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The Foundation of Health

Posted By Rachelle Morehead, Friday, May 26, 2017

I have written about vitamin and mineral supplementation before in The Link, but for those of us who provide healthcare services, we are very aware of its importance as a foundational step towards excellent health.  In our practices, we confront the consequences of subclinical malnutrition, the inadequacy of our current mainstream diet, the ongoing riptide of pesticide sequelae, and the established medical resistance towards supplementation on a daily basis. Most importantly, we are challenged by the lack of financial support for preventive services and that includes supplementation. We have made a bit of progress as now many multivitamins, vitamin D and sometimes melatonin are covered by Medicaid. That is more important than I can say because although many of my patients are willing to follow through on supplementation, they cannot afford to do so unless their insurer cooperates. The lower socioeconomic groups need these supplements the most. I know because I follow them from one hospitalization to the next. 

My job is to keep them out of the hospital, at least in terms of their mental health.  But who is to say that the 35 year old young woman who was hospitalized with serious suicidal ideation wasn’t deficient in iron, vitamin B6 or vitamin C or D? Since we do not normally test for vitamin deficiencies, we may not discover the underlying culprit for those life threatening thoughts. Iron deficiency can result in poor concentration and lack of energy, symptoms that are complained about frequently in mental health. B6 deficiency can also lead to depression and anxiety, causing decreased amounts of serotonin, the feel good hormone, dopamine, and melatonin. Decreased melatonin can produce all types of sleep disorders from trouble falling asleep, to middle insomnia, to early morning awakening. Of all the complaints I hear every day from patients, the number one complaint is inability to cope with stress. Aside from the psychologic component that reflects inadequate coping skills, there is a physiologic basis for this as well. Vitamin C is stored in the adrenal glands and how often have we heard that term “adrenal exhaustion?” Some blame poor adrenal response on consuming too much coffee, but vitamin C deficiency would be a better guess. Vitamin C is crucial in producing many important hormones and neurotransmitters in the body and when norepinephrine, thyroxin and dopamine are depleted, it takes its toll on a person’s ability to fight daily stress.

Our lifestyle today is largely unhealthy. Picture this: after a poor night’s sleep and awakening in an irritable mood, a person fights the stress of congested traffic to arrive at work to put in 8 hours or more under fluorescent lights in an artificial environment with too much noise, not enough time to eat, relax, and oftentimes even use the restroom. The pace of the work world does not wait for those who can’t keep up with its demands and these demands can become overwhelming. When the usual coping mechanisms no long seem to work, a host of unhealthy responses can set in, from shutting down and falling into a serious depression in which a person struggles to even get out of bed to becoming irate and flying into a rage that puts others at potential risk. Another response is to consume excessive alcohol or any of the many illicit substances that are so easy to come by today but which wreak complete havoc on a person’s life.

I recently listened to Dr. Tieraona Low Dog’s webinar on “Silent epidemic: the Hidden Dangers of Nutrient Deficiencies” sponsored by Emerson Ecologics. By the end of the presentation, I was in tears confronting the possibility that in my efforts to help patients by prescribing potent medications, I could have actually worsened their condition. The medications we utilize in mental health are like all prescription medications, they are extremely potent. Dr. Low Dog talked about the effect of the anticonvulsant drugs depleting vitamin B12 and folate. The anticonvulsants are one of two classes of drugs that we use as mood stabilizers. Along with the SSRIs and SNRIs, there are many medications that contribute to osteoporosis. The only thing that made me feel a little better is the fact that for as long as I can remember, I have recommended a multi vitamin/mineral supplement for ALL my patients and over the years, vitamin D3, fish oils and melatonin are also on the list. For those who feel that they can’t cope, a high stress vitamin B complex with 100% of the recommended amount of each B vitamin, is suggested. I am happy to say most follow through and I like to think that overall, my patients get better.

Dr. Low Dog also addressed the true origins of our deficiency syndromes, the lack of soil quality in which our food is grown along with the extensive use of pesticides today. I would add that another factor is well meaning but incorrect dietary advice from the medical community, pushing us to eat egg whites and throw out the perfect yolk, containing all nutrients to sustain life except vitamin C. Poor dietary habits along with small daily exposure to those nasty “endocrine disrupters” have most likely contributed to a burgeoning number of children with attention deficit disorder. Instead of examining the true cause, we throw more potent medications at these children and although I am licensed to do just that, I have my serious reservations about it. I have lived long enough to know that when I was growing up, there was no such thing as ADHD. Why has the inability to concentrate in so many children reached epidemic proportions today? I think we need to take a closer look at the physiologic origins of the problem.

With the deleterious consequences of poor nutrition in mind, it is inspiring to come across an agricultural business that is “safe for people, plants and pets!” I get a lot of catalogues and one that definitely caught my attention is “Spray-N-Grow,” a trio of organic plant foods developed by a chemist and father, Bill Muskopf, from Rockport, TX. There are three different products that when combined in a spray delivers the “Perfect Blend.” Rather than targeting the root system, these nutrients are sprayed right on the leaves where they make their way down the stems to the roots. The catalogue states that “foliar feeding is up to 10X more efficient than root feeding.” The first product is the fertilizer in “a perfect ratio of nitrogen, phosphorus, and potassium.” Next comes the second product, the Spray-N-Grow Micronutrients that are “like vitamins for your plants” and contain calcium, zinc, copper, iron, sodium, magnesium and other compounds. The third part of the trio is the Coco-Wet, which is a nonionic wetting agent that assists the other products to stick better to the leaves for better absorption and is made from all natural coconut oil. I think I have discovered my new approach to developing a beautiful, nutritious garden and look forward to trying out these unique products this summer. There are other products as well for natural pest control and animal repellents. Order a catalogue by phone: 800-323-2363 or go online to spray-n-grow.com.

If you haven’t done it thus far, get started on your vitamin supplements and a good quality multi is a good place to start. The information out there is overwhelming and can be confusing, so seek out a trusted professional to guide you through the process. 

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Strawberry Rhubarb Quinoa Pudding

Posted By Rachelle Morehead, Friday, May 26, 2017

As summer approaches, we look forward to more fresh fruit selections put together in interesting and nutritious ways. While I love presenting my own recipes, I also love to give credit to those who have offered a unique recipe and this one by “eating well.com” filled the bill. Including a healthy grain in a dessert is a great way to boost nutrition and please the palate at the same time. I always avoid using sugar if I can and substitute with maple syrup; otherwise I stayed with the original ingredients. This fruit combination of strawberry and rhubarb is one of my very favorites and always reminds me of the great pies at our New Mexico State Fair. Bon Appetit!

Ingredients:

1/3 cup quinoa

½ teaspoon ground cinnamon

Pinch of sea salt

¼ cup organic maple syrup plus tablespoon

1 tablespoon corn starch

1 cup nonfat plain Greek yogurt

1 teaspoon vanilla extract

Preparation time: 20 minutes active; 1hour 45 minutes until ready

1). Combine 2 cups water in a medium saucepan with rhubarb, strawberries, quinoa, cinnamon and salt. Bring to a boil over high heat, then reduce to maintain a simmer. Cover and cook until the quinoa is tender, about 25 minutes. Stir in the maple syrup and lemon zest. Whisk cornstarch with the remaining ¼ cup water in a small bowl. Stir into quinoa mixture, return to a simmer and cook, stirring constantly for one minute.

2) Remove from heat. Divide the pudding among 6 bowls and refrigerate until cool, about one hour.

3) Just before serving, combine yogurt, vanilla and the remaining 1 tablespoon maple syrup in a small bowl. Top each serving with a generous dollop of vanilla yogurt and fresh strawberries, if desired.

Nutrition information: calories per serving: 151; serving size: about 2/3 cup; nutrition bonus: 33% daily value of vitamin C.

Credit: http://www.eatingwell.com/recipe/250696/strawberry-rhubarb-quinoa-pudding/

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Cannabis Drug Reduces Seizures in Severe Epilepsy Cases

Posted By Maggie Fox & Lauren Dunn - NBC News, Thursday, May 25, 2017

A compound taken from marijuana greatly helped some children with a severe and often deadly form of epilepsy and completely stopped seizures in a very few, researchers reported Wednesday.

It's a rare success in a field suffused with more hope than facts — in which advocates clamor to have marijuana and compounds taken from the herb legalized for free use, while government rules limit use and researchers struggle to prove what works and what doesn't.

In this study, the researchers enrolled kids with Dravet syndrome, a very rare and often deadly form of epilepsy caused by a genetic mutation. These kids have multiple, prolonged seizures that cause brain damage.

There's no treatment.

"It's hard to portray how serious and devastating this is," Dr. Orrin Devinsky, director of the New York University Comprehensive Epilepsy Center, told NBC News.

Devinsky and colleagues around the country tested a cannabis derivative called cannabidiol — CBD for short — on 120 Dravet syndrome patients.

Half took it for 14 weeks and half got a placebo.

 

"Seizure frequency dropped in the cannabidiol-treated group by 39 percent from nearly 12 convulsive seizures per month before the study to about six; three patients' seizures stopped entirely," the team wrote in the New England Journal of Medicine.

"In the placebo group, there was a 13 percent reduction in seizures from about 15 monthly seizures to 14," they added.

"Quite remarkably, 5 percent of the children in the active treatment group with CBD were completely seizure free during the 14 weeks of the trial," Devinsky said.

"And these were kids who were often having dozens of seizures, if not many more than that per week."

The kids who got CBD were more likely to stop the trial because of side-effects. "Side-effects were generally mild or moderate in severity, with the most common being vomiting, fatigue and fever," Devinsky wrote.

But those who have been helped have been transformed, he added.

"There's no doubt for some children this is just been an incredibly effective and game changing medication for them," Devinsky said.

"These are some of the children I care for [who] were in wheelchairs, were barely able to open their eyes in an office visit and really showed no emotion and … now they come in, they're walking, they're smiling, they're interactive. It's like a different human being in front of you."

He said it's not quite accurate to called CBD "medical marijuana."

"Cannabidiol is the major non-psychoactive compound present in cannabis or marijuana," Devinsky said.

"In this study, we were giving a compound CBD which has no high-producing or psychoactive properties."

It's highly processed to strict standards. A British company, GW Pharmaceuticals, is seeking Food and Drug Administration approval for the product under the brand name Epidiolex.

"The drug we gave was derived from cannabis or marijuana but it really should not be confused with the medical marijuana that would be obtained from dispensaries in the 44 U.S. states that have approved it. Those typically contain combinations of THC with CBD and many other compounds," Devinsky said.

 

It's not clear precisely how CBD works. It appears to attach to brain cells, he said.

"The CBD binds with a novel receptor in the brain and thereby dampens down too much electrical activity," he said. "It seems to be a relatively unique mechanism of action that's not shared by any of the existing seizure medications."

Doctors are interested in trying CBD on autism, anxiety, inflammatory and autoimmune disorders, Devinsky said.

It may help people with other types of seizures, as well. Jack Ziokowski, now 13, has been taking CBD for more than two years.

His seizures started with a viral infection, said his mother Jenny Ziolkowski, who lives in Stamford, Connecticut.

