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Black Cohosh May Reduce Side Effects of Clomid/Clomiphene

Posted By Administration, Thursday, April 15, 2010
Updated: Friday, April 18, 2014

 

 

by Fiona McCulloch, ND

Clomid is one of the most commonly used pharmaceuticals in the treatment of fertility concerns today.  It is often the first therapy used.  Clomid (also known as clomiphene) binds to estrogen receptors, inhibiting the action of estrogen (which is produced by developing follicles) on the hypothalamus in the brain.   As a result, the pituitary gland perceives estrogen levels to be low (when they actually are not), and it responds by producing increased levels of both LH and FSH.  This causes increased follicle production by the ovaries, and stimulation of ovulation.pregnancy with clomid therapy

As effective as this therapy can be at inducing ovulation, studies have indicated fertility specific side effects of clomiphene, many of which are caused by its antagonism to estrogen. The major fertility related side effects are: 1) thinning of the endometrial lining and 2) reduction of cervical mucous required for entry of sperm into the uterus.

One of the isomer forms of clomiphene has a slow excretion rate from the body (it can take more than 6 weeks to be excreted).  If clomiphene therapy is used for longer than two months, side effects can be more pronounced, resulting in greater thinning of the endometrial lining which is needed for healthy implantation. In women over 40, endometrial lining thins naturally, and perhaps this is why clomiphene is often not an effective treatment in this group of patients.

For many women, the ovulation induction produced by this medication can be the answer to ovulation difficulties however therapy often must be stopped after a short period due to side effects over time. Estrogen therapy has been studied in conjunction with Clomid presumably to offset the anti-estrogenic effects of the medication, with mixed results.  Some studies have found giving additional estrogen to women to be helpful, and others have found it to be of no benefit.

Recently, two studies have been completed on combining black cohosh (also known as Cimicifuga racemosa) with clomiphene in patients seeking treatment for infertility.  Cimicifuga is a botanical therapy, often used in womens health to treat menopausal conditions such as hot flashes.  Estrogenic effects of black cohosh remain highly debated, with early studies indicating that it  directly affects estrogen receptors, and more recent studies showing that the effect of the plant may occur from an entirely different mechanism.  Without yet knowing the exact mechanisms through which black cohosh works, several convincing studies have indicated it to be beneficial in the clinical treatment of hormonal disorders.  A recent study has indicated that black cohosh may reduce proliferative effects of estrogens on tissues, which is in line with the effect of many phytoestrogens, however the mechanism for this remains to be elucidated.

In the first study conducted in 2008, black cohosh was found to significantly increase estradiol and LH concentrations in patients taking clomiphene therapy.   Endometrial thickness, serum progesterone and clinical pregnancy rate in patients were significantly higher in the black cohosh group as compared to control.

The second study was completed in 2009. In this study of patients taking clomiphene, black cohosh given in the follicular phase was compared to estrogen therapy, presumably in order to determine which could reduce side effects more effectively. The black cohosh group needed significantly fewer days for healthy follicular development, had a thicker endometrial lining and had higher estradiol concentration at the time of HGG ovulation trigger when compared to the estrogen replacement therapy group.  Clinical pregnancy rate was 14.0% in the estrogen replacement group versus 21.1% in the black cohosh group. Although this did not reach clinical significance, it appears that the black cohosh group did display many benefits overall when compared to the estrogen replacement group. When results from the previous study are also considered, it appears that this therapy may warrant serious consideration and further study for those undergoing clomiphene treatment.

More studies will need to be conducted in order to determine the mechanisms of this herbal medicine’s benefits for patients undergoing modern assisted reproductive technology therapies.

References:

Homburg, I.  Clomiphene citrate—end of an era? a mini-review.  Human Reproduction 2005 20(8):2043-2051

Insler, V MB, BCh; Zakut, H MD; Serr, D M MB, ChB. Cycle Pattern and Pregnancy Rate Following Combined Clomiphene-Estrogen Therapy. April 73 (4) 4

Massai et al.  Clomiphene citrate affects cervical mucus and endometrial morphology independently of the changes in plasma hormonal levels induced by multiple follicular recruitment.  Fertil Steril. 1993 Jun;59(6):1179-86

Osmers et al. Efficacy and Safety of Isopropanolic Black Cohosh Extract for Climacteric Symptoms. Obstetrics & Gynecology:  May 2005 – Volume 105 – Issue 5, Part 1 – pp 1074-1083

Sandro Gerli, Hossein Gholami, Antonio Manna, Antonio Scotto Di Frega, Costantino Vitiello, Vittorio Unfer, Use of ethinyl estradiol to reverse the antiestrogenic effects of clomiphene citrate in patients undergoing intrauterine insemination: a comparative, randomized study, Fertility and Sterility, Volume 73, Issue 1, January 2000, Pages 85-89

Shahin AY, Ismail AM, Shaaban OM. Supplementation of clomiphene citrate cycles with Cimicifuga racemosa or ethinyl oestradiol–a randomized trial. Reprod Biomed Online. 2009 Oct;19(4):501-7.

Shahin, Ahmed Y.1; Ismail, Alaa M.1; Zahran, Kamal M.1; Makhlouf, Ahmad M.1 Adding phytoestrogens to clomiphene induction in unexplained infertility patients – a randomized trial. Reproductive BioMedicine Online, Volume 16, Number 4, April 2008 , pp. 580-588(9)

Tags:  black cohosh  clomid  clomiphene  side effects 

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The Relationship Between Alzheimer's Disease and Diabetes: Type 3 Diabetes?

Posted By Administration, Friday, April 9, 2010
Updated: Friday, April 18, 2014

Zina

Published in Alternative Medicine Review, Volume 14, Number 4 2009

by Zina Kroner, DO

 

 

 

Abstract 

In recent years, Alzheimer’s disease (AD) has been considered to be, in part, a neuroendocrine disorder, even referred to by some as type 3 diabetes. Insulin functions by controlling neurotransmitter release processes at the synapses and activating signaling pathways associated with learning and long-term memory. Novel research demonstrates that impaired insulin signaling may be implicated in AD. Post-mortem brain studies show that insulin expression is inversely proportional to the Braak stage of AD progression. It was also demonstrated that neurotoxins, coined amyloid beta-derived diffusible ligands (ADDLs), disrupt signal transduction at synapses, making the cell insulin resistant. ADDLs reduce plasticity of the synapse, potentiate synapse loss, contribute to oxidative damage, and cause AD-type tau hyperphosphorylation. Diabetes and AD have signs of increased oxidative stress in common, including advanced glycation end products (AGEs), when compared to normal subjects. Diabetic patients appear to have an increased risk for AD because AGEs accumulate in neurofibrillary tangles and amyloid plaques in AD brains. This research should encourage a more proactive approach to early diagnosis of diabetes and nutritional counseling for AD patients. (Altern Med Rev 2009;14(4):373-379) 

Introduction 

The epidemic of insulin resistance/prediabetes and type 2 diabetes may be associated with the emergence of higher rates of Alzheimer’s disease (AD). New research delineates a direct correlation between sugar imbalance and AD. AD is associated with consistent pathological findings, including neurofibrillary tangles, amyloid-beta deposits, and signs of oxidative stress. No common link among the proposed pathological processes has been identified. Novel evidence demonstrates that impaired insulin signaling may significantly contribute to the pathogenesis of AD, contributing to the idea that it is actually a neuroendocrine disease. Neurotoxins called amyloid beta-derived diffusible ligands (ADDLs) have been implicated as a cause of impaired insulin signaling. Advanced glycation end products (AGEs) are found in higher concentration in both hyperglycemia and AD, contributing to oxidative stress and cell damage. These AGEs are known to be further modified to reactive advanced glycation end products, (RAGEs), which can generate oxidative injury. 

Understanding the mechanism of action of this neuroendocrine disorder, termed type 3 diabetes by some, may shed light on new tools for diagnosing and treating AD and for the need for early intervention in obese patients with insulin resistance. 

The Clinical Link: Diabetes and AD 

The research linking diabetes and AD has its roots in the groundbreaking Rotterdam study. Of 6,370 elderly subjects studied for 2.1 years, 126 developed dementia; 89 of these were specifically diagnosed with AD. Type 2 diabetes doubled the risk of a patient having dementia and patients on insulin had four times the risk.As rates of insulin resistance and diabetes in the senior population are both increasing, this landmark study, conducted almost a decade ago, has been getting more attention in recent years since further studies have solidified the connection between diabetes and AD.

Since type 2 diabetes is reaching epidemic proportions and is under-diagnosed, and AD may be associated with hyperglycemia, more attention should be drawn to early diagnosis of diabetes. The Gertner Institute for Epidemiology and Health Policy Research in Israel, in a recently published 25-year, cross-sectional study of 623 adults, demonstrated that approximately 13 percent of the studied population had undiagnosed type 2 diabetes. This study reinforces the importance of early diagnosis of type 2 diabetes by identifying patients with risk factors, including hypertension, hypertriglyceridemia, and a large waist circumference (males: ≥40 inches [102 cm], females: ≥35 inches [88 cm]) – factors seen in metabolic syndrome. These results encourage early detection via screening methods targeting those with traits of metabolic syndrome in otherwise healthy adults.

Another study demonstrating the high prevalence of diabetes showed almost one-third of elderly patients in a sample of 7,267 subjects had diabetes, and three-fourths had impaired fasting glucose (glucose lev- els >99 but <126) or diabetes.

Elevated body mass index (BMI), adiposity, impaired fasting glucose, and diabetes increase the risk of AD substantially. The latest study, utilizing data on 2,322 participants in the Baltimore Longitudinal Study of Aging, shows the incidence of AD increased in men who gained weight between the ages of 30 and 45 and in women with a BMI >30 at ages 30, 40, and 45.7 This suggests more emphasis should be placed on early weight-loss strategies for preventing AD. 

A 2008 Swedish study showed a statistically significant increase in the risk of developing AD in men who develop type 2 diabetes in midlife. The researchers followed 2,269 men for 32 years and found that those with low insulin production at age 50 were 150-percent more likely to develop AD than those with adequate insulin production. This association was greatest in patients who did not have the apolipoprotein E4 (ApoE4) genetic predisposition to AD (which renders individuals less efficient at breaking down beta-amyloid plaques), thereby making diabetes a possible independent risk factor for AD. This study illustrates the importance of maintaining healthy blood glucose control in middle-aged men as a possible means of preventing AD later in life. 

A recent investigation suggests that AD is associated with metabolic syndrome. After studying 50 patients diagnosed with AD and comparing them to 75 cognitively normal controls, the AD patients had a greater waist circumference, higher triglyceride and glucose levels, and lower high-density lipoprotein cholesterol. Patients with metabolic syndrome are diagnosed with AD at a younger age than AD patients without metabolic syndrome.

Type 3 Diabetes: Is It Actually a Unique Condition? 

The term type 3 diabetes was coined in 2005 by Suzanne de la Monte, MD, MPH, Associate Professor of Pathology and Medicine and neuropathologist at Brown Medical School. Her team, examining postmortem brain tissue of AD patients, found that AD may be a neuroendocrine disease associated with insulin signaling. The team termed it type 3 diabetes because it harbors elements of both types 1 and 2 diabetes, since there is both a decrease in the production of insulin and a resistance to insulin receptors.

The team analyzed 45 postmortem brains of patients of varying Braak stages of AD neurodegeneration and found that insulin expression was inversely proportional to the Braak stage, with an 80-percent decrease in the number of insulin receptors in AD patients compared to normal subjects. In addition, the ability of insulin to bind to the receptors was compromised. There was a reduced level of mRNA corresponding to insulin, insulin-like growth factor-1 (IGF-1) and -2 polypeptides, and their receptors. The research team also noted a reduction in the tau protein, which is regulated by insulin and IGF-1. This phenomenon ultimately could lead to neuronal cell death and AD exacerbation.  

The postmortem studies inspired a rat study in which intracerebral injection of streptozotocin resulted in a chemical depletion of insulin and an alteration of IGF-signaling mechanisms together with oxidative injury. The combination of alterations resulted in neurodegeneration, including reduction in brain size and other neurological changes seen in AD.

AD is characterized by a reduction in the utilization of glucose, and treatment with insulin has been associated with improved memory. Insulin, important in memory processing, crosses the blood-brain barrier and is even produced in brain tissue itself. AD patients have less insulin and fewer insulin receptors than non-AD patients, and correction of insulin levels improves cognition. Insulin binds to insulin receptors in the brain, most of which are located in the cerebral cortex, olfactory bulb, hippocampus, cerebellum, and hypothalamus. Since there are more insulin receptors in the cognitionpertinent areas of the brain, it is logical to consider the association between insulin and cognition.

Several studies utilizing intranasal, intravenous, and intracerebral administration of insulin demonstrate improved cognition. A study utilizing intranasal insulin showed that its administration enhanced verbal recall in normoglycemic adults with early AD or cognitive impairment. In the study, 25 participants were randomly assigned to receive either placebo (n=12) or 20 IU intranasal insulin (n=13) twice daily. After 21 days of treatment, changes in cognition were measured. The fasting plasma glucose and insulin levels were unchanged with treatment. However, when compared with the placebo treated subjects, the insulin-treated subjects retained more verbal information and displayed superior attention and functional status. 

A study utilizing intravenous (IV) insulin assessed cognitive performance in 22 adults with AD and 15 normal adults receiving five consecutively higher IV doses of insulin resulting in five plasma insulin levels (10, 25, 35, 85, and 135 microU/mL), while plasma glucose levels of ~100 mg/dL were maintained. Cognitive performance was measured after 120 minutes of infusion. AD patients who were ApoE4-positive were found to have improved memory at lower insulin levels of 25 microU/mL, compared to their ApoE4-negative counterparts, who required a higher blood insulin level of 35 and 85 microU/mL before an improvement in memory was noted. Interestingly, normal adults also showed improved memory at insulin levels of 25 and 85 microU/mL. This shows that AD patients who are ApoE4-negative may not be as sensitive to insulin.  

A study utilizing intracerebroventricular insulin showed that its administration enhanced memory formation in rodents undergoing a step-through passive avoidance task These studies suggest that insulin may have a role in enhancement of cognition and memory. The other implication is that patients with the ApoE4 genetic predisposition to AD may not reap the benefits of improvement in AD by glycemic control. 

Based on a recent epidemiological study, individuals who are ApoE4-positive are not more likely to be insulin resistant than those who are ApoE4-negative. Therefore, insulin resistance and being positive for the ApoE4 allele are independent risk factors for AD; having both may pose an additive risk. 

Pathophysiological Connections between Insulin and AD 

AD is characterized by both low insulin levels and insulin resistance within the central nervous system (CNS), as opposed to type 2 diabetes, which is characterized by high insulin levels and insulin resistance outside of the CNS. Insulin resistance and hyperinsulinemia cause a reduction in brain insulin. Several mechanisms might explain why insulin mediates memory facilitation. As noted, insulin receptors are found in areas of the brain responsible for cognition. Insulin activates signaling pathways associated with learning and long-term memory. According to de la Monte, insulin helps to regulate processes such as neuronal survival, energy metabolism, and plasticity. These processes are required for learning and memory.  Peripheral insulin resistance, therefore, affects cognition.

In addition to regulating blood sugar levels, insulin functions as a growth factor for all cells, including neurons in the brain. Thus, insulin resistance or lack of insulin, in addition to adversely affecting blood sugar levels, contributes to degenerative processes in the brain.

When insulin levels reach an exceedingly high level, the beta-amyloid peptide, the hallmark of AD that accumulates in senile plaques, is modulated. Exaggerated elevation of plasma insulin levels causes amyloid peptide levels in the cerebrospinal fluid to increase, resulting in memory insult.

Amyloid beta-Derived Diffusible Ligands 

A group of researchers at Northwestern University studied why brains of AD patients are both low in, and resistant to, insulin. According to William Klein, PhD, who led the research, amyloid beta-derived diffusible ligands may be responsible for the phenomenon. ADDLs are oligomers similar in morphology and size to prions that have been linked to neurodegenerative disease. ADDLs may contribute to lowered insulin levels and insulin resistance in AD brains. Because the ADDLs are so small, they are more diffusible and therefore more harmful than amyloid. 

In healthy brains, insulin binds to a receptor at a synapse, resulting ultimately in memory formation. Klein’s team found that ADDLs disrupt this mechanism of communication by binding to the synapse and changing its shape, thereby causing dysfunction. Because the shape of the synapse is altered, insulin cannot effectively bind, disrupting signal transduction and resulting in insulin resistance. ADDLs have been shown to reduce the plasticity of the synapse, potentiate synapse loss, cause oxidative damage, and result in AD-type tau hyperphosphorylation, mechanisms linked to AD. Since ADDLs have been shown to affect neuronal insulin receptor signaling, it has been suggested that insulin resistance in the AD brain is a response to  ADDLs, inducing a neurological form of diabetes.  Neurons with no ADDLs show an adequate number of insulin receptors. 

Measuring ADDL levels may potentially be a novel tool for diagnosing AD. In 2005, the ultrasensitive bio-barcode assay was used to measure ADDL concentration in cerebrospinal fluid. Of 30 subjects, ADDL concentrations were found to be higher in those diagnosed with AD compared to non-AD patients. This test is not readily available and less invasive testing is underway. An ADDL vaccine is being studied and ADDL-blocking drugs are being considered by Klein et al.


Insulin and the Cholinergic Hypothesis 

The cholinergic hypothesis that suggests AD is caused by an inadequate production of acetylcholine may also have links to blood sugar abnormalities and insulin resistance. The researchers at Brown point out that insulin also participates significantly in neurological function by stimulating the expression of choline acetyltransferase (ChAT), the enzyme responsible for acetylcholine synthesis. Therefore, suboptimal insulin levels as well as poor insulin receptor sensitivity can ultimately contribute to a decrease in acetylcholine, which further elucidates a possible bio-chemical link between diabetes and AD.

AGEs and Oxidation – Common Thread between Diabetes and AD 

Another mechanism linking diabetes with AD is that both diseases, as mentioned previously, are associated with increased oxidative stress and production of AGEs. Although the association between vascular dementia and AGEs is well established, new research points to a link between AGEs and AD. AGEs are formed by a sequence of events originally identified in 1912 as the end-products of the Maillard reaction, during which reducing sugars can react with the amino groups of proteins to produce cross-linked complexes and unstable compounds. 

