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WHAT EVERYONE NEEDS TO KNOW ABOUT
"I am concerned that the federal government, the media, the processed food manufacturers and billion dollar drug and biotech companies have commandeered our food supply and health care systems. Routinely, information and evidence about what truly constitutes healthy eating is altered or hidden from the public in order to advance financial or face saving agendas. And worse, people who aren't aware of the deceptions are being injured and dying because they follow this agenda driven advice. Since the privately owned Academy of Nutrition and Dietetics (formerly the American Dietetics Association) receives great sums of money from processed food manufacturers, they can't just suddenly start saying that a high fat, low grain diet is healthiest - they would lose all their funding from companies like Kraft Foods, Hershey's and Coca-Cola." From Ellen Davis' (Master's in Applied Clinical Nutrition) website, Ketogenic Diet Resource.
"I remember exactly where I was sitting in a clinic at Johns Hopkins in 2002 explaining to (admonishing, really) a patient who was on the Atkins diet how harmful it was because of DKA. I am so embarrassed by my complete stupidity and utter failure to pick up a single scientific article to fact check this dogma I was spewing to this poor patient. If you’re reading this, sir, please forgive me. You deserved a smarter doctor." From a blog post (Ketosis – Advantaged or Misunderstood State?) off of Ketogenic Diet proponent, Dr. Peter Attia's (MD) website --- The Eating Academy dot com. If you want to see the metabolic pathways that show how safe and effective this diet is, this is the site to visit.
"Ketones are the ideal fuel for our bodies unlike glucose – which is damaging, less stable, more excitatory and in fact shortens your life span. The energy producing factories of our cells – the mitochondria – work much better on a ketogenic diet as they are able to increase energy levels on a stable, long-burning, efficient, and steady way. Not only that, a ketogenic diet induces epigenetic changes which increases the energetic output of our mitochondria, reduces the production of damaging free radicals. Furthermore, recent data suggests that ketosis alleviates pain other than having an overall anti-inflammatory effect. The ketogenic diet acts on multiple levels at once, something that no drug has been able to mimic. This is because mitochondria is specifically designed to use fat for energy. When our mitochondria uses fat as an energetic source, its toxic load is decreased, expression of energy producing genes are increased, its energetic output is increased, and the load of inflammatory energetic-end-products is decreased. In short, let fat be thy medicine and medicine be thy fat!" From an article by Cardio-thoracic Surgeon, Gabriela Segura (The Ketogenic Diet --- An Overview)
Because there are people who stay in Ketosis virtually all the time, the question arises --- are there any side effects of eating a ketogenic diet; particularly over the long haul? When I started researching Ketogenic Diets for these two posts, the first thing I did was go to PubMed and start scrolling through some of the 1,750 studies on the topic. The peer-reviewed scientific literature is all but unanimous in pronouncing the Ketogenic Diet safe --- far safer than the DRUGS / MEDICATIONS people would otherwise be taking for diabetes (HERE) or high cholesterol (HERE). Although most problems that arise from the Ketogenic Diet are quite benign, THERE ARE some potential side effects and contraindications to eating this way.
For instance, the Ketogenic Diet has the potential to cause both stunted bone growth and fractures in pre-pubescent epileptic children (Part I revealed why). But remember that both Antidepressants and Anticonvulsants (widely prescribed for those with seizures) are notorious for themselves causing bone loss (HERE). You'll likewise hear the argument that losing weight too rapidly is bad for you. RUBBISH! Research shows that once you get into Ketosis, your body would actually rather burn Ketone Bodies than burn Glucose. Furthermore, as long as you are getting enough protein, you will not burn your own muscle mass for energy --- something that happens during Ketoacidosis, which we'll cover momentarily.
You'll also run into the argument (this always occurs in a grudging manner) that while consuming all this fat might cause you lose weight, it will cause blood lipid issues (HIGH CHOLESTEROL, HIGH TRIGLYCERIDES, etc, etc). While this might be true initially, the results of virtually every study that I've seen shows that Ketogenic Diets actually normalize blood lipid profiles --- something I dealt with yesterday as well.
Doctors who are not up on the MOST CURRENT RESEARCH CONCERNING SATURATED FATS; if they are even willing to 'OK' a Ketogenic Diet at all (again, grudgingly), will tell you that most of your dietary fat should come from unsaturated sources like Vegetable Oils (yes, even MARGARINE), Flax Oil and FISH OIL. This is simply not true. Vegetable Oil is garbage (HERE --- particularly SOY); and while there are undeniable benefits to the other two oils, moderation with any and all DIETARY SUPPLEMENTS is key. Bottom line; do your own research (HERE is my post on everything you ever wanted to know about fats and inflammation).
And while I absolutely advocate talking to your physician before putting yourself on a Ketogenic Diet (for those keeping score, this is another disclaimer), please realize that it's quite likely that when it comes to almost anything and everything that has to do with nutrition, he / she knows less than you --- possibly way less (HERE). This is why you can expect to run into the argument over the difference between "Ketosis" and "Keto-acidosis" (often called DKA or Diabetic Keto-Acidosis).
Hans Krebs, the German-born British MD / Biochemist, won the 1953 Nobel Prize for Medicine for figuring out the Citric Acid / TCA Cycle. If you learned your biology back in the day, you probably had to memorize "The Krebs Cycle". A few months ago, the December issue of Multiple Sclerosis International carried a study (The Therapeutic Potential of the Ketogenic Diet in Treating Progressive Multiple Sclerosis) that clarified this all-too-common objection to Ketogenic Diets (Ketoacidosis).
"Hans Krebs first made the distinction between the normal, 'physiological' ketosis that is induced when following a carbohydrate-restricted diet, and diabetic ketoacidosis, a complication of [Type I] diabetes."
In Type I Diabetics, Blood Sugar can skyrocket because Insulin is not available to move it from the blood and into the cells. Because the body is essentially starving for glucose, it switches over to burn Ketones. Unfortunately, the protein and fat source in Ketoacidosis is usually yourself. In other words, the body will consume itself as a source of Ketone-based, non-glucose fuel. As you can see, this is a pathological state --- a far cry from strictly regulating your dietary ratios of fats, proteins, and carbs in order to induce a state of Ketosis. It's the difference between the highly controlled nuclear reactions that occur in power plants, and a NUCLEAR BOMB, whose reactions are completely uncontrolled.
Although I hit you with a veritable barrage of peer-reviewed research yesterday, hang with me as I give you just a little bit more. A 12 year old study from the Fall 2004 issue of the medical journal Experimental & Clinical Cardiology (Long-Term Effects of a Ketogenic Diet in Obese Patients) came to essentially the same conclusions as a Brazilian study published a decade later in PubMed Health (Very-Low-Carbohydrate Ketogenic Diet -vs- Low-Fat Diet for Long-Term Weight Loss: A Meta-Analysis of Randomised Controlled Trials). The cherry-picked conclusions of the studies are respectively as follows.
"The present study shows the beneficial effects of a long-term ketogenic diet. It significantly reduced the body weight and body mass index of the patients. Furthermore, it decreased the level of triglycerides, LDL cholesterol and blood glucose, and increased the level of HDL cholesterol. Administering a ketogenic diet for a relatively longer period of time did not produce any significant side effects in the patients. Therefore, the present study confirms that it is safe to use a ketogenic diet for a longer period of time than previously demonstrated."
"Individuals assigned to a very-low-carbohydrate ketogenic diet achieved greater long-term reductions in body weight, triacylglycerol and diastolic blood pressure and greater increases in HDL cholesterol levels than those assigned to a low fat diet."
When epileptics or those who are extremely OBESE ('grossly' or 'morbidly' Obese ---- BMI's of 40 or higher) start a Ketogenic Diet, not only is it typically done in a clinic or hospital setting by people with experience in inducing Ketosis (especially true for epileptic children), but most medical plans actually cover it as well. However, what do you do if you are one of the "others" (those without Epilepsy) that I dealt so much with yesterday? How does the average person go about starting a Ketogenic Diet and inducing Ketosis? After speaking with your physician of course.........
WHAT IT TAKES TO INDUCE DIETARY KETOSIS
Take a look at the pie charts above (these show what are known as Ketogenic "Macros"). As per the key at the bottom, the yellow represents dietary carbs, the burgandy represents dietary protein, and the blue represents dietary fat (we'll cover the MCT Ketogenic Diet later). The first thing people notice is how much fat is being consumed in a Ketogenic Diet (you can see why the Atkins Induction Phase of the Atkins Diet is considered "moderate"). For the standard 4:1 Ketogenic Diet, your "Macros" are approximately 70% fat, 25% protein, and 5% carbs). The questions usually arise, how do I consume that much fat and where does it come from; and how can I live on so few carbs?
A QUICK NOTE ON FAT CONSUMPTION: Because you are consuming a lot of fat on a Ketogenic Diet, and because bad things are stored in the fat (ANTIBIOTIC RESIDUES, XENOHORMONES, ENDOCRINE DISRUPTORS, ectc), you need to treat this as a "PALEO KETOGENIC DIET". In other words, keep it clean (see link!). This becomes even more critical for those of you who are really sick or really heavy.
To get yourself into Ketosis, some doctors will recommend you start with a fast, while others recommend jumping in whole-hog (fairly easy if you have been doing LOW CARB or PALEO). The 'whole hog' approach can be much tougher if you have been eating STANDARD AMERICAN FARE as per the pie chart at the top. Still others suggest slowly decreasing carbs to the 5% target over the course of a couple of weeks. While this approach might work well for a few; for THE HARDCORE CARB ADDICT --- a huge segment of the American population --- I am not a big fan of this approach, as it will likely feed the cravings longer than necessary.
The fat's the easy part. It's the carbohydrates you are going to have to count. On this diet, you are not going to eat GRAINS, FRUITS, BEANS, etc (you can probably do some cheese, due to its high fat content). You are going to live on meat, eggs, and green leafy vegetables (spinach, kale, greens, broccoli, cabbage, etc, etc, etc --- natural BIOTRANSFORMERS). You are going to have to eat lots of good fat (HERE). I have a patient who brings me lard he has rendered from naturally raised beef or pork (incredible stuff). EVOO will be a staple, but do not cook with it. Cook with Coconut Oil, butter, or lard --- and don't be stingy with it as 70% of your diet must come from good fats (less will not allow you to switch over to Ketosis). Good snacks include foods like cheese, seeds, nuts (peanuts are not nuts --- they are legumes), and nut butters.
To calculate the grams of carbs in the vegetables you are going to consume, you'll need a chart that automatically subtracts the FIBER from the total grams of carbohydrates. HERE is one of many. You will also need a "Keto Calculator" to help you calculate your "Macros" according to both your body weight and your level of activity (they are widely available online at no cost).
Be aware that particularly if you are not used to a low carb approach to eating, you will likely have varying degrees of what is commonly referred to as "The Keto Flu". Because your body is converting over from burning carbs for energy (Glucose), to burning Ketone Bodies (a byproduct of fat metabolism), you may feel like crap for a week or two. What does this entail? Some people actually have FLU-LIKE SYMPTOMS, but most will report headaches, foggy thinking, dizziness / wooziness, and similar. No big deal as it will soon resolve itself.
In order to keep yourself in Ketosis, you are going to monitor your urine with "Keto Strips". These help you check to see if you are in Ketosis and burning Ketone Bodies for fuel. Be aware that the strips will not turn color as much once you have actually converted over to burning Ketones. also be aware that if you have a "CHEAT DAY" and binge out on carbs, it will take some time to get back into Ketosis again. And for those who are interested, you can purchase inexpensive blood Ketosis measuring instruments that are analogous to the home monitors for Blood Sugar.
WHAT ABOUT THE KETOGENIC
"The energy-enhancing properties of MCTs are attributed to the fact that they cross the double mitochondrial membrane very rapidly, and do not require the presence of carnitine, as do LCTs. The result is an excess of acetyl-coA, which then follows various metabolic pathways, both in the mitochondria (Krebs Cycle) and in the cytosol, resulting in the production of ketones. Scientists attribute the increased energy from consumption of MCTs to the rapid formation of ketone bodies. MCTs are thus a good choice for anyone who has increased energy needs, as following major surgery, during normal or stunted growth, to enhance athletic performance, and to counteract the decreased energy production that results from aging."
Sounds pretty darn good to me. Which begs the question of the best dietary sources of MCT's. Although grass-fed dairy / beef and free-range egg yolks contain moderate amounts of MCT's, nothing touches coconut oil, which is made up of 65% MCT's. For those who are wanting to add MCT's to their diet, they are widely available at health food stores as bottled oils (there are some companies out there making outrageous claims about their products). However, I'm not sure you can go wrong with organic coconut oil. My favorite products are those that actually have a coconut taste to them. (Some of you will need to realize that coconut itself is a FODMAP that has the potential to throw those of you dealing with SIBO into a tailspin)
WHAT CAUSED A PALEO PROPONENT TO JUMP ON THE KETOGENIC BANDWAGON?
