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It's time for some non-COVID information.  In general, fruit is thought of as healhy to eat and that you basically can't really eat too much of it. But it turns out that's not entirely true.  Some fruits have high sugar (fructose) content without the benefits of high fiber.  The importance of the fiber is that it is good for the health of the intestinal tract, fills you up without adding calories, and helps maintain a more steady blood sugar, which controls hunger and decreases overall calorc intake.  The problem with fructose is that it raises blood sugar and also raises cholesterol and triglycerides.  The article linked below has more information and a chart that can be helpful.  People who are trying to lose weight or who have borderline or high cholesterol or triglycerides might want to limit their intake of foods in the blue area of the chart and increase their intake of those in the green area.


We get a lot of questions of what parents can do to protect their children from COVID-19. We continue to recommend physical distancing, masks, and hand washing as the most effective means of preventing infection. However, there has been some recent literature coming out about a possible connection between low Vitamin D levels and severe COVID-19 disease, including the rare severe disease in children called MIS-C.


We have reviewed the literature and feel this is a low risk and inexpensive recommendation that may have the potential to limit the severity of COVID-19. The dosing recommendation below is higher than standard dosing but well below toxic levels, even for those without vitamin D deficiency. Please note that Vitamin D will NOT necessarily prevent infection or the risk of hospitalization.


Vitamin D does have known health benefits, including improved bone health and prevention of heart disease; also vitamin D deficiency has been linked to some cancers. There have been numerous studies showing vitamin D to protect from some pediatric infections (especially respiratory infections) and to improve immune function.


If your child has an underlying medical condition in which they have high levels of calcium, then please do speak with your pediatrician first before considering supplementing Vitamin D.


Daily Vitamin D3 supplementation recommendations:


0 – 12 months: 800 IU (20 mcg) daily (2 drops of D-Drops or 2 ml of D-vi-sol = 800 International Units)

1 yr to 12 yr : 2,000 IU (50 mcg) daily

12y+ and Adults: 4,000 IU (100 mcg) daily

We understand that there is some confusion about COVID-19 testing. Data suggests that people may spread the infection beginning a few days before symptoms begin (pre-symptomatic spread) and they also may be contagious even if they never develop symptoms at all (asymptomatic spread). We are following the current CDC recommendations on testing as listed here:


Symptomatic children: Call office to schedule testing (may be limited based on availability of test kits)

  • Fever (100.4 or higher) or chills

  • Shortness of breath

  • Fatigue (being tired)

  • Muscle or body aches

  • Headache

  • Loss of taste or smell

  • Sore throat

  • Congestion or runny nose

  • Nausea or vomiting

  • Diarrhea


Asymptomatic children: Do not need to be tested

  • Individuals who have close contact (described as within 6 feet for 15 minutes or more) with a person who has COVID-19 symptoms or who has tested positive for COVID-19

    • Stay home for 14 days after last exposure. Maintain social distance for all others

    • Self monitor for symptoms: check temperature twice a day

    • Avoid contact with people at higher risk


However, it is important to know that a negative test does not necessarily rule out COVID-19 infection. The timing and type of testing are important. Rapid tests are much more likely to miss an infection than the PCR tests that take more time (false negatives). Even with PCR, a study in the Annals of Internal Medicine showed that the probability of a false negative test is 100% on the first day of infection (typically before symptoms start). By day 5, the typical day that symptoms start, the false negative rate is still 38%. On day 8, the false negative rate is at its lowest but is still 20%. So anyone who suspects they may be infected, especially if they have been in contact with someone who is infected, should assume that they are infected even if their test is negative and follow the self-quarantine recommendations above.

We've updated our COVID-19 general information page to be more up to date reflecting the current situation in Arizona and recommendations for reducing the spread.  See it here:


I’ve been getting a lot of questions from parents about whether it’s going to be safe to send their kids to school in a few weeks. Understandably, people are concerned about the safety of their kids with the outbreak continuing but also many are eager to get their kids out of the house and back to more of a “normal” life. Unfortunately there’s no right answer for everyone. These decisions need to be made by each family individually as there are many varying factors that contribute to the decision.


On one hand, it’s clear that a lot of kids would benefit greatly from heading out of the house and going to school. Being stuck at home for most of the last 3-4 months has been hard on all of us. It’s taking a physical and emotional toll on a lot of our patients and families – from lack of exercise, unhealthy snacking, and extra screen time to social isolation, boredom, and increased conflict within the home. Some parents can’t work from home and don’t really have a choice of allowing their kids to stay home; parents that do work from home may have a hard time getting things done when they are trying to manage/teach their kids all day. Getting kids back to school could do a lot to alleviate these problems.


On the other hand, of course, is the pandemic. COVID-19 is not going away any time soon. The United States has not seen a decrease in cases, and Arizona has had an alarming increase. While young kids rarely get very sick from COVID-19 and probably are not as contagious as adults, transmission of viruses in school is really impossible to prevent. So no matter how careful schools are, there’s a good chance that some kids are going to get the virus and some of those kids are going to get their family members sick. At this point, it’s impossible to predict how big a problem that is going to be.


So the decision really comes down to a balance between risk and reward: the risk of your child getting the virus and possibly getting family members and friends sick vs. the reward of getting your kids out of the house for the various reasons above. Families that have a household member who is high risk because they are immunocompromised have a different calculation of risk vs. reward than those that are young and generally healthy without any high risk family members. So our advice is: assess your own family’s risks and how much you are willing to tolerate, compare that to the benefits to your family of sending your kids to school, and go with whichever wins in the balance.


Good luck and we hope that you all stay safe and healthy this fall! And don’t forget to get flu vaccines for everyone this fall when they become available!


Jeff Couchman, MD

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