Sleep matters… for more than neurodegenerative disease

15 years ago I was involved in competitive martial arts, and competed nationally as part of a provincial BC team. The training often involved heavy sparring at mid-to-full contact. Nowadays I tend to dream about naturopathic medicine, but back then my dreams were definitely about martial arts.

In fact, in many of the dreams I found it interesting that I would “act out” one or two moves in the dream, and thus a punch would be accompanied by a very large muscle twitch that would wake me up.

I thus found this piece of news very interesting:

WASHINGTON, Dec. 25 (Xinhua) — People with a sleep disorder that causes them to kick or cry out during their sleep may be at greater risk of developing dementia or Parkinson’s disease, according to a study published in the Dec. 24 online issue of U.S. journal Neurology.

The sleep disorder is called REM sleep behavior disorder. People with the disorder do not have the normal lack of muscle tone that occurs during REM sleep, often known as the dream stage of sleep. Instead, they have excessive muscle activity such as punching, kicking, or crying out, essentially acting out their dreams.

The study involved 93 people with this type of sleep disorder who had no signs of a neurodegenerative disease, such as dementia or Parkinson’s disease. The participants were followed for an average of five years.

During that time, 26 of the people developed a neurodegenerative disease. Fourteen developed Parkinson’s disease,11 developed dementia and were diagnosed with either Alzheimer’s disease or Lewy body dementia. One person developed multiple system atrophy, a rare disorder that affects movement, blood pressure and other body functions.

The estimated five-year risk of developing a neurodegenerative disease was 18 percent, with the 10-year risk at 41 percent and the 12-year risk at 52 percent.

I have since stopped “acting out” any dreams, but the study still piques my curiousity. Sleep is vitally important to health. There are studies that link and associate poor sleep with chronic obstructive airway disease, kidney disease, cardiovascular disease, depression, diabetes, and of course fatigue, including chronic fatigue syndrome and fibromyalgia.

I did come across an interesting study in the journal Sleep Medicine Reviews 2007 that summarized a few interesting biochemical mechanism of how sleep deprivation –> weight gain –> diabetes.

Sleep and glucose tolerance

Sleep of less than 6-7 hours per night (depending on the study), caused a patient to be more likely to have a poor response to sugar (impaired glucose tolerance). Thus, chronic sleep deprivation would make a patient more likely to have higher levels of blood sugar after a carbohydrate meal, compared to a patient who had normal sleep and had the same meal. This alone is a risk factor for metabolic syndrome and diabetes.

Sleep and appetite

Leptin is a hormone secreted by fat cells and it promotes satiety, or a sensation of fullness. Interestingly, leptin has a daily rhythm and rises markedly during sleep. Chronic sleep deprivation may lead to a “deficiency” in leptin, and thus may contribute to excess calorie intake, eventually leading to weight gain. 7-7.7 hours seemed to be the length associated with healthiest body weight. The effect may be small, with someone only getting 2-4 hours a night being 2.35 times more likely to be obese compared to someone getting 7 hours a night.

Sleep loss contributes to weight gain through the effects of impairing sugar tolerance (diabetes risk), through increasing appetite, and probably by contributing to poor food choices and to decreased exercise.

Tips for helping sleep (from the University of Maryland)

• Fix a bedtime and an awakening time. Do not be one of those people who allows bedtime and awakening time to drift. The body “gets used” to falling asleep at a certain time, but only if this is relatively fixed. Even if you are retired or not working, this is an essential component of good sleeping habits.
• Avoid napping during the day. If you nap throughout the day, it is no wonder that you will not be able to sleep at night. The late afternoon for most people is a “sleepy time.” Many people will take a nap at that time. This is generally not a bad thing to do, provided you limit the nap to 30-45 minutes and can sleep well at night.
• Avoid alcohol 4-6 hours before bedtime. Many people believe that alcohol helps them sleep. While alcohol has an immediate sleep-inducing effect, a few hours later as the alcohol levels in your blood start to fall, there is a stimulant or wake-up effect.
• Avoid caffeine 4-6 hours before bedtime. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate, so be careful.
• Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime. These can affect your ability to stay asleep.
• Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep. Strenuous exercise within the 2 hours before bedtime, however, can decrease your ability to fall asleep.

Your Sleeping Environment

• Use comfortable bedding. Uncomfortable bedding can prevent good sleep. Evaluate whether or not this is a source of your problem, and make appropriate changes.
• Find a comfortable temperature setting for sleeping and keep the room well ventilated. If your bedroom is too cold or too hot, it can keep you awake. A cool (not cold) bedroom is often the most conducive to sleep.
• Block out all distracting noise, and eliminate as much light as possible.
• Reserve the bed for sleep and sex. Don’t use the bed as an office, workroom or recreation room. Let your body “know” that the bed is associated with sleeping.

Getting Ready For Bed

• Try a light snack before bed. Warm milk and foods high in the amino acid tryptophan, such as bananas, may help you to sleep.
• Practice relaxation techniques before bed. Relaxation techniques such as yoga, deep breathing and others may help relieve anxiety and reduce muscle tension.
• Don’t take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed. Some people find it useful to assign a “worry period” during the evening or late afternoon to deal with these issues.
• Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep.
• Get into your favorite sleeping position. If you don’t fall asleep within 15-30 minutes, get up, go into another room, and read until sleepy.