 

"We got a phone call from the school saying that Jack had had a massive seizure on his first day of first grade," Ziolkowski told NBC News.

"He was having seizure after seizure and they couldn't stop the seizures, and they couldn't figure out what was causing them so he was just hooked up to all these machines and wires," she added.

"He couldn't walk, he couldn't talk, he couldn't feed himself and he couldn't do any of those things."

Jack recovered somewhat but could never be left alone. "The post-illness Jack is not much like the pre-illness Jack," his mother said.

But once Jack started taking CBD, he went six full months without having a seizure and now rarely has one, his parents said.

"That was like a miracle. I mean ... we were actually able to see him grow and make progress," Ziolkowski said.

"He got a skateboard for his 13th birthday three weeks ago."

Australian epilepsy expert Dr. Samuel Berkovic said much more testing is needed. "This trial represents the beginning of solid evidence for the use of cannabinoids in epilepsy," Berkovic, who works at the University of Melbourne, wrote in a commentary.

Devinsky is hopeful.

"For 3,800 years, healers and physicians have been prescribing cannabis and documented that use to treat epilepsy," he said.

"After nearly 4,000 years we for the first time have vigorous scientific data that a compound from cannabis works to treat epilepsy."

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ANH Founder: Food IS Medicine

Posted By Alliance for Natural Health, Wednesday, May 24, 2017

The founder of the Alliance for Natural Health, Dr. Robert Verkerk, spoke this past weekend at the Natural and Organic Products Europe conference in London during what is clearly an important time for big ideas, given the changes occurring there.

The potential impact of “Brexit” (the United Kingdom’s “divorce” from the European Union passed by referendum in June 2016) was a focus of the panel discussion. Dr. Verkerk made this all-important point :

One of the biggest problems we have is the intersection of food and medicine law. The reason we have a roadblock, with products being taken off the market, is because medicinal law imposes itself far too often on food law….We’ve now got a very different scientific environment to the one that this regulation grew up in. We now know that food is medicine, we know that exercise is medicine, and therefore we need to re-frame the way that foods can be used for therapeutic benefit, and I think that will yield a fundamental change. I believe we need to review the whole of medicinal law in relation to the use of therapeutic foods. And that could create a possibility of a third route.

Of course, Dr. Verkerk is alluding to the fact that, by law, only government-approved drugs (in the US, only FDA-approved drugs) can claim to diagnose, cure, mitigate, treat, or prevent diseases, even if there are mountains of evidence to show that a natural vitamin or mineral can help with a disease. And because such approval commonly costs billions, only patentable, new-to-nature molecules fit the system. Food, food supplements, and exercise are totally excluded, even though we now know that they are often the most powerful medicine we have.

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VIDEO: Why Other Countries Don't Want American Food

Posted By Alliance for Natural Health, Wednesday, May 24, 2017

 

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How AMHA Can Meet the Needs of You and Your Patients

Posted By Alexander Lopera, American Health Alliance (AMHA), Monday, May 22, 2017

Far too many people face a debilitating illness such as cancer, Lyme disease, or other conditions that require more energy than normal to fight and endure treatments. But unfortunately, they also face a need to maneuver through the complexities associated with a very complicated insurance and health system. Long-term or grave illnesses often involve recommended treatments that are not covered by insurance or seeing providers that are out-of-network. Or, perhaps conventional treatments and medications are not working. As a result, some patients are seeking alternative, holistic, or naturopathic treatments. However many of these treatments, both overseas and within the U.S., require payment upfront.

As the need for medical help continues and the complexities of dealing with insurance companies becomes an epidemic, more and more patients need someone to help them evaluate every aspect of their hospital stay, possible treatments, and appointments. Not just any help, but someone who will evaluate and assist in the preparation of those billable medical expenses for reimbursement.

Alexander Lopera realized the need for this service. With years of experience working within the insurance and health fields, he founded AMHA - a company that helps remove the stresses of dealing with insurance companies from those who need to save their energy to fight their illness.

 

The Alternative Myth
Patients are under the assumption that treatments received at alternative clinics are all non-approved; however, that is not the case.  Ancillary services such as lab tests, radiology, diagnostic imaging, consultations, and more, are billable services. AMHA has a team of billing experts who will thoroughly review a patient’s medical bill to identify which aspects of their treatment and medical care are billable. However, each item needs to be properly coded in accordance to rules set forth by the American Medical Association.

In addition, some facilities will give patients a basic bill with a few codes. Thinking that this is enough, the bills are submitted to the insurance company, hoping for a reimbursement. But, when it’s insufficient, as it often is, it will either be delayed or denied. AMHA has worked with providers to help them create a billing template that itemizes the various treatments a patient receives so a claim is submitted with all the necessary information to properly process it.

 

How the Process Works
Prior to treatment, perspective clients can complete an AMHA patient information form, and then return it to AMHA’s office so it can be evaluated by the trained staff, free of cost. Even though they cannot make any guarantee of coverage, they will have a much better understanding on what coverage the patient may or may not have after evaluation. With this valuable information, they can then instruct you in the best manner to proceed.

After the treatment, the patient will submit a completed AMHA patient information form, along with the medical bill and proof of payment to AMHA’s office. Upon receiving the completed paperwork, the billing staff will determine which treatments and services provided are FDA approved. They will then note them with the appropriate codes and submit the claim for processing. The claim will be followed by AMHA throughout the entire processing stage, until a final decision is made.

 

 How AMHA Benefits Patients
With the help and expertise of AMHA, many patients can now afford to receive more medical care, due to successful reimbursements by the insurance company. Working on a contingent basis, AMHA will only get paid if they can obtain a reimbursement for a patient. So, there is absolutely no risk in utilizing their professional services.

 Here are some of the services AMHA provide:

  •  Free verification of patient insurance benefits
  •  Professionally and accurately prepared coded claims
  • Certified CPT/ICD10 coders
  • Electronically submitted claims
  • Secondary insurance billing
  • Insurance follow up in a timely manner
  • Level 1 appeals

Alexander Lopera has over 20 years of experience, and has an experienced and dedicated team to help you in your needs. If you feel as though you could benefit from AMHA’s team, or want more information, give them a call at (281) 580-1423 or visit www.amhabilling.com

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Kentucky Derby Pie

Posted By Carol L. Hunter PhD, PMHCNS, CNP, Wednesday, May 3, 2017
Updated: Tuesday, April 18, 2017

Ingredients:

2 eggs

2 TBSP oil (grapeseed)

1 TBSP Kentucky straight bourbon

1 tsp vanilla extract

¾ cup flour (garbanzo bean, gluten free)

4 TBSP pure maple syrup

1 tsp organic blackstrap molasses

½ cup dark brown sugar

8 oz organic buttery spread

1 and a half cups pecan pieces

12 oz package of semisweet chocolate chips

One bottom dough crust (Pillsbury, premade)


Directions:

Preheat oven to 325 degrees F

Beat eggs in an electric mixer until fluffy

Add oil, vanilla extract, the maple syrup, the molasses and the bourbon until blended.

Beat flour and dark brown sugar into mixture until smooth

Beat in butter until creamy and smooth

Hand stir in the pecan pieces and the chocolate chips

Mould the dough into the bottom and sides of a deep pie dish

Gently stir-fold in the ingredients

Place on a cookie sheet in the 2nd rack of the oven and bake for 55 to 60 minutes until golden brown on top.

Decorate with a dollop of whipped cream or vanilla ice cream.

Basic recipe courtesy of 1000toprecipes.com/recipes/Kentucky-derby. Thank you 1000 top recipes for this wonderful recipe BUT I just had to make it a bit healthier!!

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“Oh, the sun shines bright…”

Posted By Carol L. Hunter PhD, PMHCNS, CNP, Tuesday, May 2, 2017
Updated: Tuesday, April 18, 2017

On the first Saturday in May, the “longest two minutes in sports” takes place at Churchill Downs. This May 6th will be the 143rd running of the Kentucky Derby. Truly, there is nothing quite like it in the racing world, as it has evolved into the premier race of the year. Whether you love the beauty and power of the magnificent horses in the field, the splendor and vibrancy of Southern charm, the signature feature of colorful hats and mint juleps or the prospect of choosing the winner, there is something for everyone. In addition, the Barnstable Brown Gala is a charity event that in the last 10 years has donated $13 million to the University of Kentucky's Barnstable Brown Diabetes and Obesity Center.

For a horse to get to the top 20 contenders, it’s a long and strenuous road. Most all have won a derby somewhere along the way or other prominent race. Some have been undefeated and never lost a race; others have done poorly, suddenly rising like a phoenix out of the pyre. As the race looms closer and closer, the leadership board is constantly changing and horses create their odds. Experts and racing pundits spout their words of wisdom based on formulas, angles, odds and statistics. Some of the experts really do seem to possess the algorithm for success and have a proven track record for calling the winners. Some are talented at identifying the pretenders, the ones who are destined to struggle to keep up. Regardless of all the strategic commotion, there is one basic truth and that is that the race is always unpredictable. The leaders in the field with the most points have the odds in their favor of course, but it’s the dark horse that keeps everyone on their toes. The horse who overcomes such great odds that it brings the house down in buckets of cash. One such nondescript bay pulled off this monumental upset in 2009 when Mine that Bird overcame odds of 50 to 1 to win the Kentucky Derby. Not only did he win the first race at Churchill Downs, but he nearly became a Triple Crown winner, coming in second place at Preakness Stakes and third at Belmont Stakes. The unusual circumstances of his life, from his early failures to the long journey in the trailer from New Mexico to Kentucky, to his incredible win after having been last in the field became worthy of a movie, 50 to1, released in 2014.


Are there lessons to be learned for humans in all of this risky but lucrative business? We humans struggle to control as much as we possibly can in our lives. To do otherwise and drift along in a sea of nonchalance and passivity is anxiety provoking. But sometimes it is the things we know we cannot control that offer the biggest attractions. The thrill of competition and victory, whether in sports, the stock market, in careers or relationships, propels us forward and gives us the perseverance, the stamina and the resolve to put forth our best, much like a field of racing horses.  In the starting gate, the competing horse is a culmination of thoughtful breeding, inherent talents, excellent training and above all, the spirit to win. The unpredictability of it all lays down a perfectly equal playing field. The same is true for us and we’ve all heard the stories of how some have overcome the most drastic odds for achievement or success or even survival.  So when that monster anxiety grabs you and you start to fret over your lack of control, take a deep breath and learn to relish the unpredictable moments, developments and outcomes in life. They might just bring a smile to your face. 

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Alzheimer's Association Creates Care-Plan Toolkit for Clinicians

Posted By Administration, Wednesday, April 26, 2017

After Medicare began covering care-planning visits for patients with cognitive impairment, the Alzheimer’s Association developed a toolkit to help clinicians provide better care.

In January, Medicare began covering care-planning sessions for patients with cognitive impairment, including Alzheimer’s disease and other dementias. In response, the Alzheimer’s Association has created the Cognitive Impairment Care Planning Toolkit to help physicians, nurse practitioners, and physician assistants provide the best care under the new Medicare code.