AGEs have been found in retinal vessels, peripheral nerves, kidneys, and the CNS of diabetics. AGEs couple with free radicals and create oxidative damage, which in turn leads to cellular injury. Diabetic patients could have an increased risk of AD via AGE production. Oxidative stress on its own also causes AGEs, creating a vicious cycle.

AGEs are also known to modify plaques and neurofibrillary tangles, both implicated in AD. AGEs have been identified in neurofibrillary tangles (consisting of tau protein) and senile plaques (consisting of beta-amyloid protein). Since type 2 diabetes accelerates the production of AGEs, it may be another causative factor in the development of AD. It has been proposed that a potential biomarker for early detection of AD may be measurement of toxic AGEs in the serum or cerebrospinal fluid.

Conclusion 

Understanding that AD has its foundation in neuroendocrinology is persuasive evidence that there should be greater emphasis on early diagnosis of metabolic syndrome, insulin resistance, and type 2 diabetes. Referring to AD as type 3 diabetes has its foundation in the fact that the CNS in AD is characterized by a paucity of insulin and resistance of the insulin receptors. This results in cognitive dysfunction, since insulin is crucial for neurological signaling processes to occur. Insulin also participates in neurological function by stimulating the expression of ChAT, the enzyme responsible for acetylcholine synthesis; acetylcholine is in turn a necessary neurotransmitter for cognition. AGEs, found in greater amounts in diabetic patients compared to controls with normal glucose regulation, have also been found in high concentration in AD brains. 

The links between hyperglycemic states and AD can allow for better future diagnostic strategies. Since ADDLs may contribute to lowered insulin levels and insulin resistance in AD brains, the future of diagnosis may entail the measurement of ADDLs. Measurement of AGEs has also been proposed. 

Treatment strategies utilizing this information require more research. The knowledge that there is a reduction of the sensitivity to insulin in AD patients who are not ApoE4-positive suggests that optimization of blood sugar levels may have therapeutic benefits. Insulin-sensitizing agents may potentially be used in the setting of early AD. 

References 

1. Rönnemaa E, Zethelius B, Sundelöf J, et al. Impaired insulin secretion increases the risk of Alzheimer disease. Neurology 2008;71:1065-1071. 

2. Steen E, Terry BM, Rivera EJ, et al. Impaired insulin and insulin-like growth factor expression and signaling mechanisms in Alzheimer’s disease – is this type 3 diabetes? J Alzheimers Dis 2005;7:63-80. 

3. Viola KL, Velasco PT, Klein WL. Why Alzheimer’s is a disease of memory: the attack on synapses by A beta oligomers (ADDLs). J Nutr Health Aging 2008;12:51S-57S. 

4. Ott A, Stolk RP, van Harskamp F, et al. Diabetes mellitus and the risk of dementia: The Rotterdam Study. Neurology 1999;53:1937-1942. 

5. Dankner R, Geulayov G, Olmer L, Kaplan G. Undetected type 2 diabetes in older adults. Age Ageing 2009;38:56-62. Psychoneuroendocrinology 2003;28:809-822. 

6. Cowie CC, Rust KF, Ford ES, et al. Full accounting of diabetes and pre-diabetes in the U.S. population in 1988-1994 and 2005-2006. Diabetes Care 2009;32:287-294. 

7. Beydoun MA, Lhotsky A, Wang Y, et al. Association of adiposity status and changes in early to mid- adulthood with incidence of Alzheimer’s disease. Am J Epidemiol 2008;168:1179-1189. 

8. Razay G, Vreugdenhil A, Wilcock G. The metabolic syndrome and Alzheimer disease. Arch Neurol 2007;64:93-96. 

9. Vilalta-Franch J, López-Pousa S, Garre-Olmo J, et al. Metabolic syndrome in Alzheimer’s disease: clinical and developmental influences. Rev Neurol 2008;46:13-17. 

10. Rivera EJ, Goldin A, Fulmer N, et al. Insulin and insulin-like growth factor expression and function deteriorate with progression of Alzheimer’s disease: link to brain reductions in acetylcholine. J Alzheimers Dis 2005;8:247-268. 

11. de la Monte SM, Tong M, Lester-Coll N, et al. Therapeutic rescue of neurodegeneration in experimental type 3 diabetes: relevance to Alzheimer’s disease. J Alzheimers Dis 2006;10:89-109. 

12. Lester-Coll N, Rivera EJ, Soscia SJ, et al. Intracerebral streptozotocin model of type 3 diabetes: relevance to sporadic Alzheimer’s disease. J Alzheimers Dis 2006;9:13-33. 

13. Craft S, Watson GS. Insulin and neurodegenerative disease: shared and specific mechanisms. Lancet Neurol 2004;3:169-178. 

14. Reger MA, Watson GS, Green PS, et al. Intranasal insulin improves cognition and modulates beta- amyloid in early AD. Neurology 2008;70:440-448. 

15. Craft S, Asthana S, Cook DG, et al. Insulin dose-response effects on memory and plasma amyloid precursor protein in Alzheimer’s disease: interactions with apolipoprotein E genotype. Psychoneuroendocrinology 2003;28:809-822. 

16. Park CR, Seeley RJ, Craft S, Woods SC. Intracerebroventricular insulin enhances memory in a passive-avoidance task. Physiol Behav 2000;68:509- 514. 

17. Peila R, Rodriguez BL, Launer LJ, et al. Type 2 diabetes, APOE gene, and the risk for dementia and related pathologies: The Honolulu-Asia Aging Study. Diabetes 2002;51:1256-1262. 

18. Zhao WQ, Alkon DL. Role of insulin and insulin receptor in learning and memory. Mol Cell Endocrinol 2001;177:125-134. 

19. Bingham EM, Hopkins D, Smith D, et al. The role of insulin in human brain glucose metabolism: an 18fluoro-deoxyglucose positron emission tomography study. Diabetes 2002;51:3384-3390. 

20. de la Monte SM. Insulin resistance and Alzheimers’s disease. BMB Rep 2009;42:475-481. 

21. Li L, Holscher C. Common pathological processes in Alzheimer disease and type 2 diabetes: a review. Brain Res Rev 2007;56:384-402.

22. Westerman MA, Cooper-Blacketer D, Mariash A, et al. The relationship between Abeta and memory in the Tg2576 mouse model of Alzheimer’s disease. J Neurosci 2002;22:1858-1867. 

23. De Felice FG, Wu D, Lambert MP, et al. Alzheimer’s disease-type neuronal tau hyperphosphorylation induced by A beta oligomers. Neurobiol Aging 2008;29:1334-1347. 

24. Zhao WQ, De Felice FG, Fernandez S, et al. Amyloid beta oligomers induce impairment of neuronal insulin receptors. FASEB J 2008;22:246-260. 

25. Gong Y, Chang L, Viola KL, et al. Alzheimer’s disease-affected brain: presence of oligomeric A beta ligands (ADDLs) suggests a molecular basis for reversible memory loss. Proc Natl Acad Sci U S A 2003;100:10417-10422. 

26. Georganopoulou DG, Chang L, Nam JM, et al. Nanoparticle-based detection in cerebral spinal fluid of a soluble pathogenic biomarker for Alzheimer’s disease. Proc Natl Acad Sci U S A 2005;102:2273- 2276. 

27. http://www.ibis.northwestern.edu/faculty/klein.html [Accessed October 19, 2009] 

28. Rivera EJ, Goldin A, Fulmer N, et al. Insulin and insulin-like growth factor expression and function deteriorate with progression of Alzheimer’s disease: link to brain reductions in acetylcholine. J Alzheimers Dis 2005;8:247-268. 

29. Yamagishi S, Ueda S, Okuda S. Food-derived advanced glycation end products (AGEs): a novel therapeutic target for various disorders. Curr Pharm Des 2007;13:2832-2836. 

30. Pasquier F, Boulogne A, Leys D, Fontaine P. Diabetes mellitus and dementia. Diabetes Metab 2006;32:403- 414. 

31. Sato T, Shimogaito N, Wu X, et al. Toxic advanced glycation end products (TAGE) theory in Alzheimer’s disease. Am J Alzheimers Dis Other Demen 2006;21:197-208. 

32. Valente T, Gella A, Fernàndez-Busquets X, et al. Immunohistochemical analysis of human brain suggests pathological synergism of Alzheimer’s disease and diabetes mellitus. Neurobiol Dis 2009;Sep 22 [Epub ahead of print] 

33. Zhu X, Su B, Wang X, et al. Causes of oxidative stress in Alzheimer disease. Cell Mol Life Sci 2007;64:2202-2210. 

34. Takeuchi M, Yamagishi S. Possible involvement of advanced glycation end-products (AGEs) in the pathogenesis of Alzheimer’s disease. Curr Pharm Des 2008;14:973-978. 

35. Takeuchi M, Sato T, Takino J, et al. Diagnostic utility of serum or cerebrospinal fluid levels of toxic advanced glycation end-products (TAGE) in early detection of Alzheimer’s disease. Med Hypotheses 2007;69:1358-1366. 

 

Tags:  alzheimer's  diabetes 

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Are Rice and Spicy Diets Good for Functional Gastrointestinal Disorders?

Posted By Administration, Friday, April 9, 2010
Updated: Friday, April 18, 2014

263141343_81f39a201b_oAbstract 

Rice- and chili-containing foods are common in Asia. Studies suggest that rice is completely absorbed in the small bowel, produces little intestinal gas and has a low allergenicity. Several clinical studies have demonstrated that rice-based meals are well tolerated and may improve gastrointestinal symptoms in functional gastrointestinal disorders (FGID). Chili is a spicy ingredient commonly use throughout Asia. The active component of chili is capsaicin. Capsaicin can mediate a painful, burning sensation in the human gut via the transient receptor potential vanilloid-1 (TRPV1). Recently, the TRPV1 expressing sensory fibers have been reported to increase in the gastrointestinal tract of patients with FGID and visceral hypersensitivity. Acute exposure to capsaicin or chili can aggravate abdominal pain and burning in dyspepsia and IBS patients. Whereas, chronic ingestion of natural capsaicin agonist or chili has been shown to decrease dyspeptic and gastroesophageal reflux disease (GERD) symptoms. The high prevalence of spicy food in Asia may modify gastrointestinal burning symptoms in patients with FGID. Studies in Asia demonstrated a low prevalence of heartburn symptoms in GERD patients in several Asian countries. In conclusion rice is well tolerated and should be advocated as the carbohydrate source of choice for patients with FGID. Although, acute chili ingestion can aggravate abdominal pain and burning symptoms in FGID, chronic ingestion of chili was found to improve functional dyspepsia and GERD symptoms in small randomized, controlled studies. 

Keywords: Chili pepper, Rice, Functional gastrointestinal disorder, Capsaicin, TRPV1 receptor 

Introduction 

Complaints of gastrointestinal symptoms after food ingestion are common in patients with functional gastrointestinal disorders (FGID) and are reported in 25-64% of irritable bowel syndrome (IBS) patients.IBS patients often complain of food-related gastrointestinal symptoms secondary to more than one specific food. A recent population-based study in the USA demonstrated that 16.5% and 28.3% of IBS patients had intolerance to 1-2 food items and > 2 items, respectively. These statistics suggest that hyper-sensitivity to the ingestion of foods is common in IBS. Research studies also demonstrate that certain foods, such as chili, fructose or fructan containing foods and fatty foods, can affect gastrointestinal motility and sensation and induce gastrointestinal symptoms more than other foods.This suggests that certain foods, and not just the process of eating foods, can aggravate symptoms in patients with FGID. Therefore, modification of either eating habits (reducing meal size and/or the time of meals) or the composition of meals (avoiding specific food items) may benefit patients with FGID, and studies on the effects of food on gastrointestinal functions and symptoms are important. 

The effects of food ingestion on gastrointestinal symptoms in patients with FGID have been extensively studied, mainly in Western countries and with Western diets. Moreover, information regarding the effects of typical Asian foods on gastrointestinal symptoms of FGID is quite limited. This review will focus on the effects of specific but widely used Asian diets/ingredients, "rice and chili or spicy foods," on gastrointestinal functions and their roles on the symptoms of FGID. 

Characteristics of the Asian Diet 

The Asian diet is characterized by a high-carbohydrate, high-fiber, low-fat, and low-meat protein composition. Typical Asian food generally consists of rice and vegetables as the major source of carbohydrate and fiber. Vegetable oil is a common source of fat, whereas fish, eggs, poultry, and pork are the main sources of protein. This is in contrast to Western diets, which are rich in animal fat and beef protein but lower in carbohydrate and fiber contents. In addition, Asian foods often consist of several ingredients, such as chili, to make the foods tastier. 

 


1. Role of rice and high-carbohydrate diet in FGID 

In general, food can aggravate gastrointestinal symptoms by several mechanisms including: exaggerated physiologic responses of the gastrointestinal tract, food intolerance, allergy, increased intestinal gas,and modification of gut motility and sensation. 

Food with high-carbohydrate content may cause symptoms of functional bowel disorders by both allergic and non-allergic mechanisms. As for the latter, carbohydrate may cause gastrointestinal symptoms because of incomplete absorption in the small bowel, such as lactose mal-absorption. In the allergic mechanism, the protein contents in the carbohydrate sources may cause allergic reactions to the gastrointestinal tract, such as gluten in wheat. 

Major types of carbohydrate in the human diet are: starches, sucrose, and lactose. They have to be digested into monosaccharide before being absorbed through the gut mucosa. If the complex-carbohydrate and monosaccharide are not completely absorbed into the small bowel, then these substances will enter the colon and will be fermented by colonic bacteria to produce gas and short-chain fatty acids, which may contribute to the symptoms reported in patients with FGID such as diarrhea, gas, bloating, and abdominal discomfort and pain. The non-absorbable carbohydrates and their metabolites may induce gastrointestinal symptoms by their effects on gut sensation and gut motility, such as decreased gastric tone, decreased lower esophageal sphincter pressure and accelerated small bowel transit. A recent study in Asia (India) demonstrated that there is a similar prevalence of lactose intolerance in IBS patients and healthy controls. The authors performed lactose hydrogen breath tests in 124 IBS patients and 53 age- and gender-matched healthy controls. They found a similar prevalence of abnormal lactose hydrogen breath tests in IBS patients and healthy volunteers (72% vs. 60%). However, IBS patients developed gastrointestinal symptoms more often than healthy volunteers after ingestion of lactose (56% vs. 34%). This higher rate of gastrointestinal symptoms suggests that there is a role of visceral hypersensitivity in the expression of carbohydrate mal-absorption symptoms and that the completeness of small intestinal absorption of carbohydrate is important in patients with IBS and can associate with their IBS symptoms. 

2. Rice is completely absorbed in the small intestine, producing little gas 

Major sources of complex carbohydrate or starch in the human diet are wheat, rice, oat, potato, and corn. The effects of each complex carbohydrate or starch on gastrointestinal symptoms depend on its fiber content, its allergenicity, and the completeness of the small bowel digestion and absorption. In Western countries, wheat is the major source of carbohydrate. It may cause gastrointestinal symptoms by allergic reaction to gluten, the major protein component of wheat. In a recent meta-analysis of 14 studies, patients who fulfill the criteria of IBS (n = 2,278) have a higher prevalence of celiac disease than controls (n = 1,926). The pooled prevalence of positive IgA-class antigliadin antibody, either positive endomysial antibody or tissue transglutaminase, and biopsy-proved celiac disease in IBS were 4.0%, 1.63%, and 4.1%, respectively. Pooled odds ratios (95% confidence interval) for positive IgA-class antigliadin antibody, either positive endomysial antibody or tissue transglutaminase, and biopsy-proved celiac disease in IBS patients compared with controls were 3.40 (1.62-7.13), 2.94 (1.36-6.35), and 4.34 (1.78-10.6), respecttively. This implies that, in a subgroup of IBS patients, ingestion of a gluten-containing diet may aggravate and avoidance of the diet may improve gastrointestinal symptoms.Furthermore, wheat ingestion produces the highest peak of breath hydrogen compared to other sources of carbohydrate such as corn, oats, potatoes, beans, and rice in healthy humans. This suggests that wheat carbohydrate is not completely absorbed in the small bowel and that it may produce gastrointestinal symptoms, independent of gluten hypersensitivity.

Rice is the major source of carbohydrate in Asian populations. In contrast to wheat and other sources of carbohydrate, rice is completely absorbed in the small bowel and produces very little intestinal gas after ingestion. A previous study demonstrated that the amount of hydrogen, a maker of carbohydrate metabolism by intestinal bacteria, in breath samples after rice ingestion is minimally increased and not significantly different from the fasting period. Furthermore, rice has been shown to have a low allergenicity. Previous studies demonstrated that serum IgG levels produced in reaction to several kinds of food such as wheat, beef, pork, lamb, soybean, shrimp, egg, and crab were increased in IBS patients compared to healthy humans, but the serum IgG levels produced to rice in IBS patients is mild or not increased. A study from China in 37 IBS,  functional dyspepsia, and 20 healthy controls demonstrated that serum IgG antibody titers to rice was similar in IBS (28.7 ± 0.5 U/mL) and functional dyspepsia patients (29.5 ± 0.7 U/mL) compared to healthy controls (28.4 ± 0.5 U/mL). In contrast, the serum IgG antibody titer to wheat was increased in IBS patients (60.6 ± 3.4 U/mL) compared to functional dyspepsia patients (49.4 ± 2.0 U/mL) and healthy controls (48.1 ± 2.0 U/mL). This low production of IgG suggests that rice has a low allergenicity compared to other common foods. 