Related links:

Glucose tolerance and how the hormone insulin is VERY bad for you
Poor glucose tolerance can lead to non-alcoholic fatty liver disease
Treating poor glucose tolerance and diabetes with naturopathic and natural methods
Chronic fatigue syndrome natural treatment

www.pannaturopathic.com

Dealing with chronic fatigue

Perhaps the number one complaint that accompanies a patient into any doctors office is chronic fatigue. It is definitely not the only complaint, but it usually is most prominent amongst a list of symptoms. And it is very important, as it is difficult to have a good quality of life if there is no zest or energy to enjoy life.

I’ve written many times before on fatigue, but we need to keep in mind it is only a symptom. Any doctor will test to make sure that reasonably likely underlying diseases are not present, which may be causing the fatigue. Most commonly, we will think of oxygen delivery to the tissues. Thus, doctors will rule out any major heart problems; if the pump to move oxygen-rich blood is not working well, you will be tired. Doctors will rule out major lung problems; if there is not good oxygenation of the blood, the heart can pump all it wants but it is delivering nutrient-poor blood. Anemia will be checked for, as you need to have enough blood cells (and iron, B12 etc, for those blood cells) to carry oxygen in the blood. Finally, hypothyroidism (low thyroid function) is usually checked for, as this can be a relatively common cause of fatigue.

All the above comes back “normal” 90% of the time.

This is where a naturopathic doctor usually moves into the “functional” or naturopathic diagnostic work up. Common causes that are looked into include:

hypoglycemia: poor blood sugar control. These patients have to eat every 2-3 hours or else they will get anxiety, fatigue, and headaches. They find that even eating frequently can just barely control symptoms, and they often don’t feel 100%, and thus still speak of chronic fatigue. This is diagosed by a insulin-glucose tolerance test, where you come into the office fasting, insulin and blood sugar is measured, and then you are given a carbohydrate-rich beverage. Tests are run for 3-4 hours and symptoms are recorded so that we can confirm if fatigue, anxiety, or headaches are coming with certain peaks and troughs in insulin or sugar.

adrenal fatigue: this is not Addison’s disease, but rather a maladaption to chronic stress. Cortisol, a hormone from the adrenals, can either be too high (short term) or too low (chronic adaptation). This fatigue is worst on waking. The patient never wakes refreshed. There is a second wind that comes in the night just before bed, often contributing to insomnia. This patient feels “stressed and wired” all the time. I’ve written on this before here, here, and here. Testing is done through blood tests and a 4 point saliva test done throughout one day to assess hormonal rhythm.

hidden allergies: to foods, molds, or chemicals are very common. These patients feel worse after eating certain foods, but can’t seem to pin down which ones. Mold sensitive patients often have sinus problems, and are worse in warm, damp, moist environments. Chemically sensitive patients are worse around perfumes or smells from cleaners, and can get physically ill or have a severe headache. This is the realm of environmental medicine, allergy, and detoxification. Testing is done through skin testing and blood tests for antibodies against specific allergens.

chronic infections: including lyme disease, chronic fatigue syndrome. These patients are always fatigued, often have muscular pain coexisting, have poor exercise tolerance, and can have a host of related symptoms (such as dizziness, balance problems, brain fog). Testing is done through western blot for lyme, inflammation tests, and often a treatment trial.

Of course, there are many other components of working up fatigue from a naturopathic perspective, but the above are the most common that I see.

What if you are healthy and just a little stressed or tired? Should you wait until you have fatigue day in and day out?

That was a rhetorical question, but if fatigue is a recurring concern, a basic exam and workup should be done to rule out the conventional causes. Many of us are just a little too busy and have trouble dealing with a hectic schedule. Some of the tips below may be helpful:

Controlling stress and anxiety:

Having good hydration can decrease stress. Vitamin C and niacin (no flush form) can be useful. Breathing techniques, done when feeling slightly anxious, as described below can be done.

Starting with 2 slow, deep breaths, a deep inhalation, and then going through the rapid exhalations to a count of 20 is excellent, followed by another 2 slow, deep breaths. This can be done twice a day.

Adding graduated exercise:

The most important thing here to deal with fatigue is to add in short bursts of mid-level intensity activity. For example, weight control aside, a short and brisk walk outside for 5-10 minutes done after lunch and right after work goes far at helping circulation and reducing that stagnant feeling of fatigue.

Adding protein:

Stabilizing your blood sugar is important at all times, but especially at times of stress. You shouldn’t have to eat every 2-3 hours, (and if you do, you need to be worked up naturopathically for this) – but adding more protein to your main meals, especially breakfast, will help to keep a stable source of fuel throughout the day. Limiting efined carbohydrates and adding vegetabler fiber to lunch, along with protein, can further prevent fatigue that tends to happen towards the end of a work day.

Don’t multi-task, if you can avoid it:

Multi-tasking is very “stressful” and usually stimulates more beta-activity type brain waves. These type of beta waves will make you feel alert while doing your tasks, but burn out will be sure to happen. Giving 100% effort on one task at a time, in a relaxed manner, perhaps with the aid of some green tea for its theanine content, is more inducive of alpha wave activity. Theanine increases alpha wave activity in your brain, which is associated with an alert, focused, meditative type state. Less burn out is likely.