A change to the G0505 Medicare code means healthcare providers can get reimbursed for a clinical visit to develop a comprehensive care plan for a patient. It also helps providers identify community support services that are appropriate for the patient.

The Alzheimer’s Association, along with its sister organization, the Alzheimer’s Impact Movement, had pushed for this change. They had advocated for the Centers for Medicare & Medicaid Services to cover cognitive and functional assessments and care planning for patients with cognitive impairments.

“Diagnosing patients and linking them to services is a challenge,” said Beth Kallmyer, the association’s vice president of constituent services. This toolkit is “an opportunity to make a big difference in how people are diagnosed and how they’re linked to services.”

Most people with dementia are treated by primary care physicians, even if they are diagnosed by specialists, Kallmyer noted. The association had heard from doctors that putting together a care plan is time-consuming and difficult, so it assembled a group of specialists to decide what the association could offer to help clinicians conduct the care-planning session and implement the new Medicare code.

The toolkit helps clinicians understand what the code covers and provides resources to use in these sessions. It includes best practices and materials such as an overview of the code, validated tools to assist with diagnosis (including the Dementia Severity Rating Scale), a safety assessment guide, a caregiver profile checklist, and an end-of-life checklist.

Part of the association’s mission is to provide and enhance care and support for everyone affected by Alzheimer’s. Care planning helps improve outcomes and maintain quality of life. “It’s huge for people living with the disease,” Kallmyer said, explaining that some patients get diagnosed with dementia but then don’t receive much follow-up care or any comprehensive care planning.

Having a plan in place helps people living with the disease as well as their caregivers. A comprehensive plan can empower patients by giving them a better understanding of their future and allowing them to plan better for it, Kallmyer said. “They can say to their family, ‘This is how I want things to go.’”

“Alzheimer’s is one of the costliest diseases out there,” she said. A care plan helps families plan for when the patient might need to turn to residential care, for example. “Having a plan in place makes a big difference for families every single day with this disease.”

Now, the association is working on raising awareness and getting the word out to all the association’s 80 chapters about the toolkit and the resources it offers. “They are our boots on the ground,” Kallmyer said.

Tags:  alzheimer's  Toolkit 

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Dr. Warren M. Levin- Mentor, Innovator, and Friend of ACAM

Posted By Administration, Wednesday, April 19, 2017

Dear Friends, Colleagues, Former Patients:

As many of you know, Warren (Dr. Warren M. Levin, MD) aka Saba for Grandpa, Dad, Brother, and so much more to so many, relocated to Atlanta, GA in August 2015.  For him it has been a wonderful retirement filled with reading endlessly, doing level 5+ Sudoku, crossword puzzles and jig saw puzzles. It has also been a time for him to sleep as much as he wants and only waking up when he wants. He tells everyone that he is in retirement, and he is not to be disturbed until he is ready. He eats what he wants and when he wants and totally enjoying it. After 50+ years of serving others, he is now being served.

With his legacy website (www.warrenmlevinmd.org) continues to hear from former patients as well as new patients wanting to just have a few minutes of his time to consult with them. He has received and continues to receive letters from patients from as long ago as perhaps 40 years ago. Remarkable, wouldn’t you agree? 

It is not often that a Physician touches so many people and supports them in helping them to recover and achieve optimal wellness. What a gift. 

In my recent travels, I have had the privilege of seeing Dr. Levin’s colleagues that we have not connected with for years. Hearing their stories of how Warren Levin touched them, mentored them, inspired them and helped transform their lives and the lives of their patients. Most recently I was so touched by the kind words from Jeffrey Bland, PhD.,  Dr. Boyd Haley, PhD., and Dr. Michael Gerber all describing how Dr. Levin influenced their lives. I have been moved to tears and feel an overwhelming sense of gratitude.  They come at a very special time.

Dr. Warren Levin was closely acquainted with Dr. Linus Pauling, Dr. Jonas Salk, MD PhD. and Dr. Hans Selye, the Father of Stress. He was also privileged to meet 5 other Nobel Prize winners. Other luminaries closely related in Dr. Levin’s life are Dr. Abram Hoffer, Dr. William Rea, Dr. Theron Randolph, Dr. Virginia Livingston Jackson, MD, Dr. Bruce Halstead, Dr. Elmer Cranton, MD Dr. Richard Casdorf, MD, and Dr. James Carter, MD. PhD. Dr. James Frackelton, MD Dr. Michael Schachter, MD, Dr.  Murray Susser, MD, Dr. Ross Gordon and Dr. Garry Gordon, Dr. Bob Atkins, Dr. David Steenblock, MD. Dr. Johnathan Wright, Dr. Alan Gaby, MD, Dr. Julian Whitaker, MD, Dr. Richard Horowitz, MD, Dr. Daniel Amen, MD, Dr. Martin Waugh, DO, and Dr. Carlton Fredricks, PhD, Dr. Sidney Baker, MD, Dr. John Trowbridge,MD, Dr. David Perlmutter, MD and  Dr. Terry Chappell, MD  just to name a few.  

 Along with this exciting and stimulating time, it was certainly intermingled with times of great stress, angst and struggle. However, there have been angels in our life that helped support the complementary medicine movement and believed in Dr. Warren Levin, his alternative medical mission and his integrity.  

Today, Dr. Levin is facing the next steps in life’s transition. He has now entered into kidney failure. Having only one kidney, dialysis not being an option for him in terms of his quality of life, we have now been given the gift of whatever precious time there is available to us. Because of all the incredible sharing of thoughts and memories most recently, I am reaching out to each and every one of you to put your pen to paper and share your memories and experiences -- the special gifts he has given to all of you freely, with love and integrity. 

I have been privileged to be beside him. He has been a mentor and I have soaked in as much as possible. For me now, I have chosen that my work is to carry on his work and make a difference in people’s lives. Please be so kind as to share how Dr. Levin has impacted your life and work.

I ask that you forward your letters to Dr. Sue Vogan, Peerobmagazine@aol.com, who has offered to help organize this tribute to Dr. Warren Levin. We will put a book together that he will be given so that he will be comforted in these final days. The book will also serve as a treasure for his friends and family so that may be consoled and encouraged for years to come by the sentiments. 

Susan Levin

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Lead Poisoning Afflicts Neighborhoods Across California

Posted By Reuters: Joshua Schneyer and M.B. Pell | NEW YORK, Friday, March 31, 2017


Dozens of California communities have experienced recent rates of childhood lead poisoning that surpass those of Flint, Michigan, with one Fresno locale showing rates nearly three times higher, blood testing data obtained by Reuters shows.

The data shows how lead poisoning affects even a state known for its environmental advocacy, with high rates of childhood exposure found in a swath of the Bay Area and downtown Los Angeles. And the figures show that, despite national strides in eliminating lead-based products, hazards remain in areas far from the Rust Belt or East Coast regions filled with old housing and legacy industry.

In one central Fresno zip code, 13.6 percent of blood tests on children under six years old came back high for lead. That compares to 5 percent across the city of Flint during its recent water contamination crisis. In all, Reuters found at least 29 Golden State neighborhoods where children had elevated lead tests at rates at least as high as in Flint.

“It’s a widespread problem and we have to get a better idea of where the sources of exposure are,” said California Assembly member Bill Quirk, who chairs the state legislature’s Committee on Environmental Safety and Toxic Materials.

(To see the Reuters interactive map of U.S. lead hotspots, click here reut.rs/2h55POf)

Last week, prompted in part by a December Reuters investigation pinpointing thousands of lead hotspots across the country, Quirk introduced a bill that would require blood lead screening for all California children. Now, just a fraction of the state’s children are tested.

 

READ COMPLETE ARTICLE

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European Parliament votes to ban amalgam for children

Posted By Charles G. Brown, President - World Alliance for Mercury-Free Dentistry, Tuesday, March 28, 2017

By an overwhelming 663 to 8, the European Parliament voted last week for a comprehensive package to reduce mercury use, as required by the Minamata Convention on Mercury. Under this new European Union regulation:

  • Amalgam use in children under age 15 will be banned on 1 July 2018.
  • Amalgam use in pregnant women will be banned on 1 July 2018.
  • Amalgam use in breastfeeding mothers will be banned on 1 July 2018.
  • Each country in the European Union will be required to develop a national plan by 1 July 2019, laying out how it will reduce its amalgam use.
  • The European Commission must decide by mid-2020 whether to move forward with plans to phase out dental amalgam completely in the European Union.

This progress is the result of our team’s seven years of toil: building a united European coalition...meeting after meeting with government officials...submitting comments to one scientific committee after another...presenting testimony at a half dozen public hearings...organizing the grassroots... finding the right experts...and collecting signatures for petitions.

When we started, the European Union was the largest user of amalgam in the world – but that will change dramatically when this new regulation goes into effect in 2018. As the European Parliament explains in its press release, this new regulation “aims to phase out the use of mercury in dental amalgam by 2030.”

But we’re aiming to finish off this primitive, polluting mercury product even sooner – including in the United States. (After all, if we can win in the complicated European Union system, we can win anywhere!)

Today, Consumers for Dental Choice filed a petition that calls on the U.S. Food and Drug Administration (FDA) to act. It points out that while the European Parliament is taking steps to protect European children from amalgam, FDA’s 2009 amalgam rule fails to protect American children. To solve this problem, our petition urges FDA to follow the European Union’s example: ban amalgam use in children under age 15, pregnant women, and breastfeeding mothers....and then take the lead in championing a mercury-free future!

Now FDA needs to hear from you too! Please sign this online petition* telling FDA to catch up with the European Union. Then share it with your friends, colleagues, patients, and family.

Banning amalgam use in children and pregnant women was the step that led to the ultimate phase out of all amalgam use in Sweden. Now that the European Parliament has taken that first step, there’s no going back in Europe….and if we pull together, we can take this most crucial step in the United States too!

 

Charles G. Brown
National Counsel, Consumers for Dental Choice
President, World Alliance for Mercury-Free Dentistry
316 F St. NE, Suite 210 Washington, DC 20002 USA
Phone: 202-544-6333   Fax: 202-544-6331
www.ToxicTeeth.org 

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Urban Air Pollution is a Causative Factor in the Development of Insulin Resistance, T2DM, and Obesity

Posted By Walter Crinnion, ND, Monday, March 27, 2017
Lifestyle approaches for the prevention and treatment of insulin resistance, metabolic syndrome and T2DM are typically focused on diet and exercise. The goal being to reduce the number of calories going in and increase the number of calories being burned. Yet, a number of environmental pollutants have been clearly linked to increased risk for T2DM including persistent organic pollutants and arsenic.

Over the last decade articles have begun to associate vehicular exhaust – ambient air pollution commonly elevated in all urban areas across the globe. In the last seven years several studies have demonstrated that adults and youth who are exposed to higher levels of nitric oxides, NO2 and PM2.5 had higher rates of T2DM. Three studies have demonstrated that children and adults with increased exposure to vehicular exhaust had higher calculated insulin resistance (using the homeostatic model assessment of insulin-resistance – HOMA IR). Since HOMA-IR results are not always confirmed with glucose tolerance testing, this longitudinal study was done. A new study provides more proof that urban air pollution plays a role in the development of T2DM and weight gain.