3. Rice has lowest fiber content compared to other common sources of carbohydrate 

It has been reported that fiber speeds up human gut transit and can improve constipation symptoms. However, its benefit in FGID is limited. Recent meta-analysis studies on the effect of fiber on global symptoms of IBS patients demonstrated conflicting results. In addition, it may worsen abdominal pain and bloating symptoms. In healthy humans, ingestion of fiber (psyllium) can delay intestinal gas transit and cause more gas retention after intestinal gas perfusion. Thus, a high-fiber diet may worsen abdominal bloating and pain by delaying intestinal gas transit and increasing gas production in the colon secondary to bacterial fermentation. In certain parts of Asia, such as in India, healthy controls and patients with IBS have more dietary fiber (51.7 and 52.3 g/day, respectively) than the recommended amount for the general population (20-40 g/day). Therefore, increasing the dietary fiber consumption of functional gastrointestinal disorder patients in certain parts of Asia may not provide any benefit but may worsen the bloating and abdominal pain symptoms. 

Although the Asian diet is rich in fiber, rice - the widely used complex carbohydrate - has the lowest fiber content compared to other kinds of cereal. A previous study demonstrated that the total fiber content (insoluble + soluble fiber) of different kinds of cereal is lowest in rice and highest in wheat (4.1% in rice vs. 12.5% in wheat). As high-fiber may worsen abdominal pain and bloating symptoms, rice may be the most preferable carbohydrate source for functional gastrointestinal disorder patients with predominant symptoms of bloating and abdominal pain. 

4. Clinical studies suggest benefits of rice-base meal in IBS 

Rice has been the major source of carbohydrate in exclusion diets in several clinical studies. These studies demonstrated that the exclusion diet is well tolerated and can improve IBS symptoms in both open and controlled studies. A recent study by King et al. suggests that the rice-based exclusion diet may improve symptoms in IBS by reducing intestinal gas production. The study was performed in 6 female IBS patients and 6 female controls by measuring 24-hour hydrogen and methane production after ingestion of rice-based exclusion diet or standard diet, in a crossover controlled trial, using a whole-body calorimeter. The authors found that after standard diet the gas excretion rate and hydrogen production was higher in IBS patients (2.4 mL/min and 332 mL/24 hr, respectively) than in controls (0.6 mL/min and 162 mL/24 hr). The rice-based exclusion diet reduced hydrogen production compared to standard diet in both IBS (79 vs. 332 mL/24 hr) and controls (95 vs. 162 mL/24 hr). In addition, in IBS patients, the exclusion diet reduced symptoms [symptom score = 8 (5.25-10) vs. 4 (3-7)] and reduced the maximum gas excretion rate compared to the standard diet (0.5 vs. 2.4 mL/min). 

Recently, the very-low-carbohydrate strategy has been shown to improve IBS-D symptoms in a small open study. The authors found that 13 of the 17 patients who were enrolled completed the study. Ten (77%) of the patients who completed the study reported adequate relief of IBS symptoms. Furthermore, the stool frequency, stool consistency, pain scores, and quality of life were significantly improved. 

Because there have been reports of inadequate dietary intake because of food avoidance in IBS patients, the avoidance of poorly-absorbed carbohydrates combined with the consumption of well-absorbed carbohydrates or rice may be more appropriate than the use of very-low-carbohydrate diets in the dietary treatment strategy for IBS patients. 

All together, rice may be the best source of carbohydrate for patients with functional bowel disorder because of its low allergenicity, its nearly complete absorption in the small bowel, and its low fiber content. In addition, a small crossover controlled study supports its benefit in IBS. 

5. Effect of chili on FGID 

Chili and spicy food are common in most Asian countries. The average daily chili consumption in Asian people is 2.5-8 g/person. It is much higher than that of 0.05-0.5 g/person in European and American peoples. Recent studies suggest that acute and chronic ingestion of chili can modify gastrointestinal symptoms in FGID. Whether or not a high prevalence of spicy food modifies gastrointestinal symptoms at the population level is not known. In addition, data on the effect of chili or spicy foods on FGID in Asian countries with a high prevalence of spicy food have been limited. 

6. Capsaicin mediated visceral nociception in FGID 

The active ingredient of chili is capsaicin. Capsaicin can modulate gastrointestinal sensation via capsaicin or TRPV1 receptors. These receptors have been found at different levels throughout the gastrointestinal tract. Capsaicin, acid, and heat can stimulate the TRPV1 receptors and mediate a sensation of burning and pain. Several studies suggested that TRPV1 receptors can mediate sensations of warmth, pressure, cramping, and pain in the human gut. Increases in the number of TRPV1 receptors have been found in the gut mucosa of patients with conditions associated with visceral hypersensitivity, including in the esophagus of patients with non-erosive reflux disease (NERD), in the colon of patients with irritable bowel syndrome and in the rectum of patients with rectal hypersensitivity. Recent studies demonstrated that patients with FGID, including functional dyspepsia and irritable bowel syndrome, exhibit gut hypersensitivity to capsaicin or capsaicin containing chili. Hammer et al. studied the effect of 0.75 mg capsaicin powder ingestion on gastrointestinal symptoms in 54 functional dyspepsia patients and 61 healthy controls. They found that after capsaicin ingestion, nausea, a flutter-like sensation, warmth and abdominal pain scores were higher in functional dyspepsia patients than in healthy volunteers. A recent study in 20 IBS-D patients demonstrated that ingestion of chili-containing meals produces higher abdominal pain and abdominal burning symptom scores than standard meals and when compared to the symptoms reported by healthy volunteers in response to ingestion of chili-containing meals. Studies suggest that abdominal pain and burning symptoms seem to be the typical gastrointestinal symptoms of capsaicin hypersensitivity, whereas abdominal bloating symptoms seems to be independent of the capsaicin pathways. 

Low-grade inflammation in the gastrointestinal tract has been proposed as a major pathogenesis of FGID, especially in irritable bowel syndrome. Up-regulation of TRPV1 pathways resulting in visceral hypersensitivity to mechanical and chemical stimulations has been reported following an induction of colonic inflammation in an animal model. In humans, gut inflammation has been reported to be associated with an increased number of TRPV1-expressing nerve fibers. Thus, hypersensitivity of the TRPV1 pathways in patients with FGID is likely a result of low-grade inflammation and may be an important pathogenesis of gut hypersensitivity, abdominal pain, and abdominal burning symptoms in FGID. 

7. Desensitization of capsaicin receptors, its role on patients' symptom profiles and treatment of FGID 

It has been reported that prior exposure of esophageal mucosa to capsaicin solution do not affect esophageal sensation in response to acid perfusion or to balloon distention. However, the study evaluated the effect of single stimulation of esophageal mucosa by perfusion of capsaicin solution into the esophagus and could not exclude the desensitization effects of capsaicin receptors in the gut mucosa after repeated exposure to capsaicin agonists. 

It has been demonstrated that TRPV1 receptors can be desensitized by repeated exposure to capsaicin. Recent small studies suggested that chronic ingestion of capsaicin containing chili can modify dyspepsia symptoms in functional dyspepsia patients and GERD symptoms in NERD by decreasing dyspeptic and GERD symptoms, respectively. Bortolotti et al.randomized 30 functional dyspepsia patients to receive 2.5 g/day of red pepper powder or placebo in a double-blind manner for 5 weeks. They found that red pepper significantly improved overall symptom scores, epigastric pain, fullness, and nausea scores relative to placebo. The overall symptom scores decreased from 3.3 ± 0.6 at baseline to 1.7 ± 0.2 at the end of week 5 for red chili treatment compared to from 3.4 ± 0.7 to 2.5 ± 0.3 for placebo treatment. In a preliminary study in 8 patients with NERD, red chili ingestion for 6 weeks significantly improved total GERD, heartburn, and regurgitation symptom scores compared to placebo. The authors found that, at baseline, total GERD scores, heartburn, and regurgitation scores were similar comparing between chili and placebo capsules (chili vs. placebo: 7.6 ± 3.7 vs. 4.7 ± 2.8, 4.6 ± 2.3 vs. 3.2 ± 2.1, and 2.9 ± 2.4 vs. 1.5 ± 1.6, respectively). At the end of week 6, red chili significantly decreased GERD symptom scores (chili vs. placebo: 0.9 ± 1.2 vs. 4.9 ± 2.4), heartburn symptom scores (0.4 ± 0.6 vs. 3.7 ± 1.6), and food regurgitation symptom scores (0.5 ± 0.8 vs. 1.3 ± 1.6) compared to placebo. The effects of chili ingestion on functional dyspepsia and GERD symptoms were observed after the 2nd week of treatment in both studies. The similar effects of chronic ingestion of red chili in functional dyspepsia and NERD patients suggests that capsaicin receptors play role on the development of both functional dyspepsia and NERD symptoms and is consistent with previous reports of visceral hypersensitivity to capsaicin in functional dyspepsia54 and increase TRPV1 receptors in NERD.42 In contrast, a previous study in 12 healthy volunteers reported that chronic chili ingestion induce more gastroesophageal refluxes. However, the duration of chili ingestions was too short (≤ 1 week) in relative to the other studies, which showed the desensitization effect of chili (5-6 weeks). These limited data suggest that the natural capsaicin agonist (chili) may have a therapeutic role for pain and burning symptoms in FGID and more research studies are needed to confirm this hypothesis. 

The effect of spicy food, which is frequently eaten in Asia, on the gastrointestinal symptom profiles in FGID at population level is not clearly known. Studies of GERD symptoms in Asian patients have reported a lower prevalence of heartburn compared to Western patients. A study of GERD symptoms in German patients who underwent 24-hour esophageal pH monitoring showed that both heartburn and acid regurgitation are the main typical GERD symptoms, whereas a similar study in an Asian country (Thailand) with a high prevalence of spicy food reported only acid regurgitation, but not heartburn, as the main GERD symptom (Fig. 1). Furthermore, epidemiologic studies in Asian countries, including China, Iran, and Thailand, demonstrated lower heartburn/regurgitation symptom prevalence ratios compared to Western or developed countries with a low prevalence of spicy food. However, the low heartburn/regurgitation symptom prevalence ratio was not observed in Korea. In Turkey, an European country with a high prevalence of spicy food, the prevalence of heartburn in the population is much lower than the prevalence of acid regurgitation (weekly heartburn vs. acid regurgitation: 10% vs. 15.6%, respectively).71 When the studies that reported the prevalence of annual regurgitation and heartburn symptoms were included, studies of the American population reported a heartburn/regurgitation prevalence ratio of 0.91-0.94, whereas studies in China reported a lower ratio of 0.34. There has been no study that directly compares GERD symptom profiles between Asian and Western peoples or patients in the area of high and low prevalence of chili in the diet. However, the collective results of the available studies imply that acid or gastric content regurgitation into the esophagus in people in certain regions of Asia is not perceived as heartburn symptoms by the esophagus in the same way that heartburn symptoms are perceived by Western people. The high prevalence of spicy food may play a role in this finding, but this hypothesis has not been proven. The low prevalence of heartburn symptoms is not likely to be a misinterpretation of acid reflux symptoms in Thai people because acid perfusion tests produce no symptoms in most Thai GERD patients (GI Motility Research Unit, Chulalongkorn University, Thailand, un-published data). However, the heartburn/regurgitation symptom prevalence ratio is not lower in Mexico, where the prevalence of spicy food is high. This inconsistency suggests that not only spicy food, but also other factors, may influence the sensitivity of esophagus to gastro-esophageal reflux contents at the population level.   

In summary, capsaicin or TRPV1 receptors are involved in the pathogenesis of burning and pain symptoms of the gastrointestinal tract. Recent small studies suggest that the chronic use of capsaicin-containing chili can decrease heartburn and abdominal pain in GERD and dyspepsia, respectively. In addition, the ratio of the prevalence of heartburn/regurgitation symptoms in the population is lower in several parts of Asia; this lower rate may be related to the high prevalence of chili or spicy food. 

Conclusion 

Rice seems to be the most preferable source of carbohydrate in patients with FGID. It has a low allergenicity and fiber content; it is also completely absorbed in the small bowel and produces little gas after ingestion. Therefore, it should be advocated as a major source of carbohydrate for patients with IBS and those with other functional GI disorders. 

There has been increasing evidence to support the role of capsaicin receptors in the pathogenesis of symptoms of FGID. Preliminary studies support the role of desensitization of capsaicin receptors by chili, a natural capsaicin receptor agonist, for the treatment of functional dyspepsia and NERD. However, more research studies are needed to confirm this hypothesis. 

Footnotes 

Financial support: This review was supported by the Ratchadapisek Sompotch Endowment Fund (GI Motility Research Unit grant). Conflicts of interest: None. 

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66. Chen M, Xiong L, Chen H, Xu A, He L, Hu P. Prevalence, risk factors and impact of gastroesophageal reflux disease symptoms: a population-based study in South China. Scand J Gastroenterol. 2005;40:759–767. [PubMed] 

67. Eslick GD, Talley NJ. Gastroesophageal reflux disease (GERD): risk factors, and impact on quality of life-a population-based study. J Clin Gastroenterol. 2009;43:111–117. [PubMed] 

68. Locke GR, 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ., 3rd Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology. 1997;112:1448–1456. [PubMed]

69. Locke GR, 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ., 3rd Risk factors associated with symptoms of gastroesophageal reflux. Am J Med. 1999;106:642–649. [PubMed] 

70. Yang SY, Lee OY, Bak YT, et al. Prevalence of gastroesophageal reflux disease symptoms and uninvestigated dyspepsia in Korea: a population-based study. Dig Dis Sci. 2008;53:188–193. [PubMed] 

71. Kitapçioğlu G, Mandiracioğlu A, Caymaz Bor C, Bor S. Overlap of symptoms of dyspepsia and gastroesophageal reflux in the community. Turk J Gastroenterol. 2007;18:14–19. [PubMed]

Source: J Neurogastroenterol Motil. 2010 April; 16(2): 131-138. Published online 2010 April 27. doi: 10.5056/jnm.2010.16.2.131. By, Sutep Gonlachanvit MD.

Tags:  food and drink  gastrointestinal disease 

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Low Testosterone Linked to Heart Disease

Posted By Administration, Thursday, March 25, 2010
Updated: Friday, April 18, 2014

3227286803_3cbf819f60_m Low levels of testosterone have been associated with increased body weight, insulin resistance (a precursor to diabetes and a risk factor for heart disease), and poor cholesterol levels.  These metabolic factors ultimately lead to cardiovascular disease.   

A noteworthy overview of androgen deprivation therapy and its tight link to cardiovascular disease has been published in the journal Circulation.  In it, a group that included members of prominent heart, cancer and urological societies, issued a well-researched position stating that prostate cancer patients who are on androgen deprivation therapy (ADT) are at an elevated risk for getting heart disease.  

Evidence shows that when one’s androgen levels are lowered, a metabolic syndrome ensues.  This does not necessarily mean that patients should not be on ADT, but does pave the way to new screening strategies for metabolic syndrome for those on ADT.   

Most importantly, this brings to light, again, the negative effect that low testosterone has on insulin sensitivity and the heart.  Metabolic syndrome and cardiovascular disease can potentially be prevented via the optimization of testosterone levels.  

For males, it is important to understand what your “total” and “free” testosterone levels are, and to perform a thorough workup that focuses of deciphering the cause of why the levels are low (or high) in the first place.  Then, a treatment strategy should ensue.  This should focus on addressing the cause, first and foremost.  Thereafter, treating the cause is key.  

There are many options for patients with low testosterone.  Lifestyle changes should ensue as they are often significant contributors to low testosterone levels.  Supplements and/or medication that can boost testosterone levels can also be judiciously utilized.  There are also supplements and medications that can work on preventing the aromatization of testosterone (conversion of testosterone into estrogen in fatty tissue).  Those patients on intentional ADT in the setting of prostate cancer cannot be on androgen replacement therapy.   

- Zina Kroner, DO
 

Tags:  heart disease  testosterone 

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Have We Abandoned Our Children to Toxins?

Posted By Administration, Friday, March 19, 2010
Updated: Friday, April 18, 2014

Many of us are aware of the recent Centers for Disease Control (CDC) report indicating that 1 in every 110 children has some form of autism. Fewer know the work of Dr. Philip Landrigan, of Mt. Sinai Medical School, who was quoted in a February 25, 2010, New York Times editorial by Nicholas Kristof: "Do Toxins Cause Autism?"  According to Landrigan, 1 in 6 American children is currently learning or behaviorally disabled. childwithmaskAnother excellent resource is the work of ACAM member, Dr. Kenneth Bock, chronicled in his recent book Healing the New Childhood Epidemics: Autism, ADHD, Asthma and Allergies The Groundbreaking Program for the 4-A Disorders.

As the following, recent news stories indicate, our nation’s children live in an environment that is increasingly toxic:

  • Studies show danger of even small amounts of lead in children's blood
  • Dust bunnies tainted with toxins? Household dust consists of a potpourri that can include lead, arsenic, and other potentially harmful substances
  • Phthalates (plastics softeners used in children's products) predispose mice to allergies

Add to these the fact that our children are exposed to more vaccinations than ever before. In 1985, children were vaccinated for seven diseases; that number has swelled to 16. And vaccinations are grouped together solely to make children more likely to get them, even though the risks increase to an unknown degree.

Parents deserve to know that vaccines are neither 100 percent effective nor 100 percent safe. A 16-year old girl lost her vision following vaccination against the HPV virus. Do we have to wait until most children are autistic or otherwise damaged before we try to do something about this situation?

Published March 16, 2010 at ANH-USA.org. Have We Abandoned Our Children to Toxins?

Tags:  toxins 

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Aging Gracefully Now

Posted By Administration, Thursday, March 18, 2010
Updated: Friday, April 18, 2014

4016109413_10fc490c33_m Aging in the West conjures up images of people in nursing homes, unable to enjoy the few remaining years in their lives and totally dependent on other people for some of the basic things in life such as eating or bathing themselves. Who wants to have a long life if this would be the eventual outcome for anyone? How many people live independently and abundantly into their senior years? How can someone make sure that they could enjoy their lives free from chronic disease or infirmities?

That’s where the concept of holistic preventive care comes in. Preventive care unfortunately, usually just involves early detection and screening in allopathic medicine. It’s the advice given to women about annual Pap’s smears and mammograms or PSA testing for men at a certain age. There’s more to prevention however than getting yearly tests. Prevention should be done on a daily basis by taking care of the body’s needs, primarily through clean food, water and air. Then, there are also important things such as sleep, exercise, stress reduction, detoxification and intake of nutritional supplements.

Our health is very closely related to that of the health of our environment. Just as clean air and water are necessary for the survival of the earth, they are also needed for our survival as a species.