Find out if morning exercise or after work exercise works better for you:

If you are generally healthy, usually exercise is already part of a 3-4 times a week routine. Sometimes, even short bursts of 15-20 minute jogging or rope jumping is enough to reset the adrenals, improve circulation and oxygenation, and keep energy high. The key is to find whether your day is better and more productive with you exercising right on waking up, or right after work. Squeezing in the 15-20 minutes is sometimes difficult, but usually easier at the two above times. The vast majority of my patients will do better with morning exercise as it does seem to help the adrenals adapt to daily stresses and rhythm better.

All in all, fatigue usually falls into one of three categories.

1. A symptom of an underlying disease that can be found with conventional medical workups, including heart, lung, and basic blood tests for anemia, iron deficiency, etc
2. A symptom or early warning sign that is difficult to detect or classify with conventional medicine, and in which naturopathic work ups and treatments for things like adrenal deficiency, allergies, hypoglycemia, chronic infections, lyme disease, etc can be markedly helpful
3. A symptom of a busy lifestyle and your body catching up – of which the above tips can help.

www.pannaturopathic.com

Do you really need Ritalin for cognitive enhancement?

Ritalin, or methylphenidate, has been in the news in the last few days. It seems that many believe that methylphenidate can help their cognitive performance, giving them an edge in work or study. Apparently even college students are starting to use the drug as a means of staying up later and focusing while having a late-night study sesssion.

From the Discover Magazine website:

If you could take a pill to boost your concentration and mental stamina, would you do it? Around the country, thousands of college students are already answering “yes” to that question and are using prescription medications like Ritalin as study aids, and researchers say the demand for such “smart pills” is likely to grow. Now, in a new essay, a group of neuroscientists and bioethicists is arguing that society shouldn’t frown on such practices; instead the authors assert that “we should welcome new methods of improving our brain function,” and that doing it with pills is no more morally objectionable than eating right or getting a good night’s sleep [Chronicle of Higher Education].

And on the same website, one retired family MD comments with:

Well said. But before giving methylphenidate the benefit of the doubt, we have to remember that the drug is mostly studied and used in patients diagnosed with ADHD. It hasn’t been shown to be of much benefit in healthy adults. There are far better ways that I would treat ADHD in both adults in children, but this article is about alternatives for those who think methylphenidate or Ritalin could benefit them even if they haven’t been diagnosed with ADHD.

Is methylphenidate even effective for enhancing cognitive performance? Or does it just make you feel better?

A study by Bray et al:

J Investig Med. 2004 Apr;52(3):192-201

Methylphenidate does not improve cognitive function in healthy sleep-deprived young adults.

CONCLUSIONS: Cognitive improvement among sleep-deprived young adults was not observed following methylphenidate administration. Benefits perceived by abusers may relate to increased confidence and sense of well-being, as well as to sympathetic nervous system stimulation. Moreover, methylphenidate administration results in physiologic effects that could be harmful to certain individuals.

Ritalin seemed to make sleep-deprived adults feel better, but didn’t actually make them better at performing mental tasks. It may have made them feel better by giving stimulating the adrenaline system, or the sympathetic nervous system. This is concerning to me because any long term use of a medication that stimulates the sympathetic nervous system is eventually going to give you the opposite effects; ie instead of feeling good, you will feel burnt out, exhausted, and start to have anxiety attacks. These effects are mediated because the sympathetic nervous system is meant to respond to stress. We already have enough stimulation from stress without the need for a drug-induced one.

So what are some better alternatives for optimal cognitive and mental function?

Getting a good nights sleep for a healthy stress response

A healthy daily stress response involves interplays of a variety of hormones, but melatonin and cortisol are particularly important.

(image from a physiology course at UNMC)

Cortisol should be highest in the morning a few hours after waking, and a second peak should occur a few hours after lunch. If this system fails them people start to wake feeling groggy, needing lots of caffeine or sugar to get their concentration going. If this system fails then people also feel fatigued and tired after lunch, having their productivity drop way down.

Getting a good night’s sleep helps keep this cortisol rhythm going the way it should.

Sometimes  a lab test that assesses the cortisol at 4 points during the day can be useful to determine if this is something that can be improved. Patients who effectively optimize their sleep/wake cycles and adrenal function (adrenal glands secrete the cortisol that is pictured above) notice a drastic improvement in their energy and productivity.

And we never have to use cortisol as a hormone replacement therapy. While there are many different causes to pursue to investigate optimizing sleep (giving adrenal specific nutrients, Myer’s injections, niacinamide to decrease stress, valerian or melatonin temporarily to help sleep), once we find the cause and treat, it sure beats taking methylphenidate daily. We already know methylphenidate doesn’t work for sleep-deprived adults, so why not make our sleep/wake cycle and adrenal responses work for us?

Nutrients instead of drugs

Caffeine is one of them, and it is well-studied to improve performance in adults without ADHD. There seems to be a cap where more is not better though, and depending on the study, the upper limit for cognitive performance may be capped around 3 cups. And not surprisingly, caffeine was most effective in sleep-deprived adults.

Theanine is even better. Green tea is a great source of theanine, particularly matcha tea. While an excess of caffeine stimulates too much beta wave activity, leaving you feeling scattered, jittery, and sometimes anxious. Theanine, on the other hand, stimulates alpha wave activity, which is akin to a relaxed and focused type of concentration. This is the same brain wave activity in deep focused meditation where you are alert yet relaxed.