This study followed 314 obese or overweight Latino youth, between 8 and 15 years of age, in the Los Angeles area who participated in the Childhood Obesity Research Center Air Study. These children were recruited between 2001 and 2012 and were followed for an average of 3.4 years. None of those included in the study were diabetic (assessed by an oral glucose tolerance test) or were on any medication that would affect insulin or glucose tolerance.

Levels of ambient vehicular exhaust air pollutants, including nitric oxide, nitrogen dioxide and particulate matter less than 2.5 microns (PM2.5), were estimated by utilizing data collected from monitoring stations in the Los Angeles area. Monthly average exposure levels were calculated from daily values and based on the distance from the measuring stations (using a distance-squared weighting algorithm).

Insulin sensitivity was assessed with a 13-sample insulin-modified frequently sampled intravenous glucose tolerance test. Data from this test provided a rating for whole body insulin sensitivity (Si), acute insulin response to glucose (AIRg), and a assessment of beta-cell function (disposition index [DI]). BMI was also measured throughout the study.

When the exposure data and the BMI status, insulin and glucose response were correlated clear associations were found. Both PM2.5 and NO2 were independently associated with statistically significant reduction in insulin sensitivity. NO2 was associated with a statistically significant decline in beta-cell function. Both PM2.5 and NO2 were associated with a statistically significant increase in BMI.

This new study demonstrates the causal link between urban air pollution, insulin resistance, beta-cell function and adiposity. Clinicians need to start paying attention to the myriad adverse health effects from simply breathing air in any metropolitan area. Air purification units for the home that force air through a series of filters to remove particles down to 1 micron should be on the list of “must haves” for all patients, right next to water filters, organic varieties of “the dirty dozen” (most toxic) fruits and vegetables, and exercise.

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Tags:  causative factor  insulin resistance  obesity  T2DM  Urban Air Pollution  Walter Crinnion 

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Teta’s Hungarian Goulash

Posted By Administration, Friday, March 24, 2017

Many years ago I knew a lovely Czech woman we called Teta who had been exceedingly kind to me and my children. She was an excellent cook and I especially loved her Hungarian goulash. Back in the 70s, we weren’t so cognizant of our cholesterol intake and with the addition of the sour cream, the calories and cholesterol could mount up. I hadn’t made this dish in years but wondered if I could change a few things to make it a bit healthier. I think it turned out well and I substituted low fat plain Greek yogurt for the sour cream. I did not add the potatoes because I wanted to use noodles as an accompaniment. Teta used to serve the dish with spaetzli and cucumbers with dill in yes, more sour cream! So don’t give up on your favorite recipes from the “old country,” just change a few things to make it more healthful. Bon appetite!

Ingredients

½ to 3/4 pound lean, grass fed beef, cut up into small bite size pieces

4 large carrots

4 celery stalks

1 small container of organic mushrooms

1 large purple onion

½ bulb fennel root (optional)

4 cloves chopped garlic

Sprinkle caraway seeds

Sprinkle dill

1 to 2 TBSPs paprika

One 28 oz can of Muir Glen organic diced tomatoes

2 cups vegetable or beef broth

4 large potatoes, peeled and diced, optional

Directions

Heat up a heavy cast iron pan with several tablespoons of grapeseed oil on medium to high heat and saute the carrots, celery, mushrooms, onions, fennel and garlic for 10 minutes or until browned and softened.

Push them to the side and add the beef, sautéing until browned, about another five minutes.

Add the broth, dill, caraway seed and paprika and stir well.

Add the tomatoes and stir again.

Turn down the heat to low and simmer on top of the stove for an hour or until the meat is tender. You can also bake it in the oven if you prefer at 350 degrees until the meat is tender.

If you are adding potatoes, add them in after about a half hour of cooking time so they don’t fall apart.

You can cook this dish on low heat and keep it simmering until everything else is ready.  I served the goulash over” No Yolks,” cholesterol free egg white pasta, Kluski European style.

The cucumber, peeled and sliced, is chilled in no/low fat yogurt in the refrigerator. Teta traditionally sweetened hers with a dash of sugar but stevia or maple syrup would do even better. Add in a couple teaspoons of dill and mix well. Serve the goulash with a large tablespoon of yogurt on top over the noodles.

Enjoy!

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To Replace or Regenerate, that is the question!

Posted By Carol L. Hunter PhD, PMHCNS, CNP,, Friday, March 24, 2017

Last fall after having enough pain in my left hip to take my breath away when making normal movements, I saw an orthopedic physician who informed me that the x-rays showed bone on bone. That made me a great candidate for hip replacement surgery. The young physician was quick to tell me that “cartilage does not regenerate.” The hip, unlike the knee, is not easily accessible and is buried deep within the pelvis, classifying it as major surgery. I’ve known many people who proclaim they have breezed through this surgery and never looked back. There are also the horror stories. At any rate, I decided to do more research on options and was surprised to find many resources that challenged the doc’s thinking and insisted that yes, joint cartilage can regenerate. After mentioning my dilemma to a friend, she told me about two sisters who went to a physician in California to have stem cell transplants in their knees. I doubted if this relatively new procedure extended to the hip, but in fact, it did, and there were several testimonials in this regard on the doctor’s website. I talked to one of the sisters who was gracious enough to walk me through the whole process from beginning to end. She is in the early stages of recovery so the end result is not quite in yet, but it looks promising for her. Stem cells are extracted from the posterior side of the pelvic bone and also from abdominal fat cells beneath the umbilicus. After being processed they are injected back into the joint space along with dextrose, an irritant that serves to catalyze the inflammatory response. It is this response from the body that brings in nutrients to the young cells and allows them to differentiate into cartilaginous cells. The procedure is done under conscious sedation and can be completed in a morning’s time. There are two more injections needed of plasma rich platelets approximately six weeks apart that are reported to promote collagen synthesis, cell proliferation and cartilage repair. My informant called it “Miracle Gro!” There is a second center located in Florida and between the two clinics, costs range from $6500 to $8000 per joint or $8000 to $13,000 for two joints. To the best of my knowledge this procedure is not covered under commercial or federal health plans because it is still considered to be under investigation and experimental. Jennifer Elisseeff, Ph.D., an associate professor of biomedical engineering and her team of researchers, affiliated with the Whitaker Biomedical Engineering Institute at Johns Hopkins, have used a liquid transporter for the stem cells that when subjected to a ultraviolet light, becomes a gel like substance that provides a matrix known as a hydrogel, for the immature cells to attach to and grow. The advantage of using adult stem cells is that patients can use their own stem cells decreasing the risk of infection and tissue rejection. It also eliminates the controversy over use of embryonic stem cells. Unfortunately, this technique is not yet available in humans but research produced impressive results using adult goat stem cells that indeed developed into cartilage. All in all, it looks very promising for cartilage regeneration (Sneiderman, Phil; John Hopkins Medicine, no date.)

Short of surgery, is there any other approach that can help the condition of osteoarthritis? Here is my anecdotal evidence to date. I decided to start using systemic enzymes, which are similar to a cleanup crew in the body. Taken upon an empty stomach, the little enzymes find their way to areas that are “troubled” and go to work to remove debris. The catch is remembering to take them so my solution was to take them in the middle of the night when I invariably wake up. This has worked well and I have not missed more than a few nights since starting last November. In addition, I started a pair of supplements manufactured by Zycal Bioceuticals Healthcare Co. The first is Ostinol Advanced, 5X. which contains a complex of collagen and bone morphogenetic proteins and boswelia. The second is Chondrinol, containing glucosamine, chondroitin and the same complex as in the Ostinol. These are expensive supplements but far less than the costs of surgery and if they can help, it is worth the cost. More recently I have also started quercetin, PPQ and UC-II, a patented form of bio collagen, all of which have shown efficacy in promoting joint comfort and mobility. In Life Extension Magazine of September, 2014, Michael Enders references several studies by Kanzaki et al (2012) and Matsuno et al (2009) stating that “quercetin has demonstrated superior anti-inflammatory properties. When a group of flavonoids was studied, quercetin showed the strongest specific inhibitory effects on the pro-inflammatory enzymes. Added to a standard glucosamine/chondroitin supplement, 45mg/day for 12 to 16 weeks showed significantly improved joint pain and function scores compared with placebo.”  Both pyrroloquinoline quinone (PPQ) and UC-II are also potent anti-inflammatory compounds. UC-II is the cartilage from chicken breast and its collagen has a unique way of teaching killer T-cells in the gut to ignore exposed joint cartilage, thus reducing damage and destruction (Preston, W., 2/2012, Life Extension Magazine.)

For pain, I use boswelia, an additional dose from the one mentioned above and CBD, an extract of cannabidiol, from the hemp plant that does not have any psychoactive effect and is legal in all 50 states. From the natural remedies as cited above, I can say my condition has significantly improved. I no longer have the sudden, sharp pains that took away my breath. I have no pain or achiness at night when it is most noticeable. As if that was not enough, I was able to get back on my incline trainer and spinner and start back on my exercise regimen. I still have stiffness and decreased range of motion and occasional aches but it is nothing like it was and I am greatly encouraged. Perhaps that young doctor was wrong after all. I would prefer to believe that our wondrous human bodies have the capacity for regeneration if given the tools that are required.

For more information, the websites on stem cell transplants are: drfields.com and smartchoicestemcell.com. (These are only two examples and are not intended to be a complete listing.)

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Can CAM Docs Legally Prescribe and Sell Herbals and Nutritional Supplements as Therapy Without Bad Things Happening? Prescribe, Yes. Sell? We'll See

Posted By Richard Jaffe, Esq., Thursday, March 23, 2017
Many CAM and integrative doctors recommend and/or sell all kinds of nutritional and herbal products to their patients. There is a supplement manufacturer sub-industry which only sells to physicians and other health care professionals, for resale to patients. And most of the top tier, high profile docs have their own private label supplement brands. That’s a fact. But is it legal and ethical to do so?

Legal is a matter of state law. But for better, (but mostly) for worse, ethical is largely determined by those noble, public-spirited and never ethically-challenged folks at the AMA (American Medical Association for those living under a rock). They’re not completely controlled by Pharma; just ask them and they will tell you. And they’re not trying to stop cheaper non-patentable interventions like nutritional supplements and herbs, all at Pharma’s behest. Their thought leaders do not receive tens, hundreds of thousands, or millions of dollars from Pharma for research, public relations and advocacy. Just ask them and they will tell you.

And their “ethical guidelines” reflect an open-minded attitude serving the best interests of the patients. Ok, you get the point.