There’s a concept called “internal milieu.” Dr. Louis Pasteur, on his deathbed, admitted that “the microbe is nothing, the terrain is everything.” What this means is that for instance, if several people were exposed to the same germ/pathogen, not everybody gets sick. Some people may be more resistant to illness because of genetics as well as other factors that influence their immune system (diet, presence of toxins.) If I may borrow one of my colleague’s analogies, “Our genes are like a loaded gun, our environment pulls the trigger.”

The major medical systems in the world, such as Chinese medicine, Tibetan medicine and Ayurveda, all emphasize the important role that food plays in prevention of illness as well as influencing the course of illness. Unfortunately, this is not the case in other medical systems where people are told that they can eat anything after a certain diagnoses. Ever wonder why there are fast food joints that sell deep fried or highly refined foods at major medical centers?

Anyway, in more practical terms, what are the factors that could cause premature aging?

Among the different reasons behind aging there are hormonal imbalances, nutritional deficiencies, oxidative stress, chronic inflammation and toxicities. Just like doing maintenance work on our cars is imperative to make them work more efficiently, we need to do the same thing to our bodies. Let’s start with the basics. The food we give our bodies could be compared to the things we do to maintain our cars. Again, to borrow another analogy, carbohydrates could be compared to the fuel system, fats to the oil used to lubricate the car and protein to the actual skeleton/frame of the car. Neglect one of these and it could lead to eventual breakdown of our cars and in this case, our bodies.

Regarding food, I believe that everybody is different and therefore, have different food requirements. One of my mentors taught me that we in North America, actually don’t have a traditional diet unlike peoples from Asia, Africa or the Mediterranean. The Standard American Diet (SAD) of meat and potatoes in general doesn’t give us adequate nutrition to prevent illness. What I would recommend for one person may be different from what I recommend to another.

For instance, for Asians in general, a typical meal of fish with rice and vegetables should suffice. However, for a Caucasian, I may recommend food combining with protein and vegetables without any starches during a meal.

There are many diets available out there. These include the blood type diet, the South Beach diet, raw food diet, etc. In general, I would recommend eating organic foods. Having greater portions of vegetables and fruits in the diet and a limited amount of meat would work for most people. As far as meat is concerned, free-range chicken or grass-fed beef would be a better choice than regular chicken or beef.

Then, there’s concern about fish or seafood. The higher you go up on the food chain, the greater the chances of mercury toxicity. I would recommend smaller fish such as anchovies or sardines.

There’s the timing of meals that’s also equally important. I would recommend small, frequent meals rather than three “square meals a day.” Not eating after 6 pm ideally would be best, but if necessary, at least keeping it light at night would be advisable.

Nutrition is a very touchy subject because of the different recommendations you get from authorities. What I would recommend in general is to only eat when hungry and only eat as natural as possible. Any food adulterated by man (boxed cereal grains, “low-fat” TV dinners) could cause more problems long-term. Just a quick note, fat is what tells our satiety centers that we’re full. Thus, a low-fat meal won’t really curb someone’s appetite or help with weight loss.

- Joel Lopez, MD, CNS

Tags:  anti-aging 

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Integrated Medicine for Neurologic Disorders

Posted By Administration, Tuesday, March 9, 2010
Updated: Friday, April 18, 2014

Imgres Integrated Medicine for Neurologic Disorders is a book which addresses herbal and holistic medicine for brain health and neurological disorders such as Alzheimer’s Disease, Parkinson’s Disease, Multiple Sclerosis, Stroke, Migraine, and Seizures. This book can help patients and medical practitioners to integrate Western medicine with herbal and holistic medicine to reduce symptoms and slow disease progression.

Sheryl Shook, Ph.D., a physiology professor with a Ph.D. in neuroscience, co-authored the book with Dr. Sidney Kurn. They have combined their expertise to work in the community educating about improving health by integrating the benefits of mainstream medicine with the rich and valuable practices from many cultures that rely on plants, nutrition, and lifestyle for healing. 

“Keeping your body healthy is an expression of gratitude to the whole cosmos - the trees, the clouds, everything.” Thich Nhat Hanh 

As one of the oldest medical subspecialties, neurology has a long history of clinical observation and theoretical development. The extreme complexity and inaccessibility of the nervous system continues to challenge researchers, compared with the rapid, technological development of other specialties such as cardiology or nephrology. Until the last 20 years, even drug treatments were rather limited. Neurologists have witnessed a rapid growth in our pharmacopoeia, including drugs for disorders previously untreatable such as ALS and Alzheimer’s disease.

 Most exciting is the seminal breakthrough in seeing an underlying order involving a few abnormal processes that manifest variably as Parkinson’s disease in one patient, Alzheimer’s disease in another, and so on. Numerous articles report on studies revealing inflammation, excitotoxicity, oxidation, genetic predilection, nutrient deficiencies and environmental toxicity in the onset and development of neurologic disorders. Disorders as disparate as stroke and multiple sclerosis, share these underlying processes. The contribution of each process, the particular positive feedback loops, and particularly the genetic predilection appear to determine the particular disease in any one individual. Even the fields of neuroprotection and system theory, generally not part of mainstream neurology, are receiving attention with numerous articles in peer-reviewed journals (1). 

Unfortunately, despite these important developments in clinical neuroscience, patients continue to suffer the symptoms of neurologic illness. Our drugs are not as effective as we would like, illnesses continue to progress, and the chronicity of some diseases overwhelm our best efforts. As patients and clinicians, we are committed to being pragmatic, finding what works, even if usage is based on tradition without good double-blind, placebo-controlled trials. Large randomized trials are expensive, and for natural herbs and nutrients, do not necessarily lead to a patentable product. Numerous studies on supplements exist and appear regularly in peer-reviewed journals. Studies may not rise to the level of large randomized trials necessary for FDA approval. The absence of this type of evidence is not proof of lack of efficacy. In regards to toxicity, the long history of usage provides ample information, and new interactions are reported on a regular basis. The “gold standard” of clinical drug usage, the Physician’s Desk Reference (PDR), has its second addition on herbs and nutrients. The standard pharmacist’s reference on herbs, nutrients and their interactions has also been re-edited. These texts, plus innumerable Medline references help guide the judicious use of supplements in clinical practice, or, what I call, clinical supplementation.

 Integrated Neurology is the practice of neurology utilizing all appropriate measures to alleviate suffering in an individual patient with a neurologic disorder. This may involve drugs, herbs, nutrients, acupuncture and a large group of bodywork modalities. It is an “open system”, drawing information as needed from science, medicine and the more traditional healing arts. It is “evidence based”, from large randomized trials, millennial long traditional usage as well as anecdotal evidence. The principle of “do no harm”, applies to Integrated Neurology as it does to medicine in general. Even though herbs and nutrients are generally much less toxic than drugs, known side effects, toxicities and drug interactions exist and require careful consideration. Integratedneurology.net offers the reader an introduction to Integrated Neurology including basic principles, treatment suggestions, references and appropriate linkages. Feedback is welcome on the E-mail site. 

“The wisest mind has something yet to learn.”  George Santayana 

          - Sidney Kurn, MD

References:

1. Albergina L and Colangelo AM The modular systems biology approach to investigate the control of apoptosis in Alzheimer’s disease neurodegeneration. BMC Neurosci. 2006 Oct 30;7 Suppl 1:82 (Epub ahead of print)

Tags:  integrative medicine  neurology 

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Soy and Fertility in Men

Posted By Administration, Thursday, March 4, 2010
Updated: Friday, April 18, 2014

There is so much controversy about the effect of soy foods on men’s fertility.  With each study that is released, a news article follows declaring it to be either safe or harmful for men’s fertility.   I would like to go through some of the studies in this area and review the significance of them before drawing a conclusion based on the current evidence.  Soy is well-known for its health benefits for men, including the reduction of risk for both cardiovascular disease and prostate cancer.  Due to these benefits, it has become a larger part of the North American diet than it ever has been in the past so it is important to fully understand its impact on hormones and fertility.

Effects of Soy on Infants and During Pregnancy on Adult Male Fertility

The following studies investigate reproductive effects on men who were given soy products either through infant formula, or while their mothers were pregnant.  This is a very sensitive time of development for the reproductive organs, so much concern remains about the possibility of permanent negative effects.

Soy Formula in Infant Male Marmoset Monkeys causes no Adverse Effects
This study concluded that infant feeding with soy formula has no major adverse reproductive effects in male marmoset monkeys. Although it did not appear to affect fertility, soy infant formula did alter testis size and cell composition.

Again I would like to mention here that both rats and monkeys produce much higher levels of equol (an estrogen like substance which is much stronger than soy isoflavones) in their intestines than humans in general.  The equol is produced through fermentation of isoflavones by bacteria which reside in the intestine.  It’s hard to compare humans directly with rats or monkeys especially when it comes to estrogenic effects.  Studies investigating the effects of phytoestrogens on the fertility of different animal species have been very inconsistent. This indicates that soy has very species specific effects on fertility and highlights the need for more studies on humans before we can draw definitive conclusions.

Study on Vegetarian Mothers and Hypospadias in Infants
This famous study investigated the difference between vegetarian and omnivorous women and the likelihood of a condition known as hypospadias in their newborns.  Hypospadias is a condition (which is currently on the rise) where the urethral opening is in a lower position.  This study found that significantly more of the vegetarian mothers had babies with hypospadias.  As vegetarians have a greater exposure to phytoestrogens than do omnivores, the researchers concluded that phytoestrogens may have a negative effect on the developing male reproductive system. However, this study was not specific for soy, it only examined whether or not vegetarians tended to have more infants with hypospadias. Other factors cannot be excluded for example, vegetarians could be more likely to be deficient in other vitamins or nutrients such as B12, and could also be consuming a larger amount of estrogenic pesticide 
Soy Infant Formularesidue, and this study did not question participants about consumption of organic foods.   It was also found that the vegetarian mothers who did not take iron supplements had more infants with hypospadias.  In Japan, there are 1/10th the number of infants born with hypospadias as there are in North America and yet there is a much higher level of phytoestrogen consumption.  Therefore, this study is not fully conclusive that phytoestrogens are the cause of this developmental condition since there are too many unaccounted for variables.

Study on Soy Formula in Infants and Reproductive Outcome In Young Adulthood
This study on 811 men and women, who were fed either soy or cow milk formula as infants were assessed in young adulthood for their pubertal maturation, menstrual and reproductive history, height/weight, and current health.  It concluded that exposure to soy formula does not appear to lead to different general health or reproductive outcomes than exposure to cow milk formula in infancy. This study did not go into details asking about length of time to conceive. Also, no reproductive health markers were reported for male subjects with the exception of sexual maturation. Although men were questioned about pregnancy outcomes in partners the results were not reported.

In conclusion on the subject of male reproduction and feeding of infant soy formula, it appears that overall there may be a risk for some long-term reproductive developmental changes, however, the full effects of this are unknown and may not go so far as to cause fertility concerns.  However, as we know from so much current data, breast milk is a far superior nutrition method for infants, and avoids any of the risks that soy formula may hold.

Studies on Male Adult Animals

Phytoestrogenic Plant given to Adult Male Mice – Some Effects on Reproduction
A phytoestrogenic plant(pueraria mirifica) was given in two doses, one high and one low,  to a group of adult male mice. Neither treatment had effect on testicular weight, sperm count, LH, FSH or testosterone. However the high (100mg/kg) dose reduced the weight of epididymis, seminal vesicle and sperm motility.  There were no effects on fertility. This effect was seen to be reversible after the phytoestrogen was stopped. However, this plant, though it does contain some of the same components as soy, is not identical to soy.

Acute Exposure of Adult Male Rats to Dietary Phytoestrogens Causes Temporary Reduction in Fertility
This study found that lipid peroxidation damage of sperm was increased in rats fed a high phytoestrogen diet for 3 days.   No such changes were noted in low phytoestrogen group.  As in the previous study, this effect was temporary, with fertility returning to control levels by day 12. Rats who were fed the phytoestrogens for longer than 6 days did not show this reduction in fertility and in fact showed no change in any reproductive parameters.

Phytoestrogens cause no Negative Effects on Fertility of Rhesus Monkeys
In this study, phytoestrogens were given to rhesus monkeys at the age of puberty.  They had no adverse effects on the reproductive systems of male or females as evaluated by hormone concentrations.  Cardiovascular benefits were observed in the monkeys receiving the phytoestrogens.

Studies on Adult Men

Soy Products Related with Slightly Lower Testosterone and Lower Estradiol in Japanese MenMale Symbol

This study on Japanese men investigated the relationship between soy product intake and serum testosterone and estrogen concentrations.  The results found that blood levels of estradiol concentration were significantly lower with increased soy product intake, and blood estrone levels were not related to soy intake.  Testosterone levels were also lower with increased soy intake but this effect was so slight it did not reach significance in the study.  This study also concluded that this may be part of the reason soy reduces risk of prostate cancer in men.

Soymilk Given to Japanese Men Results in Lower Estrogen Concentrations

This  second study on Japanese men investigates the effects of drinking 400 mL daily soymilk on serum estrogen and testosterone concentrations.  In contrast to the previous study, the results of this study indicate that soymilk consumption is associated with lower levels of the estrone form of estrogen.  In this study there was no effect of soymilk on any of the other hormones measured including testosterone, estradiol, and sex hormone binding globulin.

These two studies indicate that soy can affect serum estrogen levels.  It is known from other research that estrogen is required for proper formation of sperm, but also, that elevated levels of estrogen can interfere with fertility (especially if testosterone to estrogen ratios are altered).  So, what we can say is that a good level of balance of estrogen is required for optimal male fertility, and the real question is, does soy interfere with the balance of estrogen enough to impact actual fertility parameters in males.  These two studies do not answer this question, so we need to look more to studies on soy consumption and the end result on adult male fertility.

Soy Food Intake Related to lower Sperm Concentration Among Men from an Infertility Clinic
This very well-known study took a group of men from a fertility clinic and evaluated the relationship between soy food intake and sperm quality and count.  It found that there was a relationship between the intake of soy foods and the reduction of sperm concentration.  72% of men in this study were either overweight, or obese according to their BMI levels.  The relationship was more pronounced in the men who had the highest sperm concentration and among overweight or obese men. Soy foods did not reduce sperm motility, sperm morphology, or ejaculate volume.  This suggests that because androgens are converted into estrogen in fatty tissue,  this may increase tissue sensitivity to phytoestrogens in those who have higher amounts of body fat.   This study did not consider that those who eat more soy could be exposed to more estrogenic pesticides (it did not ask about consumption of organic versus non organic soy).  It also did not account for the addition of soy in many foods that may not have been reported by the participants (such as soy based additives in baked goods, processed foods and so forth).  Therefore, although this study is quite interesting, it not conclusive.   
Couple preparing a healthy mealThis study does however,  make an important association between elevated body mass index, and effects of soy on fertility in men.

Healthy Adult Men of Normal BMI: Soy Isoflavones have No Negative Effect on Sperm Parameters

This new study from the University of Guelph which involved healthy adult men with a healthy body mass index investigated the effects of isoflavones on sperm parameters.  In this study, men were given a daily serving of soy isoflavones in low concentration, high concentration, and then isoflavone free milk protein isolate.  The different substrates were given for 57 days each separated by a 28 day ‘break period’.  The study showed no significant effect of soy isoflavones on sperm concentration, motility and morphology of the men.  This study adds to the evidence that soy has a much lesser effect on semen parameters in men of healthy body mass index.

Summary

In summary, more research needs to be done before we can have any conclusive answers about the impact of soy on male fertility.  There are many conflicting studies on this subject, which indicates we need to investigate further.  There are a few points though that we can learn from the current research which can probably be protective to male fertility, and also allow men to have some of the health benefits that soy foods can provide.

1)  Soy can have a temporary, acute effect on adult male reproductive parameters if taken in high quantities, especially if not normally included in the diet.  Therefore, it would not be a good idea to consume large amounts of soy directly around the time when your partner is ovulating.

2)  Soy appears to reduce sperm concentration in males who are overweight or obese, so if you are overweight, try to achieve a healthy BMI.  In cases where BMI is high, soy foods might not be the best staple for the diet while trying to conceive.

3)  It is probably likely that small amounts of organic soy have little negative effect on reproduction in males of healthy body mass index and can provide health benefits such as improvement of cardiovascular profiles, and reduction of risk for prostate cancer.  More research still needs to be done in order to truly understand the impact of soy fertility of healthy adult males.

- Fiona McCulloch, ND


References

Anthony et al. J Nutr. 1996 January; 126(1): 43–50. Soybean isoflavones improve cardiovascular risk factors without affecting the reproductive system of peripubertal rhesus monkeys.Beaton et al. Soy protein isolates of varying isoflavone content do not adversely affect semen quality in healthy young men. Fertility Sterility in press

 

Chavarro et al. Hum Reprod. 2008 November; 23(11): 2584–2590Soy food and isoflavone intake in relation to semen quality parameters among men from an infertility clinic

Eddy et al. Targeted disruption of the estrogen receptor gene in male mice causes alteration of spermatogenesis and infertility. Endocrinology 1996 137 4796 – 4805.

A Glover et al. Acute exposure of adult male rats to dietary phytoestrogens reduces fecundity and alters epididymal steroid hormone receptor expression. J Endocrinol. 2006

Hess RA. Estrogen in the adult male reproductive tract: a review. Reprod Biol Endocrinol 2003; 1: 52.

Jaroenporn S et al. Effects of pueraria mirifica, an herb containing phytoestrogens, on reproductive organs and fertility of adult male mice. Endocrine 30(1) August 2006.
Jay et al. Aromatase Inhibitors for Male Infertility. The Journal of Urology – February 2002 (Vol. 167, Issue 2, Part 1, Pages 624-629)

Karen et al. Infant feeding with soy formula milk: effects on puberty progression, reproductive function and testicular cell numbers in marmoset monkeys in adulthood. Hum. Reprod. 21: 896-904.

Nagata et al. Nutr Cancer. 2000; 36(1): 14–18. Inverse association of soy product intake with serum androgen and estrogen concentrations in Japanese men.