Ginseng formulas are also excellent for enhancing performance. One mechanism in which they work is that they act as adrenal adaptogens, meaning that they bind to cortisol receptors and exert a weak, cortisol-like action. If cortisol is low, the ginsengs bind to the same receptors and stimulate cortisol-like actions. If cortisol is high, the net effect is to decrease the cortisol effect since the ginsengs are much weaker than the actual hormone. The second mechanism in which they work is by increasing the neurotransmitter dopamine in the brain, similar to methylphenidate. Ginseng has a huge advantage in that while it increases dopaminergic brain activity, it also modulates stress through the first mechanism. As we know, in healthy, sleep-deprived adults methylphenidate seems to increase stress. There is a large variety of quality and dosing in the various ginseng formulas on the market, so I don’t recommend purchasing any old brand. Adreset from Metagenics and Withania Complex from Mediherb are consistently reliable.

Detoxification

This one is probably the most important. Even low levels of both metals and pesticides in the body can drastically affect optimal mental function and intelligence. We even know that low levels of blood lead are detrimental. Lead above 40 mcg/dL is considered to be acutely toxic, but levels above 2 mcg/dL are associated with increased ADHD, decreased school performance, and lower IQ. And that’s just blood lead; it isn’t tissue levels of lead that are best assessed by a provoked metals urine test.

Pesticides are known neurotoxins, and being fat soluble, are stored in our fat for extended periods of time. Our nerve cells are very fatty as well, and these pesticides can exert neurotoxic effects there as well. Thus, detoxification is generally done very carefully, but aggressively using a combination of sauna therapy, hydrotherapy, rectal ozone, and IV vitamin C.

What about oral B-vitamin complex?

The very common B complex vitamins orally probably do not have much effect, except for the B6. B6 does help your body activate the same neurotransmitters that keep us feeling active and sharp.

B12 on the other hand, is widely used clinically with great results at improving cognitive function. This is true not only for healthy adults but also for those with diseases that can seriously impair cognitive function, giving a sort of brain fog. Such conditions include depression, chronic fatigue syndrome, and chronic lyme disease.

B12 is not absorbed orally in very high amounts, making it difficult to get a good dosage for clinical improvement or optimization of cognitive function. Sure, we can absorb enough orally to prevent overt deficiency, but when using it as an alternative to Ritalin, we need to give it by injection. Sometimes I teach patients how to give these to themselves, and sometimes I will give a short course of the injection. Importantly, methyl B12 is the form we want to use, as opposed to cyanocobalamin. Dosages are very high, in the range of 5 to 25 mg intramuscularly.

Do we need Ritalin for cognitive in cognitive enhancement in healthy adults? I highly doubt it. I will stick to the caffeine, green tea and theanine, and occasionally methyl B12 injection. And I’d make sure that I have a healthy stress response, and assess the adrenals if I were not waking refreshed or were not having a consistently good nights sleep.

www.pannaturopathic.com

What to do about the sugar that is killing you

Sugar, refined carbohydrates, have far more a detrimental effect on the body than most people realize. I could estimate that excess sugar and refined carbohydrate intake contribute to at least half of the chronic diseases that I see. It doesn’t mean that cutting out the sugar and refined carbs immediately will help patients that are already sick, in fact, that could make patients worse. It does mean that if you are relatively healthy and have no overt disease then controlling sugar and its effects will go very far in optimizing health.

It’s actually not just sugar that is the problem, but rather the insulin resistance that comes with it. Insulin is a nasty hormone when it is present in amounts higher than the very low end of a normal range. In other words, the lab reference range for insulin is really not optimal, and usually the fasting insulin should be below 5 uIU/ml (or 34 pmol/L SI units). The lab range considers everything up to 100 pmol/L to be normal.

Consider the following patient examples and how insulin resistance contributes:

1. 45 year old male with NASH (non-alcoholic steatohepatitis / fatty liver disease). This patient is a borderline diabetic with blood sugar levels that have hovered around 7-8 fasting. The patient has now developed elevations in liver enzymes and ultrasound is showing fatty accumulation within the liver. He is not taking any prescription or naturopathic medication for his diabetes yet.

In this case, the patient has lived most of his life consuming white rice as the main component of lunch and dinner, with only small amounts of fiber from vegetables and small amounts of protein. Breakfast was even worse with milk and boxed cereal. Over time he developed more cravings for sweets and carbohydrates, and he would often need snacks of fruit or crackers to feel satiated.

Whenever carbohydrates are present as the main calorie source in meals, the blood sugar goes for a wild swing up after the meal. The pancreas responds by over-secreting insulin to bring the sugar down and into the cells. The problem is that when this happens over and over, the cells get used to the insulin and decrease their receptors for insulin, effectively becoming resistant. When the liver is sensitive and responding correctly to insulin, it does not make much sugar.

However, when the liver is resistant to insulin, it begins to manufacture excessive amounts of sugar. This is most noticeable in the diabetic and his/her elevated fasting blood sugar. The fasting blood sugar is most indicative of what your liver has made, as it has little to do with what you ate 12 hours ago.

