Tuesday, January 20, 2009

Non Surgical Weight Loss Stays Off!

Recently in the International Journal of Obesity, it was shown people who lost weight through lifestyle changes were as likely to keep the weight off as those who receive weight loss surgery. Overall weight loss was around 123lbs in both groups. while both groups did gain weight over the first year they both maintained a weight loss of 30lbs over 5 years.

Further the study concluded those who lost weight with exercise and diet had a lower risk of depression and suicide than the surgery group. Suicide rates as published in the New England Journal of Medicine for surgical weight loss patients is 58% higher than in the normal population.

One of the biggest differences between the groups is the use of diet and exercise by the lifestyle group and the lack by the surgical group.

Sources:
International Journal of Obesity January 2009
New England Journal of Medicine August 2007
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Monday, January 19, 2009

Top Nine Natural Solutions For Insomnia

Insomnia hits a whopping 30% of the population. That gives you a 1:3 chance of having it in the next 12 months. Chances are you will try some herbal teas, meditation/prayer or more commonly a little alcohol before sleep.

If this doesn't work, you may join the other insomniacs and get a prescription for Ambien, Lunesta, or maybe a Benzodiazepine. While these medications may work in the beginning, they are not intended for long term use. They are extremely addictive, and they have some bizarre side effects like sleep living.

Sleep living is when you engage in normal daily activities such as driving, cooking a meal, shopping online and making interesting phone calls all while you are totally asleep. This is pretty dangerous behavior.

Natural alternatives often have better success treating insomnia than prescription medications. They also have significantly fewer side effects.

So here it is, my top 9 natural solutions for insomnia:
  1. Melatonin usually dosed at 3mg before bed has no common side effects. Down side: only works if you have melatonin deficiency. Up side: a lot of people are low in melatonin, and it is safe.
  2. Sleep apnea: a very common issue with insomnia- consider allergy elimination to lower the inflammation around the adenoids (lymph glands).
  3. Magnesium: 500mg or so before bed. One of my favorite nutrients on earth, magnesium is a natural relaxant.
  4. Passion flower: 4-8 grams in a tea is considered a safe herb for insomnia (avoid if you are pregnant as it relaxes smooth muscle)
  5. Hops: 0.5 grams in tea is the common dose. In addition to being sedative, hops also have some very mild hormone activity, so avoid if pregnant.
  6. Kava Kava is one of my favorites. From all the years I spent traveling around the Pacific I have come to appreciate this herb. For anxiety induced insomnia Kava is brilliant. Kava does have a dark side: when over consumed, or consumed by individuals with irregular liver metabolism, Kava can induce liver damage. While the risks are much less than using a prescription medication, it is worth having Naturopathic medical supervision when taking Kava.
  7. Valerian takes action on the GABA neurotransmitters. While the FDA considers Valerian to be a safe herb, it is important to have guidance when using herbs. All herbs can have a strong impact on drug metabolism. If you take prescription medications, please speak to your Naturopath to check for interactions
  8. 5 HTP is a direct precursor to serotonin. Serotonin becomes melatonin in the brain. If serotonin levels are very low there will be less melatonin. Serotonin is involved in mood. If you are taking any anti-depressants, do not take 5htp. Consult with your Naturopathic physician first.
  9. Blood glucose levels. Often, nocturnal low blood sugar causes insomnia. Maintaining proper blood sugar levels overnight is no easy thing. If you have any blood sugar issues such as hypoglycemia, or if you consume the standard American diet (rich in fast food), consider getting a blood glucose test done
This list is by no means exhaustive but it hits the major points. The take home is this: start with the simplest remedy with the least side effects, and only try kava or 5htp with supervision. And while I did place a few warnings here and there, these supplements are by no means as significant or as dangerous as their pharmaceutical counterparts.

Here is a list of my most commonly used nutrients and their brands:
Metabolic Maintenance Melatonin, 2 mg - 180 Capsules
Thorne Research Magnesium Citrate (140 mg) 90 Capsules
Kava Kava By Gaia Herbs [60 liquid-filled capsules]
Sound Sleep By Gaia Herbs [60 liquid-filled capsules]
Valerian Root By Gaia Herbs [60 liquid-filled capsules]
PassionFlower Vine Extract - Organic [4 Fluid Ounces] Gaia Herbs

Cited:
Textbook of Natural Medicine 3rd edition Pizzorno Murray
Treatment of Insomnia: An Alternative Approach Alternative Medicine Review v5n3 2000
Kava Kava Gift Of the Islands, Piscopo Alternative Medicine Review v2n5 1997
Kava Monograph Natural Medicine Comprehensive Database www.naturaldatabase.com
Hops Monograph Natural Medicine Comprehensive Database www.naturaldatabase.com
Valerian Monograph Natural Medicine Comprehensive Database www.naturaldatabase.com
Melatonin Monograph Natural Medicine Comprehensive Database www.naturaldatabase.com


Have you had success with any of these supplements? Feel free to comment below
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Monday, January 12, 2009

Ear Infections.