Nagata et al. Cancer Epidemiol Biomarkers Prev. 2001 March; 10(3): 179–184. Effect of soymilk consumption on serum estrogen and androgen concentrations in Japanese men.

North et al. A maternal vegetarian diet in pregnancy is associated with hypospadias. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood. BJU Int. 2000 January; 85(1): 107–113.

Rozman et al. NTP-CERHR Expert Panel Report on the Reproductive and Developmental Toxicity of Soy Formula. Birth Defects Res B Dev Reprod Toxicol. 2006 August; 77(4): 280–397.

Strom et al. Exposure to soy-based formula in infancy and endocrinological and reproductive outcomes in young adulthood. JAMA 2001 August 15; 286(7): 807–814.

 

Tags:  fertility  soy 

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My Path to Integrative Medicine

Posted By Administration, Monday, February 22, 2010
Updated: Friday, April 18, 2014

 

Get to know ACAM member Stuart H. Freedenfeld, MD, and his passion for Integrative Medicine in his essay, My Path to Integrative Medicine.

 

I was a rebellious youth, born in the forties and inspired by the awareness movements of the sixties. Having aspired to scientific research since my earliest memories, it was during my last year in college that I shifted focus and came to know that my passion was to devote my life to the healing profession. Having excelled in high school and college, I felt drawn to the more glorious pursuits of the surgical subspecialties especially neurosurgery. While working in the inner city free clinics, which are training centers where inexperienced doctors-in-training practice their new skills on the areas poor and uninsured, I realized that my inspiration came from the people that I served and not from the skills that I had to offer them. Family Practice seemed the only area where I could devote myself to the patient rather than the procedure.

After completing my residency in Family Practice, I entered private practice with Kirk Seaton, MD, who had been the director of the Phillips Barber Family Health Center where I had trained. Together we formed Stockton Family Practice. After only two years he decided to return to academic medicine. For the next four years I was the solo physician at SFP. I worked six days per week including two evenings and every Saturday. I was taking call and even delivering babies seven days per week, fifty-two weeks per year. I still get excited with the memories of delivering over 500 babies during my medical career and am thrilled to have been present at the beginnings of so many new families.

These were exhausting years. So when Sal D'Angio knocked on my office door saying he was just finishing his residency training and wondered if I would consider letting him join SFP, I was more than eager to learn about this new physician. He told me about his background and how he had also studied homeopathy, acupuncture and herbal medicine. It intrigued me as it was a far different medical experience than I had had.

Medical school is a place for learning, but it is also a place for conforming. My training had not expanded my horizons, rather it had narrowed my focus. Now this new doctor reinvigorated my passion for learning and my natural tendency to think outside the box. We established a collaborative relationship as we each learned what the other had to offer. But this was not easy for me. Sal understood and taught his skills in ethereal terms but I was a scientist at heart and needed to understand healing in biochemical terms. In a sense, my early studies in these "alternative" approaches were like studying poetry in a foreign language in which I had only limited knowledge. I could say the words but could not grasp the intricacies of meaning. I could see that alternative therapies worked but I could not relate to them in terms that made sense to me.

My great awakening occurred in 1989. Three of my patients in one year had very poor outcomes related to conventional treatments for their coronary artery disease. One 54 year old died during the angiogram study, another died immediately after his bypass surgery and the third, a 79 year old woman had successful bypass but suffered terribly for a year with various complications. None of these individuals had severe symptoms and none had immediately life threatening disease, but each one suffered from standard medical care. I felt obligated to learn more about alternatives. I had heard about chelation therapy for cardiovascular disease but had no personal experience so I went to a 5-day conference on chelation and other aspects of complimentary medicine sponsored by ACAM (The American College for Advancement in Medicine).

I was blown away. Not only was there science behind chelation, but I found myself at a conference taught by world leading scientists, discussing their own particular area of research. Until then, all medical conferences that I had attended were taught by doctors discussing pharmaceutical treatments and presenting the research that was bought and paid for by the pharmaceutical industry. This same industry was also paying their speaker fees. How refreshing to hear information from people who held my own passion for research and shared their knowledge for the sake of healing rather for the sake of selling. Suddenly hawthorn, coenzyme Q 10, L-carnitine and magnesium took on whole different perspectives.

I was so overwhelmed with this abundance of information that I literally could not sleep for the entire five days of this conference. The speakers spoke of alternative medicine and they spoke in my own language, the language of science.

That five-day conference was my epiphany, Since then I have never lost my enthusiasm for learning or my zeal for the healing arts. In the years since 1989 I have continued to pursue knowledge for the sake of my patients with a driving passion that still gives me exhausted evenings and sleepless weekends. I wonder at the universe of knowledge and am humbled by the vastness of the unknown. My enthusiasm comes from the needs of symbiotic fashion, I am nourished by those that I nurture. I learn from those that I teach. I am healed by those I attend.

For the past 15 years Stockton Family Practice has been devoted to integrating the finest aspects of healing arts from around the world and throughout time. Our goal is to be able to provide the safest and most effective approaches to health and healing for those that come to learn and be well. There is no retirement from this pursuit, only gratification. And so to all of you who give me strength, I say thank you.

Dr

Dr. Freedenfeld is the medical director of Stockton Family Practice. He received his Bachelor of Science Degree with Distinction from the University of Rochester in 1970 and received his Medical Degree, with honors, from the College of Medicine and Dentistry of New Jersey in 1975.

He has become recognized as one of the leading experts on the integration of multiple forms of healing. He offers consultation on the most complex and challenging problems of our day. His forte is in the areas of autism, chronic fatigue, chronic pain, allergy, autoimmune disease, colitis, cancer, heart and cardiovascular diseases, diabetes, detoxification, longevity and health maintenance. He believes there is a vast array of routes to health and healing, and teaches the integration of the routes most appropriate to the individual.

For more information on Dr. Freedenfeld or the Stockton Family Practice, please visit www.stocktonfp.com

 

 

 



Tags:  integrative medicine 

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Shivering

Posted By Administration, Tuesday, February 9, 2010
Updated: Friday, April 18, 2014

As many parts of the United States endure a winter chill, researchers at the University of California, Davis, researchers have published noteworthy findings in the current Journal of Nutrition. Their study suggests increasing the current recommended vitamin D intake by at least a factor of five (5). The new study states that in order to achieve vitamin D sufficiency (i.e., at least 75 nm/liter), someone of European ancestry needs 1,300 IU of vitamin D a day. People of African descent require 2,100-3,100 IU daily. Many experts consider that 25(OH)D levels less than 50 nmol/liter indicate vitamin D deficiency.

2096907196_1e72a36290 A pooled analysis published in the British Medical Journal found that the combination of vitamin D and calcium reduced fractures by 8 percent and hip fractures by 16 percent.

The call by Bill Faloon of Life Extension Foundation to test hospital patients for vitamin D status grows in importance as vitamin D deficiency is linked to the following:

  • osteopenia and osteoporosis
  • muscle weakness and chronic pain
  • fractures
  • common cancers
  • autoimmune diseases including type I diabetes
  • infectious disease
  • cardiovascular or heart diseases

Of those aged 50-70 enrolled in a Chinese study, 94 percent tested vitamin D deficient. Vitamin D deficiency is also now linked to metabolic syndrome or insulin resistance. Given the approximately 2,900 studies published to date and the growing awareness of vitamin D deficiency among those who live in the United States, why no public-health action?

From ANH-USA. Published on January 26, 2010.

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What's New in Regenerative Orthopaedics?

Posted By Administration, Monday, February 8, 2010
Updated: Friday, April 18, 2014

Platelet Rich Plasma (PRP)

Many people in this country are suffering needlessly from chronic pain. Whether it be back pain, neck pain, rotator cuff injuries, headaches, sports injuries, pain from automobile accidents, often patients will suffer for years with their pain. They search for causes, see numerous specialists, and occasionally have surgery, but still go on with pain. What could be wrong? Is it really in their head?

More often than not, the pain is not in their head (unless they have head and neck issues) but is caused by damage to the soft tissue of the joints such as ligament or tendon tissue. The ligaments and tendons of our body support nearly every joint, and also send the brain information of proprioception (the position of our body in space), and nociception (pain). If a ligament or tendon is damaged, it can cause both local pain and referred pain such as sciatica, or numbness down an arm, or into the head. The ligament and tendon damage is often not seen on MRI, CT scan, nor X-ray and needs to be found on a careful physical examination by a physician who is skilled in musculoskeletal injuries. Occasionally, ultrasound may be used to diagnose the problem.

Fortunately, we have a new method to make damaged ligaments and tendons heal - Platelet Rich Plasma (PRP). Our body has the ability to heal, and contains growth factors to regenerate damaged tissue. We have learned in recent years on how to harness that ability and concentrate it into a damaged area. With PRP, after a proper diagnosis has been established, a small amount of blood is extracted from the patient. The blood is then processed and the platelets and growth factors are extracted from the blood. Under appropriate guidance, it is directly and precisely injected into the damaged area. The injection will cause a scaffold to form around the damaged area, impregnated with growth factors, and will incite the healing response. After a series of treatments, the areas will heal, and the pain will end. Since PRP is regenerating joint damage, not just treating pain, the response will often be permanent, and normal activities can be resumed - then the patient can live happily ever after!!!

- Scott Greenberg, MD


Greenberg-61 Dr. Greenberg is a practicing physician at the Magaziner Center for Wellness and a long time member of ACAM. He specializes in natural approaches to family practice problems with a distinctive emphasis on nutrition, cancer, preventive medicine, anti-aging strategies and the use of  PRP and prolotherapy for pain management. Dr. Greenberg personally performs about 100 PRP treatments per month and 4000 prolotherapy treatments per year. For more information on the Magaziner Center for Wellness and PRP please visit: www.drmagaziner.com

Tags:  orthopaedics 

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Psychotherapy: What's Metaphyscial Got to Do With It?

Posted By Administration, Friday, February 5, 2010
Updated: Friday, April 18, 2014

ABSTRACT

Clinicians have a number of treatment options for dealing with the emotional ills of patients, including psychoeducation, psychotherapy, and pharmacotherapy. However, after years of experience in the clinical field, we have recognized that these treatment options may not be sufficient to adequately address the problems of some patients. We have found that adding a metaphysical/spiritual component may be helpful, particularly for those patients with histories of childhood trauma. In this edition of The Interface, we discuss four metaphysical techniques for facilitating patient healing—1) refocusing on the present, 2) reframing adversity, 3) practicing surrender, and 4) meditation. These approaches can be mutually integrated and compliment a psychological treatment in either the psychiatric or primary care setting, regardless of whether or not the patient has formal religious beliefs.

INTRODUCTION

In working with patients for more than 25 years, we have relied on the cornerstones of our psychiatric/family-medicine training for the treatment of psychiatric disorders—psychoeducation, psychotherapy, and psychopharmacology. We candidly acknowledge that these three therapeutic approaches have been invaluable in treating many patients with emotional difficulties. However, despite this cache of clinical interventions, a number of patients continue to emotionally struggle. Something in the overall treatment strategy appears to be missing. We have long noted that these struggling patients oftentimes have histories of childhood adversity. In our earnest endeavors to address this enigmatic deficit and to enhance patient care, we began to explore additional therapeutic options and found some possible answers in the metaphysical/spiritual literature. Collectively, these metaphysical techniques seem to offer a spiritual component to the treatment of emotionally complex patients.

While novel for some healthcare professionals, the addition of a spiritual component to the preceding three conventional therapeutic components was described long ago by Native Americans. These pioneers developed the medicine wheel and its four key areas-of-life emphasis: the intellectual (i.e., psychoeducation), the emotional (i.e., psychotherapy), the physical (i.e., pharmacotherapy), and the spiritual (i.e., the metaphysical). In this edition of The Interface, we discuss this fourth component—the metaphysical/spiritual—and describe four techniques from this literature that may offer additional therapeutic support to patients.

THE IMPORTANCE OF THE "NOW"

A number of contemporary metaphysical authors stress the importance of “living in the present.”17 They pragmatically emphasize that the present is the only experiential space in which we realistically can live. This perspective essentially requires one to relinquish, to some degree, compulsive preoccupations with the past and the future. Neither past nor future allows one to experience the only reality that an individual can ever actually experience, which is the present.

Without reasonable anchorage in the present, one is left with the vicissitudes of the past and future, which at times may be entrapping through compulsive preoccupation. Indeed, Eckhart Tolle describes these mental past/future machinations as being “trapped in time [with] the compulsion to live almost exclusively through memory and anticipation.”8 This metaphysical emphasis on the present does not exclude the necessity of healthy reflection and realistic future planning in one’s life, but rather confronts the ongoing churning of distressing past/future mental movies.

Living in the past. For many of our patients, it is reflexive to emotionally anchor in the past, especially for those with traumatic life histories. Childhood adversities, particularly sexual, emotional, and physical abuses as well as physical neglect and observing repetitive violence, tend to be powerful and influential psychological material upon which to obsess. At its extreme, in some tragic cases, repeated victimization in childhood (i.e., genuine victim status) morphs into an artificial “victim” identity in adulthood, replete with its chronic self-defeating behaviors and continual re-enactments of self-destructive relationships. Such extreme mind identification with the past effectively defeats the genuine unfolding of the individual’s true identity in the present, leaving him or her trapped in a monotonous and robotic life script. In the aftermath, ongoing preoccupation with the losses and abuses of the past, which distracts from the experience of the present, may unintentionally precipitate intensely negative feelings, which may lead to clinical depression in susceptible individuals.

Living in the future. Like the past, the future is also fertile ground for mind play in a variety of forms. One common example is excessive and/or neurotic planning to avert some imaginary disaster, which behaviorally reaches a crest in the phobic patient. Another common example is the excessive mental activity focused upon “getting somewhere”—i.e., achieving a highly desirable endpoint (e.g., completing an education, closing a business deal, achieving the prescribed retirement nest egg). Granted, it is necessary to do a reasonable degree of planning for the future, but compulsive rumination about the future may set the stage for impatiently waiting for an imaginary future life to unfold—all at the expense of being able to experience the reality of the present.

As a corollary, many people seem to over-value the outcome of an experience and the foreshadowed rewards or relief that it may bring, rather than “experiencing the experience.” In this regard, American culture including the media tends to play an active role in nurturing these mental preoccupations with the future. We are constantly bombarded with futuristic formulas for success. Children have to get into the right private schools. Particular clothes, make-ups, fragrances, bodies, neighborhoods, and cars will ultimately garner social success and happiness—once one has accumulated the extensive financial resources to afford them. Happiness awaits when one moves into the big house. The folly of these cultural myths may seem self-evident, but for young patients and those with poor or absent mentoring (i.e., patients with deficient parental mentoring, whom we so commonly encounter in those with histories of childhood adversity), this cultural dogma may function as the only life guidance for scripting “success.” On an emotional level, this excessive preoccupation with the future may unintentionally reinforce worry and tension, which may lead to clinical anxiety states in susceptible individuals.


Case example 1. Regina described the situation exactly as she had experienced it. “I just sat there…thinking to myself over and over that the flight was going to be cancelled. After sitting for an hour on the tarmac, they started pulling off the luggage because of weight requirements. Then, after another hour of sitting on the plane, they started pulling people off. I just knew that I would never make my connecting flight in Atlanta. I just knew it! I would have to stay in a hotel overnight in Atlanta and get into town the next day. I hate unnecessary overnights! Then, I would never make my business appointments. I wondered if I should call work and cancel my appointments.”

Therapist: “What happened?”

Regina replied, “The plane took off two and half hours late, but I made my connection.”

Case example 2. Ben was working very hard as a first-year resident in the internal medicine program. “I’m working 80 hours a week, studying all the time, and I don’t get to spend much time with my family, but it will all pay off when I finish. I’m going to have a great salary, nice house, club membership…you know…that’s all I think about…I’m really going to have made it!”

Living in the present. Granted, the metaphysical principle of staying present appears to be a very easy concept—stay in the present and avoid an excessive focus on the past (depressogenic) or the future (anxiogenic). However, putting this principle into actual spiritual practice can be a frank challenge.

At this juncture, we wish to emphasize that the importance of living in the present is hardly a new concept. Indeed, “being present” appears to have its early roots in Buddhism and is described in the Third Noble Truth. Likewise, living in the present is not a novel concept in psychiatry. Cognitive behavioral therapy attempts to curb futuristic thinking (e.g., the endless “what ifs”) as well as the self-imposed constraints that have consolidated through past experience (e.g., “yes, but…”) by confronting unhealthy cognitive patterns. However, the importance of routinely sensing and being aware of what time frame one mentally experiences appears to be relatively novel to the field of psychiatry.

How can the clinician approach the patient who demonstrates compulsive preoccupation with either the past or the future? The initial intervention would seem to be psychoeducation. We believe that patients need to understand and accept (intellectually and emotionally) that their automatic and unattended mental activities are contributing to their overall life dissatisfaction. After explaining the benefits of present-minded thinking to the patient, we suggest several techniques that seem to promote better anchoring in the present.

One initial technique is simply beginning to recognize and be aware of past/future compulsive thinking. “Watch your thinking, observe it, witness it.” This alone may begin to result in the disruption of compulsive patterns of thought. This exercise needs to be undertaken in a nonjudgmental manner (i.e., neutral self-observation) and continually practiced.

A second technique is the immediate cueing on the environment. This technique entails using the five senses to instantaneously experience the immediate environment. “I want you to see, touch, smell, and hear your world…in the moment.” This practice relates to the principle of “mindfulness” or simply being aware. This form of mindfulness practice may be particularly helpful in a number of clinical situations. For example, in an individual with binge eating disorder, the clinician may augment the patient’s experiential tasting through mindfulness practice. “I want you to really experience, savor, and fully taste your meal. Focus solely on the food…it’s texture, color, and taste. This means no distractions, eating slowly, and fully concentrating on your eating.”

Another time-honored technique is focused attention on one’s breathing. Breathing is obviously a physiological experience that is very much “in the moment.” “I want you to concentrate on your breathing, as you breathe in and out. Observe and experience each breath.” This can be undertaken in conjunction with meditation practice.

A final technique is having the patient examine the world through the eyes of a newborn baby. “I want you to see the world in its wholeness and not focus on its parts. See the forest, not the trees. See the world as if it were the very first time you had ever seen it. Like a baby might see it.”