In order to get this patient’s liver back to normal, and decrease both the fasting sugar, fasting insulin, and fatty liver, I started the patient on nutrients to sensitize the liver to insulin and began ozone therapy to stimulate oxidation (metabolism) of fats in the liver. Over the course of 6 treatments, in combination with exercise, the patient’s fasting sugar levels have stayed below 6. The next step is dietary avoidance of refined carbs in order to resensitize the body (including the liver) to insulin.

2. A patient with “stress” and adrenal insufficiency that has caused her to have panic attacks. This patient had a similar set up, with a history of decades of eating too many refined carbohydrates along with a sedentary lifestyle. In this case, the patient gets panic attacks, anxiety, and light-headedness if she goes without food for 3-4 hours, including sleeping!

Fasting insulin was above optimal, but not above the reference range. Once we got the fasting insulin into the optimal range with nutritional therapy, the patient has stable energy levels, decreased muscular pain, and can skip meals without problems at all.

In this case, even slightly above optimal levels of insulin were enough to make this patient’s cells resistant. When this patient first presented, every frequent carbohydrate-rich meal she would have caused a spike in blood sugar. As her pancreas secreted excessive amounts of insulin, resistance was such that insulin had to be continually secreted until the response of blood sugar lowering occured. Since this tends to happen at a threshold of insulin, the blood sugar would then swoop too low.

Interestingly, the symptoms were manifested not when the blood sugar was low (many people think they get hypoglycemic symptoms or low blood sugar symptoms when in fact they don’t), but rather, the symptoms were triggered when insulin was at its highest. We tested this by running a baseline fasting sugar and insulin, then giving a carbohydrate challenge, and measured sugar and insulin for 3 hours after, noting when symptoms occured.

Insulin caused the symptoms as it strongly stimulates the fight or flight / sympathetic nervous system, causing anxiety, stress, upper back and neck muscular pain. Once the patient was given a proper diet for her condition, nutrients to support insulin sensitivity, and detoxification to remove another burden on the liver, she improved.

What’s the best way to assess if insulin resistance could be improved for optimal health?

This would be a fasting glucose and fasting insulin test. The two measurements should have an optimal ratio, and the fasting insulin should be below the thresholds mentioned above. This is a pretty important test for preventative health, as insulin resistance contributes to many common, major medical problems.

Insulin:

• stimulates the fight or flight nervous system, making stress worse
• makes you lose excess calcium and magnesium into the urine, contributing to osteoporosis and chronic muscular tightness/pain
• acts as a growth hormone, causing cells to divide more freqently (contributing to cancer risk)
• increases small sized LDL particles, which are the type that can work their way into nooks and crannies in the endothelial lining of the arteries
• contributes to central abdominal fat, and metabolic syndrome: risks for diabetes and heart disease

What’s the best way to see if insulin resistance is contributing to my disease and symptoms?

This is probably the same as the above, ie a blood test for fasting sugar and insulin. However, if there are symptoms such as chronic pain or lightheadedness/anxiety, then an insulin challenge should be done. This is done by giving a carbohydrate challenge after measuring fasting sugar and insulin, and then repeating the measurements over a few hours while we monitor symptoms.

If you are a current patient and think this might be for you, give me an email first, book an appointment in the morning and come fasting. Watch those sweets this season!

www.pannaturopathic.com

Why finding and treating the cause is vital…

There is often the misconception that naturopathic medicine is about conventional diagnosis and then treatment with “natural” drug alternatives. This actually isn’t the case at all.

Take a great patient of mine who came in today with an acute flare of dizziness, anxiety, tremors, and headache. This patient had been successfully treated for her initial symptoms of anxiety, panic attacks, upper back muscular pain for 3-4 weeks with a few Myer’s injections for energy and the adrenals, and herbal / nutritional support for adrenal function. In other words, poor, sub-optimal adrenal function was the cause. (This is not Addison’s disease, but rather a functional imbalance in the adrenal glands.)

The patient was symptom-free, energy had improved, panic attacks disappeared, and tremor disappeared until 2 weeks ago when she broke into hives and a rash from a food allergy. I treated the allergy by alkalinizing the blood and ozone therapy, and the symptoms disappeared. The allergy exposure was a trigger for adrenals to adapt; but as healing takes time, the adrenals had not yet built up the reserve and thus responded to the trigger with the original symptoms. The take away point here – we needed to continue to build up adrenal health and focus on avoiding allergens as triggers.

Today, the symptoms were triggered by skipping meals and going too far without food. As a test, I gave a simple glucose IV and the patient’s headache, dizziness, muscle tension and anxiety immediately went away. We could confirm poor sugar control as contributing by running more tests, but there really is no reason to. Instead, I placed the patient on a medical food designed for diabetics, and we will continue to support the adrenals.

The adrenal insufficiency causes all the symptoms. Instead of taking an antihistamine for allergy, caffeine for fatigue,clonazepam for anxiety, NSAIDs for the headaches, and probably diabetic medications in the future for diabetes, supporting the adrenals is the first step for cure.

Once 4-6 weeks of feeling perfect has passed, then we will work on detoxification to reduce toxic stress on the adrenals and allergy desensitization to reduce further stress so that the same situation does not recur in the future.

That’s a naturopathic approach to a very common condition.

www.pannaturopathic.com

How to keep the holiday weight off…

The Christmas and New Year holidays are full of great times as people slow their lives down and focus on the things that are really important. Usually stress comes down, and we tend to have a holiday meal or two. This time of year often also marks a new start to what can become a yearly routine: the gaining of a few extra pounds and then the motivation to get the weight off in the new year!

