tests, NAFLD has often already progressed!  That’s why prevention is key. The only way to prevent the disease is by avoiding regular consumption of excessive amounts of sugar. And remember, too much fructose is toxic to the liver, whether it comes from 100% juice, sugar-sweetened beverages, or processed foods laden with sugar.

ROBERTA
What can you say about these patients, and other early indicators of metabolic disorder that might be helpful to parents and the general public?

DR. PISHARODY
I have certainly been seeing more and more children referred to me for help managing their metabolic syndrome. As a pediatric gastroenterologist, I am alarmed by the growing number of kids with nonalcoholic fatty liver disease (NAFLD). Over the last two decades, children have become exposed to increasing amounts of sugar, especially because sugar is added to the vast majority of processed foods.  As I have already mentioned, NAFLD is now considered the leading cause of chronic liver disease in children and adolescents in the United States. Whether it be the sugar found in infant/toddler formulas or baby foods, crackers, ketchup, and breads, sugar is sneaking into our diets in excessive amounts, compared to decades ago.  Some of the earliest indicators of children developing metabolic syndrome are excessive weight gain, especially around the abdomen.  This can be reversed by going back to eating foods that are less processed, with more fiber and less sugar.

ROBERTA
What general advice can you give to parents whose child are diagnosed with blood sugar disorders? Do you do provide any education related to diet – if so, what kind of advice do you offer?

DR. PISHARODY
The dietary advice I give to my patients is pretty simple: “Just eat real food.”  It’s called the “JERF” diet!  We need to go back to the basics of cooking our own food, putting real ingredients together and enjoying the experiences and flavors of cooking with our families.  The food we prepare should be food that our great-grandparents would have recognized! We can’t continue to rely on the food industry to decide what we eat.  When we take control of the food we cook and eat, we avoid all the chemicals, additives, preservatives and sugar found in the vast majority of pre-packaged, processed foods.  If there are two secrets to healthy eating, it would be more fiber and less sugar.  If we teach our kids to be on the lookout for foods high in fiber and low in sugar, this will steer them clear of most of the unhealthier choices.

ROBERTA
How important is the school environment or teachers, or even the extended family, to get involved in a child’s health, especially related to diet?

DR. PISHARODY
The importance of having a child feel supported on all fronts, as they pursue a life of healthy eating, cannot be understated. It’s imperative that the adults in a child’s life set healthy examples to follow. We can’t improve a child’s metabolic health just by telling them to eat healthy. We have to guide by example. Having healthy food at home is a great start, but since kids spend a large part of their lives outside of their houses, we also need to make sure that the food that they are eating at school is beneficial and nutritious. Support from cafeteria workers, teachers, having healthy food choices at friends’/relatives’ homes all plays a crucial role in ensuring children continue on a lifelong path to metabolic fitness.

ROBERTA
As I mentioned, the HSF offers the only website dedicated to Children with Hypoglycemia. www.hypoglycemiaKIDS.org. Do you have any advice on how the HSF can enhance its educational work with children and families affected by hypoglycemia?

DR. PISHARODY
Since it’s so important to get education on healthy eating to schools, it would be great to see HSF start a classroom-based initiative, offering education to students, teachers and parents. Webinars or conferences could help educate about the dangers of processed food. The science of insulin resistance is complicated, but I think that the HSF has an amazing platform to put the science in an easy-to-understand, user-friendly format, and share this curriculum around the world!

Uma K. Pisharody, MD, FAAP
Dr. Pisharody currently practices in the Pediatric Gastroenterology department at Swedish Hospital in Seattle, Washington, where she helps children and families understand the connection between diet, nutrition, digestive health and well-being. In addition to being a Medical Advisor for the HSF, Dr. Pisharody serves as a member of the board of directors for the Institute for Responsible Nutrition and the medical advisory committee for the Northwest Chapter of the Crohn’s and Colitis Foundation of America. She is also a member of the American Academy of Pediatrics; the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition; the American Gastroenterological Association; and the American Society for Parenteral and Enteral Nutrition.

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