So is it AMA “ethical” for physicians to sell nutritional and herbal products? Technically yes, but practically, not so much:

Here’s the latest iteration of the AMA “ethical” rule on the sale of health related products. (Sorry, it’s longish)

9.6.4 Sale of Health-Related Products The sale of health-related products by physicians can offer convenience for patients, but can also pose ethical challenges. “Health-related products” are any products other than prescription items that, according to the manufacturer or distributor, benefit health. “Selling” refers to dispensing items from the physician’s office or website in exchange for money or endorsing a product that the patient may order or purchase elsewhere that results in remuneration for the physician. Physician sale of health-related products raises ethical concerns about financial conflict of interest, risks placing undue pressure on the patient, threatens to erode patient trust, undermine the primary obligation of physicians to serve the interests of their patients before their own, and demean the profession of medicine. Physicians who choose to sell health-related products from their offices or through their office website or other online venues have ethical obligations to:
(a) Offer only products whose claims of benefit are based on peer-reviewed literature or other sources of scientific review of efficacy that are unbiased, sound, systematic, and reliable. Physicians should not offer products whose claims to benefit lack scientific validity.
(b) Address conflict of interest and possible exploitation of patients by: (i) fully disclosing the nature of their financial interest in the sale of the product(s), either in person or through written notification, and informing patients of the availability of the product or other equivalent products elsewhere; (ii) limiting sales to products that serve immediate and pressing needs of their patients (e.g., to avoid requiring a patient on crutches to travel to a local pharmacy to purchase the product). Distributing products free of charge or at cost makes products readily available and helps to eliminate the elements of personal gain and financial conflict of interest that may interfere, or appear to interfere with the physician’s independent medical judgment.
(c) Provide information about the risks, benefits, and limits of scientific knowledge regarding the products in language that is understandable to patients.
(d) Avoid exclusive distributorship arrangements that make the products available only through physician offices. Physicians should encourage manufacturers to make products widely accessible to patients.

So what does this gobbledygook mean? Well, it means that you CAM docs have a problem.

First, virtually no supplements or herbal remedies have the kind of scientific support set out in subparagraph (a). There are only a few supplements for which the FDA have approved health claims, like folic acid for pregnant mothers, and such. I also suspect that the peer-reviewed literature the rule refers to means mainstream journals to the AMA. My guess is that this AMA subsection could be used to render “unethical” the recommendation of the products routinely recommended and sold by physicians.

But there are bigger problems.

Subsection (b) seems to suggest you have to either give away the products, or sell them at cost in order to avoid the conflict of interest or appearance of the conflict. Moreover, you’re only supposed to give away or sell at cost enough product to meet the patient’s immediate needs, or until they can get the product from a less conflict-ridden source.

This is idiotic. By the logic of this provision, if you go to a surgeon for a surgical consult, it would be unethical for the surgeon to actually perform the surgery rather than just recommend it, because he has a financial interest in performing the operation.

But not to worry, under the rule, the surgeon can lessen the conflict by either 1. Operating for free, or 2. Charging his actual cost, rather than the high fees the surgeon normally charges. To further lessen the conflict, he should only do a temporary surgery, just fix the problem enough to allow the patient to go to another surgeon who has no financial conflict of interest arising from the first surgeon’s surgery recommendation. The same would apply to an interventional cardiologist recommending a stent, angiogram/angioplasty or to any other physician who both makes recommendations and provides a procedure or therapy to effectuate or implement the recommendation.

To generalize, there is the same conflict of interest for any professional who both consults and does something. By the logic of the AMA rule, a lawyer cannot both recommend suing and actually suing (unless he sues for free or at cost). Nor could a lawyer prepare a trust, or do anything the lawyer recommends, because implementing the recommendation means that the lawyer makes extra money for the doing, which under the logic of the AMA rule irreparably taints the lawyer’s judgement (unless the service is done for free or at cost, and is only a temporary fix until a conflict-free professional is retained).

The AMA world view embodied in this rule reminds me of the commercial for a personal identity protection company. You know these commercials: There’s a patient with his mouth open in a dentist’s chair, and a guy with a white coat looking in the patient’s mouth who says “you have one of the worst cavities I’ve ever seen.” The patient says. “OK doc, fix it.” And the guy in the white coat says “Oh, I’m not a dentist; I don’t fix teeth, I’m just a dental monitor.”

In the AMA la-la ethical world, the guy tells the patient “Yes I am a dentist and I’d like to fix your tooth, but I have a conflict because I’m going to make extra money doing what I said should be done. So, we’re done here and you have to see another dentist who will actually fix your cavity”

Is this really how we want physicians who have a service or product to act? Have them become health care monitors, and have another class who are health care problem fixers?

Let’s not leave AMA ethical la la land yet: At the new dentist’s office, the dentist looks over the films, examines the patient, and concurs with the recommendation, thereby creating a chargeable evaluation and management fee. Doesn’t the new dentist also have a conflict? He’s got his examination fee, and he’ll get extra money for fixing the cavity. This can get ridiculous!

Let’s face it, we rely on professional to give their opinions and implement a solution within the professional’s expertise. This happens zillions of times a day, all over the world. To single out physicians who use and sell the kind of products used by millions of people is just nuts.

This rule obviously hasn’t been used to stop surgeons, cardiologists or dentists from doing the thing they were trained to do. But what about a CAM physician who uses herbals or nutraceuticals as primary therapy? Can they do that, or are they caught in the same AMA ethical net?

But before we get to that, here is another question:

Does this AMA ethical rule matter?

Short answer: yes

Alittle longer answer: it matters because some state medical board laws have specifically incorporated the AMA ethical rules into their standards of professional conduct, such that a violation of an AMA ethical rule is a violation of the state’s medical board law. Even in the absence of express incorporation, states can and do go after physicians for ethical violations of all sorts (just ask docs like Burzynski about that).

Why is any of this relevant or important to CAM docs?

There’s a new case against a doc (it’s my case, and not in California or Texas where I maintain offices, but I don’t want to give the details just yet) which raises the very issue of whether it is unethical and a state board law violation to use and sell herbal and nutritional interventions as primary therapy. What makes the case more interesting is that the therapy is only available from physicians, and only physicians who have gone through the company’s training about how to use the products. (Many of you CAM docs probably know the product line I’m referring to.)
How can the AMA possibly view this kind of thing as the “sale of health a related product?” Well maybe it doesn’t, but initially at least, the state medical board seems to think it is the sale of a “health related product” and is going after the doctor for do so.

Here’s where it gets interesting with the AMA ethical rules: The second opinion after the sale of health related products is the following ethical precept:

9.6.6 Prescribing & Dispensing Drugs & Devices In keeping with physicians’ ethical responsibility to hold the patient’s interests as paramount, in their role as prescribers and dispensers of drugs and devices, physicians should:
(a) Prescribe drugs, devices, and other treatments based solely on medical considerations, patient need, and reasonable expectations of effectiveness for the particular patient.
(b) Dispense drugs in their office practices only if such dispensing primarily benefits the patient. (c) Avoid direct or indirect influence of financial interests on prescribing decisions by: (i) declining any kind of payment or compensation from a drug company or device manufacturer for prescribing its products, including offers of indemnification; (ii) respecting the patient’s freedom to choose where to fill prescriptions. In general, physicians should not refer patients to a pharmacy the physician owns or operates. AMA Principles of Medical Ethics: II,III,IV,V.

Does this section apply to a doctor prescribing and selling a product used as primary therapy if the product is only available from the health care provider and only from one who is trained by the manufacturer? It seems to.

Although the heading only refers to “drugs” and “devices”, the actual rule specifically mentions “drugs, devices, and other treatments.”

A prescription is just a written order issued by a healthcare provider containing the provider’s recommendation for a product, such as a drug, device, or other treatment, or in some cases a recommendation of behavior (like bedrest). So a written order by a physician to take an herb or nutritional supplement in order to cure or mitigate a disease is a prescription and such products are prescribed. (And in case you are concerned, the fact that a physician prescribes an herb or supplement for the treatment of a disease doesn’t turn the product into a drug, because it’s the manufacturer’s intent that governs not the prescribing practices of healthcare providers, under FDA law.)

Admittedly, the language in (b) mentions a pharmacy, but not all prescribed things are found in pharmacies. Take the aforementioned bedrest for example. And we’re stipulating that the prescribed products can only be obtained through the doctor, and is not available directly to the consumer.

So does this AMA rule 9.6.6 sanction a physician prescribing an herbal remedy or supplement for the treatment or mitigation of the disease or medical condition?

I looked at the literature and haven’t seen any cases on this yet. I think it does, and the case I’m working on will provide what may be the first legal ruling on the issue.

As a backup, it seems to me that even if both AMA ethical rules could apply, I don’t see how a medical board can sanction a physician for a violation of an ethical rule where the physician’s actions are ethical under another ethical rule, or arguably so. It seems to me that a board must first make this determination, publish it and put the licensees on notice, which my research indicates has not yet been done in this state at least.

So although I think I am right, as of right now, there doesn’t appear to be a definitive answer to the question as to whether a CAM physician can prescribe and sell an herbal remedy or nutritional supplement or supplement regime as primary therapy for the treatment or mitigation of a disease, at least in a state which has specifically incorporated the AMA ethical rules.

But give me six months or so and I’ll give you the answer; hopefully the one you’re looking for.

In the meantime, and to make that happen, any academics out there with some ethics background care to opine and help make it happen? I’ll be waiting to hear from you.

Rick Jaffe, Esq.
rickjaffeesquire@gmail.com

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The Next Big CAM Battle is Here and It's Ugly

Posted By Richard Jaffe, Esq., Wednesday, March 15, 2017
Updated: Thursday, March 23, 2017

CAM or integrative medicine doctors have had their problems with the state medical boards. And CAM organizations have had their run-ins with governmental agencies. However, the groups have always survived in large part because they have had a steady income from membership dues and from their annual conferences, where their members learn the latest and greatest from their thought leaders. But the CAM organizations’ income stream is now in jeopardy, and thus so is their existence, based on what looks to be well-planned, systematic effort to put CAM groups out of business, and stop the dissemination information about CAM therapies.

AND THAT MY FRIENDS IS A VERY BIG DEAL.

Here is what’s going on

For months, at least two CAM groups have been under review/ investigation by the primary private CME accrediting company, the ACCME (Accreditation Counsel for Continuing Medical Education). Recently, the ACCME has determined that a significant portion of the groups’ prior year’s CME courses does not meet various ACCME standards. ACCME is demanding that everyone involved in these courses be informed that:

“they were presented invalid information….”

and that the groups:

“instruct them [everyone] to avoid making any clinical decisions for testing and/or treatment based on what was presented, and
direct the registrants to accurate and valid sources of information for the problems or systems presented.”

I should point out that this “incorrect” information came from some of the most accomplished, respected and published thought leaders/teachers in the CAM community. These folks have been giving CME courses without incident for decades.

Further, in terms of future CME courses at their conferences, ACCME has informed these groups – and this is the key to understand what this is all about – that:

“recommendations involving clinical medicine must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients and all patient care recommendations must conform to evidence emanating from guidelines and data that meet generally accepted standards of experimental design, data collection, and analysis.”

In short, ACCME is trying to require these groups to only teach mainstream medicine! This is crazy and a huge deal!

Furthermore, the effect on the members of these organizations who attended the conferences last year and who used these courses to satisfy their state CME requirements is unclear.

I am not familiar with ACCME’s inner workings or guidelines, but it doesn’t seem out of the question that ACCME could contact state boards about these groups’ “noncompliance” and the retroactive withdrawal of CME credits. That could cause the state boards to retroactively hold the doctors non-CME compliant. I’m not saying that this will happen, but only that it’s a possibility. But I am saying that if the idea is to delegitimize CAM and cause problems for its practitioners, notifying the state boards would certainly advance that goal.