Many of my patients have worked extremely hard to get their body composition to a healthier level. This means reducing subcutaneous and organ fat, and increasing metabolically active lean body tissue. Let’s see what we can do to limit negative changes over the holidays.

Sweet cravings

5HTP can be used at patient-specific doses. When we eat sweets, especially when related to stress, we may actually be craving the increase in serotonin (a chemical in your brain that makes you feel good) that occurs with the sweets. 5HTP (I use Tryfonia Max from AOR for consistent quality) is a direct precursor for serotonin, and many patients find that taking 5HTP as a supplement in anticipation of sweet cravings helps to avoid the sugar binge.

Methyl B12 injections are probably the most effective, when given in appropriate doses. Some people respond to oral doses, but the absorption is very poor, even when given under the tongue. Getting a methyl B12 injection on a twice weekly basis can do wonders to keeping cravings at bay, and appetite low.

Eating small protein-heavy snacks around 2-4 pm can keep the pre-dinner temptation for christmas cookies at bay. Even though our stress should be decreasing as holiday time comes around, the adrenal glands take a while to respond to vacation time. The adrenals are the organs that can get taxed with stress, and thus their function can suffer some what. Normal cortisol rhythm should give a small peak between 2-4 pm, and that peak in cortisol makes the liver produce sugar for delivery in the blood. With a stressed adrenal system, that peak may not be optimal and we may be more susceptible to the pre-dinner cravings. Eating a small protein snack in anticipation of this can keep things under control.

Exercise

This is number 1. No way around this one. Weight gain is simply from excess calories consumed vs calories burned. (This is of course only applicable if other causes of weight control have been ruled out, such as metabolic syndrome, hormonal causes, sensitivity/allergy issues.)

Many patients have worked extremely hard over the year to make amazing changes in body composition. Keeping to the exercise routine prescribed will keep motivation up and make the habit all that much stronger. Even short bursts of intense exercise, such as 20 minutes, can be extremely useful.

Make a new habit during December and January. Forgo 20 minutes of sleep by waking up 20 minutes earlier. Use that time to get in the habit of using 15-20 minutes of jogging, jumping rope, or walking outside to wake up instead of using coffee. Having everything ready to go, especially since most people are quite groggy  on waking, makes the habit easier to develop.

Cheating with supplements

Conjugated linoleic acid at 3.2 g per day in one study reduced holiday weight gain (November-Dec) in a group of patients who were taking the nutrients daily for months. It’s a little late to start now. Over 6 months, patients taking the nutrient lost fat during the holiday season, while the dummy pill group gained weight.

Focus on detoxification

Our fat is a storehouse of toxins, including chemicals that impair our body’s own burning of fats. Instead of waiting until the New Year to develop healthy habits and to detoxify the body for a fresh start, why not start before the holidays? A 10 day intensive detox can be done prior to the holiday dinners, so your body is in better shape to metabolize the extra fat we consume. Typically body composition improves also, so small fluctuations in holiday weight will make no difference. This type of detoxification involves, sauna, hydrotherapy, rectal ozone, fasting, and exercise.

Strong steeped green tea can increase fat excretion into the stool. Adding a ginger tea bag further increases this effect. The idea isn’t to increase fat excretion in stool to lose weight, but rather, to prevent reabsorption of the toxins that impair metabolism.

Fiber, for the above reasons of keeping toxins in the stool, is useful also.

Make it a healthy meal

Organic vegetables would be an ideal option. Finding organic meats are also a great option. The meat is leaner, more tender, and remains flavorful and soft even as left-overs. The Global Peasant has some good recommendations on local growers.

And if all fails, we have the new year to get right on track.

website updates:

Page on alkalinization to correct acid/base imbalances

Page on chronic fatigue syndrome

Page on fibromyalgia

www.pannaturopathic.com

35% of heart attacks from a western diet?

An article in the journal Circulation states that up to 35% of heart attacks can be attributed to a western style diet, rich in fried foods. This article has been picked up and reported by the popular press.

From CBC we have this quote that summarizes the study well:

Participants gave blood samples and filled in detailed diaries on what they ate between February 1999 and March 2003. Depending on what participants reported, they were divided into three dietary groups.

After adjusting for known risk factors, the researchers found:

• People who consumed the “prudent” diet of more fruits and vegetables had a 30 per cent lower risk of heart attack compared with people who ate few or no fruits and vegetables.
• People who consumed the “Western” diet had a 35 per cent greater risk of having a heart attack compared with people who consumed few fried foods and little meat.
• The “Oriental” diet, which is loaded with tofu but also high in salty soy sauce, showed no relationship with heart attack risk.

Avoiding the increased risk associated with the “western” diet confers protection that is greater than that afforded by many drug therapies.

I pulled up the full text of the article and have read through the comprehensive study. When I had first read the headline on news services, immediately the focus on fried foods made me think of rancidity of cooking unsaturated fats such as olive, canola, and corn oil at high temperatures causing a large part of the problem. In fact the researchers had this to say, quoted from the original article:

INTERHEART shows that unhealthy dietary intake, as
assessed by a simple DRS, increases the risk of AMI
significantly, whereas consumption of a prudent diet is
associated with a lower risk. The PAR for AMI worldwide
associated with poor dietary intake is substantial. The present
work suggests that increased consumption of fruits and
vegetables and reduced intake of fried foods, probably related
to the type of fat used for frying and salty snacks, is likely to
reduce the risk of AMI in all regions of the world.