Otitis Media (OM) can be a source of stress in a family. Affecting 2/3 of children below the age of 5 OM is extremely common. Symptoms of OM include:
  • Headache,
  • Ear tugging in children
  • Earache
  • Itching or other discomfort in the ear or ear canal
  • Drainage from the ear
  • Hearing loss
  • Hearing phenomenon such as buzzing
  • Fever/chills
  • Irritability
  • Malaise(feeling of general illness)
  • Vomiting
  • Diarrhea
OM is when the inner ear becomes infected. It begins with the eustacian tube no longer equalizing the pressure between the inner ear and the outside world. At this point if the immune system is weak and the inner ear is colonized with pathogenic bacteria, the bacteria can spawn and cause infection.

Common treatment includes antibiotics, antihistamines and pain relievers. In more severe cases the use of surgical removal of the tonsils, or the implantation of tubes in the ear drum (Myringotomy) to allow drainage of the inner ear and normalization of pressure (possibly relieving pain). The use of myringotomy replacing the tonsillectomy as the treatment of choice.

Myringotomy is very common with over a million procedures done in a year. By way of contrast there around 600,000 tonsillectomies performed in a year in America. The success rate for improvement post surgery of symptoms is only around 50%. In addition to this The Journal of the American Medical Association in 1994 stated that myringotomy was appropriate in only 42% of all cases it reviewed.

This means that 58% of all myringotomies at the time of publication were unnecessary.

Currently the prescription of antibiotics is the treatment of choice for OM. This is in spite of a 1997 study published in the British Medicine Journal that recommended against the use of antibiotics in OM.
the study found:
  • Frequently OM is self limiting, and there is no proven benefit to the use of antibiotics in OM.
  • The use of antibiotics does not shorten the course of OM, it does not prevent re occurrence of OM and it does not lessen symptoms of OM.
  • While mastoiditis (infection of the mastoid- a section of bone behind the ear) is a concern, there is no evidence that the use of antibiotics prevents mastoid infection.
While we feel better using antibiotics in children with OM it is not always the correct treatment. There are times OM requires antibiotics, and I have written antibiotics in those cases. The use of antibiotics though, must be secondary to seeking the cause.

The cause:
90% of children with OM have some allergy, either to food or to the environment. This allergy causes inflammation of the eustacian tube, thereby closing it and causing the cascade as seen earlier. Elimination of the allergic reaction is the single best approach to OM.

Allergy to food often begins in the first year of life. Common causes include:
  1. If a child is weaned too early. Cited here
  2. When the mother consumes common allergens during breast feeding
  3. When a child is pre-maturely introduced to foods, especially common allergens
Common allergens from most to least common:
  • Cows milk
  • Wheat
  • Egg
  • Peanut
  • Soy
  • Corn
  • Tomato
  • Chicken
  • Apple
Allergy list cited here, and here.

Through the elimination of the most common allergens we see the best cure rates (around 90%)

If your child has chronic ear infections, it is worth your time to consult with a naturopathic doctor to review the possibility of food allergy as a possible cause.
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Osteoporosis

The risk factors for developing osteoporosis are largely genetic. If your mother had osteoporosis, chances are you will have issues with maintaining your bone density as well. Like many of the diseases I write about, the amount of people that suffer osteoporosis has been increasing over the years.

If your Mother had osteoporosis and your grandmother had osteopenia (mild bone loss) but your great grandmother was fine what does that mean?

It could mean we have better ways of detecting and diagnosing bone density. It could mean since we live longer there is a greater period of time for you to develop osteoporosis. Or it could be something a little closer to home, such as our lifestyle.