A specialty interest group also gets the same treatment

Beyond these two professional groups, a disease based group has recently been informed that its CME status for future conferences has been rescinded by its CME intermediary. The intermediary denies that it received any pressure or orders from ACCME.

Three CAM groups which have previously received ACCME course certification without any undue problems who in the last few months have had their prior CME course approval rescinded and/or their future CME approval withdrawn or placed in serious doubt.
Is this all a coincidence? Not a chance in hell.

My guess is that more of the same has or is going to happen to other CAM groups.

What to do?

At this stage, these groups need information about what’s behind this campaign to deny CME credit and delegitimize CAM teachings.

We need to get the word out to the CAM community.

Why?
Someone out there has to know something or know someone who knows something about how this came about, and who or what group is behind it. (My guess is that ACCME is the vehicle not the originator.)

I think there is a smoking gun out there, and if we find it, we can probably reverse ACCME’s decision quickly, so my suggestion is that all the CAM groups and interested parties get the word out to search for the smoking gun.

But let’s dig in to this and see if there is anything else that can be done. A logical place to start is:

What exactly is the ACCME and what does it do?

I don’t have any special info on ACCME, but here is what it says about itself:

“CME ACCREDITATION OF, BY, AND FOR THE PROFESSION OF MEDICINE.
The ACCME was founded in 1981 in order to create a national accreditation system. It is the successor to the Liaison Committee on Continuing Medical Education and the American Medical Association’s Committee on Accreditation of Continuing Medical Education. The ACCME’s purpose is to oversee a voluntary, self-regulatory process for the accreditation of institutions that provide continuing medical education (CME) and develop rigorous standards to ensure that CME activities across the country are independent, free from commercial bias, based on valid content, and effective in meeting physicians’ learning and practice needs. The ACCME accreditation process is of, by, and for the profession of medicine.
The ACCME’s founding and current member organizations are the American Board of Medical Specialties, the American Hospital Association, the American Medical Association, the Association of American Medical Colleges, the Association for Hospital Medical Education, the Council of Medical Specialty Societies, and the Federation of State Medical Boards of the United States.
Throughout its history, the ACCME has been dedicated to maintaining a relevant and responsive accreditation system that supports CME as a strategic asset to US health care quality and safety initiatives.”

Very noble and reassuring, isn’t it?

Basically, it’s a bunch of health care trade associations, organizations in charge of medical education and specialization credentialing. (Ironically, the medical specialty societies are the reason it’s illegal for practitioners to advertise their CAM board certifications.) And last but not least is CAM’s long-time adversary, the Federation of State Medical Boards. So maybe not so reassuring.

Did you know that the ACCME is accountable to the Public? Yea, just ask them and they will tell you so.

Here is what it says about that:

“Accountability to the Public
The ACCME is accountable to the public for setting and maintaining accreditation requirements that are designed to ensure that CME accredited within the ACCME system is based on valid content, is free from commercial influence or bias, and contributes to the quality and safety of health care. As the US health care system continues to evolve, the ACCME will respond by making changes to its requirements or processes that are necessary to assure that CME serves the best interests of the public.

I’m still not clear exactly how it is accountable to the public, and nothing in its web site gives any further elucidation.

I do have a couple ideas of how it might actually be made accountable to the public.

Some basic facts

It’s obviously a matter of individual state law what type of courses a state medical board will accept as acceptable CME. The ACCME might be the primary CME credentialer, but it is not the only one. For example, here is the Texas law regarding CME accreditation: It’s Board Rule 166.2 and it requires:

(1) At least 24 credits every 24 months are to be from formal courses that are:
(A) designated for AMA/PRA Category 1 credit by a CME sponsor accredited by the Accreditation Council for Continuing Medical Education or a state medical society recognized by the Committee for Review and Recognition of the Accreditation Council for Continuing Medical Education;
(B) approved for prescribed credit by the American Academy of Family Physicians;
(C) designated for AOA Category 1-A credit required for osteopathic physicians by an accredited CME sponsor approved by the American Osteopathic Association;
(D) approved by the Texas Medical Association based on standards established by the AMA for its Physician’s Recognition Award; or
(E) approved by the board for medical ethics and/or professional responsibility courses only.”

Other states have similar types of CME rules. The bottom line is that ACCME is a very important source of state approved CME accreditation, especially for everyone other than the major national and state medical trade groups. But there’s another way of looking at it. Without a state accepting its accreditation, ACCME doesn’t have much of a purpose or job.

What About CAM laws?

Texas, California and some other states recognize the rights of patients to receive CAM therapies. Texas, for example, provides that:

“The purpose of this chapter [Texas Board Rule Chapter 200] is to recognize that physicians should be allowed a reasonable and responsible degree of latitude in the kinds of therapies they offer their patients. The Board also recognizes that patients have a right to seek complementary and alternative therapies.” (Board Rule 200.1)

What are CAM therapies in Texas?

“(1) Complementary and Alternative Medicine–Those health care methods of diagnosis, treatment, or interventions that are not acknowledged to be conventional but that may be offered by some licensed physicians in addition to, or as an alternative to, conventional medicine, and that provide a reasonable potential for therapeutic gain in a patient’s medical condition and that are not reasonably outweighed by the risk of such methods.”

Convention medicine is defined as “Those health care methods of diagnosis, treatment, or interventions that are offered by most licensed physicians as generally accepted methods of routine practice, based upon medical training, experience and review of the peer reviewed scientific literature.”
(California has a similar definition of CAM at B&C code 2234.1)

So, Texas gives practitioners the right to provide non-conventional, not generally accepted therapies to patients, and patients have the right to receive these CAM or non-conventional therapies.

But even though Texas docs can provide CAM or non-standard therapies to Texas patients, ACCME now takes the position that Texas physicians can’t obtain CME credit for learning about these Texas sanctioned treatments. How can the ACCME be acting consistent with Texas law by its insistence that CAM medical groups can only teach:

“recommendations involving clinical medicine must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients and all patient care recommendations must conform to evidence emanating from guidelines and data that meet generally accepted standards of experimental design, data collection, and analysis.”

My view is that ACCME’s position is inconsistent, if not in violation of the Texas CAM Rule (and the California CAM statute) and probably every other state that has a CAM law.

So, what to do?

Complain to ACCME? Won’t hurt, but it won’t help. It’s doing what it’s doing intentionally, and some external pressure has to be brought forth.

Complain to the boards? Maybe, but it would take a lot of complaints.

In all the big CAM states like Texas and California, I know there are legislators who are pro CAM. My suggestion would be to identify who they are (not hard in Texas). I think the boards in a few of these states need to hear from some legislators about how ACCME is undercutting board rules (in Texas) or the CAM statutes (like in California).

These legislators should copy ACCME on their concerns expressed to the boards. If one of them is on a legislative health committee, even better. Better still would be for a couple states to start an investigation on ACCME’s motives. Maybe even an invitation to appear at a specially called hearing. Legislators can hold hearings for all kinds of reasons. So can federal legislators. I think with all the politically connected CAM docs out there, mulitipled by their politically connected patients, well I think there’s a heap of trouble that could be stirred up for ACCME.

It doesn’t have to happen in every state, or even many states, just a couple of the big ones. The story is going to get out, and questions are going to be raised. The widespread dissemination of ACCME’s action might even turn-up that smoking gun I mentioned earlier. And once the nefarious motive and scope of the conspiracy publicly surfaces, I think ACCME will be forced to rescind its actions. So, we need to shine some light on these jokers.

This could all happen pretty quickly if there’s a big enough outreach to the CAM community.

Something to think about anyway.

Rick Jaffe, Esq.
rickjaffeesquire@gmail.com

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PODCAST: Chelation - A Potentially Life-Saving Therapy

Posted By Ronald Hoffman, MD & Dana Cohen, MD, Tuesday, February 21, 2017
PART I:
If you or a loved one is a diabetic over 50 who has suffered a heart attack, there's an opportunity to obtain a potentially lifesaving therapy AT NO CHARGE. 
Dr. Dana Cohen describes the TACT2 trial, a multi-million dollar government-sponsored study to evaluate the effectiveness of chelation therapy. What is chelation? What is its history? How did the first TACT study demonstrate its effectiveness? Why was it greeted with skepticism by the medical establishment? Why have only integrative doctors been eager to embrace chelation? CLICK HERE

PART II:
Dr. Hoffman continues his conversation with Dr. Dana Cohen about the TACT2 trial to evaluate the effectiveness of chelation therapy. CLICK HERE

Tags:  chelation  chelation therapy  detoxification  TACT  TACT2 

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Mung Dal Kitchari

Posted By Carol L. Hunter PhD, PMHCNS, CNP, Tuesday, February 21, 2017

Serving Size: 4 to 5
Ingredients:

  • 1 c yellow mung dal
  • 1 c basmati white or jasmine rice
  • 1 inch piece of fresh ginger, peeled and chopped fine
  • 2 Tbs shredded, unsweetened coconut
  • 1 small handful fresh cilantro leaves
  • ½ c water
  • 3 Tbs ghee
  • 1 and ½ inch of cinnamon bark
  • 5 cardamon pods
  • 5 cloves, whole
  • 10 black peppercorns, whole
  • 3 bay leaves
  • ¼ tsp turmeric
  • ¾ tsp sea salt
  • 6 c water
  • 1 slice of lime


Directions for kitchari

1.      Wash the mung dal and rice until water is clear. Soaking the dal for a few hours helps with digestibility.

2.      In a blender, put the ginger, coconut, cilantro and ½ cup water and blend until liquefied.

3.      Heat a large saucepan on medium heat and add the ghee, cinnamon, cloves, cardamom, peppercorns and bay leaves. Stir for a moment until fragrant.

4.      Add the blended items to the spices, then the turmeric and salt. Stir until lightly browned.

5.      Stir in the mung dal and rice and mix very well.

6.      Pour in the 6 cups of water, cover and bring to a boil. Let boil for 5 minutes, then turn down the heat to very low and cook lightly covered until the dal and the rice are soft, about 25 to 30 minutes. Decorate with a few sprigs of cilantro and a lime slice or two.


Nutritional information:  per 1 cup of mung dal

147 calories

14 grams protein

15.5 grams of fiber



Directions for making ghee:

1.      Melt 8 sticks of unsalted butter in a large heavy pot over low to medium heat for about 30 minutes. Use the very best quality butter you can find from grass fed, no antibiotic cows. The butter will separate into 3 layers: white foam on top (water content), clarified butter in the middle and mild solids on the bottom.

2.      Strain butter through a fine sieve or cheese cloth into a mason jar.

3.      If you still see white milk solids, you can strain it a second time. It should be a clear yellow color and is known in India as liquid gold.



Bon appetite! This will be the easiest cleanse you have tried!

Recipe compliments of Ayurvedic Cooking for Self-Healing by Usha Lad and Dr. Vasant Lad, The Ayurvedic Press, Albuquerque, NM, 2nd edition. 