Listen to what Dr. Dr. J Pérez-Guisado of the Department of Medicine of Spain's University de Córdoba said in the abstract of his decade-old paper that was published in the Internet Journal of Nutrition and Wellness (Arguments In Favor Of Ketogenic Diets). By the way, the bibliography for this paper contains nearly 200 peer-reviewed studies.
"Many negative comments have been made about the use of ketogenic diets and experts today believe that the best way to lose weight is by cutting back on calories, chiefly in the form of fat. The international consensus is that carbohydrates are the basis of the food pyramid for a healthy diet. However, this review will clarify that low-carbohydrate diets are, from a practical and physiological point of view, a much more effective way of losing weight. It is also argued that such diets provide metabolic advantages, for example: they help to preserve muscle mass, reduce appetite, diminish metabolic efficiency, induce metabolic activation of thermogenesis and favor increased fat loss and even a greater reduction in calories. These diets are also healthier because they promote a non-atherogenic lipid profile, lower blood pressure and decrease resistance to insulin with an improvement in blood levels of glucose and insulin. Low-carbohydrate diets should therefore be used to prevent and treat type II diabetes and cardiovascular problems. Such diets also have neurological and antineoplastic [anti-Cancer] benefits and diet-induced ketosis is not associated with metabolic acidosis, nor do such diets alter kidney, liver or heart functions."
Again, if you are considering a Ketogenic Diet, consult your doctor. If he / she pats your shoulder while patronizingly telling you that a LOW FAT approach is better; start looking for another doctor. If a Ketogenic Diet is something you are truly interested in doing, search the web as there are scores of excellent sites with much more information than mine, including recipes. For those of you who struggle despite a Ketogenic Diet, there could be any number of underlying reasons. HERE are a few of them.
WHAT EVERYONE NEEDS TO KNOW ABOUT
"An increasing number of data demonstrate the utility of ketogenic diets in a variety of metabolic diseases as obesity, metabolic syndrome, and diabetes. In regard to neurological disorders, ketogenic diet is recognized as an effective treatment for pharmacoresistant epilepsy but emerging data suggests that ketogenic diet could be also useful in Amyotrophic Lateral Sclerosis, Alzheimer, Parkinson's disease, and some mitochondriopathies." Cherry picked from the abstract of the journal BioMed Research International (Ketogenic Diet in Neuromuscular and Neurodegenerative Diseases)
"Very-low-carbohydrate diets or ketogenic diets have been in use since the 1920s as a therapy for epilepsy and can, in some cases, completely remove the need for medication. From the 1960's onwards they have become widely known as one of the most common methods for obesity treatment. Recent work over the last decade or so has provided evidence of the therapeutic potential of ketogenic diets in many pathological conditions, such as diabetes, polycystic ovary syndrome, acne, neurological diseases, cancer and the amelioration of respiratory and cardiovascular disease risk factors." From the August 2013 issue of the European Journal of Clinical Nutrition (Beyond Weight Loss: A Review of the Therapeutic Uses of Very-Low-Carbohydrate (Ketogenic) Diets)
"The inability of current recommendations to control the epidemic of diabetes, the specific failure of the prevailing low-fat diets to improve obesity, cardiovascular risk, or general health and the persistent reports of some serious side effects of commonly prescribed diabetic medications, in combination with the continued success of low-carbohydrate diets in the treatment of diabetes and metabolic syndrome without significant side effects, point to the need for a reappraisal of dietary guidelines. The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, is best for weight loss, and leads to the reduction or elimination of medication." A group of 25 MD / Ph.D researchers writing in the January 2015 issue of Nutrition (Dietary Carbohydrate Restriction as the First Approach in Diabetes Management: Critical Review and Evidence Base). I wrote an article on this study a few years ago (HERE).
By 1921, the "Ketogenic Diet" diet was being used on children with EPILEPSY to great benefit. Shortly before the outbreak of WWII, new anticonvulsant drugs were developed (Dilantin being the most well known) that rapidly took the place of said diet. I do not have to tell those of you who struggle in this area that these drugs, despite the fact they can arrest (or at least decrease) most seizures, turn people into zombies and generally make them feel like crap. Because there is an increasingly urgent message about the overarching dangers of drugs, we are seeing a Renaissance of the Ketogenic Diet being used for Epilepsy and other Seizure Disorders. But what about those who don't have Seizure Disorders --- the vast majority of the population? Is there any benefit of a Ketogenic Diet for you?
Unless you have some very specific health issues (I'll talk about these in Part II), the Ketogenic Diet can likely benefit you. As a short primer to today's post, I want to introduce you to Dr. Charles Mobbs. Dr. Mobbs of New York's Icahn Mount Sinai Medical School holds professorships in numerous areas including Geriatrics, Neuroscience, Endocrinology, Diabetes and Bone Disease. His research interests include Aging, Obesity, Diabetes, Alzheimer's Disease, life extension, and dietary restriction. Listen as he explains how all of these things (including Alzheimer's) are related to dietary carbohydrates and BLOOD SUGAR.
In similar fashion to the way we learned that the majority of the symptoms of Gluten Sensitivity are neurological (HERE), you are going to quickly notice is that most of the benefits (at least 'studied' benefits) of the Ketogenic Diet tend to be neurological as well. Look at this quote from last October's issue of the journal Appetite (Brain and Behavioral Perturbations in Rats Following Western Diet Access). "Energy dense "Western" diets are known to cause obesity as well as learning and memory impairments, blood-brain barrier damage, and psychological disturbances. In contrast, ketogenic diets have been shown to be neuro-protective." In a nutshell, what Americans eat (and the rest of the world is eating more like us every day) screws up the brain, and the Ketogenic Diet works to repair it! Need more proof? Roll up your sleeves and dig in.
- CANCER: There are hundreds of studies on the ability of the Ketogenic Diet to effectively treat Cancer. Last month's issue of the Cancer journal Oncology Letters provided a true mind-bender for those chemo-doctors still living in the DIET-DOESN'T-MATTER world. "Since the initial observations by Warburg in 1924, it has become clear in recent years that tumor cells require a high level of glucose to proliferate. Therefore, a ketogenic diet that provides the body with energy mainly through fat and proteins, but contains a reduced amount of carbohydrates, has become a dietary option for supporting tumor treatment and has exhibited promising results. In conclusion, the results from the present case series in general practice suggest that it may be beneficial to advise tumor patients to adopt a ketogenic diet, and that those who adhere to it may have positive results from this type of diet." For those who don't know, Dr. Otto Warburg was the German physician / scientist who won the Nobel Peace Prize back in 1931 for figuring out that SUGAR feeds CANCER.
- CANCER PART II: The title of the study that appeared in last March's issue of Medical Hypothesis (Starvation of Cancer Via Induced Ketogenesis and Severe Hypoglycemia) is so incredible, I had to share the abstract with you. I have tried to beat into people's heads (HERE, HERE, and HERE are a few) that despite the fact that this idea is largely pho-phoed by heavy hitters in the "Cancer Treatment Industry" like Johns Hopkins, MD Anderson, and others, sugar really does feed Cancer. "Neoplasms are highly dependent on glucose as their substrate for energy production and are generally not able to catabolize other fuel sources such as ketones and fatty acids. Thus, removing access to glucose has the potential to starve cancer cells and induce apoptosis. Unfortunately, other body tissues are also dependent on glucose for energy under normal conditions. However, in human starvation (or in the setting of diet-induced ketogenesis), the body "keto-adapts" and glucose requirements of most tissues drop to almost nil. Exceptions include the central nervous system (CNS) and various other tissues which have a small but obligatory requirement of glucose. Our hypothesized treatment takes keto-adaptation as a prerequisite. We then propose the induction of severe hypoglycemia by depressing gluconeogenesis while administering glucose to the brain. Although severe hypoglycemia normally produces adverse effects such as seizure and coma, it is relatively safe following keto-adaptation. We hypothesize that our therapeutic hypoglycemia treatment has potential to rapidly induce tumor cell necrosis." So, even though you'll end up with HYPOGLYCEMIA, it doesn't matter because the body has switched over and is running off Ketone Bodies --- something that Cancer cells cannot effectively do. To repeat; the purpose of the Ketogenic Diet is to dramatically reduce Blood Sugar by inducing "severe" Hypoglycemia, thereby forcing your body to burn Ketones for energy.
- AUTISM: No one can argue that AUTISM rates are exploding here in America (1 in 32 is the latest --- HERE). Listen to what the current issue of Behavioral Brain Research has to say about Autism and the Ketogenic Diet. "Amongst the diverse hypotheses regarding the pathophysiology of Autism Spectrum Disorders (ASD), one possibility is that there is increased neuronal excitation, leading to alterations in sensory processing, functional integration and behavior. The high-fat, low-carbohydrate ketogenic diet (KD), traditionally used in the treatment of medically intractable epilepsy, has already been shown to reduce autistic behaviors in both humans and in rodent models of ASD. We found that BTBR [Autistic] mice had lower movement thresholds and larger motor maps indicative of higher excitation / inhibition compared to controls, and that the KD reversed both these abnormalities." This is almost identical to a study published three years ago in PLoS One (Ketogenic Diet improves Core Symptoms of Autism in BTBR Mice) that stated, "Our results suggest that a ketogenic diet improves multiple autistic behaviors in the BTBR mouse model. Therefore, ketogenic diets or analogous metabolic strategies may offer novel opportunities to improve core behavioral symptoms of autism spectrum disorders."
- MULTIPLE SCLEROSIS: The December 2015 issue of Multiple Sclerosis International carried a study called The Therapeutic Potential of the Ketogenic Diet in Treating Progressive Multiple Sclerosis. The study stated that, "MS has traditionally been viewed as an immune-mediated inflammatory disease. An immune response is thought to be responsible for causing the spontaneously remitting relapses in RRMS. Immune cells migrate across a compromised blood brain barrier [Leaky Brain Syndrome; similar to LEAKY GUT SYNDROME] and cause focal and disseminated inflammation. The traditional view of MS as an inflammatory disease has resulted in almost all therapeutic strategies taking an immuno-suppressive approach. Neurodegeneration may play a more central role in its pathogenesis. Mitochondrial dysfunction is thought to play a central role in the neurodegenerative disease process and a growing body of evidence suggests that mitochondrial dysfunction may also be of great importance in the pathogenesis of MS. The neurodegenerative process underlying progressive MS may also result in glucose hypometabolism. This would suggest a potential therapeutic advantage in boosting energy supply through an alternative route, such as ketone metabolism. The ketogenic diet has the potential to treat the neurodegenerative component of progressive MS." The truth is, I could almost quote this entire study. Bottom line; if you have MS, you must read THIS STUDY in its entirety!
- NERVE & BRAIN REGENERATION: It seems that kidneys aren't the only organs / tissues being regenerated by the Ketogenic Diet (see Dr. Mobbs' incredible video above). There are any number of studies showing the potential for the Ketogenic Diet to help in Spinal Cord regeneration following traumatic injury. This is not surprising in light of studies like this one from the November 2014 issue of Nutritional Neuroscience (Sciatic Nerve Regeneration in Rats Subjected to Ketogenic Diet). "Besides its anticonvulsant properties, many studies have shown its neuroprotective effect in central nervous system... Regeneration of sciatic nerves was improved in Ketogenic Diet preconditioned rats. These results suggest a neuroprotective effect of KD on peripheral nerves." This is reminiscent of the study conclusions of the December 2014 issue of the Journal of Lipid Research (The Collective Therapeutic Potential of Cerebral Ketone Metabolism in Traumatic Brain Injury) that described using a Ketogenic Diet to treat TRAUMATIC BRAIN INJURIES. "Preclinical studies employing both pre- and post-injury implementation of the ketogenic diet have demonstrated improved structural and functional outcome in traumatic brain injury (TBI) models, mild TBI / concussion models, and spinal cord injury." We will get to Migraines in a moment, but it's important to realize that the bell-tower of Ketogenic therapy is the successful treatment of Epilepsy. As an interesting lead-in, the March 2014 of Current Pain and Headache Reports (Migraine and Epilepsy in the Pediatric Population) stated that, "Individually, childhood epilepsy and migraine are two of the most common conditions seen in pediatric neurology. What complicates matters is that there can be marked similarities between migraine and epilepsy as well as a variety of underlying conditions that predispose children to both seizures and headache." I'll give you two quickies --- GLUTEN SENSITIVITY and UNCONTROLLED BLOOD SUGAR.