We know for a fact that bone density relies strongly on several factors.
  1. Increased intake of calcium and magnesium. Calcium provides the structure, while magnesium allows a certain amount of "give". This helps to make strong bones (calcium) that are not brittle (magnesium)
  2. Regular exercise including light weight lifting. 3 hours a week of exercise is shown to maintain bone density and in some cases reverse bone density loss.
  3. Minerals such as boron and silicon. Boron helps to activate vitamin D, and Silicon improves the cross linking of collagen allowing for a stronger bone matrix.
  4. Vitamin D to maintain bone density. Vitamin D assists in the absorption of calcium from the diet. it also promotes the storage of calcium in bone.
  5. A diet rich in alkaline foods, such as leafy greens. The higher our diet is in acidic foods, the more our body will spill calcium into the kidneys to be lost in urination. an alkaline diet promotes the maintenance of bone integrity.
Nutrition and exercise plays a massive role in bone density. Studies exploring the standard American diet (SAD) show that over 50% of Americans fail to eat even one serving of vegetables a day. Without the intake of the essential co-factors as listed above bone density is lost. While supplementing with nutrients and vitamins is very helpful it can not take the place of a healthy diet.

In my practice it is important to first restore health via diet, and exercise. once the corner stones are in place we can add in nutrients like a calcium magnesium supplement along with Vitamin D. Through lab work and dexa scans we can monitor bone density ans measure our success. and at the same time significantly improve health.


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Wednesday, January 7, 2009

The Role Of Vitamin D In Pain

According to a 2006 National Center for Health Statistics Report: 76.5 million Americans have some form of musculo-skeletal pain (statistics here). That is fully 1/4 of the population. The National Institute of Arthritis and Musculo-Skeletal and Skin Diseases advocates taking time off and over the counter pain relievers. (report here)

While this strategy is easy to follow it is not clinically effective. Treating musculo-skeletal pain in the clinic can be very frustrating. Common modalities used are electric stimulation to ease muscle spasm, acupuncture, spinal manipulation, topical creams and herbs such as turmeric and ginger to reduce inflammation. But the darling of any protocol involving musculo-skeletal pain is the ever underestimated Vitamin D.

We all think of Vitamin D as the nutrient added to milk to enhance bone growth in children and to prevent rickets. Often overlooked is the role Vitamin D plays in Cancer, diabetes, obesity, schizophrenia, autoimmune diseases and Most definitely musculo-skeletal pain.

Research shows the epidemic of Vitamin D deficiency is widespread with 40% of the population showing deficiency upon random blood testing. 76% of all pregnant mothers are severely vitamin D deficient. This may account for the increase in type 1 diabetes, multiple sclerosis and arthritis we see in the general population.(reported here)

in the December 2003 Mayo Clinic Proceedings, there was an interesting Study on the incidence of musculo-skeletal pain and low vitamin D. They found that 92% of patients complaining of musculo-skeletal pain had lowered vitamin D levels. And 100% of the patients with darker skin pigmentation had low Vitamin D. (here)

How is this possible? How does vitamin D deficiency cause pain? Published in the same edition of the journal of Mayo Clinic Proceedings, the means by which vitamin D causes pain is detailed (here):
  1. Low Vitamin D causes us to absorb less calcium from our diet
  2. The Parathyroid gland draws calcium from bone to maintain correct levels of blood calcium
  3. The Parathyroid gland increases the urinary loss of phosphorus.
  4. Without phosphorus the body makes an un-mineralized type of collagen to surround bone.
  5. Un-mineralized collagen swells when hydrated. This swelling presses against pain receptors in the joint causing the symptoms of musculo-skeletal pain.
The impact of vitamin D in my treatment of low back pain has been nothing short of amazing. Patients who tried everything from injection therapy to back surgery have had complete resolution of symptoms with vitamin D supplementation.

Is It Right For You?

Vitamin D is a Fat Soluble vitamin meaning it must be taken with caution. Overdosing vitamin D via sunlight exposure is impossible, but through oral supplements it is very possible and dangerous. In order to establish a correct diagnosis of low vitamin D I order a simple blood test. The test is covered by insurance and is very accurate. The test lets us plan on how long and how much Vitamin D would be effective.

If you feel you may have a vitamin D deficiency I strongly recommend you see your physician (preferably a Naturopath) and get tested. Vitamin D is inexpensive, and very available. One of the brands I prefer is Metabolic Maintenance. It is prescription grade and one of the best prices on the market-Metabolic Maintenance Vitamin D-3, 2000 IU - 120 Capsules
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Tuesday, January 6, 2009

You Are Eating A Colorie Restricted Diet and Still Cant Loose Weight

Diet is a critical component to good health. We all know "junk foods" reduce our wellness, raise our weight and have a significant impact on our long-term health. But what if it wasn't just junk food? What if it was something we thought of as being healthy?