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The Dreaded Detox Cleanse

Posted By Carol L. Hunter PhD, PMHCNS, CNP, Tuesday, February 21, 2017

As spring peeks around the corner at us, our thoughts go to the rejuvenation of mind and body that this time of year seems to inspire in us. Perhaps it’s the vision of how we will appear in a bathing suit, knowing that we could still shed a few pounds. Perhaps it’s that attempt to put a better dent in that rising cholesterol level. Perhaps it’s the first touch of the warmth of the sun upon our skin, leaving the chill of winter far behind. Whatever the source of our inspiration, it drives up our motivation and prepares us to take action.

Detox cleanses are becoming more and more common in our world and more groups are joining in: the athletes, the overweight, those with chronic illnesses and of course the walking well but worried! I, for one, freely admit, I have had a love/hate relationship with green juices. When I visit my daughters, I am invariably handed a very tall glass of green “juice.” It all began with smoothies, so firm and so smooth, that I barely could tip the contents out of the glass. Between the almond milk and the banana, it was too thick for my taste. Making them was fun to watch; however, and I was amazed at how you could throw large pieces of kale and other greens in the mixer and how smooth it came out. I only lasted a few months on those.  Next in line were the green juices that are made in a juicer that removes all the pulp. While the nutrients of fresh vegetables were beneficial, there was no fiber in this drink. I didn’t really like the taste either. Actually I did better with the “red” juices, the ones made with beets, apples, celery and lots of ginger. If I tried to have one of these for breakfast and was too rushed to eat anything else, I’d be starving in a matter of hours, not a good strategy in the middle of a workday.

Fortunately, for those of us who prefer to eat solid than liquid food, there is the mighty mono food diet.  Kitchari is used as an Ayurvedic detox food that also is believed to foster spiritual growth in its native India. Kitchari is the Sanskrit word for mixture and is used to describe any dish that is made with beans and rice. Originally it was used to feed the sick, the elderly and babies due to its high digestibility. The purpose of the diet is similar to the goal of juicing with some added benefits.  First of all, the food has substance, so it is high on satiety, which is the feeling of fullness and satisfaction we get after eating a meal. The higher the satiety the higher the leptin levels which stave off hunger for longer periods of time and prevent overeating.  This makes it a perfect weight loss food.  If you have any gastrointestinal issues, it is an excellent diet for healing and repair of inflammation. Mono diet means you eat the exact same food for a period of time, up to about a week. Mung dal or moong dahl is the mono food of choice due to its high level of digestibility. Mung beans are hulled, split and soaked until ready to prepare. In combination with a grain such as rice, quinoa or teff, the meal becomes a complete protein, low in fat and high in B vitamins and minerals. White rice is recommended because brown rice has its outer shell and is harder to digest. The downside is that the shelled mung beans and white rice have a low fiber content so a caveat is to supplement some form of fiber like psyllium while on this cleanse to prevent constipation. Its estimated glycemic load is only 59 on the scale of 0-100, which means it has the ability to keep your blood glucose level at a steady level longer, able to prevent frequent hunger spikes. If you will be eating it for days at a time, you can make it more interesting by changing the vegetables from one dish to the next. One day add carrots and kale, the next add zucchini and swiss chard, the next butternut squash and cilantro. Another variation is to cook the mung dal and the rice separately instead of together. The true beauty of this dish is that it does not precipitate the “starvation response” that is characteristic of so many diets in which the body feels deprived and goes into the emergency mode of decreased metabolism in order to hold onto its calories.  Conversely, kitchari allows the nervous system to relax, feeling it is being properly nourished and satisfied. The result is that fat is metabolized and toxins washed away leading to, in the minds of many, the perfect cleanse. In addition, it is cheap! One 32 ounce bag of both rice and mung dal can feed two people 3 meals a day for a whole week! Try it out and you will be glad you did.

A word about ghee or clarified butter: I have included the recipe for making ghee as it is the most important fat in Ayurvedic  dishes. Not only does it have a high smoking point similar to coconut which makes it useful for cooking but it does not need to be refrigerated. Kept in the dark in an airtight container, it can be kept two to three months or up to a year unopened in a refrigerator. There are accounts of 100 year old ghee! It has been used in Ayurveda for thousands of years and is found in the original Sanskrit texts. A sampling of benefits include: it is safe for the lactose and casein intolerant due to the removed milk solids and impurities; It is rich in vitamin A, E, K2 and CLA (from grass fed cows;) it is a source of medium chain fatty acids that are an excellent energy source and that allow the body to burn other fats; it is rich in butyric acid which increases killer T cells in the gut that foster the immune response and help to keep the intestinal mucosa healthy. In a 2010 study by Shamara et al in the journal, AYU, the researchers concluded that data in the literature does not support a harmful effect on lipids by the moderate consumption of ghee in the general population. 

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IV Chelation Therapy: Finding a Doctor Who Will Test for and Treat Heavy Metal Toxicity

Posted By University Health News, January 17, 2017, Monday, February 20, 2017

VIEW ORIGINAL PUBLICATION by UHN

Excessive toxic metal exposure from the air, food, water, dental amalgams, and other sources is becoming a recognized and established underlying cause of both acute and chronic disease. With ongoing medical research validating the link between chronic diseases like heart disease and environmental exposure to toxic metals, it is more important than ever for doctors and patients to be well-informed about the detrimental effects of toxic metals and the potential treatments for heavy metal toxicity, including IV chelation therapy.

What is chelation?

The Greek word “chele” means claw. Chelation is the binding of metals (like lead) or minerals (like calcium) to a protein “chelator” in a pincer-like fashion, forming a ring-like structure. Chelation is an important treatment protocol for the removal of toxic metals such as lead and mercury from the body’s bloodstream and tissues. Natural chelation, although weak, regularly occurs from eating certain foods such as onions and garlic. A stronger chelation effect can be induced when certain supplements, such as some amino acids, are taken orally. The strongest chelation effect is achieved with intravenous chelation. 

What is chelation used for?

Intravenous chelation therapy is used and accepted within conventional medicine as an FDA-approved treatment for the removal of toxic minerals such as lead from the body in cases of severe poisoning. However, it is also used in a  less conventional way: the repeated administration of intravenous chelating agents is used to reduce blood vessel inflammation caused by specific toxic metals and to reduce the body’s total load of those metals, especially lead. It has been shown that the risk of dying from cardiovascular events begins when a person’s blood level of lead is still well within the established normal reference range.[1]

IV chelation therapy often utilizes the chelating agent disodium ethylene diamine tetraacetic acid (EDTA) and is sometimes referred to as EDTA chelation. EDTA chelation is being used in the treatment of all forms of atherosclerotic cardiovascular disease, especially heart disease and peripheral artery disease. Although there is less published research in these areas, chelation therapy is also being used to treat macular degeneration; osteoporosis; mild to moderate Alzheimer’s disease associated with heavy metal toxicity; autoimmune diseases, especially scleroderma; and fibromyalgia or chronic fatigue syndrome with high levels of toxic metals detected with a challenge test.[4]

Does chelation really work?

The most recent study to examine the effects of EDTA chelation therapy showed compelling value for preventing cardiovascular events, especially in people with diabetes who had a history of heart attack. The controversial Trial to Assess Chelation Therapy, or TACT, found an amazing 40% reduction in total mortality, 40% reduction in recurrent heart attacks, and about a 50% reduction in overall mortality in patients with diabetes who had previously suffered from a heart attack.[2] TACT was a large, randomized, placebo-controlled study published in JAMA that randomized patients to a series of IV chelation using EDTA or placebo.[3]

What kinds of doctors offer IV chelation therapy?

Doctors must be well-trained in chelation therapy in order to utilize the correct tests and treatments. Testing for toxic metal exposure is not straightforward since blood tests typically identify only those with severe and acute toxicity but fail to identify those with toxic metals stored in the tissues due to chronic exposure. Applying the appropriate chelating agent to properly treat toxic metal accumulation is also not a straightforward endeavor. Different chelating agents bind with different affinity to different metals. Some chelating agents may be taken orally, while others are administered intravenously.

Chelation therapy is not taught in conventional medical school but rather through various professional medical organizations. The most recognized leader in educating and certifying healthcare professionals, including MDs and NDs, in chelation therapy is the American College for the Advancement of Medicine (ACAM). ACAM’s chelation therapy training teaches doctors how to diagnose and treat patients with heavy metal toxicity as well as how to use diet and nutrients to optimize toxic metal chelation strategies and protocols.

 

[1] ACAM website. Detoxification / IV Chelation. Downloaded Jan 7, 2014.

[2] Medscape Heartwire. 2013, Nov 19. ‘Extraordinary’ Chelation Effects…. Downloaded Jan 7, 2014.

[3] JAMA. 2013;309(12):1241-1250.

[4] Townsend Ltr. 2013 Aug/Sept. Report on the Proceedings of a Summit…. Downloaded Jan 7, 2014.

This article was originally published in 2014 and has been updated.

Tags:  chelation  chelation therapy  detoxification  toxins  university health news 

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To Sleep or Not to Sleep

Posted By Administration, Monday, February 20, 2017

Sleepless nights can be triggered by countless factors, but by controlling confronting the issue head on, practitioners are able to gain a better understanding of what causes them. By Nicholas Saraceno 

As the old saying goes, time flies when you’re having fun (or sleeping for that matter). Unfortunately for some, this is not always the case. According to the American Sleep Association (ASA), 50 to 70 million adults in the United States have some sort of sleep disorder. These disorders can range from dyssomnia’s to parasomnias.

Often times, this inability to rest results in sleepless nights. Although there are a plethora of causes linked to difficulty sleeping, integrative practitioners are able to pinpoint the most popular ones, while finding potential solutions.

Causes & Common Conditions

As previously mentioned, the causes that influence the lack of sleep are numerous, but doctors and experts alike have been able to narrow these down to ones backed by science, such as brain function, which could be the root of the problem.

“There are cycles of sleep: rapid eye movement (REM) and non-rapid eye movement (non-REM),” said Jeremy A. Holt, associate director of Ajinomoto North America’s health services section in New Jersey. “REM is typically 25 percent of the sleep period. Non-REM is divided into four stages. Stage One is the period between being awake and falling asleep. Stage Two is the onset of sleep and becoming disengaged from your surroundings. Stages Three and Four are the deepest and most restorative sleep, where muscles are relaxed, blood pressure drops and breathing becomes slower.

“A restless sleeper will wake up while transitioning between these stages. Once the body wakes, it doesn’t return to the state it awoke from – it must go back to stage one. Continually waking during the night and not reaching Stages Three and Four is what causes poor sleep quality.”

However, lack of sleep can also stem from gender-related issues that interfere with the REM process.

Gina Besteman, RPH, is the director of compounding and dispensing at the Women’s International Pharmacy in Wisconsin, a compounding pharmacy that provides high-quality bioidentical hormone therapies.

“One of the more common symptoms of peri-menopause and menopause that patients complain of is difficulty sleeping. There is a significant amount of research showing how hormones affect sleep,” she noted. “Progesterone affects GABA receptors which are responsible for non-REM sleep, the deepest of the sleep stages. Progesterone also affects breathing. Its’s been shown to be a respiratory stimulant and has been used to treat mild obstructive sleep apnea. Estrogen’s role in sleep appears to be more complicated than that of progesterone. Estrogen is involved in breaking down norepinephrine, serotonin and acetylcholine in the body. Estrogen has been shown to decrease the amount of time it takes to fall asleep, decrease the number of awakenings after sleep occurs and increase total sleep time. Low estrogen levels may lead to hot flashes which can also affect sleep.”