- EPILEPSY: This month, the COCHRANE REVIEW did one of their famous meta-analysis on using the Ketogenic Diet to solve adult Epilepsy. Despite the fact that the Ketogenic Diet has been used by the medical profession to treat Epilepsy in children for 100 years (Johns Hopkins actually has a Ketogenic Diet Center for this very purpose), there are less than a dozen good studies pertaining to adults. "It is currently used mainly for children who continue to have seizures despite treatment with antiepileptic drugs. Recently, there has been interest in less restrictive KDs including the modified Atkins diet (MAD) and the use of these diets has extended into adult practice. The randomised controlled trials discussed in this review show promising results for the use of Ketogenic Diets in [adult] epilepsy." The authors said that many people dropped out, mostly because they could not maintain the strict diet, or due to "GI disturbances". I will warn you that if you have been eating a SAD, converting to a KD will cause some temporary issues in this area. By the way, there are literally hundred upon hundreds of studies touting the safety and efficacy of the Ketogenic Diet in children (and even infants). Reputable sources are now touting it as a first line of defense against Epilepsy as opposed to a last resort (HERE).
- INFANTILE SPASMS SYNDROME: Despite having "inadequate data to recommend the diet as a sole first-line therapy," the October 2015 issue of Translational Pediatrics said of Ketogenic Diets, "The ketogenic diet is used often in intractable or profound epilepsies, including infantile spasms, with or without the concurrent use of medications. Spasm freedom has been reported in 14-65% of patients within 1-3 months. Some patients had improved seizure control, were able to reduce medications, and had cognitive improvements, even without cessation of spasms. Ketogenic formula and young age make the diet an attractive option." Sounds like a viable option (one of those what-have-you-got-to-lose sort of things) considering that, "Infantile spasms syndrome is a frequently catastrophic infantile epileptic encephalopathy. Prognosis is generally poor, with the majority of patients having some or profound neurocognitive delays."
- GLUT1 DEFICIENCY SYNDROME: Not being able to get Glucose (Blood Sugar) into the cells where it can be used as energy to make ATP in the MITOCHONDRIA is bad news. GLUT1 is the protein that facilitates the movement of Glucose across the cell membranes and into the cells. Not only do TRANS FATS have a profoundly detrimental effect on this molecule (it's why they are so heavily associated with Diabetes), but a deficiency of GLUT1 can lead to Diabetes as well (Blood Sugar levels continue to climb because the body cannot move it out of the blood and into the cells). There are dozens upon dozens of studies on Glut1 Deficiency Syndrome and Ketogenic Diets, but I'll leave you with just one. This month's issue of Seizure states that, "GLUT-1 deficiency syndrome is a neurologic disorder manifesting as epilepsy, abnormal movements, and cognitive delay. The currently accepted treatment of choice is the classic ketogenic diet. Nearly all patients surveyed were on dietary therapies for long duration with reported excellent seizure control, often without anticonvulsant drugs. Several different ketogenic diets were utilized with similar efficacy." Among other things, Glut1 Deficiency Syndrome has been associated with MIGRAINE HEADACHES. The title of a study from the July 2011 issue of Cephalalgia (Ketogenic Diet in Migraine Treatment: A Brief But Ancient History) reveals that the practice of treating Migraine Headaches with a Ketogenic Diet is nothing new.
- MIGRAINE HEADACHES: Speaking of Migraine Headaches, a study published in the January 2015 issue of the European Journal of Neurology (Migraine Improvement During Short Lasting Ketogenesis...) looked at, "Ninety-six overweight female migraineurs", who did the Ketogenic Diet for six months, and compared them to women who simply did a "standard low-calorie diet" (actually, this second group was Ketogenic for the first month, shifting over to low cal for the next five). Here's what happened. Both groups showed marked improvement during the first month --- the month they were both on the Ketogenic Diet. Then, despite a some worsening between the first and second months, the Ketogenic group showed that, "baseline attack frequency, number of days with headaches, and tablet [medication] intake were significantly reduced after the first month of diet..... with continuous improvement up to month 6. The underlying mechanisms of KD efficacy could be related to its ability to enhance mitochondrial energy metabolism and counteract neural inflammation."
- ADD / ADHD, ANXIETY, DEPRESSION, & BIPOLAR DISORDER: In a fascinating study done with canines, researchers determined that dogs with problems in three distinct areas, "excitability, chasing, and trainability," were analogous to ADHD in humans, and could be helped via a Ketogenic Diet. This month's issue of Epilepsy Behavior went on to say that, "The MCTD [a version of a Ketogenic Diet] resulted in a significant improvement in the ADHD-related behavior compared with the placebo diet. The latter effect may be attributed to previously described anxiolytic effects of a KD. These data support the supposition that dogs with IE [Idiopathic Epilepsy] may exhibit behaviors that resemble ADHD symptoms seen in humans and rodent models of epilepsy, and that a MCTD may be able to improve some of these behaviors, along with potentially anxiolytic [anti-anxiety] effects." As for Bipolar Disorder, a study done three years ago for the journal Neurocase concluded that, "Two women with type II bipolar disorder were able to maintain ketosis for prolonged periods of time (2 and 3 years, respectively). Both experienced mood stabilization that exceeded that achieved with medication; experienced a significant subjective improvement that was distinctly related to ketosis; and tolerated the diet well. There were no significant adverse effects in either case. These cases demonstrate that the ketogenic diet is a potentially sustainable option for mood stabilization in type II bipolar illness." And the granddaddy of all of these; DEPRESSION. The December 2004 issue of Biological Psychiatry published a study called Antidepressant Properties of the Ketogenic Diet whose title tells the story.
- ALZHEIMER'S AND PARKINSON'S DISEASE: With the explosion of ALZHEIMER'S being heavily linked to jacked Blood Sugar, mostly due to LIVING THE HIGH CARB LIFESTYLE, it should come as no surprise that the Ketogenic Diet shows promise in this area as well. Last month's issue of the Annals of the New York Academy of Sciences (Can Ketones Compensate for Deteriorating Brain Glucose Uptake During Aging? Implications for the Risk and Treatment of Alzheimer's Disease) revealed that, "Brain glucose uptake is impaired in Alzheimer's disease (AD). A key question is whether cognitive decline can be delayed if this brain energy defect is at least partly corrected or bypassed early in the disease. The principal ketones (also called ketone bodies), are the brain's main physiological alternative fuel to glucose. Three studies in mild-to-moderate AD have shown that, unlike with glucose, brain ketone uptake is not different from that in healthy age-matched controls. Published clinical trials demonstrate that increasing ketone availability to the brain via moderate nutritional ketosis has a modest beneficial effect on cognitive outcomes in mild-to-moderate AD and in mild cognitive impairment. Nutritional ketosis can be safely achieved by a high-fat ketogenic diet....." For those who are interested (ME, FOR ONE), a similar benefit has been seen for Parkinson's Disease (HERE).
- SCHIZOPHRENIA: About 25 million people world wide are thought to have Schizophrenia --- a form of mental illness that along with any number of other neurological disorders (including many on this page), has been heavily linked to Gluten / wheat protein (HERE). The December 2015 issue of Schizophrenia Review (Ketogenic Diet Reverses Behavioral Abnormalities in an Acute NMDA Receptor Hypofunction Model of Schizophrenia) concluded that, "Here we demonstrated for the first time that ketogenic diet normalized pathological behaviors in an animal model of Schizophrenia."
- POST-STROKE REHAB: What have we done as far as treating problems like Heart Disease, Strokes, and HIGH BLOOD PRESSURE here in America? We've told people that red meat and saturated fat are the problem (THEY'RE NOT), and that if we'll all just AVOID SALT and TAKE OUR STATINS like good little boys and girls, everything will be OK. Forget this model! The December 2014 issue of the journal Advanced Pharmaceutical Bulletin (Ketogenic Diet Provides Neuroprotective Effects against Ischemic Stroke Neuronal Damages) says, "Ischemic stroke is a leading cause of death and disability in the world. Many mechanisms contribute in cell death in ischemic stroke. Ketogenic diet which has been successfully used in the drug-resistant epilepsy has been shown to be effective in many other neurologic disorders. The mechanisms underlying of its effects are not well studied, but it seems that its neuroprotective ability is mediated at least through alleviation of excitotoxicity, oxidative stress and apoptosis events." By the way, "apoptosis" is the fancy way to say cellular death. If you want to see a wild article on "excitotoxicity" as a mechanism for all sorts of health problems, including Obesity, check THIS out.
- PCOS / INFERTILITY: Ladies, I've shown you repeatedly that if you want to get pregnant, you've got to get serious about controlling your Blood Sugar (HERE is the last thing I wrote on this topic). Furthermore, when you understand how intimately PCOS --- America's number one reason for INFERTILITY --- is so closely related to jacked Blood Sugar, treating with a Ketogenic Diet is only logical. Listen to the conclusions of a study that was published eleven years ago, in the Journal of Nutrition and Metabolism (The Effects of a Low-Carbohydrate, Ketogenic Diet on the Polycystic Ovary Syndrome: A Pilot Study). "Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age and is associated with obesity, hyperinsulinemia, and insulin resistance. There are no known curative therapies for PCOS, though anti-diabetic medications do improve many of the metabolic abnormalities." For those of you keeping score at home, Insulin Resistance is "PRE-DIABETES". Make sure to pay close attention to the following numbers. "Recent studies have shown that a low-carbohydrate, ketogenic diet can lead to weight loss and improvements in insulin resistance. From baseline to week 24, there were statistically significant reductions in percent free testosterone (from 2.19 to 1.70), LH/FSH ratio (from 2.23 to 1.21), and fasting serum insulin (from 23.5 to 8.2). A reduction in serum insulin while maintaining fasting serum glucose and HgbA1c suggests an overall improvement in insulin resistance. During the 24 week period, the average systolic blood pressure decreased 6.3 mm Hg and average diastolic blood pressure decreased 9.6 mm Hg from baseline. No subject dropped out due to reported symptomatic adverse effects. Two women became pregnant during the study despite previous infertility problems."
- INFLAMMATION & CHRONIC PAIN: The August 2013 issue of the Journal of Child Neurology carried a study simply called Ketogenic Diets and Pain carries some interesting (cherry-picked) tidbits as well. "Pain is one of the most commonly indicated health-related factors leading to poor quality of life. Not surprisingly, persons suffering from pain are more likely to also suffer from anxiety or depression compared to the normal population. Many types of pain and painful or progressive conditions involve chronic inflammation. As noted above, several mechanistic threads support the hypothesis that a ketogenic diet will reduce inflammation, compared to glucose metabolism. Inflammation is increasingly appreciated as part of the epileptogenic process, and becomes ever more strongly associated with neurological problems in young and old alike. Data suggesting positive effects of a ketogenic diet itself on inflammation or associated inflammatory processes have been accumulating recently. Recent reviews have highlighted the potential for ketogenic diets in diverse disorders. Aside from disease-based processes, cognitive impairment has been observed alongside prediabetes even in adolescents, thus underscoring the ability for altered metabolic homeostasis to affect brain function throughout the lifetime." In light of the typical diet eaten by the typical teenager (HERE), go back and re-read the last sentence about a dozen times. By the way, there are lots of studies showing the ability of Ketogenic Diets to modulate the Immune System (INFLAMMATION, if you remember, is an Immune System response).
- DIABETES AND NEUROPATHY: Because the Ketogenic Diet dramatically reduces Blood Sugar, it's a natural for helping TYPE II DIABETICS (with or without NEUROPATHY). Interestingly enough, I have talked to Diabetic patients who were told by their doctor that they could not be on a Ketogenic Diet because it causes Blood Sugar to go too low --- a condition known as Hypoglycemia. That, folks, is exactly the point! Sort of like converting your pickup to run on LPG instead of gasoline; you are forcing your body to run on Ketone Bodies instead of Glucose. Thus, you don't need much Blood Sugar to keep things up and running. Although there is an immense body of research pertaining specifically to Ketogenic Diets for Diabetes, I will leave you with one --- again from the July 2013 issue of the Journal of Child Neurology; this one called Treatment of Diabetes and Diabetic Complications With a Ketogenic Diet. "Accumulating evidence suggests that low-carbohydrate, high-fat diets are safe and effective to reduce glycemia in diabetic patients, without producing significant cardiovascular risks. Diets that limit protein as well as carbohydrates, entailing a composition very high in fat, appear even more effective to reduce glucose and whole-body glucose metabolism in humans." Despite the fact that in America, our government cannot get it through their heads that the WAR ON DIETARY FAT SHOULD BE LONG OVER, England seems to have less trouble with this fact. Diabetes dot co dot UK ("The Global Diabetes Community") has an article called Low Carb Diet and Diabetic Neuropathy Prevention that actually touts things like the Atkins Diet and a Ketogenic Diet. It's not really rocket science. "It is hypothesized that being on a low carbohydrate diet may be used as a method for potentially limiting or reversing the progression of diabetic neuropathy. This is due to the fact that a main contributing factor to neuropathy is prolonged exposure to high blood sugar levels. By reducing carbohydrate content, and in turn blood glucose levels, symptoms of nerve damage may be reduced. Diabetic neuropathy is the name given to nerve damage that can occur in a diabetic as a result of high blood glucose levels or hyperglycemia."