DRS was short for their dietary score, and AMI is short for heart attack or acute myocardial infarction. The last sentence says it all, that increasing fruits and vegetables likely reduces risk, and the risk associated with fried foods is probably related to the type of fat used.

Unsaturated vegetable oils should not be used for frying because the double bond in their chemical structure is susceptible to breaking down under high temperature. In effect, when the fat goes rancid, you can imagine eating old, rancid, stale oils, which are large promoters of inflammation in the arteries. Imagine fast food restaurants that fry with this vegetable oil at high temperatures, over and over again. Then imagine soaking up some nice french fries in that oil.

Perhaps butter, a saturated fat, isn’t that bad, when used for pan frying. Saturated fats do not go rancid at high temperatures, as they do not have that double bond in their structure.

I stop short of recommending that butter is a free food, but one oil you can use for cooking is grapeseed oil. This oil has a much higher smoking or burning point, and thus is a better option for pan frying over medium to medium-high heat. Oils like olive oil should not really be heated or used for cooking at high temperatures. Olive oil is great on salads, etc.

By making healthier choices of choosing oils that do not go rancid when you cook them, eating more fruits and vegetables, we can reduce our risk of our heart attack significantly. Add to that exercise to increase blood flow, and for patients with disease already present, detoxification to prevent the cholesterol and fats in our blood from going rancid, and you can do quite well with regards to circulatory disorders.

Web updates:

A page on alkalinization therapy, a page on why I love treating heart disease, and a page on chronic fatigue syndrome.

www.pannaturopathic.com

Vitamin C and blood pressure

The University of Pisa in Italy came out with a study that showed that intravenous vitamin C, in the dosage commonly given in the Myer’s cocktail, lowered blood pressure by decreasing the stress response acutely.

AHN Staff

Pisa, Italy (AHN) – Intravenously delivered vitamin C helps lowering high blood pressure by calming an overactive central nervous system, new Italian research suggests.

Lead author Dr. Rosa Maria Bruno from the University of Pisa treated 12 patients with high doses of vitamin C given intravenously. None of the patients had received any kind of prior treatment for their condition. Over a five-minute period, all the patients were intravenously administered three grams of vitamin C.

On average, after about 20 minutes, most of the patients saw their blood pressure plunge at least seven percent. There was a specific drop in diastolic blood pressure (the bottom number on a reading) of 9 percent. However, no significant drop in systolic blood pressure was observed, the study found.

The authors believe that the vitamin works by calming an overactive central nervous system. However, they also warned that more study is needed to confirm the results.

The Italian team was expected to report its findings Friday in Atlanta at the American Heart Association’s Conference of the Council for High Blood Pressure Research. The study is published in the Journal of Clinical Nutrition.

The mechanism likely involves reducing abnormal oxidative stress that impairs blood flow. Another study in Journal Applied Physiology found that intravenous vitamin C improved blood flow in patients who had poor circulation in the legs, by 37%.  The journal Hypertension in 2005 found that post-menopausal females receiving intravenous vitamin C had a increase in the ability of large arteries to relax, or had increased compliance. Interestingly these two studies did not find a decrease in the blood pressure, even though the latter study used similar doses of vitamin C. The reason may lie because in the Hypertension journal, they infused the dosage over 20 minutes, wherease the Italian researchers took 5 minutes to give the infusion, thus achieving much higher blood levels, and better saturation of the tissues.

Myer’s injection given as a push seems to be a good way to treat stress and associated blood pressure problems. A drip can be used as well, but there should be accordingly more vitamin C in the longer infusions to get similar, (and I think better) results.

Arthroscopic knee surgery? Here is an alternative…

Update: this page has consistently received the most hits per day. I do find that the ozone injections most consistently help knee arthritis, then musculotendinous pain and trigger points, and less commonly severe OA of the shoulder. The page on the clinic website www.pannaturopathic.com describes more about this procedure.

By now, I am sure that many of you have read the recent report that arthroscopic knee surgery for degenerative arthritis or osteoarthritis knee pain does not work. Here’s an excerpt from the BBC that reports on the recently published study:

The operation involves inserting instruments through small incisions to try to flush out loose fragments of cartilage, and to smooth the surfaces of the joints, in the hope that this will relieve symptoms.

A group of 178 men and women, with an average age of 60, were enrolled in the trial at the University of Western Ontario.

All of them were given physiotherapy and painkilling drugs such as ibuprofen, but half of the volunteers were also given the “la

vage and debridement” procedure.

When their symptoms were compared at various poi

nts afterwards, the group who had the operation were faring no better than those who had not received it.

Guidelines breached

Dr Brian Feagan, one of the researchers, said: “This is definitive evidence that arthroscopic surgery provides no additional therapeutic value when added to physical therapy and medication for patients with moderate osteoarthritis of the knee.”

It should also be noted that osteoarthritis is a degenerative condition, m

eaning that it really is a “wear-and-tear” type of condition that is very difficult to reverse.

The common arthroscopic surgery aims to “clean up” the joint on the right of the above picture, smoothing out the rough edges. It does not really address the lack of cartilage and increased dependency on lubrication within the joint itself.