Again, we wish to emphasize that the shift from past/future to present-minded thinking is far easier said than done. It seems to require a consistent and authentic desire to retool one’s thinking processes and ongoing frames of experience. Like any skill, present-mindedness requires continual practice, so we frame this technique to patients as a lifestyle change. At the same time, just as any skill, it becomes easier with practice and more automatic with time.

THE ADVERSITY PARADIGM

Adversity—it sounds onerous—hardship, misfortune, difficulties. No one is immune to life’s obstacles. Yet, a number of metaphysical authors emphasize that all things happen for a reason.2,6,9 For some individuals, this proposition may require the proverbial “leap of faith.” How could all things happen for a reason? Certainly, bad things don’t purposefully occur. Whether the position that all-things-happen-for-a-reason is causally valid or not, believing so may improve mental health functioning by facilitating the patient’s adaptation to adverse circumstances.

How does reframing adversity promote patient adaptation? First, we must illustrate the differences between perceiving adversity as a random event versus perceiving adversity as an event by design. If the patient perceives adversity as a random event, then a series of well-honed cognitions are likely to follow—such as “I got screwed,” “I’m a loser,” and “Why me?” These distressing cognitions naturally result in negative feelings, such as helplessness, demoralization, and a sense of victimization, and may culminate in the troubling behaviors of either acting out or internalizing. However, by accepting that all things happen for a reason, the patient is actively challenged around determining what is to be learned from this adverse experience. There is a shift from random victim to psychological explorer. As an example, perhaps an impulsive son (the adversity) is there to remind an impulsive father to keep on his spiritual path of growth and not get side-tracked in his own impulsive behaviors. Perhaps an emotionally vacant mother (the adversity) is there to reinforce to the daughter the importance of being a good mother to her children.

Usually it is possible to construct a positive interpretation of most adverse events. Of course, this approach does not exclude the validation of the patient’s pain and sense of loss with such events. However, helping the patient to refocus in this way seems to redirect them from “stuckness” toward more productive problem-solving and self-awareness. This approach consistently promotes the development of responding rather than reacting to adverse situations. But, again, this reframing requires a spiritual leap of faith—that all things are in ongoing order and that nothing is left to random design.

SURRENDER

Surrender is an emotionally charged concept in our culture. Yet, surrender is a word that has very different meanings when viewed from Western versus Eastern perspectives. From a Western perspective, surrender is associated with giving in, admitting defeat, submitting, or capitulating. The connotation is blatantly negative and implies weakness. However, in Eastern thought, surrender entails the relinquishing of unrealistic fantasies of controlling others or events. It is the active acceptance of what is. In other words, it reflects a positive mindset.

To be clear, surrender is not the equivalent of resignation. It is not the commonplace attitude of “whatever” that we so often encounter in adolescents. Surrender is about acknowledging one’s own internal resistance to a situation and relinquishing the belief that in resistance resides one’s strength. Surrender is an action that relates to truly and genuinely accepting what is. It is about not opposing the course of life. Perhaps another way to think about surrender is that it is simply and genuinely accepting one’s path at any given time, yet understanding that choice is always a part of that path.

As an example, this metaphysical concept is particularly useful in helping patients to deal with their seemingly unending comparisons with others. We all tend to look at others and compare ourselves. People around us may seem far more gifted or more fortunate than ourselves. By assessing ourselves in this way, however, we fall into a hazardous comparison trap. Realistically, there is always someone who is more accomplished, talented, attractive, well liked—we can rarely triumph. As a result, comparison tends to generate bad feelings about one’s self. At this juncture, the metaphysical intervention would entail encouraging the patient to accept his or her unique and personal current path as highly relevant and necessary to his or her overall life course, whatever that may be (i.e., surrender), while empowering him or her around active choices. From a pragmatic perspective, comparing one’s path with the paths of others is unproductive and redirects the patient away from his or her own individualized life course.

Case example 3. Danne, a female patient with an eating disorder (ED), commented, “I can’t believe this! Here I am in this ED unit, and these girls are all thinner than me, have more money, and are prettier! Why can’t I be like them?”

Therapist: “Danne, focusing on the other patients only distracts you from the work that you have to do. Everybody has a unique path in life. You cannot have their path and they cannot have your path. Each path is uniquely valid. I encourage you to accept the idea that your path, while distasteful to you, is your path. Stay focused on the inner and be careful about being caught up in the outer.”

As so eloquently summed up by Eckhart Tolle, “Surrender is the simple but profound wisdom of yielding rather than opposing the flow of life.”10 Indeed, opposing the flow of life is likely to precipitate profound negative emotional states.

MEDITATION

Meditation is a structured mind/body experience that seems to transcend the thinking mind by allowing one to enter into a heightened state of relaxation and awareness. The techniques for undertaking meditation are numerous, but most, if not all, entail a relaxed sitting position in a quiet place and begin with a focus on breathing. The focus on breathing promotes relaxation as well as a sense of presentness. Following focused breathing, meditation practices may diverge into a variety of different directions. For example, some practitioners meditate to heighten relaxation. Some initiate auto-suggestion, which may be particularly effective in this relaxed state. Others seek a different level of consciousness, sometimes referred to as a fourth dimension. Yet others use meditation to broach and focus upon major life questions, hoping that the heightened sense of clarity in this unique state will facilitate a response (i.e., an intuitive “knowingness”). Whatever the reason, meditation is a strongly espoused spiritual practice by the metaphysical community, and certainly our patients may potentially benefit from any of the preceding functions. We do not espouse a particular meditation technique, but underscore with the patient the following: 1) the potential value of meditation, 2) the importance of meditating in a calm environment in a relaxed position, 3) the initiation of this experience with paced and focused breathing, and 4) the use of simple words (a mantra) for promoting focus. After continued practice, the patient will find it easier to “calm the mind” and contain intrusive thoughts. Note that meditation may be undertaken as a practice for mindfulness and present-moment awareness.

MINDFULNESS

An interconnecting theme in the preceding metaphysical approaches is the practice of mindfulness. Mindfulness is simply being aware. This means being both internally and externally attuned, without the filters of judgment, the emotions, or the culture. Note that in each of the preceding techniques, there is an element of being present—i.e., being in a mindful and aware state. For example, dealing with adversity entails being mindful of the obstacle from the perspective of “here by design.” The technique of surrender requires one to experience and accept the nowness of the path. Finally, meditation and its attendant focus on breathing is clearly an exercise in mindfulness. Mindfulness seems to be the fabric that supports the metaphysical design in the presented techniques.

WHAT ABOUT RELIGION?

Religious beliefs are not, per se, a limitation to using any of the preceding metaphysical approaches. Nor is a religious orientation necessary to use them. However, religious belief may temper some interventions such that “by design” is easily interpretable as God determined. In addition, meditation may be translated as “prayer” or “spending time with God.”

CONCLUSION

The modern era has certainly provided clinicians with an invaluable array of psychotherapeutic tools to address the emotional difficulties experienced by patients. These tools include psychoeducation, psychotherapy, and psychopharmacology. Yet, for a number of patients, these approaches fall short of providing a satisfying resolution to their inner turmoil, particularly among those individuals with histories of childhood trauma. In our search to compliment these contemporary approaches to treatment, we have integrated a number of metaphysical/spiritual techniques that have the potential to offer comfort and peace to many patients. While we have only presented four specific techniques, there are others that can be gleaned from the recommended reading list in the sidebars. We are all pilgrims on this planet. We are all seeking inner harmony. Why not benefit from the centuries of wisdom that have preceded us?

From: Psychiatry (Edgmont). 2009 December; 6(12): 26–31. Randy A. Sansone, MD and Lori A. Sansone, MD.

CONTRIBUTOR INFORMATION

Randy A. Sansone, Dr. R. Sansone is a professor in the Departments of Psychiatry and Internal Medicine at Wright State University School of Medicine in Dayton, Ohio, and Director of Psychiatry Education at Kettering Medical Center in Kettering, Ohio;

Lori A. Sansone, Dr. L. Sansone is a family medicine physician (government service) and Medical Director of the Primary Care Clinic at Wright-Patterson Air Force Base. The views and opinions expressed in this column are those of the authors and do not reflect the official policy or the position of the United States Air Force, Department of Defense, or US government;

REFERENCES

1.Davis J. The Diamond Approach. Boston, MA: Shambala; 1999. p. 24.

2.Tolle E. Tolle E. Oneness With All Life. New York, NY: Penguin Group; 2008. The power of the present moment; pp. 21–35.

3.Almaas AH. The Unfolding Now. Boston, MA: Shambala; 2008.

4.Bodian S. Bodian S. Wake Up Now. New York, NY: McGraw Hill; 2008. The practice of presence; pp. 79–98.

5.Batchelor S. Batchelor S. Buddism Without Beliefs. New York, NY: Riverhead Books; 1997. Awareness; pp. 57–66.

6.Jacobson L. Journey into Now. La Selva Beach, CA: Conscious Living Publications; 2007.

7.Brown M. The Presence Process. New York, NY: Namaste Publishing; 2005.

8.Tolle E. Practicing the Power of Now. Novato, CA: New World Library; 1999. p. 31.

9.Richo D. The Five Things We Cannot Change. Boston, MA: Shambala; 2006. p. 27.

10.Tolle E. Practicing the Power of Now. Novato, CA: New World Library; 1999. p. 115.

 

Tags:  metaphysical  psychotherapy 

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Enzymes for Health

Posted By Administration, Thursday, January 28, 2010
Updated: Friday, April 18, 2014

 

 

2752472918_e2926279ea_mOne of the processes that first decline as we age is the production of digestive enzymes. That’s the reason why one of the most popular drugs in the 20-40 year old age group are the antacids or proton pump inhibitors. It usually presents itself as heart burn, indigestion or flatulence. This decline in enzyme production is part of normal aging but dietary and lifestyle influences could actually hasten its occurrence.

For instance, eating primarily cooked, devitalized food could make the process of digestion harder. Eating rapidly or on-the-go (like most busy people) can also affect the digestive process. The normal response to having dyspepsia is to give medications to suppress the symptoms. However, this approach sometimes doesn’t address issues  like Helicobacter pylori (or other pathogens that may affect digestion) or chronic elevation of cortisol from prolonged stress. If a person has a documented ulcer by endoscopic procedure, then it’s okay to give these proton-pump inhibitors for a certain period but to take these drugs indefinitely is not a good idea. These medications could actually deplete the body of nutrients such as vitamin B12, D, folic acid, calcium, iron, zinc and protein.

What are enzymes anyway? Enzymes are complex proteins that facilitate chemical reactions in the body. They’re found in digestive juices where they act upon food, breaking it down into simpler molecules that the body can use for energy. Enzymes could be either derived from plants or animals. Popular plant enzymes include bromelain and papain from pineapples and papaya, respectively. Animal enzymes are usually derived from porcine sources. They closely resemble human digestive enzymes. They’re more sensitive to pH changes. Thus, they need to be taken at least 30 minutes prior to meals.

- Dr. Joel Lopez

Tags:  enzyme 

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Thyroid and Fertility

Posted By Administration, Wednesday, January 20, 2010
Updated: Friday, April 18, 2014

Fiona 021e website size  Thyroid problems are extremely common, and because they can be asymptomatic, it can be difficult to know if a condition is present.  The thyroid is absolutely essential for healthy fertility.  Dysfunction can cause ovulatory disorders, menstrual irregularity, and recurrent miscarriage.  The thyroid gland is key to support ovarian function. If thyroid function is low, the eggs will not mature fully and, ovulation can be either delayed or prevented.  Surprisingly, 5-20 percent of women in their reproductive years have a thyroid condition.

Autoimmune thyroid disease is one major cause of many thyroid conditions. Women who test positive for thyroid antibodies will generally develop hypothyroidism at a rate of 20% per year.  Often times, when a fertility general health screening is done, the only test completed for the thyroid is TSH (Thyroid Stimulating Hormone).  TSH is a useful test to screen for hypo or hyperthyroidism, however it does not detect autoimmune conditions.  Autoimmune thyroid antibodies can be present with no symptoms of hypothyroidism at all.  In autoimmune thyroiditis, TSH levels are often normal so it is important to complete a full thyroid panel. This can determine if there is a risk of developing hypothyroidism which could threaten a pregnancy.  When a woman becomes pregnant, there are widespread hormonal changes in the body, including an increased demand for thyroid function. If autoimmune antibodies are present, this can trigger miscarriage due to inability of the thyroid to compensate normally for pregnancy. Many cases of recurrent miscarriage or premature birth are related to thyroid disease so this is a very important part of fertility screening in those who suffer from miscarriages. One of the protective functions of pregnancy is a decrease in immunity, so it is unlikely that a new flare up of Grave’s disease (an autoimmune disease which causes symptoms of hyperthyroidism and goitre) will occur during pregnancy, however often we see worsening of hypothyroidism.

Another condition which can be present in those with thyroid disease is primary ovarian failure.  This is caused by autoantibodies to the ovary and is associated with autoantibodies to the thyroid.  This condition, although not common, can be devastating for women.

In men, hypo- or hyper- thyroidism can cause poor development of sperm, so for all men with sperm quality concerns, the thyroid should be screened.   Although thyroid disease is more common in women, it can still happen for many men and go undetected.

Symptoms of Hypothyroidism:

fatigue, weakness, weight gain, dry skin or hair, feeling cold, constipation, irritability, depression, muscle cramps, menstrual irregularities.

Symptoms of Hyperthyroidism:

anxiety, feeling hot, insomnia, heart palpitations, weight loss, hunger, sweating, trembling

To optimize fertility the following lab testing for thyroid should be done.  Explanation of thyroid lab values and normal ranges are included.

TSH – Thyroid Stimulating Hormone.

This is a hormone released by the pituitary gland (in the brain) which stimulates the thyroid to release thyroid hormones.  It is controlled by feedback mechanisms, when thyroid hormone is low in the bloodstream, the pituitary gland will increase its output of TSH to stimulate more release of thyroid hormones.

Normal Levels :  0.4 – 4 mIU/L.   If levels are above 2, and especially if thyroid antibodies are present with signs and symptoms of hypothyroidism, this is suspect of “subclinical hypothyroidism” and may present risks for fertility.

Free T4 – Thyroxine.

A thyroid hormone produced by the thyroid gland.  This is the most abundant thyroid hormone in the body.  It is also the weaker of the thyroid hormones.  It represents 80% of the thyroid hormones in the body, and its major function is to be converted into the stronger T3 hormone.  This is a measure of the T4 which is not bound to carrier proteins.

Normal Levels:   8.5-15.2 pmol/L

Free T3 – Triiodothyronine.

A thyroid hormone produced from the conversion of T4 by enzymes.  This is a much stronger thyroid hormone and has powerful effects on the body’s metabolism.  It represents 20% of the total thyroid hormones in the body. The conversion of T4 into T3 can also be impaired, so this is important to investigate.  This is a measure of the T3 which is not bound to carrier proteins.

Normal Levels:  3.5 – 6.5 pmol/L

Reverse T3

When there is sufficient T3, the body will convert excess T4 into a compound known as reverse T3.  This compound is inactive, and serves to protect the body from excessive overstimulation by thyroid hormone. It can bind to receptors where T3 would normally bind, however it does not stimulate the receptor as T3 would. In some cases, the body may actually convert T4 excessively into reverse T3, which can result in metabolic abnormalities. This condition should be screened for whenever signs and symptoms (including low body temperature) are present in fertility patients.

Normal Levels:  200-300 pmol/L

Thyroid peroxidase antibodies

These are antibodies against an enzyme known as Thyroid Peroxidase.  Thyroid peroxidase is involved in the conversion of T4 to T3.  If antibodies exist, this can cause a conversion disorder which results in hypothyroidism.

Normal Levels: <35

Antithyroglobulin antibodies

These are antibodies directed against a protein known as Thyroglobulin.  Thyroglobulin is present in the thyroid gland and is essential for the production of thyroid hormones.  These antibodies can trigger destruction of the thyroid gland.

Normal Levels:  <20

Treatment for thyroid conditions can involve thyroid hormones, nutritional supplements, amino acids and herbal medicines, depending on which type of thyroid condition is present.  Naturopathic treatment for thyroid is often integrated with conventional thyroid medications when needed to optimize response for fertility concerns.

- Dr. Fiona McCulloch

Reference:  Mosby’s Manual of Diagnostic and Laboratory Tests

Tags:  Infertility  thyroid 

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Anti-Aging Medicine

Posted By Administration, Thursday, January 14, 2010
Updated: Friday, April 18, 2014

Images There is no question that the horizons of longevity have already been extended. This has come about largely through the efforts, not of doctors, but of plumbers. By this I mean that improvements in sanitation over the past few centuries have vastly reduced the incidence of infectious diseases that used to dispatch many individuals in the prime of life. The average life span of people during the Middle Ages in Europe was around 40 years. Today, it is around 75 years. According to Scientific American magazine, "the centenarian population grew by 160 percent in the U.S. during the 1980s. Many demographers predict that 20 million to 40 million people will be aged 85 or older in the year 2040, and 500,000 to four million will be centenarians in 2050. the economic burden of caring for people older than 85 could be vast, especially if a huge percentage of them need special care."

The concern, of course, is that while longevity has been extended, quality of life, by and large, has not. Far too many Americans are living well beyond the medieval life expectancy only to encounter decades of chronic pain, immobilization, mental deterioration, and prescription drug dependency.

The approach to life extension has been, until lately, one of targeting the major killer-diseases for eradication. Thus the search for hi-tech approaches to heart disease and cancer have dominated the arena of medical research, consuming billions annually. At first, this may seem a logical way of promoting longevity, but biostatisticians have pinpointed a remarkable fact: even as dramatic an innovation as a universally successful cancer cure would have a minimal impact on life span. Remarkably, eliminating cancer as a cause of death would extend the average longevity by a mere 2 years!

Evidently, the conclusion to be drawn is that it is not disease, but the aging process itself that is responsible for the death of most Americans. Yet the National Institutes of Health allocate to cancer research twenty times the amount of money that they allocate to anti-aging research. A re-balancing of national priorities is clearly in order.