- OBESITY: If something helps solve Diabetes, it's only logical to assume it will likely benefit Obesity as well (this goes for the millions of you who are of a "normal" weight, but clinically Obese --- HERE). Not only is the Ketogenic Diet beneficial for Obesity, there are more studies backing this up than you could likely read through in a day. For instance, a study from last month's issue of Obesity Review (Do Ketogenic Diets Really Suppress Appetite? A Systematic Review and Meta-Analysis) showed that at least part of, "the clinical benefit of a ketogenic diet is in preventing an increase in appetite, despite weight loss". If you are a person who has fallen into extreme (morbid) Obesity, a study from the June 2015 issue of Obesity Research and Clinical Practice (Aggressive Nutritional Strategy in Morbid Obesity in Clinical Practice: Safety, Feasibility, and Effects on Metabolic and Haemodynamic Risk Factors) might be right up your alley. "In morbid obesity, an aggressive nutritional cycle comprising a short-term ketogenic EN followed by an almost carbohydrates-free ON [liquid diet through a nasal tube] may be feasible, safe, and highly effective in reducing body weight, waist circumference, blood pressure, and insulin resistance." As you may have learned from the ahead-of-his-time cardiologist, ROBERT ATKINS, clear back in the 1990's that low carb diets are not only the best thing going for WEIGHT LOSS, but for normalizing blood work (Cholesterol, Blood Sugar, A1C, etc) as well.
- PSORIASIS: Depending on whose stats you choose to hang your hat on, Psoriasis (an AUTOIMMUNE DISEASE) affects somewhere between 8 and 16 million Americans. This past November's issue of the journal Obesity Research & Clinical Practice says, "Psoriasis is a chronic disease associated with overweight/obesity and related cardiometabolic complications. The link between these diseases is likely the inflammatory background associated with adipose tissue, particularly the visceral one. Accordingly, previous studies have demonstrated that in the long-term weight loss may improve the response to systemic therapies. Accordingly, through rapid and consistent weight loss, ketogenic diet may allow restoring a quick response to systemic therapy in a patient suffering from relapsing psoriasis." The point of this study was to prove that the Ketogenic Diet caused weight loss that people with Psoriasis that allowed them to better-respond to their IMMUNO-SUPPRESSIVE MEDICATION. While this is probably accurate, the goal of most therapies should be to provide an EXIT STRATEGY --- i.e. getting off the MEDICAL MERRY-GO-ROUND completely.
I have shown you repeatedly that regularly jacking your Blood Sugar --- even though your doctor keeps telling you that all is well --- is tied to virtually every disease you can name (as well as any number you can't). Furthermore, I have also shown you that what we call "normal" blood sugar levels here in America are too high --- many experts believe way too high. This is probably due to the fact that when it comes to blood work, clinical "normals" are nothing more than population averages. In a population where between 1 in 4 and 1 in 3 citizens has Pre-Diabetes, and 1 in 10 has Diabetes (not to mention the 80% of the population that is either Obese or FUNCTIONALLY OBESE) do you think Blood Sugar "normals" might be skewed a bit? Darn straight they are! And if we play the law of averages, it's likely they're affecting your health.
As a side note to this post, various studies have shown that Ketogenic Diets can sometimes, over long periods of time, interfere with mineral absorption --- the most commonly studied deficiency being CALCIUM (click the link to see the best and worst calcium supplements). It makes me wonder if at least a portion of this might be related to HYPOCHLORHYDRIA or a lack of DIGESTIVE ENZYMES.
On a similar note, because both digestion as well as most of the problems mentioned on this page are intimately related to ONE'S MOCROBIOME, it also leaves me to wonder if at least part of the effects of the Ketogenic Diet are because "good" bacteria prefer Ketone Bodies as their food source (we already know that "bad" bacteria prefer glucose --- HERE). I would love for GUT HEALTH expert, DR. ART AYERS, to chime in with his two cents on this matter.
ABDOMINAL WALL OR ABDOMINAL CAVITY?
"The incidence of adhesions following abdominal surgery is cumulative with multiple surgeries and female gynecological surgeries giving a particularly high rate of adhesions. In one study, autopsy investigations indicated a 90% incidence of adhesions in patients with multiple surgeries, 70% incidence of adhesions in patients with a gynecologic surgery, a 50% incidence of adhesions with appendectomy, and a greater than 20% incidence of adhesions in patients with no surgical history. Adhesions may occur as the result of tissue damage to the abdomen besides surgery, including traumatic injury, inflammatory disease, intraperitoneal chemotherapy, and radiation therapy." From Dr. Subhuti Dharmananda's article called Abdominal Adhesions: Prevention and Treatment
INSIDE OR OUTSIDE MAKES ALL THE DIFFERENCE IN THE WORLD
The first point to remember is that Inflammation always leads to a form of Scar Tissue that the medical community refers to as fibrosis (HERE). Due to INFLAMMATION, tissues in the Abdominal Cavity such as the messentery (a membranous fold of connective tissue that attaches to the intestine to supply it with blood), the two ommentums (apron-like folds of peritoneum that hang from the stomach), and the peritoneum itself, can become Fibrotic. In their natural state, these tissues should be slick / moist, supple, soft, and pliable. Exposure to Inflammation can leave them dry, hard, and inflexible (see first link in this paragraph).
As you might imagine, the resulting adhesions are essentially a "TETHERING" of your organs (intestines, bladder, uterus, ovaries, stomach, liver, etc, etc, etc) to each other as well as the surrounding tissues. As you also might imagine, this can cause pain --- pain that is frequently both severe and chronic. As is the case with virtually all CHRONIC PAIN SYNDROMES, simply prescribing more MEDICATION is never the answer. What's the solution? Doctors used to go back and surgically remove said Scar Tissue. The problem is, in many (maybe even the majority of) cases, the Scar Tissue was caused by surgery in the first place. Thus, even though the thought process for doing so was both logical and noble (SORT OF LIKE WHAT WE TALKED ABOUT IN YESTERDAY'S POST), the end result is that people often get worse. It's why this is not done nearly as frequently as it used to be.
"The treatment of adhesions is straight-forward. Patients undergo either laparoscopic or open surgery and the adhesions are cut by scalpel or electrical current (lyses). The problem is that adhesions have a tendency to reform. Whether the adhesions are lysed by laparoscopic or open surgery, the inflammation caused by the process of cutting can result in recurrent adhesions." Cherry-picked from WebMD's article by Dr. Bhupinder Anand, called Abdominal Adhesions: Symptoms & Treatment
"There is no way for you to prevent adhesions. This problem is one reason that doctors are cautious to recommend abdominal surgery only when it is necessary. If you are having abdominal surgery, your surgeon can minimize the risk of adhesions by using a gentle surgical technique and powder-free gloves. Abdominal adhesions can be treated, but they can be a recurring problem. Because surgery is both the cause and the treatment, the problem can keep returning. For example, when surgery is done to remove an intestinal obstruction caused by adhesions, adhesions tend to form again and create a new obstruction" Even though this quote came from Drugs dot com (a site devoted to giving you the lowdown on various medications), the authors did not offer any sort of drug therapy as a viable method of treating Abdominal Adhesions.
How can you tell whether the "Adhesion" is superficial (in the Abdominal Wall) or deep (in the Abdominal Cavity)? Truth is, it can be extremely difficult --- sometimes to the point of being virtually impossible. In similar fashion to the test I came up with to help differentiate Piriformis Syndrome from Disc Problems (HERE), I created a simple test that you can do in the comfort of your own home to try and differentiate superficial adhesions from deep adhesions.
Frequently, people with external Scar Tissue (Abdominal Wall) are going to be pulled forward into flexion sue to the tethering action of the Adhesion. When I try and get these people into EXTENSION, they either cannot do it, or they balk because it hurts --- typically at, or very close to, the area of the surgical incision. While this scenario might prove true in some people who have internal Scar Tissue (Abdominal Cavity), this group typically has pain all the time. They tend to not be able to get away from their pain by changing their posture or position, which the "Abdominal Wall" group typically can (activity will help them, but when they stop moving, they stiffen up and hurt in the problem area). As you might gather, this test is not anywhere 100% accurate. But then again, remember that unless your Internal Adhesions are severe enough to be causing a major structural issue such as bowel obstruction, diagnostic imaging will come back negative (HERE --- see Dandi's heart breaking comment at the bottom of the page).
Logically, the next question is, can anything be done for the pain if the problem is coming from inside the Abdominal Cavity? As you can see from the quotes above, this is a serious problem. And if you start looking at lists of things that doctors recommend for people with Post-Surgical Adhesions, it doesn't take long to see how perplexing it really is (a great example is the Cleveland Clinic's article, 4 Best Ways to Take Care of Abdominal Adhesions). While following the advice of these sorts of articles is certainly not going to hurt you, there must be something better? For many of you there is.
I would suggest to you that because it is so intimately related to Fibrosis (Scar Tissue), SOLVING THE UNDERLYING CAUSES OF INFLAMMATION is as good an option for dealing with Post-Surgical Adhesions as any available today. And if you will make the effort to get your levels of Systemic Inflammation under control before you have surgery, all the better. However, it's never too late to deal with Inflammation, as it is the root of almost EVERY NON-GENETIC PROBLEM that can go wrong in your body.
If you are one of the many people struggling with Post-Surgical Adhesions and have not tried ACUPUNCTURE or LOW LEVEL LASER THERAPY (you will have to use a Class IV as opposed to Class III because the later will not penetrate deep enough), they are options with practically zero side effects. There are also specialized therapists / massage therapists who deal with this thing specifically. For those of you for whom INFERTILITY is an issue (infertility can be related to Adhesions), you may want to look at this link as well.
NOT WHAT IT IS MADE OUT TO BE, NOR WHAT IT SHOULD BE
The problem was so bad that the authors warned, "poor diet and physical inactivity may soon overtake tobacco as the leading cause of death". Naturally, they ended the paper with a plea for more research monies, saying we need to, "establish a more preventive orientation in the US health care and public health systems". It makes sense doesn't it? I mean.... who could argue with their logic? The problem is, despite decades of a steadily increasing emphasis on "Prevention," most chronic health conditions have gotten worse --- way worse.
In an era where EVERYTHING YOU THOUGHT YOU KNEW ABOUT HEALTHCARE is being turned on its head every single day, "Prevention" might just take the cake. According to Webster's, Prevention' means, "the act or practice of stopping something bad from happening". Dorland's Medical Dictionary says that Prevention is, "Serving to avert the occurrence of. Preventing or slowing the course of an illness or disease; prophylactic". But is this what we are really doing with Preventive Medicine?
When we talk about "Preventative Medicine" today, what's the first thing to pop into your mind? Usually it's VACCINES. I am not going to spend a great deal of time on this subject. We already know that the most heavily promoted vaccine (the ANNUAL FLU VACCINE) has been an abject failure for both the 65 AND OLDER crowd, as well as those 18 AND UNDER. And as for other Vaccines (not to mention the NEARLY 300 CURRENTLY IN R&D), even though they may have helped to reduce or contain any number of childhood diseases (many would argue that they have not -- HERE), there are any number of experts who would argue that they have likewise played a big part in the explosion of Chronic Degenerative Diseases and Autoimmunity (see previous link as well as HERE). So; Vaccines aside, let's take a moment and see how Preventative Medicine is faring in other areas of healthcare.
The Robert Wood Johnson Foundation (The Long-Term Returns of Obesity Prevention Policies) says that, "Because such programs [the "various obesity-prevention efforts" spoken of earlier] would prevent obesity and related chronic conditions in the long run, they can help save money by reducing health care costs and increasing wages." While this is certainly true, it is only true if "Prevention" programs for Obesity actually work. Is there any indication whatsoever that these programs are functioning as intended? Although the internet abounds with sites (most of them from governmental sources) declaring this to be the case, the issue is far from cut and dried.