A large part of the success I have in practice is the simple elimination of potentially allergenic foods from my patients diet. Thyroids begin to work, blood pressure medications are reduced, type 2 diabetes resolves.


Our immune system runs on protein. It looks for specific proteins that don't belong and reacts to them. Often the protein is thought of as being benign and a part of our diet.
Symptoms of a food sensitivity can be pretty significant:


* Autoimmune diseases of any kind, thyroid, diabetes myasthenia gravis, etc

* Respiratory symptoms like snoring, asthma, chronic cough and ear infection

* Neurological symptoms such as headaches, dizziness, depression and dementia

* Skin issues like acne, psoriasis, dandruff, eczema and rosacea

* Malabsorption symptoms like poor energy, chronic fatigue, difficulty concentrating, vitamin and mineral deficiency symptoms

* Metabolism problems like weight gain, weight loss, moodiness, chills, addictions

* Gastric symptoms such as Irritable bowel syndrome, diarrhea, constipation, indigestion, gastro esophageal reflux, ulcers
* Genital reproductive disorders include infertility, chronic miscarriage, genital thrush.



-

If food intolerance is not treated, and suppressed by over-the-counter (or worse- prescription) medications, specific diseases may occur, including:


* Atherosclerosis

* Bowel cancer

* Anemia

* Osteoporosis

* Celiac disease

* Chron's disease

* Multiple sclerosis

* Rheumatoid arthritis

* High blood pressure

* Graves disease

* Hashimoto's thyroiditis

* Sjogren's Syndrome


-And many others

How do you figure out if a food is causing you all this discomfort? Sometimes it is a simple act of looking at your diet and evaluating it for excessive amounts of any one kind of food. Once you pick the food out you eliminate it from your diet for 2 weeks. If you see symptoms disappear then you know you have solved the mystery.


When do you need a visit with me? When your symptoms are complex and you are unsure where to begin. I put together a customized hypoallergenic diet and set a time table for elimination and re-introduction.

The best part of doing this dietary protocol on my patients is the results and rate of cure. After we have found the food that is causing symptoms and removed it, the patient experiences an almost miraculous turn around in health.
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Folic Acid For Depression

According to the Journal of Affective Disorders, 1/3 of depressive patients have an outright Folic Acid deficiency. Folic Acid plays a role in the production of the neurotransmitters Dopamine, Seratonin, Epinephrine and Norepinephrine

Patients that have low success with common anti-depressants tend to have low blood levels of Folic Acid. The addition of Folic Acid to these patients tends to cause the anti-depressant to work or more commonly causes the patients symptoms of depression to fade.

Folic Acid when combined with pharmaceuticals is shown to reduce the depth and length of depressive states in major depressive disorder far more efficiently than pharmaceuticals alone.

Folic Acid deficiency is associated with diseases like: Neural Tube Defects, Cardiovascular Disease and Depression. While the advent of using pre-natal vitamins has lowered the incidents of Neural Tube Defects, the same cant be said for Depression and Cardiovascular Disease.

Folic Acid is found in leafy green vegetables, beans, legumes, citrus fruit, yeast and liver. With the Standard American Diet being so deficient in leafy green vegetables and nutrient dense foods, It is no wonder we have such a high percentage of the population experiencing Folic Acid deficiency induced diseases.
A common hurdle to eating leafy greens is knowing how to cook them

The current RDA for Folic Acid is around 400mcg (more for pregnancy and lactation). The therapeutic doses of Folic Acid for depression is much higher.

Should you take high levels of Folic acid? Not without a Doctors care and definitly not if you have a history of convulsions or are taking anti-convulsive medications. Knowing how much to dose depends upon symptoms, how much you have in your blood (can be found in a simple blood test) and most importantly the dose will depend on the kind of Folic Acid you are using.

The cost of Folic Acid as a supplement is relatively inexpensive, while the positive effect can be far reaching. If you have Depression or Dysthmia (low grade depression) consult with your Physician (preferably Naturopathic) on what dose and what form of Folic Acid would be to your benefit.
The version of Folic acid that has some of the best absorption and is supported in the research is Thorne Research 5-MTHF (5-Methyltetrahydrofolate) 60 Capsules
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