Perhaps part of the problem is a lack of rational resolve. Policy-makers in this area lack a clear vision of what enhanced longevity might bring. Perhaps they fear that active promotion of anti-aging research might threaten the fabric of society by creating a huge elderly population, sustained only via expensive technological support, inundating Social Security and Medicare, and devastating pension programs. A vast army of disabled and senescent oldsters would prove an unacceptable burden to 21st Century America.

While partly justified, fears of this scenario may be exaggerated. First, our approach to longevity need not prioritize just numerical survival; it must also emphasize quality aging. Languishing for years on sophisticated life-support systems in the critical care unit of the hospital of the future just does not constitute acceptable life extension.

Secondly, the anti-aging movement, while embracing sophisticated high-tech innovations, aligns itself mostly with economical lifestyle modifications like diet, exercise, modest stress reduction, and the use of anti-aging "nutraceuticals." Drugs and hormone therapies are envisioned as low-cost interventions to forestall more costly medical and surgical catastrophes.

Finally, research suggests that, if critical barriers to longevity are removed, older individuals can remain healthy and unencumbered by serious debility well past ninety, until they naturally "drop off the end of the aging curve." There is evidence that the incidence of medically-costly and debilitating illness actually decreases once an individual surpasses certain key aging milestones. According to Thomas T. Perls, M.D., a geriatrician at Harvard: "People in their late nineties or older are often healthier and more robust than those 20 years younger. Traditional views of aging may need rethinking."

What actually is aging? Here, a distinction must be made between chronological and biological aging. A person's age in years correlates only roughly with the rate at which his or her bodily systems age. In the rare hereditary medical condition argyria, for example, aging is markedly accelerated, to the point where children afflicted with the disease take on the appearance of elderly dwarves.

Conversely, others seem to cheat Father Time by maintaining youthful appearance and vitality well into their mature years.

Consequently, anti-aging researchers have proposed a series of "biomarkers" to better delineate the aging process. A few of these appear below:

  • muscle mass

  • Muscle strength

  • Post-exercise time

  • Reflex speed

  • Joint mobility

  • Breathing capacity

  • Endurance

  • Short-term memory

  • Problem-solving skills

  • Balance

  • Liver function

  • Skin elasticity

  • Wound healing capability

  • Hormone levels

  • Sleep quality

  • Immune function

  • Cancer markers

  • Free radical defenses

  • Fat to lean ratio

  • Glucose/insulin tolerance

  • Lipid profile

  • Susceptibility to blood clots

No doubt, other biomarkers may merit inclusion in this list. The routine preventive physical exam of the future may derive more relevance from a biological age assessment based on such objective parameters. The technology is already here.


Several scientific theories attempt to explain the aging process, and provide insights into how we might retard it. Among the most popular is the Free Radical Theory of Aging, first promulgated by Denham Harmon. This concept has recently gained influence from an ingenious experiment comparing fruit flies with or without bioengineered adoptive antioxidant protection: the free radical-shielded flies lived up to 20% longer, and remained physically active far longer into old age. The implication for humans is that, via consumption of antioxidant-rich supplements or foods, aging can be delayed.

Indeed, lifestyle influences have been linked to a variety of disease processes that curtail longevity. Smoking, poor diet, excessive (but not moderate) alcohol consumption, illegal drug use, unsafe sex, reckless driving, exposure to environmental and occupational pollutants, and firearms hasten the demise of many Americans who should otherwise reach an advanced age. Therefore, a rational approach to life-extension is predicted on fundamental lifestyle intervention.

Another mechanism of aging is via a process called "protein cross-linking." A simple analogy is the way foods "brown" while baking: heat induces changes in protein structure called cross-links which render the food cooked. Similarly, in biological systems, the aging process results in a steady accumulation of dysfunctional cross-linked proteins, culminating in deterioration and death. Ingenious strategies are being investigated which slow the cross-linking cascade.

Other theories hold that human aging results from fundamental changes in immune function. Immune surveillance declines with age, resulting in greater susceptibility to cancer, infectious disease, and auto-immune conditions. Administration of thymic extracts or specifically bioengineered monoclonal antibodies might help buttress a flagging immune function.

Maladaptive reactions to stress have also been shown to accelerate the aging process. They do so by increasing the production of catecholamines, stress hormones that include adrenaline, the well-known "fight-or-flight hormone." Elevated levels of catcholamines have been shown to impair immunity, promote high blood pressure, diabetes, and heart disease; as well as to impair memory, and worsen allergic diseases. Most individuals who survive into their 80s or 90s embody personal traits of resilience and stress-coping that have sheltered them from the adverse effects of rampaging catecholamines.

Evidence also suggests a role for hormones in the process of aging. Deft manipulation of estrogen, progesterone, testosterone, thyroid, growth hormone, and melatonin

 --all of which decline with age--may preserve certain aspects of youthful vigor. By contrast, levels of insulin tend to rise in response to dietary excess and sedentary lifestyle. The resultant "Syndrome x" is a major precipitant of premature disease.

It is also clear that certain aspects of aging are genetically programmed. For example, the presence of a gene called Apo-E4 predicts susceptibility to Alzheimer's Disease. Through the genetic engineering of the future, doctors may be able to selectively "edit out" deleterious genes, or modify the expression of genes already encoded. Specific growth factors may be available to "turn on" the mechanisms for organ repair, or "turn off" the harmful proliferation of tissue that occurs in certain degenerative diseases like arthritis, arteriosclerosis, or cancer.

"Smart drugs" are already available that crudely modulate levels of neurotransmitters in the brain. Among the most popular is Deprenyl, a prescription medication used to slow the progression of Parkinson's disease. It is held by some anti-aging researchers that Deprenyl and other drugs can be used to halt the decline in mental functioning that is the hallmark of aging. The advent of better "smart drugs" may provide a breakthrough in enhancing the quality of our later years.

Cosmetic aspects of rejuvenation deserve attention here, too. Conscientious application of improved techniques of dermatology and plastic surgery (always used in conduction with appropriate lifestyle modification,) can create a meaningful anti-aging "makeover." Newer less invasive techniques such as laser surgery and natural skin treatments now enhance the repertoire of longevity specialists.

Finally, high-tech advances such as exquisitely-modeled miniature micro-processor seeing and hearing devices may eventually reduce the debilitation now suffered by many of the aging. New techniques of locomotion utilizing robotics and virtual reality could eventually resuscitate failing motor skills. Remarkable progress in organ transplantation and artificial organ technology may also ultimately transform the search for longevity.

Nevertheless, the zeal for life extension must be tempered with a healthy recognition of our ultimate limitations. We live in a dazzlingly youth-oriented culture which places a premium on beauty, fitness, hedonistic indulgence, and sexuality. We need to acknowledge the importance of maturity, even debility, illness, pain and death. Our efforts to extend life and to improve the quality of our newly-attained longevity must be tempered with respect for our humble biological origins, and the spiritual connectedness our lives embody.

- Dr. Ronald Hoffman

Tags:  anti-aging 

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Interested in Detoxing?

Posted By Administration, Monday, January 4, 2010
Updated: Friday, April 18, 2014

Images ACAM is excited about the upcoming release of ACAM member, Dr. Gerald Wootan's new book, Detox Diets for Dummies. 

This guide to making informed choices about cleansing your body and mind safely and conveniently will be released on March 1, and is currently available for pre-order on amazon.com.

The book discusses how our bodies accumulate toxins from everyday exposure to different chemicals and the ways we can rid them from our systems. A screening quiz is also included to help decipher which plan is most suitable for each individual.

Detox Diets For Dummies also discusses chelation therapy, which detox programs cause more harm than good, plans for quitting smoking and drinking, fighting allergies, losing weight, calming stress and anxiety, increasing your energy, and revitalizing your spirit, as well as over 35 recipes for safe cleansing of toxins and other harmful agents.

Whether you are motivated by weight loss, disease prevention, metal purification, or physical revival-Read Detox Diets For Dummies for a variety of detox programs that are all natural and fit every lifestyle. 

Check ACAM's IM Blog often for more exciting news from ACAM members.       

Tags:  detoxification 

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Case Studies on Mesothelioma and Non-Traditional Therapies

Posted By Administration, Saturday, January 2, 2010
Updated: Friday, April 18, 2014

Patients who have been diagnosed with mesothelioma—an unusual cancer which is associated with asbestos exposure—have been particularly receptive to trying alternative and complementary therapies. One of the reasons for their willingness to look outside of conventional medicine for treatment is the fact that mesothelioma, generally an incurable cancer which is often diagnosed in advanced stages, usually renders traditional therapies ineffective. Other patients pursue an integrative approach, using holistic methods to ameliorate the side effects of chemotherapy and/or radiation.

Although mesothelioma is considered a fatal cancer, there is one man who has become something of a legend due to how long he has lived with the disease. Paul Kraus was diagnosed with the rare subtype peritoneal mesothelioma, which affects the lining of the abdominal cavity, in 1997. Now, thirteen years later, he is alive and well—against all odds, since fewer than 10 percent of all mesothelioma patients live more than two years after diagnosis. Kraus credits a radical lifestyle change, including an extremely healthful diet and a regimen of nutritional supplements, for his remarkable survival. He also meditated, visualized, received intravenous Vitamin C infusions, and underwent a treatment called ozone therapy, in which extra oxygen was added to his blood.

Soy-whey-protein-diet  After embracing the idea that our bodies are equipped with powerful capabilities for self-healing, if we can only tap into and support them, Kraus began juicing—beet juice, carrot juice, and various green juices. He drank fresh juice several times a day, supplementing his diet with high-fiber, vegetarian and mostly raw foods. Additionally, he exercised and began taking vitamins, minerals, homeopathic remedies and amino acids. Although admitting that these changes were extremely difficult, Kraus also knew that they were necessary for his survival and his overall health. Today, he is in his mid-sixties and doing well. In order to help others who may be facing a similar diagnosis and who wish to heal their cancer using holistic methods, he has written a book entitled “Surviving Mesothelioma and Other Cancers: A Patient's Guide.”

In a 2005 interview, Kraus summed up his philosophy. “The mind-body connection is very important for healing. They are inextricably linked. If one has the wrong attitude one cannot be a survivor of mesothelioma or any form of cancer.”

Another odds-defying survival story is that of Marie Augustine, a Canadian woman who was diagnosed with malignant pleural mesothelioma three years ago. Augustine was given only six months to live, but  she was determined to attend her 50th wedding anniversary, which was seven months away. Too weak to be a good candidate for either radiation or chemo, Augustine decided to look at alternatives. She worked with a practitioner of Traditional Chinese Medicine and tried other holistic treatments, with varying results. Then she stumbled upon pawpaw, a tree whose fruit and bark have been shown in laboratory tests to have potent anticancer effects. Pawpaw has been studied at Purdue University, and although there are as yet no published studies on its efficacy for mesothelioma patients, this is a treatment that bears watching.

Augustine calls her experience with pawpaw “miraculous.” Within a month of taking pawpaw capsules,Pawpaw-fruit   she noticed a difference in her energy level and endurance. Once nearly bedridden, and unable to venture outside of her house, Augustine is now able to take walks around the neighborhood, to drive, and to attend community events.

The memoir “They Said Months, I Chose Years: A Mesothelioma Survivor's Story” chronicles the courageous fight of another mesothelioma survivor, James “Rhio” O'Connor against this deadly cancer. Diagnosed in 2001 with mesothelioma and given less than a year to live, O'Connor went on to survive for over seven years, astounding his family and the medical community. Like Kraus, O'Connor established for himself a nutritional regimen consisting of over 100 supplements per day and changed his eating habits. On his website, O'Connor quotes Hippocrates, whose belief in the practice of mind-body medicine is summed up by the expression, “Let food be thy medicine and medicine be thy food.”

The conviction that nutrition, supplements such as minerals, vitamins, enzymes, and amino acids can actually help a patient overcome something as serious as cancer is often seen as a radical one, but O'Connor did his research, and his book cites almost one hundred medical articles that support this view. 

James “Rhio” O'Connor, whose oncologist encouraged him to take his wife on a cruise, then to return home and enter hospice care—in other words, to succumb to the mesothelioma and get ready to die—fought the traditional paradigm of treatment, and succeeded in his battle against cancer for over seven years. Yet he did not eschew traditional therapies, admitting that if chemotherapy could have effected a cure, he would have been the first to sign up. Indeed, it was probably the fact that his cancer was inoperable, due to the position of the tumor, that sent him to seek answers from alternative modalities in the first place.

O'Connor died on July 11, 2009, more than seven years later than anticipated, leaving behind a legacy that speaks to the success of integrative medicine, just as the lives of Marie Augustine and Paul Kraus continue to do.

Tags:  mesothelioma 

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Chelation

Posted By Administration, Thursday, November 19, 2009
Updated: Friday, April 18, 2014

Meetdr4_12_5 by Ronald Hoffman, MD       

The most common and toxic heavy metals that can poison our systems and lead to fatigue and illness are iron, lead, cadmium, and mercury. Iron is by far the most common of the heavy metals that predisposes individuals to heart disease. It promotes free radical activity and thereby leads to accelerated arterial damage. Lead and cadmium are common industrial pollutants that also foster free radical activity and poison critical enzymes which repair tissue. Mercury is found in some kinds of seafood and in dental fillings. Its toxicity can depress the immune system and cause an array of symptoms. Even too much iron, such as occurs in the hereditary disease hemochromatosis, can hasten degenerative disease and damage the heart, hastening free radical damage.

One of the most reliable approaches to determining heavy metal toxicity is to test a person with a chelator--a substance that tends to pull metals and minerals out of the body. You simply give the person two urine tests--one before chelation and one after chelation. If, between the two tests, metals in the urine increase dramatically, toxicity is almost certain. Chelation tests can detect lead toxicity in people who have stored high levels of lead in their bone, even though blood levels may be "safe."

Getting the iron, lead, cadmium, and mercury out can be accomplished with chelation therapy, which both prevents and can reverse heart disease, atherosclerosis, and the other problems mentioned above.

How does chelation therapy work? For most of these metals, an intravenous solution of vitamins, minerals, and the chelator EDTA is prepared. EDTA is a substance known for its ability to pull heavy metals out of the body. This is infused into the bloodstream through a vein. EDTA leaves the body in the same form by which it entered, but on its way out, it chelates metals and minerals from the body. Patients usually undergo between 10 and 20 chelation treatments over a period of weeks or months. Each treatment lasts several hours, during which patients can read or watch a movie.

I've seen patients with mysterious, low-level, chronic fatigue feel absolutely rejuvenated after a series of chelation treatments. The spring is back in their walk, the energy back in their lives. Circulation is improved, and the body no longer has to work overtime to carry its load of toxic metals.

Chelation therapy must be performed by an experienced practitioner. Because EDTA is excreted by the kidneys, the possibility of kidney damage is a concern and must be closely monitored. Minerals and nutrients may also bind with EDTA, so their levels must be carefully checked and controlled through supplementation. Chelation must be done slowly over a period of three to four hours. Too much fluid at too rapid a rate might cause an increase in blood volume and a fluid overload, which could be problematic, particularly in patients with serious heart disease. Oddly enough, the magnesium in the chelation bottle might cause the opposite--a drop in blood pressure. That's why all patients must be closely supervised.

To safeguard against possible problems, blood and urine tests are taken before chelation to check kidney function. Cardiac function is evaluated, through a stress test and a noninvasive heart test called an echocardiogram. After every few chelations, blood work is repeated. The patient is advised to eat a good meal before the treatment, and blood pressure is monitored before and after each infusion. To flush the kidneys, at least 16 ounces of water must be drunk during the treatment.

If high levels of mercury have been detected in the body's cells, two other chelating agents called DMSA (also known as succimer) and DMPS can help pull the mercury out. If mercury levels are high, either DMSA or DMPS can be used as chelators. Another chelator, which sometimes causes allergic side effects, is known as D-penicillamine (or Depen.) In addition, the following nutrients are known to chelate mercury in the body: the amino acid L-cysteine, the antioxidant glutathione, the mineral selenium, and vitamin C. Garlic is rich in the sulfhydryl groups that help chelate mercury. Selenium, in particular, competes with mercury for binding sites in the cell. The other nutrients grab on to mercury and help the cells release it.

Beyond its effects on heavy metals, chelation with EDTA also helps to remove inappropriate accumulations of calcium from tissue. Calcium gravitates to atherosclerotic plaque in blood vessels, leading to arterial narrowing and blockage. Chelation gently and gradually mobilizes calcium from plaque, restoring elasticity and flow to blood vessels.

While controversial (chelation for cardiovascular disease reversal has few adherents among orthodox cardiologists), several thousand physicians practice chelation throughout North America and the world.

Tags:  chelation therapy 

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Zinc and Copper Levels Are Key Factors in ADHD/ADD

Posted By Administration, Saturday, October 10, 2009
Updated: Friday, April 18, 2014

Research has found that many children and young adults with ADHD/ADD are deficient in zinc. Zinc is found in the brain's hippocampus and interacts with other chemicals to send messages to the sensory brain center, enhancing memory and thinking skills. It has a significant effect on visual memory, learning, emotional and behavioral state and overall cognitive function. A deficiency may result in learning impairments, poor memory and emotional and behavioral problems.

A study carried out on 135 males aged between 3 and 20 with a history of aggressive behavior found that many of the subjects were likely to have high levels of copper and low levels of zinc compared with non-aggressive people. Zinc and copper compete for absorption. Because of this inverse relationship, zinc supplements can be effective for lowering copper levels. Proper mineral balance is essential for the production of chemical signals in the brain that influence behavior. Both copper and zinc tend to be concentrated in the hippocampus of the brain, which is the area known to be associated with stress response.

Since it usually takes two to three months to overcome a copper-zinc imbalance, treatment with zinc supplements should be continued for a minimum of four months before determining effectiveness. Zinc deficiency can result from exposure to heavy metal toxins, such as cadmium (usually from exposure to cigarette smoke) and lead, which prevent its absorption. Poor dietary habits such as excessive consumption of sugar or carbohydrates are also known to reduce zinc absorption.

--
Doc Howard

Dr.  Julie Howard is CEO of The Howard Clark Corporation and founder/director of Youth Essential Solutions, Head Out Rehabilitation Camp, and Texas Preparatory Academy. For more information visit, http://docjhoward.com/. 