For instance, according to Harvard's School of Public Health, all we need to lick OBESITY is better health insurance. "Health insurance plans, with their broad reach, can in many ways be the most important influence on the weight control behaviors of patients. They can cover the cost of obesity prevention and treatment; create and promote prevention programs that can be instituted plan wide." Those who believe in the nearly mythical powers of government programs certainly believe this. In fact, the "Medicaid dot gov" website says (I'm cherry-picking here)........
"Medicaid and the Children's Health Insurance Program (CHIP) can play a role in reducing the rate of obesity in the United States by improving access to health care services that support healthy weight. For children enrolled in Medicaid, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit covers all medically necessary services which can include obesity-related services. For adults, the states can choose which services to provide, with most states choosing to cover at least one obesity treatment. Obesity screening and counseling for children, adolescents and adults is a USPSTF recommended service." Some of the specific things mentioned by Medicaid to help stem the tide of Obesity include (I am cherry-picking again), "designing public awareness campaigns, hosting calls and webinars, developing fact sheets, and efforts to increase awareness of preventive services." I'm sure I've seen worse governmental gobblety gook somewhere else; I just can't remember when or where.
A scientific paper from BYU (Cutting the Fat on Healthcare: An Investigation of Preventive Healthcare and the Fight on Obesity) from 2010 let the cat at least part way out of the bag. Even though the authors are extremely pro-Preventative, they reveal that, "Changing the behavior of millions of Americans is not going to be accomplished merely through strategic legislation. In reality, such a change cannot come from any one office or program. Indeed, changing the behavior of millions of Americans requires just that—millions of Americans. Perhaps the answer to America’s healthcare issue does not lie in a change of policy but in a change of mindset". Although I could agree with this statement; how's that change of mindset working out for the 80% of our nation who is either overweight or appear that way via their blood work (see next link)?
"Studies have shown that although some forms of preventable action can save money, others only add to costs. In fact, some estimates claim that fewer than 20 percent of preventive options would be cost-savings. Whether these estimates nullify the importance of more preventive measures is debatable.... Implementing preventive policies is somewhat hit or miss..... Localizing programs to only those at high risk is easier said than done."
I guess because they don't have anything better to offer in light of the fact that their bubble has just been burst, the authors advocate for more and smarter government programs --- which is almost always where "Prevention" seems to take us. However, it was our own government's U.S. Preventive Services Task Force (Final Recommendation Statement: Obesity in Adults: Screening and Management, June 2012) that concluded, "with moderate certainty that screening for obesity in adults has a moderate net benefit". What does moderate mean? After all is said and done, "The USPSTF found adequate evidence that intensive, multi-component behavioral interventions for obese adults can lead to an average weight loss of 8.8 to 15.4 lb." Not only are these sorts of interventions extremely expensive, according to virtually all the research, the effects are short-lived.
Ten years ago in May, our government (HHS Public Access) carried a study called A Meta-Analytic Review of Obesity Prevention Programs for Children and Adolescents: The Skinny on Interventions that Work. "A literature search identified 64 prevention programs seeking to produce weight gain prevention effects, of which 21% produced significant prevention effects (13 of 64)... Unfortunately, successful treatments have been elusive. For adults, the current treatment of choice only results in about a 10% reduction in body weight and virtually all patients regain this weight within a few years of treatment. Obesity treatments for children and adolescents have yielded similar effects. This meta-analytic review suggests that most interventions do not produce the hypothesized weight gain prevention effects and that the overall average intervention effect was small..."
At the end of the day, however, it's not the studies that should be telling us that "Obesity Prevention" programs are successful and cost-effective or not. It's the eye test. The brutal truth is that despite everything we are doing (not to mention the incredible amount of tax dollars being spent), obesity rates continue to soar. And after you factor in those who are MONW into the equation (Medically Obese Normal Weight --- some estimates say this group accounts for nearly 10% of the population), we begin to see that things are much worse than we ever imagined and getting worse.
The reason that I dealt first with Obesity is that all the others on this list largely flow from it (as well as it's just as ugly twin sister, BLOOD SUGAR DYSREGULATION, which we will get to momentarily). Solve the Obesity crisis, and you go a long way toward solving the other problems on this page --- all of them. The problem is, despite all the time, energy, and tax-payer dollars being poured into solving this problem (HERE then HERE), we continue to spin our wheels. It sort of reminds me of having your car stuck in the snow or mud. Even though you put the pedal to the metal and rev the engine until the RPM's approach red-line, the vehicle isn't going anywhere.
Last July's issue of Obesity Review proved this when they published a study called What Childhood Obesity Prevention Programs Work? A Systematic Review and Meta-Analysis. This study, like any number of others, determined that, "strength of evidence was moderate for school-based interventions targeting either diet or physical activity." In other words, these programs seem to work --- at least to a moderate degree --- while at school. However, at home --- where kids live, eat, sleep, and SPEND MOST OF THEIR TIME --- was a completely different story. After crunching the data from nearly 150 studies on the subject, researchers determined that, "strength of evidence was low for combined interventions [diet, exercise, education efforts] in childcare or home settings." In other words, you may be able to force kids to do certain things at school, but they essentially do what they want to do when they get home.
PREVENTING HEART DISEASE
After DECLARING WAR ON DIETARY FAT, and making words like "CHOLESTEROL" and "STATIN DRUGS" a 'normal' part of American vernacular and culture, we now know that this approach was almost 180 degrees opposite of what actually works. What did decades of promoting 'Low Fat' and 'Fat Free' foods do to Americans? It left us fatter and sicker than any generation in the history of the world. Even though our lifespan is longer, research says that we are not more satisfied or happy. We are essentially being kept alive with drugs and new technology (HERE), making our collective existence a proverbial goldmine for BIG PHARMA. Forget gold mines for a moment, let's see what the gold standard of research --- the COCHRANE REVIEW --- had to say about this subject.
In 2011, Dr. Carl Heneghan, Director for Oxford University's Evidence-Based Medicine & Clinical Reader Department, published a paper called Considerable Uncertainty Remains in the Evidence for Primary Prevention of Cardiovascular Disease. Of course it talked about the benefits of quitting CIGARETTES, which you'll find on virtually all lists for Heart Disease "Prevention". But that's where the similarities to the usual back-slapping that goes on within the medical community over their 'raging successes' against Heart Disease, ends. Here are some cherry-picked tidbits from his paper.
"Disappointingly, the current evidence concluded that counseling and education to change behavior do not reduce total or coronary heart disease mortality or clinical events in general populations. In the second Cochrane Review in this edition, which assessed statins for the primary prevention of CVD, 14 randomized controlled trials were included. Overall all-cause mortality was reduced by statins, as well as combined fatal and non-fatal cardiovascular endpoints."
So, when the numbers were crunched in these studies, we saw that even though education efforts and counseling do not make a difference, Statins did help to reduce heart attacks, strokes, and death. Sounds pretty good to me. However, the paper does not end there.
"There are a number of concerning points with this review that arise due to limitations in the published data. The current Cochrane Review results for primary prevention using statins are at odds with previous reviews."
At odds with previous reviews? What could this phrase possibly mean? If you take a look at THIS POST, I show you the numerous ways that Big Pharma is finagling their research to make it say whatever they want it to say. For one, they are only reporting the findings that show their products or services in a good light ("in over one third of trials, outcomes were reported selectively"). Another way of making things look better than they actually are is by, "not reporting on adverse events at all". There were others. And when Cochrane went back to get the "INVISIBLE DATA," guess what? The researchers refused to turn it over ("important data were not obtainable despite attempts to contact authors"). Dr. Heneghan went on to write that....
"This is unacceptable. All of these shortcomings significantly undermine the findings of this review. To date only one trial has been publicly funded, while the authors of nine trials reported having been sponsored either fully or partially by pharmaceutical companies. Although various multiple prevention strategies exist, the most effective and cost-effective intervention for primary prevention in adults at low risk currently remains unclear. Given the current limitations of the evidence-base, the alternative approach for policy is to focus on population-wide prevention. Legislating for smoke-free public spaces, re-designing public spaces to improve exercise or reducing daily dietary salt intake prove generally effective and can be cost-saving interventions."
Although dealing with HYPERTENSION is certainly important for reducing Heart Disease, there is a great deal of debate about how to go about accomplishing this. The good doctor should realize that the evidence for dietary restriction of salt is far more controversial than most people ever dreamed (HERE). By the way, because the studies did not, for the most part, differentiate between participants with previous Cardiovascular Disease and those without, Dr. Heneghan was loathe to make population-wide recommendations for Statin Drugs --- something that many in the medical community have been pushing for mightily (HERE).
I will get there, but I want to say something about Type II Diabetes and our government. The American Heart Association's recommended diet for halting or reversing Diabetes, used to be worse than you could imagine. The recommendations were to avoid any and all fat like the plague (eat MARGARINE or vegetable oil if you must put fat in your body), stay far away from RED MEAT, BUTTER, or EGGS, and essentially live on staples like low-fat bread, potatoes, and pasta.
Although I no longer have it, I used to keep a copy of the AHA's actual recommended diet. Believe it or not, one of their 'healthy' snacks was fat-free saltine crackers. As you may have noticed, THE GOVERNMENT'S RECOMMENDATIONS have not necessarily improved much over the decades. What does this mean for those who actually follow these recommendations? Once more it means that lay a significant chunk of the blame for the explosion of Diabetes at the very feet of the entity that was trying to save us from ourselves in the first place --- our government.
Because research tells us that simply cutting things like PROCESSED CRAP and SODA from our diet, and exercising just a little bit, can reduce our chances of Diabetes by something like 60%, we should be seeing amazing results with Prevention efforts.
- In 2006, Cochrane looked at studies on the efficacy of using exercise alone for treating Type II Diabetes. "Exercise significantly improves glycemic control and reduces visceral adipose tissue [BELLY FAT] and plasma triglycerides, but not plasma cholesterol, in people with type 2 diabetes, even without weight loss."
- In 2007, the Cochrane Review looked at the studies on the efficacy of using diet alone for treating Diabetes. "There are no high quality data on the efficacy of the dietary treatment of type 2 diabetes."
- In 2008, Cochrane looked at both diet and exercise together. "Incidence of diabetes was reduced by 37% with exercise and diet. This had favorable effects on body weight, waist circumference and blood pressure."
Believe me when I tell you that America is not the only nation fighting to get the recent explosion of Type II Diabetes under control. Virtually every Westernized nation (most nations are slowly becoming Westernized) is struggling with this issue. England is no different. Last year, the British Medical Journal published a paper from a group of doctors called Time to Question the NHS Diabetes Prevention Programme.
"A newly published evidence synthesis of the effect of lifestyle interventions on overall mortality in prediabetes cites 17 trials that failed to show a significant effect, and one that just reached statistical significance. Effects tend to be far smaller in unselected free living populations than in trial participants. Astonishingly, given that this lifestyle intervention will become national policy, the Public Health England reports offer no formal estimate of the programme’s cost or cost effectiveness. The assumption that it will save money is based on speculation that the intervention will produce 'optimal effects whilst keeping costs to a minimum.'"
Assumptions. Hmmmmm? Let me hit you with another that will rock your diabetic world. Back when I was attending Logan College of Chiropractic in the late 80's and early 90's, one of my professors was the brilliant (and funny) Dr. Duane Marquardt. Dr. M always made us think outside the box; and one of the statements I remember him making was that Diabetes is not a Blood Sugar problem.
Instead, ALONG WITH A WHOLE HOST OF OTHER HEALTH PROBLEMS (everything on today's bullet points and many more), Diabetes is a problem of "INFLAMMATION". And because I don't see one person in a thousand who truly understands Inflammation, I see many people missing the boat because despite the fact they've lost enough weight to be considered downright skinny (not to mention they are exercising like there's no tomorrow) they still can't control their Blood Sugar without drugs (even though THIS CLASS OF DRUGS HAS BEEN PROVEN LARGELY WORTHLESS).
Dr. Warburg came to the conclusion that Cancer cells generated energy via "fermentation" as opposed the way that healthy cells generate energy (Glycolosis --- remember the Krebs TCA Cycle from biology class?). Because all of this takes place in the MITOCHONDRIA, he determined that Cancer is largely the result of defects in mitochondrial function. In fact, listen to what Warburg wrote back in the 1960's (The Prime Cause and Prevention of Cancer - Part I).
"Cancer, above all other diseases, has countless secondary causes. But, even for cancer, there is only one prime cause. Summarized in a few words, the prime cause of cancer is the replacement of the respiration of oxygen in normal body cells by a fermentation of sugar."