Natural alternatives

Most of my patients who want their knee pain addressed are already on the basics such as glucosamine sulfate and chondroitin sulfate. These are pretty good nutrients, and can be considered disease-modifying agents, in that they actually act to slow down the degenerative process.  Both glucosamine sulfate orally, and hyaluronic acid injected into the joint, have consistently been shown to reduce pain. A recent study published in BMC Musculoskelet Disord showed that glucosamine stimulated synovial cells (cells lining the joint) to produce hyaluronic acid. Hyaluronic acid is a lubricant within the joint.

Sometimes glucosamine isn’t enough, as the pain is still present. In these cases, often I will add in a herbal formula called Kaprex and Withania Complex, both of which have been shown to reduce the inflammation and associated pain in a subset of patients with degenerative arthritis or osteoarthritis. At this point, I do an exam to assess whether or not there is any ligament laxity or meniscal disc injury in the affected joint.

If there is an injury or weakened, stretched, ligament or a partially damaged meniscus, then ozone can be injected into the ligament in order to stimulate an ordered, natural inflammation. It is the localized inflammation that creates growth factors to stimulate healing. At times, if the condition is severe, ozonized platelets from the patient can be injected, as the platelets are a potent source of growth factors to stimulate the ligaments and the meniscus to heal.

History is very important as well. If there is a pre-pain history of trauma, either a single event, or repetitive strain, then often times the ligaments, menisci, or joint-supporting structures need to be treated. The menisci in the above pictures are pads where the weight is distributed at the knee, and are under pressure with flexion and twisting type motions. Thus, they are often susceptible to injury. Unfortunately, glucosamine alone or anti-inflammatories (drug or the above natural options) won’t cause repair. Ozone injections or platelet injections can.

For osteoarthritis, or purely degenerative joint disease though, the natural treatments are much simpler. It basically involves the injection of the same ozone or ozonated platelets but this time, instead of small amounts into specific ligaments or menisci, larger amounts are injected directly into the knee joint. The problem is within the knee joint, where structures are in contact with each other. The natural treatment involves stimulating the synovial tissue to produce more lubrication and to produce more cartilage.

Above is a picture of a knee being injected by ozone.

Here is some research that looks at the use of ozone in various cases of pain (I use it also in chronic myofascial and musculotendinous pain, or the trigger points and knots in the muscles.)

One study in the Saudi Medical Journal looked at 220 patients who had osteoarthritis of the knee or spine, and found that ozone injections twice a week for at least 12 sessions showed a significant reduction in pain at the 4th, 8th, and 12th injection. The reduction in pain was present at 10 months after the first treatment.  I would not tend to do the injections that frequently, instead I would do it usually once a week to once every two weeks.

A group in Taiwan published in Rheumatology International that ozone injections into the knee could even help with the destruction associated with rheumatoid arthritis. They found that injections of 3% or 5% ozone significantly decreased chemicals called cytokines that were associated with inflammation and rheumatoid arthritis. When I treat rheumatoid arthritis, I prefer to treat the blood system itself, using autohemotherapy to balance the immune system.

In a Chinese study, published in a journal that translates to Chinese Acupuncture and Moxibustion, showed that ozone injection was superior in pain relief compared to injection of fluid into acupuncture points and compared to electroacupuncture. This study involved 120 patients with low back pain, but did not specifically include only degenerative arthritis patients. I list this study because I have also found that injections of ozone can resolve many chronic myofascial and muscular pain.

In the journal Radiology, a study found that injections of ozone into to the low back was more effective than steroid and anesthetic alone. This effect was present even 6 months after treatment.

The American Journal of Neurobiology found also that injections of ozone were superior to injections of steroid alone for low back pain, at 6 months after the treatment. Patients were pain free after treatment in both groups but the ozone group had pain relief that lasted longer.

The list goes on – but I think you get the idea. Ozone is the way to go for knee (and other types) of pain. Usually the number of treatments necessary vary, but range from one treatment to up to 15, with most chronic patients needing 2-6 treatments. This, in combination with oral kaprex, withania complex, and glucosamine, can be profoundly helpful as a natural alternative for chronic degenerative joint disease, or osteoarthritis.

Alzheimer’s coffee break…

While on vacation today I read in the news, along with stories about Hurricane Gustav and minor earthquakes back in BC, that the Alzheimer’s Society of Canada is having their annual coffee break on Sept 18. This is a fundraising activity.

The headline caught my attention because coffee, and probably caffeine, has a noted protective effect in certain neurological diseases. One of these is Alzheimer’s disease.

In the journal Neurological Research, a quantitative review of studies looking at coffee consumption and Alzheimer’s risk showed an inverse association, meaning that coffee drinkers tended to have less Alzheimer’s risk. The risk was only marginally lower, at about 30% reduced risk compared to non-caffeinators. But worth savoring, along with that cup of morning coffee.

I can speculate on the mechanisms involved, but the most likely involves a combination of more rapid thought (training the nerves) and some of the antioxidant properties in coffee.

Naturopathically, I typically use a combination of nutrients based on blood chemistries that are likely to be protective, and definitely detoxification of heavy metals, a known risk for a variety of neurological diseases. The best way to test these metals is a combination of blood lead and blood mercury levels, and provoked metal testing in the urine.

www.pannaturopathic.com