Perimenopause refers to the menopausal transition, normally occurring in a women’s 40’s, sometimes mid-30’s (mayoclinic.org). Dr. Besteman also cited that if there is a disruption in cortisol, the stress hormone produced by the adrenal glands and melatonin, the hormone responsible for sleep and wakefulness manufactured by the brain’s pineal gland, these could be contributors to the issue.

As a result, different sleep conditions affect different societal demographics.  According to Svetlana Kogan, MD, an integrative doctor in New York, NY and author of Diet Slave No More!, individuals affected by difficulty sleeping can be broken up into three categories.

“Young people have over stimulated nervous systems due to cell phones, video games, computers, TV and other electronic gadgets,” she said. “Older people (ages 35-60) are having difficulty sleeping due to all of the above, plus the stress of having to balance family, children and work. Much older people (over 60) have physiologic issues during sleep that cause them to wake up many times during the night (urinary incontinence or frequency, sleep apnea, insomnia, pain syndromes). Overall, people who live in big cities sleep much less than the rest of the country. This could be due to overstimulation of the nervous system, work stress and lack of time spent outdoors (that is, less oxygen to the brain).”

Solutions to Better Sleep

After hearing of patients’ difficulty sleeping, the next question is: what exactly can practitioners recommend to their patients to help combat these issues?

A great starting point would be in the mineral magnesium, which notably has a calming effect to it.

“Magnesium is an essential electrolyte and is known as the anti-stress mineral, and is a natural sleep aid,” mentioned Carolyn Dean, MD, ND, advisory board member of the Nutritional Magnesium Association. “Numerous Studies have shown its effectiveness in reducing stress levels as well as helping with deeper more restful sleep. This mineral has been depleted from our soils and foods due to modern farming methods and food processing. More than 75 percent of Americans do not get their recommended daily allowance of this mineral, which is a co-factor in 700-800 enzyme reactions in the body.

“A magnesium deficiency can magnify stress because of serotonin, the feel-good brain chemical that is boosted artificially by some medications, depends on magnesium for its production and function. Not all forms of magnesium are easily absorbed by the body. Magnesium citrate powder is a highly absorbable form that can be mixed with hot or cold water and sipped at work or at home throughout the day.”

As another option, Boiron USA, a Pennsylvania-based manufacturer of homeopathic medicine, offers Quietude, dissolvable tablets that help target lack of sleep, without the effects that come with it. Christopher Merville, DPharm, director of education and pharmacy development at the company, explained how exactly the medication is effective.

“Quietude temporary relieves sleeplessness, restless sleep and occasional awakening without grogginess or risk of dependency,” he said. “The biggest advantage of this sleep aid is that it doesn’t knock you out. It may sound funny for a sleep medicine to be non-drowsy and non-doping, but this means you won’t have that groggy hangover effect the next day like you are still in a fog, which is typical with sleep aids that mask the problem by sedating you. Instead, Quietude helps and overactive mind calm down. It’s perfect for when your head hits the pillow but you keep going over that to-do list or replaying the day’s events. If you’ve had a particularly exciting day- whether it’s from good or bad news- prepare for bed by taking Quietude once in the early evening and then again at bedtime.”

A common trend among those struggling with sleeplessness is the fact that the body, especially the brain, is operating at full capacity even during the late evening hours, when it should be resting. Glycine, and amino acid found in Ajinomoto’s Glysom, is able to affect he body accordingly.

“Glycine is a naturally occurring amino acid that induces sleep by setting the body’s internal clock and reducing the core body temperature,” said Holt. “It signals the body to relax and prepare for a better sleep cycle, improving the body’s sleep architecture. Taking Glysom together with melatonin provides a combo effect- the melatonin helps you fall asleep, the Glysom keeps you asleep.”

State of the Market

Being that difficulty sleeping is an ongoing issue, there are positive strides being made in the market, precisely in terms of both traditional and natural medications respectively. In fact, a major contributor to traditional medicine’s success is the severity of the conditions that it treats.

“Insomnia is recognized as the fourth most prominent health issue just behind stress,” said Dr. Dean. “The projections for sleep aids for 2018 are approximately $732 million with a 27 percent category growth rate. The recognized drawbacks are side effects and addictive nature of these medications.”

Moreover, as Dr. Kogan stated, “the sales are unprecedentedly high- especially those of generic sleep meds, as they are cheaper.”

On the other hand, natural sleep medication has continuously garnered attention, partly due to individuals that are popular in the public eye. “Awareness of the importance of sleep an getting proper sleep is growing, and with high profile celebrity deaths (Michael Jackson, Prince) related to sleep issues, consumers are searching for and demanding natural alternative to otherwise harmful side-effect ridden medications,” added Dr. Dean.

As a result, being that pros and cons lie in both forms of medication, practitioners must fairly provide both options to their patients.

Research

There are endless questions surrounding sleep, such as what in fact is the best solution to a good night’s sleep and how one gets to that point. Progress has been made in this regard, and to further enhance this progress, practitioners are thinking out of the box with their interest in research.

“I am interest in researching auto-hypnosis and sleep- specifically how teaching patient’s self-hypnosis techniques can help them fall asleep easier,” noted Dr. Kogan.

In fact, she is quite fond of this delivery method, as it takes more of a holistic approach to medicine. “Self-hypnosis (which I admire) is the least popular method because it’s an acquired skill that needs to be rehearsed many times over, until it becomes a lifestyle,” she mentioned. “Teaching patients self-hypnosis is my favorite modality, because it empowers patients to tap into their own inner resources, instead of depending on pills.”

Although the medical world may not have received all the answers is has been looking for thus far, one ideas is for sure: good sleep is king.

“There is a much greater understanding of the overall physiological and emotional role sleep plays on a body’s health,” said Holt. “Polysomnographic studies have proven that there is no substitute for good sleep. If a body is deficient in vitamin C, a supplement will help adjust that. The same cannot be said of sleep deficiency. Lack of sleep affects the whole body, including metabolism. That’s why good sleep  is so important for weight loss.”

 

 

 

 

 

Tags:  Better Sleep  Glysom  integrative medicine  Magnesium  REM sleep  sleep apnea 

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GASP - ACAM BOD Howard Hindin, DDS announces new book

Posted By Administration, Tuesday, February 7, 2017

The Airway Centric® Model prevents Airway-Centered Disorders, Sleep-Disordered Breathing to maintain mental and physical health. Learn how to recognize and correct Airway-Centered Disorders, Sleep-Disordered Breathing. Gasp is about our airway, breathing and sleep. Problems can start at birth. Many premature babies are mouth breathers. A poorly structured and functioning airway leads to mouth breathing, snoring and sleep apnea; it can interfere with restorative sleep and ultimately damage the part of the brain called the prefrontal cortex, which controls executive function skills, attentiveness, anxiety and depression. Learn how to restore an ideal airway with early intervention, and where to go for help. Learn how once the airway is established with breastfeeding, allergy treatment, and other methods, neurocognitive and neurobehavioral problems are greatly improved—often without any medication. Anxiety and depression are alleviated, and the behavior and performance of children are remarkably transformed.

Today there is a health movement toward “Wellness.” Wellness is about diet and nutrition, exercise, and mental attitude. The new paradigm is called “Functional Medicine.” It addresses the causes of chronic disease with an individualized approach and emphasizes early intervention. It restores the balance amongst functional systems and the networks that connect them. The missing link is airway, breathing, and sleep. If we don’t breathe well when we sleep, 1/3 of our life is affected. Gasp describes the impact of a narrowed airway from cradle to grave. Every day, we encounter fatigued patients with chronic headaches and neck pain. They have difficulty concentrating; they suffer with GI problems from acid reflux to irritable bowel syndrome. They range from thin women to men who have put on a few pounds. And you do not have to be obese to have an airway problem. Many of our younger patients with ADHD and airway issues have little body fat. Time after time we see that once the airway is opened during the day and maintained during sleep, the transformation is quick and dramatic. Breathing is life.

 

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The Cancer Revolution - ACAM BOD Leigh Erin Connealy, MD announces new book

Posted By Administration, Tuesday, February 7, 2017

In her new book The Cancer Revolution, Leigh Erin Connealy,MD shares her groundbreaking integrative approach to both treating and preventing cancer.

“Fortunately, you can learn about many cutting-edge cancer therapies by reading this book,” says Dr. Joseph Mercola in The Cancer Revolution foreword. “Dr. Connealy carefully and clearly details the wide array of comprehensive strategies that you can consider for treating cancer. There really are an astounding number of choices and she does a magnificent job of compiling them conveniently in one place. It would take you many weeks, and more likely months or years, to collect the options that she concisely reviews here…Not only does she outline the natural options for treating cancer, but she provides resources that you can use to identify a natural clinician that resonates with your philosophy and budget.”

Dr. Connealy’s latest book offers practical strategies that have helped thousands of patients:

  • Let food be your medicine.
  • Remove toxins to repair and restore your body.
  • Harness the healing power of supplements.
  • Reduce stress and reclaim your life.
  • Strengthen your immune system with sleep.

With a 7-day detox and a 14-day healing program — including recipes based on anti-cancer foods, as well as inspiring stories from patients successfully treated at her Cancer Center for Healing — Dr. Connealy provides healing strategies for patients and those at risk.

“Dr. Connealy understands the role of nutrition, epigenetics, and integrative approaches in healing cancer and even preventing cancer,” says author and documentarian Ty Bollinger. “Cancer is not a death sentence. There is always hope, and this book will empower you with knowledge that just might save your life or the life of a loved one.”

The Cancer Revolution reveals its’ secrets in this three-part book:

A New Way to Prevent, Treat, and Beat Cancer

  • Cancer: What It Is, What Causes It, and How to Fight It
  • How to Detect Cancer Before It Wreaks Havoc
  • Groundbreaking Cancer Treatments

The Six Revolutionary Cancer Strategies

  • Let Food Be Your Medicine
  • Remove Toxins to Boost Your Health
  • Harness the Power of Supplements
  • Get Moving to Get Well
  • Reduce Stress and Reclaim Your Life
  • Strengthen Your Immune System with Sleep

The Cancer Revolution Plan for Health and Wellness

  • Putting Together Your Support System
  • Creating an Anticancer Living Environment
  • The 14-Day Anticancer Wellness Plan
  • The 7-Day Juicing Detoxification Program
  • Living a Cancer-Free Life
  • The Recipes: Dishes for Repairing and Restoring Your Body

“The Cancer Revolution enables everyone to understand and take responsibility for their health and their role in the prevention of disease. It is truly an outstanding guide of how to create health and maintain wellness — from a personal and professional standpoint,” notes Paul Fisher of Biotics Research.


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Chelation Therapy: Life-saving Alternative Treatment?

Posted By Allan Magaziner, DO, Monday, February 6, 2017
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