And although he at least partially missed the boat concerning Cancer's relationship to nutrition (he was a proponent of adding huge amounts of SYNTHETIC NUTRIENTS to foods), he was right on the money when it came to the realization that food and nutrition were important as far as their relationship to Cancer. "There exists no alternative today to the prevention of cancer as proposed at Lindau. Indeed millions of experiments in man, through the effectiveness of some vitamins, have shown, that cell respiration is impaired if the active groups of the respiratory enzymes are removed from the food; and that cell respiration is repaired at once, if these groups are added again to the food."
But when it comes to Cancer, what are we trained to think of by the powers that be (the medical community, the government, Big Pharma, etc). What do most of us think of when we think of "preventing" Cancer? Take a look at the posters at the top of this bullet point (or Obama's quote) and see if your memory is not jogged. We are taught that because early detection equals high cure rates, everyone needs to be going through all sorts of diagnostic screening on a regular basis. I've dealt extensively with this myth in the past, but if you want to see a very brief example what I am talking about, HERE is the link (look under the bullet point that says, "Routine Prostate Exams, Breast Exams, Mammograms, Colonoscopies, Female Exams, Physicals, Cancer Screenings, Blood Work, etc)".
PREVENTING POOR DIETS AND SEDENTARY LIFESTYLES
"A 2010 study in the journal Health Affairs calculated that if 90 percent of the U.S. population used proven preventive services, more than do now, it would save only 0.2 percent of healthcare spending." Susan Perry from her January 13, 2013 issue of the Minneapolis Post (Why Preventive-Medicine Services Aren't Lowering Health-Care Costs)
As I showed you today, you can't trust much of the Prevention advice floating around the world wide web --- especially if it comes from the government or healthcare entities working hand-in-hand with the government. Case in point; a 2012 issue of Circulation: The Official Journal of the American Heart Association (Role of Policy and Government in the Obesity Epidemic) actually equated meat with junk food and cola --- something that was likewise done just a few months ago in the Lancet (HERE). "The primary determinants of weight gain were consumption of unhealthy foods such as potato chips, French fries, sugary drinks, and meat." Fat-free milk was then mentioned as a "healthy" alternative to soda pop. Honestly folks, with friends like this, who needs enemies? But every dark cloud has a silver lining.
The cool thing is that the same protocol can be used to help prevent all of the health problems we discussed today. That's all as in all. Just remember that Prevention is just that --- preventing problems before they manifest with visible symptoms. There's no shortcut to getting healthy and staying healthy. It's something that no doctor can do for you. You'll have to make up your mind and do it yourself. This means that you will have to expend some effort.
Rather than me spending tons of time rehashing the best diets or the best sorts of exercise for preventing (or possibly reversing) the various health problems we've discussed today (as well as any number of others), you can find it all HERE. And I'm including a bonus. This link shows you numerous ways to help diminish the Inflammation that causes (that's right folks; it causes) each and every one of the points on this list because they are all --- every one of them (along with most AUTOIMMUNE DISEASES) --- considered to be "inflammatory" (caused by inflammation). It will also help you even your odds of corralling the EPIGENETIC FACTORS that are constantly trying to destroy your health and life.
OFTEN ANYTHING BUT ROUTINE
"The new analyses may show that primary colonoscopy screening is best limited to subgroups. For most of the population, going the distance [colonoscopies for everyone of a certain age] may well provide small benefits with larger costs and harms." From the editorial mentioned above
"H. Gilbert Welch has told us this before, but he doesn’t think we’ve been listening: The central problem with U.S. medical care is not that it’s expensive or complicated or impersonal — it’s that there’s too much of it, and too much of it is ineffective." Nancy Szokan's opening paragraph from last year's article she wrote for the Washington Post (Do You Really Need that Colonoscopy?)
"Many European countries with national population based screening programs have, after thorough evaluation of all evidence, reached the conclusion that fecal testing, rather than colonoscopy is their best option for reducing death from colorectal cancer." From the November, 2012 issue of Practical Gastroenterology (Chronic Polyps: The Harm of Overdiagnosis)
"Another analysis of British data on colon cancer, by the watchdog group Straight Statistics, concluded that screening 1,000 patients for 10 years will prevent two deaths from the disease. Meanwhile, colonoscopies lead to "serious medical complications" in 5 out of every 1,000 patients, according to a 2006 report in the Annals of Internal Medicine. Given these risks, my guess is that a rigorous examination of colonoscopies will find that their benefits do not outweigh their downside." From John Horgan's 2012 article for Scientific American (Why I Won't Get a Colonoscopy)
Dr. Harlan Krumholz and his team discovered that of the estimated 14 million "routine" colonoscopes performed in the US each year on patients 65 and older, 1.6% had serious enough complications to require hospitalization within one week of the procedure. The study, published in last month's issue of Gastroenterology (Differences in Colonoscopy Quality Among Facilities: Development of a Post-Colonoscopy Risk-Standardized Rate of Unplanned Hospital Visits) provided some hard-hitting conclusions. Of the patients the authors looked at, "colonoscopies were followed by 5412 unplanned hospital visits within 7 days. Hemorrhage, abdominal pain, and perforation were the most common causes of unplanned hospital visits"
Mind you, these stats do not count the little old ladies (or men) I mentioned earlier. Why not? Even though they are having pain (and likely ended up at their doctor's office or the ER), most are not hospitalized. They usually end up going back to be re-scoped to look for damage caused from the first scope. These patients are then told by their doctors that they couldn't find anything. When said patients continue complaining about the pain, they are invariably told that it will eventually go away. My experience is that sometimes it does, and sometimes it doesn't. But what about complication rates that extend beyond the seven days looked at in this study?
A 2014 memo from CMS (Medicare), published in the July 14 issue of the Federal Register goes on to say that, says that the rate of hospitalization is, "2.4 to 3.8% at 30 days post procedure." This estimate more than doubles the potential rate estimated for one week after the test. But even this doesn't tell the entire story.
Sick people (those with polyps, diverticulitis, INFLAMMATORY BOWEL DISEASE, or any number of others) are the people most likely to have an "Adverse Event" following their scope. None of these people were counted for the studies mentioned, as the authors were only looking at "routine" scopes --- periodic scopes for those without known problems. Cheryl Clark of Medpage Today (Colonoscopy Complications Occur at Surprisingly High Rate) lets us know that the problem is actually worse than this (if you took "Statistics" in college, this will make more sense).
"The risk is even higher on a per-person basis, because one must consider that patients who undergo colonoscopies at recommended intervals -- every 10 years, or every 5 years if polyps are found -- would have from three to six colonoscopies before age 76."
Add it all up, and we see that of the reported complications for 'routine' Colonoscopies (we already know that THE VAST MAJORITY OF ADVERSE EVENTS FOR ALL PROCEDURES ARE NEVER REPORTED), the number of people requiring hospitalization is going to be at least 5% --- maybe significantly higher. Once we factor in the whole OVERDIAGNOSIS / OVERTREATMENT thing, you have to start wondering if it's worth it. Dr. Gil Welch sums it up in this quote taken from a book he wrote on the subject a few years ago.
"Screening apparently healthy potentially saves a few lives (although the National Cancer Institute couldn’t find any evidence for this in its recent large studies of prostate and ovarian cancer screening). But it definitely drags many others into the system needlessly—into needless appointments, needless tests, needless drugs and needless operations (not to mention all the accompanying needless insurance forms). This process doesn’t promote health; it promotes disease. People suffer from more anxiety about their health, from drug side effects, from complications of surgery. A few die. And remember: these people all felt fine when they entered the health care system." From H. Gilbert Welch's 2011 offering, Overdiagnosed: Making People Sick in the Pursuit of Health. Dr. Welch is a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice
In other words, scoping the colon is a search for disease, but does absolutely nothing to promote health (a WIDESPREAD PROBLEM IN MEDICINE). All of which begs the question of why we are so concerned with Colon Cancer in the first place? Probably because it's the third most common form of CANCER in the US. And like another common form of Cancer (Lung Cancer) is largely preventable via diet and / or lifestyle.
In following the logic of Dr. Welch's statement above (that screening actually promotes disease), my suggestion would be to start leading that healthy lifestyle now. And if you are of the age where your doctor is pushing you to be tested for Colon Cancer, whether you decide to have the test or not, make it a point to STAY FIT AND HEALTHY. It's a much different concept than living however you please, getting routinely tested for various diseases, then using drugs and surgery to treat said diseases. You'd be surprised to learn how many people don't care about changing their diet and lifestyle as long as someone else is paying for the scenario in the previous sentence.
Listen to the expert himself (Dr. Gil Welch) describe the phenomenon of overdiagnosis as it pertains to Cancer. Oh; and as an interesting side note to this issue, THIS ARTICLE on the Canadian recommendations for Colonoscopies was published just days after my post.
FIT AND STRONG AT FIFTY AND BEYOND
"Some studies suggest exercise for seniors is one of the critical elements in aging slowly and in a healthy fashion. Seniors suffering from a variety of ailments are typically folk who do little to no exercising. On the other hand, seniors who exercise regularly are both stronger and have more vitality with fewer incidents of illness." From Exercise Critical for Seniors in the Senior Citizen Journal
"Exercise and nutrition, they go hand in glove. Just like you can't separate the mind and the body, you can't separate exercise and proper nutrition." One of my heroes; the late, great, Dr. Jack LaLane, from his television show back in the 1960's. Yes, he really was a Chiropractor.
As you get older, you start to realize that health means much more than looking good in the mirror. Health equals independence. And independence means you are diminishing your odds of having to one day rely on others for help performing activities of daily living (i.e. eating, bathing, dressing, toilet, etc, etc, etc). What are my tips for keeping you healthy (and ultimately independent) as you head into your 50's, 60's, 70's, and beyond?
- DIET IS YOUR #1 PRIORITY: As you get older, EATING PROPERLY is more important than ever. When we were young, most of us made the mistake of automatically equating thinness with good health (I MYSELF WAS GUILTY). This is a mistake that can cause you all sorts of problems you as you get older. TAKEAWAY: Diet is far more important than exercise when it comes to staying fit and healthy. In other words, you can't workout hard enough to overcome a CRAPPY DIET --- especially as you age.
- DON'T NEGLECT THE STRENGTH TRAINING: After the age of 30, experts tell us we lose 10% of our muscle mass per decade for the rest of our lives. The only way to throw a proverbial wrench in the gears of this machine is to engage in some form of RESISTANCE TRAINING. Although there are any number of ways to go about doing this (KETTLEBELL SWINGS with my 100 lb T-bar have become a staple), if your body will handle it, make sure to do some basic strength movements. Squats and deadlifts are tough to beat. And if you start slowly and concentrate on good form, they aren't as difficult or dangerous as you have been led to believe. TAKEAWAY: Although lifting does not burn as many calories as cardio up front, it increases your metabolism up to 9 times longer than cardio increases your metabolism (4 hours as compared to 36 hours).
- FORGO TYPICAL "CARDIO" TRAINING FOR H.I.I.T. The old way of doing cardio --- slogging on the treadmill for an hour --- is largely a thing of the past. Everything in the peer-reviewed literature points to 'short and intense' as being best when it comes to practically all forms of exercise. RUNNING IS NO DIFFERENT. Rather than going for an eight mile run, go down to the football field (or park) and jog fifty yards / sprint fifty yards. Back and forth, non-stop, for 10-15 minutes. You'll be amazed at the difference. And if you are at that point in your life when you don't feel you can run anymore, walk fast(er). Also; you can avoid a great deal of impact to aging joints by staying off harder surfaces and wearing appropriate footwear. TAKEAWAY: The only form of exercise that approaches the benefits of strength training is HIIT (High Intensity Interval Training).
- FLEXIBILITY / POSTURE TRAINING: Motion is lotion --- especially as we roll our body's odometers over. Plainly stated, when joints lose their normal ranges of motion, they wear out. "Wearing out" means your joints lose their cartilage, they develop bone spurs, and they become engulfed in calcium deposits. Although there about a jillion ways to tackle this bullet point, it is my belief that EXTENSION TRAINING is a quick and easy way to kill two birds with one stone. TAKEAWAY: Start by spending just a few minutes a day working on Extension, because it's much tougher to regain it than it is to let it go south in the first place.
- CORE STRENGTH & BALANCE TRAINING: If done correctly, CORE STRENGTH is both easy and fun. What do I suggest? If you are weightlifting on a regular basis, do exercises you would normally do on a bench, on a ball (shoulder presses are a great example). One thing I want to warn you against --- especially if you have a history of back problems --- is SIT UPS OR CRUNCHES. And although I could mention it under any number of these bullets, Yoga Stretches are a fabulous way to train your whole body. TAKEAWAY: If you are into thinking outside of the box, TRAMPOLINING and / or WHOLE BODY VIBRATION are both incredibly effective at taking care of this bullet point.