 

Tags:  ADD/ADHD  ADHD/ADD 

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Integrative Mesothelioma Treatment Modalities Emerging

Posted By Administration, Saturday, October 3, 2009
Updated: Friday, April 18, 2014

Mesothelioma is a rare but aggressive cancer that is almost exclusively linked to an exposure to theImages-2 building and insulating material, asbestos. During the course of manufacturing, installing, or break-down of asbestos-containing materials, a fine particulate – composed of microscopic and needle-like fibers – may be released into the surrounding air. After being inhaled or ingested, those fibers can embed themselves deep into the mesothelium, which is a membranous lining that protects the lungs, heart and stomach, and which also lines the thoracic and abdominal cavities. The fibers can cause irritation, lung scarring (asbestosis) and eventual malignancy, known as malignant mesothelioma.

One of the most unfortunate hallmarks of mesothelioma is the fact that it is often asymptomatic, remaining undiagnosed for an astonishing 20 to 50 years. By the time the cancer is diagnosed, it has usually reached Stage III or Stage IV, and is often not receptive to traditional treatment. Curative surgery is only feasible in Stage I mesothelioma, and such early detection is very rare. In later stages, surgery may be attempted to remove some of the cancer, usually in combination with radiation therapy and chemotherapy. Clinical studies have shown that a trimodal approach to mesothelioma treatment is generally most effective, but most patients still have a life expectancy of only 18 months after diagnosis. In later stages, many mesothelioma patients find that the benefits of palliative chemotherapy and radiotherapy do not outweigh the side effects and discomfort that accompany these treatments, and therefore opt not to pursue conventional methods of cancer treatment.

For these reasons, homeopathic and other alternative treatments have been proven popular with mesothelioma patients. Alternative approaches can be used as stand-alone treatments to reduce the pain and symptoms of the disease, or as complementary therapy intended to help ease the side effects of more conventional therapies.

Some of the most popular alternative therapies include massage, yoga, acupuncture and acupressure Images-3 (including reflexology), traditional Chinese medicine (TCM), use of select herbs as a nebulizer, nutritional regimens, supplements, meditation or hypnosis, and aromatherapy. TENS therapy, or transcutaneous electrical nerve stimulation, is also becoming popular. This therapy involves no drug interactions, is non-invasive, and has no known harmful side effects. In TENS therapy, pain relief is achieved by attaching electrodes to specific areas on the patient's skin and administering an electrical current. TENS is believed by some to stimulate the body's natural production of endorphins, which are analgesics.

Images-5 Acupuncture, similarly, is used to relieve pain, as well as to ameliorate some of the side effects,  including nausea, commonly experienced by patients undergoing chemotherapy and radiation. The same is true of meditation and hypnosis, which some patients claim can help them alleviate their pain. Other therapies, such as aromatherapy, massage and practicing the ancient exercise of yoga, help primarily by relaxing the patient and improving their overall mind-body wellness. Herbal treatments are gaining in popularity and efficacy as well, as they become better understood, and evidence is emerging that certain herbs, such as licorice root, American ginseng and oldenlandia can ameliorate advanced lung cancer symptoms. Nutritional approaches, such as supplements, herbal teas or tinctures, and a change in diet can help improve the patient's overall health as well as targeting both specific symptoms of mesothelioma and the side effects of its conventional treatments.

An increasing number of physicians and oncologists are recognizing the value of alternative therapies, and integrating them into the treatment plan. Each treatment program is individually tailored, in order to best address the individual patient's needs, symptoms, advancement of disease, and wishes. Integrative medicine, as the combination of traditional cancer treatments and more holistic approaches has come to be known, is considered by many health care professionals to be the best path to superlative patient care. Indeed, the incorporation of proven alternative therapies into a standard medical treatment regimen can yield more satisfying results for patients and their caregivers than can reliance upon conventional modalities alone, and it is likely that future preferred mesothelioma treatment methods will be integrative in nature.

Tags:  mesothelioma 

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The Vaccine-Autism Debate Revisited

Posted By Administration, Thursday, September 17, 2009
Updated: Friday, April 18, 2014

Picture of dr. pittman by John C. Pittman, MD

 

 

 

Back in February of this year, the Associated Press released an article titled “Officials say 'bad science' links vaccines, autism.”  The article, which was picked up by newspapers across the country, proclaimed that the U.S. Court of Claims had found little if any evidence to support a connection between vaccine use and autism risk, and that overall the evidence was evidence "weak, contradictory and unpersuasive."  The ruling was in response to some 5,500 claims filed by families who were seeking compensation through the government’s Vaccine Injury Compensation Program.

 

In 1998, considerable media attention in the United States and Europe followed the publication of a controversial report on autism in the esteemed medical journal, The Lancet.  In that report, British researchers documented the emergence of autistic behaviors and intestinal problems, which in several cases closely followed vaccination for measles, mumps and rubella (MMR). The study found measles virus antigens in the intestinal linings of many autistic children—antigens presumably linked with MMR vaccination.  The Lancet’s publication of this issue sparked a torrent of media attention because of the fact that Thimerosal, an antiseptic containing ethyl mercury, was being used as a preservative of vaccines distributed and administered worldwide. 

 

As documented in the 12 March 2009 issue of the American Journal of Perinatology, “There are studies that point to a significant link between exposure to TCVs [Thimerosal-containing vaccines] and neurodevelopmental delays.” Direct intramuscular injection of Thimerosal results in the rapid release of mercury into the blood stream, and this mercury can eventually accumulate in the tissues of the brain. In animal experiments, vaccination was shown to result in autistic symptoms.

 

Some evidence has begun to link Thimerosal-containing vaccines to the onset of autistic behaviors.  In 2001, researchers at the Institute of Medicine published an analysis of autism rates and mercury exposure and found an association between rising autism rates in California and mercury exposure in childhood vaccines.  This preliminary report, though heavily criticized at the time, was followed by a more rigorous report published in the August 2006 issue of Neuro Endocrinology Letters—a meta-analysis of autism and other neurodevelopmental disorders following vaccines administered in the United States from 1994 through 2000.  Pooling together data from many studies at once, the researchers found a statistically significant association between the development of autism and early exposure to Thimerosal-containing vaccines. 

 

Prior to the hubbub over vaccines and autism, there was a history of toxic effects associated with the use of Thimerosal in topical medicines, such as contact lens solution, eye drops, and other products. Indeed, it was due to this history of documented toxic effects that the Food and Drug Administration (FDA) eventually instituted restrictions on the use of Thimerosal in these medical products in the late 1990s.  And in 1999, the United States and the European Union countries took major steps to reduce and even eliminate Thimerosal from most vaccines.  Nevertheless, all U.S. pregnant women, infants, and children (until 18 years old) are still advised to receive an annual influenza vaccination, of which more than 90% still contain Thimerosal.  In addition, Thimerosal is still found in trace amounts in many vaccines on the market today, according to the FDA.

 

What worries many integrative physicians and environmental medicine experts is that any mercury at all—whether from vaccines, the diet, or from the silver fillings used in dental work—can be a threat to young brains, which undergo many changes in the early years. Mercury exposure begins in utero, being passed easily from the mother to fetus due to consumption of tuna and other fish, presence of amalgam dental fillings, and sometimes the use of mercury-containing vaccines like Rhogam.  Mercury exposure may then continue after birth through fish consumption, dental amalgams (especially with increasing age), and flu vaccines.  Both the fetal brain and infant brain are uniquely vulnerable to the effects of even small amounts of mercury, lead, and other neurotoxic factors.

 

Researchers reported in the October 2007 Journal of Toxicology and Environmental Health that individuals with severe Autistic Spectrum Disorders (ASDs) had significantly increased levels of various indicators of mercury exposure in their urine.  These indicators, called “porphyrins”, were much higher in people with severe ASDs compared to those with mild ASDs, whereas other urinary porphyrins—those not linked with mercury exposure—were similar in both groups. At the same time, the individuals with severe ASDs had much lower levels of glutathione, a core antioxidant in healthy cells that is inextricably linked to the body’s detoxifying capacity.

 

This last point offers us a vital piece to the autism puzzle:  Along with the unique developmental vulnerability of the young brain, autistic kids are far less able to process and eliminate mercury from their bodies, often due to having extremely low glutathione levels.  Many of these children have a genetic predisposition to low glutathione levels.  This means that, even with low-level exposure to mercury and other toxic metals, they may be far more vulnerable than other kids with normal glutathione levels.

 

At the Raleigh-based Carolina Center for Integrative Medicine, we see the best outcomes when glutathione, intestinal infections and other factors are addressed in a systematic way. The mother’s mercury burden from her diet and from dental amalgams may also contribute substantially to the higher mercury levels that are often seen in autistic children.  Ridding the body of mercury and other toxins is most likely to be therapeutically successful in the context of this more comprehensive approach.

 

 

Shifting the Focus to the Immune System

 

If there is an adverse impact of vaccinations, it probably has more to do with disrupting the functioning of the immune system and with "developmental immunotoxicity", as reviewed by Cornell immunologist Rodney Dietert in the October 2008 Journal of Toxicology and Environmental Health. Part B. These days, vaccination programs often entail more than 30 immunizations administered to the child between the ages of 12 and 24 months. This practice introduces a vast number of foreign proteins into the body—sometimes as three different attenuated viruses in one vaccine, as in the case of the MMR.  This raises the possibility that there may be insufficient time between vaccinations for the child’s immune system to return to a normal healthy baseline.  Side effects of these vaccinations have included allergic reactions, autoimmunity, and on some rare occasions, the full development of viral diseases (ostensibly from infections by the attenuated viral particles of the vaccine). 

 

It is possible that such inflammatory immune reactions to a multi-vaccine program could result in neurobehavioral changes that have been linked with autism and ASDs.  This is something we have heard repeatedly from parents who brought their autistic children into our Raleigh-based clinic, the Carolina Center for Integrative Medicine.  In some cases, we have been able to document the effects ourselves.  Even with contemporary vaccine programs (containing little or no Thimerosal), we still see children who are fine one day and then quit talking or behaving normally the day after they get vaccinated.  Some of these children will regress dramatically, so much so that the parents fear they are losing their children before their eyes.

 

So, the question remains: Are we overvaccinating our children?  According to an April 2009 article by Bernadine Healy, M.D.  in U.S. News & World Report, the United States “gives more vaccines to all its children, and earlier in life, than the rest of the developed world: some 36 doses before our little ones hit kindergarten, with most crammed into the first 18 months of life. If you look at the best-performing countries in terms of infant and early-childhood mortality, the average number of doses is 18, with most of the Scandinavian countries, Japan, and Israel mandating just 11 to 12.”

 

Does the simultaneous administration of multiple vaccines overwhelm the immune system and predispose some individuals to autism?  Epidemiological studies (which focus on populations, not individuals) have thus far been unable to show a significant link between autism and vaccinations.  However, epidemiology is a crude science in some respects, often leading to general conclusions that overlook individual differences or variations.  Large population studies may look impressive, but they may totally miss the small and specific subsets of the general population (such as those with glutathione deficiency) that may be at elevated risk of neurodevelopmental problems, possibly including developing autism subsequent to live virus vaccination.

 

Autism most likely arises from a complex interplay of genes, nutrients, and toxic factors, all affecting the individual during unique windows of developmental vulnerability.  Studies are now underway to examine the possible role of environmental risk factors and their interplay with genetic susceptibility during the prenatal, neonatal and early postnatal periods.  Let’s hope that some studies will compare groups of vaccinated and unvaccinated children by measuring individual effects on their immune systems while also taking into account their genetics, detoxification capacity (again, many autistic children lack the essential means to detoxify due to low glutathione levels), and exposure to toxic factors such as mercury and intestinal infections.

 

Until such studies are done, the jury is still out on whether we are overvaccinating our children and fueling the autism epidemic.  Multiple vaccinations could certainly play a role, especially given the many immune problems that have been found in autistic children.  On a precautionary basis, then, pediatricians should consider spacing out shots that are normally given in one visit—particularly those that contain live viruses like measles, mumps, and chicken pox and tend to deliver strong immune reactions.  Some Docs now advocate delaying hepatitis B vaccination until school age.  Helping our kids develop strong, healthy bodies and immune systems, and giving parents the tools to support such development, could prove extremely valuable.

 

 

 

To reach Dr. Pittman, or to obtain more information on his integrative pediatrics program, contact the Carolina Center for Integrative Medicine in Raleigh, NC at 919-571-4391, or visit the website at carolinacenter.com.

 

Tags:  autism  vaccine 

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Vitamin D3 and Curcumin for Brain Health

Posted By Administration, Wednesday, September 9, 2009
Updated: Friday, April 18, 2014

Brain-1 by Gina Nick, NMD, PhD

A new research study, published in theJournal of Alzheimer’s Disease, points to the combination of Vitamin D3 and curcumin (derived from the common spice turmeric) to protect the brain against beta amyloid deposits. Beta amlyoid deposits can build up to form plaque.  This plaque is associated with an increase in brain cell damage and a significant increase in Alzheimer’s disease, which affects over 13 million people worldwide.

The combination of Vitamin D3 and curcumin help boost the immune system to the point of neutralizing and/or preventing the formation of these amlyoid deposits. The deposits are caused by excessive free radical production in the brain.  Other well researched foods that help to neutralize free radical production in the brain are spinach and raspberries.   Unfortunately, they are also at the top of the list of foods that have a higher content of pesticides, which increase free radical production and DNA damage. I recommend consuming these foods if they are locally grown and organic.

There are several genetic forms of Alzheimer’s.  The research shows that while one form responds well to curcumin, the other form does not.  However, when you combine the curcumin with Vitamin D3, it supports the immune system’s ability to eliminate the beta amyloid deposits from two different mechanisms, so that it also impacts patients with the genetic form of Alzheimer’s that does not respond to curcumin alone.

I am always in awe of the medicines offered in nature that impact even the most troublesome of health challenges.

In health,

Dr. Gina

Tags:  curcumin  VitaminD3 

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Allergies: More Than Meets the Eye

Posted By Administration, Monday, August 24, 2009
Updated: Friday, April 18, 2014

by Jeffrey A. Morrison, M. D.

 

Allergy2pic The beginning of fall means more than just changing leaves and walks in the park to many allergy sufferers. This is the season that many people with known allergies begin to suffer the typical symptoms of itchy eyes, runny nose and sneezing due to inhaled allergies. However, food allergies are frequently a hidden and overlooked cause of these symptoms.
 
Studies in the medical journal, Lancet, show that some foods cause a wide spectrum of "non-typical" disabling symptoms in people who are sensitive to them. Unlike conventional reactions such as skin rash, the patient is usually unaware of the food to which he or she is sensitive. They may even be unaware that the symptom is due to food sensitivities, especially if the agent is a favorite food eaten on a daily basis in large quantities. The foods which are frequently implicated include wheat (78%), orange (65%), eggs (45%), milk (37%), and sugar (33%).
 
If you feel you may be suffering from food sensitivities that have previously gone undiagnosed, an excellent program to explore is "Dr Morrison's Detox Diet" where the foods that are mostly likely causing symptoms are completely eliminated from your diet for at least 10days and then re-introduced to determine which is the offending agent. A non-allergenic protein shake is used to facilitate the process.  If symptoms reoccur when the foods are reintroduced, that is a sure sign that sensitivities to the food are present.  For more information on the plan, please visit, www.dailybenefit.com.

Tags:  allergies 

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9 Silent Assailants Threatening Your Heart and How to Beat Them

Posted By Administration, Friday, August 21, 2009
Updated: Friday, April 18, 2014

Check out this new book: 9 Silent Assailants Threatening Your Heart and How to Beat Them.  The foreword was written by Frederic Vagnini, M.D., a noted doctor in the field of cardiovascular and metabolic diseases, author and host of The Heart Show on WOR, Sunday 4-5 PM.

This  book is written with the purpose of raising people’s awareness to being their own health advocate as well as finding a doctor who advocates prevention and supplements as a first line of defense against disease only using prescription drugs, when necessary.

Visit http://www.9silentassailants.com

 

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Tags:  heart 

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Osteoporotic Fractures Increase Risk of Dying by 300%

Posted By Administration, Thursday, August 6, 2009
Updated: Friday, April 18, 2014

By John Neustadt, ND

On August 4, 2009 the Canadian Medical Association Journal released results of the largest study to date on the risk dying after breaking a bone.1 They studied nearly 10,000 people across Canada over five years. Women and men 50 and older with osteoporosis who experienced a vertebral fracture were 270% more likely to die than those without fractures. And those with a hip fracture were 320% more likely to die. Additionally, the researchers observed that hip fractures "may have long-lasting effects that result in eventual death by signaling or actually inducing a progressive decline in health."

These findings add to at least six other studies that all confirm the same thing: breaking a hip or vertebrae increases your risk of dying.2,3,4,5,6,7

 

What can you do about it?

Falls are the number one reason for breaking a bone, and exercises, such as Qi Qong and Tai Chi, have been shown to decrease falls and fall-related injuries by up to 75%.8,9

While Fosamax, Actonel, Boniva can help reduce fractures, these medications only decrease fracture risk by less than 50%.
10,11,12And calcium supplements and vitamin D only decrease fractures by about 18%.13 However, 45 mg/day of MK4, a form of vitamin K2, plus calcium and vitamin D have been shown in numerous clinical trials to decrease fractures by more than 80%, independent of the number of falls. 14,15,16 In Japan, 45 mg MK4 (a form of vitamin K2) has been approved for the prevention and treatment of osteoporosis since 1995.

John Neustadt, ND is medical director of Montana Integrative Medicine and the co-founder, with Steve Pieczenik, MD, PhD, of Nutritional Biochemistry, Incorporated (NBI) and NBI Testing and Consulting Corp (NBITC). The doctors created Osteo-K, a dietary osteoporosis supplement formulated by physicians from Harvard, Cornell, MIT and Bastyr. For more information on osteoporosis supplements and decreasing your risk for osteoporosis and fractures, visit www.bonehealthproduct.com.Their latest book, Foundations and Applications of Medical Biochemistry in Clinical Practice, is available on Amazon.

 

Tags:  osteoporotic fractures 

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