- WEIGHT LOSS: Be aware that BMI Charts are skewed by people who carry more muscle mass (weightlifters). On the other hand, it's also important to realize that the average American does not realize just how fat they really are (HERE and HERE). Take some photographs of yourself in your underwear. Pictures don't lie like mirrors (or best friends) can. TAKEAWAY: As long as you are hitting it hard, firming up, and getting leaner, don't fret about what the scale says.
- GET IN THE WATER: Whether it's the pool or THE CURRENT RIVER, try to make water activities part of what you do to stay fit. For instance, our local pool offers water aerobics in the summer, and I have yet to hear a patient say it did not benefit them tremendously. Exercising in the water is easy on the joints, promotes flexibility, strength, and cardio fitness, and on top of all that, is a great calorie-burner because of the extra energy required to warm your body. Exercising on top of the water is fantastic as well. Our area is perfect for KAYAKING. If you are really serious, paddle your kayak up river. TAKEAWAY: There aren't many people who don't enjoy exercise when it involves water.
- TAKE UP A SPORT OR ACTIVE HOBBY: There are any number of sports that people participate in well into their 60's, 70's, and beyond. Golf comes immediately to mind (just remember that using a cart negates its benefits). We could mention any number of others, including Tennis, Racquetball, Martial Arts / Tai Chi, Cycling, Zumba Classes, Yoga, Dancing, Badminton, Mall-Walking groups, etc, etc, etc. Some people even COMPETE well into their twilight years. TAKEAWAY: Exercise does not need to be boring. Find something you love and go with it.
- MAKE EXERCISING PART OF YOUR SOCIAL LIFE: If you've ever been a gym rat, you know how social working out can be. Not that it can't be incredibly focused and intense, but because you always see the same people, it's pretty easy to make acquaintances / friends. An ACCOUNTABILITY PARTNER is a great way to workout with a friend, and make sure each of you are doing what you are supposed to be doing. TAKEAWAY: If you don't figure out a way to make exercise enjoyable, you are unlikely to stick with it.
- AVOID FLU SHOTS: I get it. This is seems a rather strange point to stick in this list. I'll show you real quickly why it's not. In fact, for some of you it may be the most important. Even though "EVIDENCE-BASED MEDICINE" has shown us that Flu Shots don't work worth a flip for senior citizens (HERE); who is it that lines up for them like they're trying to purchase the last ticket for the Wayne Newton Reunion Tour concert? That's right; senior citizens. Who tends to get Alzheimer's? Again; senior citizens. Unfortunately, even though most of you are not aware of the fact, there is a significant (and scary) connection between the two (HERE). TAKEAWAY: Leave Flu Shots to the younger folks (Oops! They don't work so hot for them either --- HERE).
- SEX: Although the average (or even above average) sexual encounter is not going to burn nearly as many calories as you may have been led to believe, the health benefits of regular sex are legion. Increasingly, it's thought that part of this could be due to keeping the MICROBIOME healthy. TAKEAWAY: While it might not be the best workout, it's undoubtedly the "best" workout. Trouble in this department? CLICK HERE.
- BODY / MIND CONNECTION: As strange as it may seem, keeping your body fit is one of the top ways to keep your mind fit (HERE and HERE). The opposite is largely true as well. Could be why hours upon hours of sitting in front of a TV every day is bad for you on so many different levels. TAKEAWAY: It's important to stay mentally fit as well as physically fit. Make sure you are working on learning something new each and every day.
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IF YOU HAVE CHILDREN OR GRANDCHILDREN
READ THIS POST
Jan 27, 2016
My 13 year old daughter was diagnosed back in May with costochondritis. At that time she had been battling multiple bouts of strep throat and possibly a second mono infection (she had mono at age 10). She didn't do anything strenuous over the summer (no camp, no theater, no dance, no amusement parks, etc). She tried cheerleading for the first time in years in August and it set her way back.
We went back to her doctor who sent us to pain management (for the chest pain). They gave her lidocaine cream and advised physical therapy. PT advised she was hypermobile and had weak muscles. He worked a lot on her hips to get them aligned. She came home from physical therapy bruised and swollen at times.
This prompted a visit to a Rheumatologist who didn't do much other than order an MRI, which showed Pectus Excavatum. She had been seeing an acupuncturist which provided a little relief but wouldn't last. It was a good counter to the pain caused by Physical Therapy. Her echo-cardiogram came back okay, and we are awaiting her results from the pulmonary function test.
Her orthopedist thinks that musculoskeletal disruption from an acrobatic move she did months prior to the costochondritis diagnosis is causing her pain. She felt / heard a click or pop, and it hurt a couple of days but then she was okay. While we wait for an appointment in late February for pain management (mind you, we only gave her Advil and topicals, and the Advil caused esophagitis so she had to stop taking that and start taking Zantac instead) we have started seeing a chiropractor. The first gentle thing he did provided some relief (placebo effect?). She was the best I had seen her in some time. Shortly after he started working muscles, and she isn't feeling so great.
What I have learned so far during this is that all these things are kind of related yet they tell me they are not the cause of her problem. She is hypermobile, has pectus excavatum, may or may not have costochondritis, has muscle spasms, her spleen tip is palpable again (mono) but they didn't seem concerned, the chiropractor thinks she might have a hiatal hernia, X-rays and MRI seem okay other than pectus excavatum, mild scoliosis that orthopedic doesn't even consider scoliosis because it's so minor........
Is she a candidate for what you do? You are a long way away but I would consider it. Our chiropractor is following the pain for now but even he says he really hasn't dealt with something like this before.
Jan 28, 2016
A couple things. Firstly, unless it is grossly severe, the PE has nothing to do with anything. Secondly, she would obviously not tolerate what I do. It sounds to me like a systemic thing --- probably autoimmune (commonly triggered by viral infections such as mono --- EBV / Cytomegalovirus --- or any number of other reasons). Sounds like there's probably a history of lots of antibiotics as well. Tons of info on my site about addressing these problems. Read my post called "EXIT STRATEGY".
Jan 28, 2016
Thank you for responding and for being upfront that she wouldn't be receptive to your treatment. She seemed to do well with the electric stim and the basic adjustment, but not so much with the muscle work. I will look up your web site. Thanks again. I do appreciate it.
Feb 12, 2016 (After spending a couple of weeks studying)
Oh my goodness,
After your initial response I have been reading your Facebook and website pages, and it brought me back to when my daughter was an infant - colic, severe and was given prescription drops. She also had baby eczema. Her first breathing treatment at an ER was when she was 10 months old. She was later diagnosed with asthma.
My daughter has dealt with GI issues forever. As a young child we finally went to a GI doc and went the psych route at the same time. Celiac was negative and she was only mildly lactose intolerant so specialist said it was probably IBS, made worse by anxiety. So we went with that to no avail.
Psych meds had terrible effects on her - all the SSRI's [antidepressants] with the worst being Zoloft. I swore never again (so if the pain management clinic we go to in a couple of weeks even tries this road again they can forget it). She was able to tolerate Buspar [anti-anxiety] but it did not help her GI problems at all. Things got worse for a while with the start of her menstrual cycle, and for about a year she would get diarrhea, and a day or two later she would throw up --- then the following week she would have her period like clockwork.
After that first year I thought the stomach problems subsided a bit. Now I am thinking she just got used to it. I am noticing she still has bouts of loose bowels and bouts of constipation, I guess she just doesn't complain as much about it. Any nausea complaints get dismissed by her doctors as a consequence of the pain.
I have since bought some items in the gluten free variety, and just today downloaded the FODMAPS diet. I don't know if any of this will help her rib/sternum pain, but it might help her stomach. If our current chiropractor is correct and she does have a hiatal hernia, I'm sure eating better will help that as well since she has been on the typical terrible teenage diet the last couple of years.
Today you posted about NSAIDS and I almost commented but decided against it (for privacy issues I guess) but you may post the info if you like.... It was ibuprofen use (the thing the doctors told her to take) for her pain, which was round the clock during physical therapy, that caused esophagitis. That pain was probably worse than her original pain and scary for her because she felt like she couldn't get a good breath and had to find awkward positions to lay in to get some relief and rest. I knew long-term use could cause stomach problems and possibly an ulcer but I thought that would be very long term use. I had no idea that it could irritate the esophagus in such a short period of time.
So I want to thank you again Dr. Schierling. I enjoy reading your pages as you are not selling anything. Other pages I have visited with similar postings all seem to be selling their own supplements or services. I reached out and you were honest about my daughter not being a good candidate for your form of treatment. I'm not gonna lie, I wish you were closer to my area anyway.
MY TAKE ON LORI'S DAUGHTER'S CONDITION:
Let me first say that the following is entirely speculation --- an "educated guess" if you will. The cool thing is that even if I am wrong, the method I recommend to start her down the path of solving her problem will be quite similar. And unlike the numerous drugs she has taken, there are no real side-effects from using THIS APPROACH.
Due to her history of ECZEMA and IRRITABLE BOWEL SYNDROME, we can be pretty sure that she is AUTOIMMUNE (does she have a positive ANA blood test? --- not a great test but a start). The ASTHMA could possibly be due to Antibiotics taken as an infant (HERE and HERE). Coupled with her symptoms of Rhinitis, it might indicate Lori's use of ACETAMINOPHEN when she was pregnant. It might also be the result of her daughter's ANTIDEPRESSANT use (also in previous link). It could also be the result of VACCINES. Please note that I am not picking on Lori here, as all of these things are promoted by the average physician as completely safe, whether pregnant or not.
Add COLIC and ANXIETY into the mix, and we can rest assured that Lori's daughter has some pretty serious GUT HEALTH issues (I would be surprised if she does not have both DYSBIOSIS and a LEAKY GUT). Although these problems are easily tested for, they are rarely tested for in mainstream medicine, mainly because 99 times out of 100 they are caused by the very drugs being used to treat them --- the worst offender being ANTIBIOTICS. Particularly disconcerting once you realize that 80% of your body's entire Immune System is made up of the BACTERIA THAT LIVE IN THE GUT (aka your 'Microbiome'). On top of everything else, the fact that this girl has had mono twice, tells me her Immune System is extremely weak (Mayo's website says, "Most people who have infectious mononucleosis, or mono, get it only once. Rarely, however, mononucleosis symptoms may recur").
All of this leads me to believe that she probably has something called HYPOCHLORHYDRIA (not enough stomach acid). Because the symptoms are erroneously believed by most doctors to be caused by too much stomach acid instead of not enough, she was given a PPI DRUG (Zantac), which in reality, makes the problem worse. Now add in NSAIDS, whose number one side effect is destruction of the GI tract, and you have a living, breathing, nightmare on your hands --- a nightmare that the average doctor is clueless about solving. As you can see from her history, they love to order tests like MRI'S, but don't understand basic physiology, like the importance of having plenty of strong Stomach Acid (see link at top of paragraph).
A couple of observations. Because Lori mentions it, I will second the motion that the TYPICAL TEEN DIET is bad --- probably far worse than most parents can even comprehend (dietary stress, like other forms of stress, leads to ADRENAL FATIGUE). Also, the FODMAPS DIET is a good starting point. Be sure to realize two things. Firstly, that most "GLUTEN FREE" foods are just as bad as their gluten-containing counterparts --- only without the gluten. Secondly, the fact that she did not test positive for Celiac means little more than she is not mounting a wheat-induced autoimmune attack against her own small intestine. If you understand NON-CELIAC GLUTEN SENSITIVITY (far more common than Celiac), you will realize that GLUTEN (or its CROSS-REACTORS, of which milk is one) could be inducing autoimmune attacks against any one of the millions of other tissues in her body besides her small intestine. This is not my opinion. It's what the peer-reviewed scientific literature reveals over and over again.
As for the "costochondritis", it's extremely difficult for me to make a judgement about this. Just guessing, but I am not convinced it is either a RIB SUBLUXATION or a RIB TISSUE PROBLEM (or for that matter, a hiatal hernia). There are any number of points (the 'Liver Point' on the 3rd rib to the right of the sternum, Chapman's Liver / Gallbladder, and Pancreas Points, and Murphy's Point, just to name a few) that indicate pain being reflexed to the chest / upper abdomen from internal problems (often digestive). It could also be part of the whole autoimmune thing. Be aware that because we only have tests for a relatively small number of Autoimmune Diseases (HERE is a short list), many --- maybe even the majority --- go undiagnosed.
Unfortunately, cases like Lori's daughter are common. No; I take that back. They are the norm --- and all too often they are either being caused or heavily contributed to by the medical profession. The crazy thing about the practice of medicine is that even though "BEST EVIDENCE" proves that much of what they are doing on a day-to-day basis is not nearly as "evidence-based" as we have been led to believe. But the band plays on. The prescriptions continue to be written in record numbers. The money continues to pour in. And little seems to change. It's business as usual. And who suffers because of it? The millions upon millions of Americans struggling with CHRONIC PAIN and CHRONIC INFLAMMATORY ILLNESSES.
BTW, Chiropractic Adjustments do much more than deliver a "placebo effect" (HERE is a cool example that I cannot personally take credit for even though I was part of).
I wish you well Lori, and please keep me in the loop as to what you figure out with your daughter. There is likely someone well-versed in FUNCTIONAL MEDICINE quite close to you.
TODAY: FEB 15, 2016
Wow, that was amazing.
I expected a small excerpt maybe about the NSAIDS causing worse problems not the entire history and blog about her. I literally read your blog about the low stomach acid last night! I will absolutely let you know what comes of all this. I will also reach out to a functional medicine practitioner as I think I have an idea of how our pain management visit is going to go.
Thanks so much,
ARE OTC TYLENOL / ACETAMINOPHEN
AS SAFE AS WE'VE BEEN LED TO BELIEVE?
"Tylenol (acetaminophen / paracetamol) is the most popular over-the-counter (OTC) pain relief medication used in the United States and around the world. According to the U.S. Food and Drug Administration (FDA), Americans bought 28 billion doses of products containing Tylenol in 2005 alone. It is marketed as an effective painkiller that is safer than non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen, which are associated with stomach discomfort or bleeding. Tylenol is not without its serious complications. It is the leading cause of acute liver failure in the United States." Cherry-picked from Drugwatch dot com (Tylenol).
"I occasionally treat an older gentleman --- an eccentric intellectual type --- from New York City. Back in the 1950's he was delivering Tylenol by truck. He told me that when he delivered to hospitals, there were no charges for the crates of pills. When he quizzed his superiors about this, he was told that it was so the manufacturers could claim it was recommended by 4 out of 5 doctors." Dr. Russell Schierling
"Paracetamol: do we have to reconsider the benefit/risk ratio?" The title of a study from the September 2015 issue of La Revu Da Practicien
Let me first say that Acetaminophen (aka Paracetamol) is not technically considered an NSAID. Although it certainly has certain similar properties, it is technically a pain medication that does not relieve inflammation (even though it works on similar pathways). What led me to address this topic is the amount of research linking Acetaminophen use in expecting mothers to ASTHMA in their offspring.
It's important to remember that for decades women have been told that Tylenol is safe to take while pregnant --- that it does not cross the placental barrier (or that if it does, it doesn't matter). Turns out this isn't true. For a number of years, studies have been taking place concerning the link between Tylenol and Asthma. A study from this month's issue of the International Journal of Epidemiology (Prenatal and Infant Paracetamol Exposure and Development of Asthma: the Norwegian Mother and Child Cohort Study) was published because previously, "Paracetamol exposure has been positively associated with asthma development." In other words, there are already studies linking the two together.
After reviewing the records of 115,000 Norwegian children, researchers found a consistent relationship between pregnant mother's Acetaminophen use, and their children developing Asthma by age seven. The authors concluded that, "This study provides evidence that prenatal and infant paracetamol exposure have independent associations with asthma development." What are we doing about this situation here in the US? Good question. The FDA's website tells expecting mothers that........
"The U.S. Food and Drug Administration (FDA) is aware of and understands the concerns arising from recent reports questioning the safety of prescription and over-the-counter (OTC) pain medicines when used during pregnancy..... Because of this uncertainty, the use of pain medicines during pregnancy should be carefully considered. We urge pregnant women to always discuss all medicines with their health care professionals before using them."
But are doctors really warning pregnant women about these dangers? Or for that matter, about the dangers of Acetaminophen in general ---- i.e., for those who aren't pregnant? Maybe some are, but I'm certainly not seeing it.
There is so much of this stuff taken worldwide (HERE is a list of products containing Acetaminophen) that trying to find out via Google exactly how many doses are taken annually in America was difficult because estimates vary so widely. Suffice it to say, we take a proverbial "boatload" (there are an estimated 600 products for sale in the US containing Acetaminophen). The major brand, Tylenol, sold 200 million dollars worth in 2013 (this does not count Children's Tylenol, Tylenol PM, Herbal Tylenol, Extra Strength Tylenol, Tylenol w/ Codeine, Tylenol Back Pain, Tylenol Arthritis, etc, etc, etc). These figures do not count generics, which are a huge part of the Acetaminophen market.
Although Acetaminophen is said to have relatively little anti-inflammatory activity (it is not considered an NSAID), it's mechanism of action is not well understood. This is probably why the mechanisms of many of its side effects are poorly understood as well. How bad are these side effects, and should you be worried about keeping a bottle of the stuff in your medicine cabinet? Only you can decide that.
Pro Publica is an independent news outlet that was founded by an ex-editor of the Wall Street Journal. On September 20 of 2013, they rocked the world with a massive expose titled Use Only as Directed. Using data from the National Institutes of Health and the Poison Control Center they stated that, "Acetaminophen overdose send as many as 78,000 Americans to the emergency room annually and results in 33,000 hospitalizations a year... Acetaminophen is also the nation’s leading cause of acute liver failure..." 1,567 of these individuals died. And for the record, during the same period, 1,400 people committed suicide using Acetaminophen.
Furthermore, they showed through documents obtained via sunshine laws, that our very own you-can-trust-us-even-though-our-fingers-are-crossed safety organization (THE FDA) ignored their own advice for over three decades. "In 1977, an expert panel convened by the FDA issued urgently worded advice, saying it was 'obligatory' to put a warning on the drug’s label that it could cause 'severe liver damage'." The FDA did not actually warn consumers of this fact until May of 2009. When you factor in the reality of UNDER-REPORTING, we can only speculate that the government's numbers are far lower than what's really going on. Although it's long, if you are interested in learning how this problem has been systematically and purposefully buried by Big Pharma (working hand-in-hand with Big Government), HERE it is. Let me show you a few other realities of Acetaminophen.
- ALCOHOL AND PARACETAMOL DON'T MIX: There is tons of research showing that mixing alcohol with Acetamenophin is a recipe for liver failure. One of the first studies on this subject was published in the September, 1977 issue of the same journal I discussed yesterday, the Annals of Internal Medicine (Chronic Excessive Acetaminophen Use and Liver Damage). Because in the big scheme of things your liver is a rather important organ, I would advise you to heed these warnings.
- CAREFULLY READ LABELS: Because there are so many OTC medications that contain Acetaminophen, and because it is such a potentially dangerous substance, England enacted laws requiring non-pharmaceutical retail outlets to warn consumers of the Paracetamol-containing meds at checkout. A study published in last month's issue of BMJ Open concluded that, "Data revealed that 58% of retailers sold more than the MHRA guidelines recommended for paracetamol." All this proves is that the average person is still living under the assumption that since it's OTC, it's safe. Nothing could be farther from the truth, as this is a drug that is extremely toxic in any amount over what is considered to be a "safe" dose.
- ACETAMINOPHEN AND ASTHMA: Although I already dealt with this in expectant mothers, the same thing holds true for children who take Acetaminophen. Calpol is the European version of Tylenol --- their nation's most popular OTC pain medication. The September 15, 2013 issue of the Daily Mail (Babies Given Calpol Just Once a Month are Five Times as Likely to Develop Asthma) discussed a study published in that same month's European Journal of Public Health (Exposure to Paracetamol and Asthma Symptoms). "The drug [Calpol] is the most popular painkiller in Britain and 84 per cent of babies are given it for pain and fever within the first six months of their life. In one of the largest studies of its kind, academics from the University of A Coruna in northern Spain questioned the parents of 10,371 children aged six and seven and 10,372 aged 13 and 14. All were asked whether the children had asthma – and if so, how severe – and how often they had been given paracetamol within the previous year and when they were babies. Those in the younger age group who were given the medicine at least once a month were 5.4 more times likely to have asthma and those given it just once a year were 70% more at risk. Children who had a dose of the medicine at any time before their first birthday were 60% more at risk. The study also found that 13 and 14-year-olds were 40% more likely to have asthma if they had taken paracetamol within the previous 12 months."
- SKIN CONDITIONS: On August 1 of 2013, the FDA issued one of their many "Consumer Updates" concerning Acetaminophen (FDA Warns of Rare Acetaminophen Risk). Some of the skin conditions associated with Paracetamol include, Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TENS), and Acute Generalized Exanthematous Pustulosis (AGEP). Best guess is that this is an area where under-reporting has been particularly rampant.
- PREGNANCY AND PARACETAMOL PART II: We already showed you that Asthma rates skyrocket when mom takes Acetaminophen during her pregnancy. Unfortunately, the problems go far beyond Asthma. A study from last month's issue of Scientific Reports (Analgesic Exposure in Pregnant Rats Affects Fetal Germ Cell Development with Inter-Generational Reproductive Consequences) revealed that Paracetamol taken by pregnant mom, affected the fertility of female offspring for at least two generations. "Assuming our results are translatable to humans, they raise concerns that analgesic use in pregnancy could potentially affect fertility of resulting daughters and grand-daughters." Another study, from last month's issue of Toxicological Sciences (Intrauterine Exposure to Paracetamol and Aniline Impairs Female Reproductive Development by Reducing Follicle Reserves and Fertility), came to virtually the same conclusion.
- IMMUNE SYSTEM PROBLEMS: It's impossible to argue that there is not far more incidence of Food Allergy / Food Sensitivities than there used to be (one that immediately comes to mind is GLUTEN). Could Acetaminophen be playing a part in this? Listen to the shocking conclusions of this month's issue of Medical Hypothesis (Possible Effects of Repeated Exposure to Ibuprofen and Acetaminophen on the Intestinal Immune Response in Young Infants). Although the average American tends to have far too much INFLAMMATION in their systems, Inflammation is actually a good and necessary thing in normal levels (it allows various parts of the body to communicate with other parts of the body). "There has been an exponential increase in the frequency of immune deviations in young children. It seems that acetaminophen - like ibuprofen - also carries a non-selective inhibitory action on peripheral COXs. The impact of repeated inhibition of mucosal PGE2 synthesis due to COX-inhibitor exposure on maturational immunity has been demonstrated in animal experiments. Repeatedly exposed young animals do not develop tolerance to food antigens and exhibit autoimmune deviations. Several recent epidemiological studies have also reported on the magnitude of acetaminophen and ibuprofen exposure in children and the increase in immune deviations, it is important to better understand the potential negative impact of repeated inhibitions of prostaglandin synthesis by COX2s during infancy." In other words, kids are suffering from food sensitivities and AUTOIMMUNE DISEASES like never before in history. Much of this can be explained by inhibiting the specific chemical compounds we collectively refer to as "Inflammation" during their developmental years (see link on Inflammation above). This doesn't even begin to address the fact that these drugs screw up GUT HEALTH (remember that 80% of the Immune System is found in the Gut) by causing / contributing to one of the hallmarks of chronic disease states --- INCREASED INTESTINAL PERMEABILITY.
- ACETAMINOPHEN FOR FEVER OR FLU? FEVER is arguably the number one way your body fights off infectious invaders. It also tends to freak parents out far more than it should. How do parents (and doctors for that matter) decrease fever in children? Tylenol / Paracetamol (in Europe, Calpol). December's issue of the Journal of Thoracic Disease carried a study called Fever: Suppress it or Let it Ride? "Fever is a protective adaptive response that should be allowed to run its course under most circumstances. The latter approach, sometime referred to as the "let it ride" philosophy, has been supported by several recent randomized controlled trials like that of Young et al. , which are challenging earlier observational studies and may be pushing the pendulum away from the Pavlovian treatment response." Another study in this month's issue of Respirology looked at the benefits of Paracetamol for Influenza. In similar fashion to what we recently learned about FLU SHOTS, "Regular paracetamol had no effect on viral shedding, temperature [fever], or clinical symptoms in patients with influenza. There remains an insufficient evidence base for paracetamol use in influenza infection."
- ACETAMINOPHEN AND DIABETES: If you are a DIABETIC who monitors your glucose levels from home (who doesn't these days?), a study from this month's copy of Diabetes Technology & Therapeutics is important to understand if you take Acetaminophen. "Although plasma glucose concentrations remained constant at approximately 90 mg/dL throughout the study, glucose measurements varied between approximately 85 to 400 mg/dL due to interference from the acetaminophen."
- ACETAMINOPHEN AND CHRONIC ALLERGIES / HAY FEVER: According to WebMD, Allergic Rhinitis (otherwise known as Hay Fever) is associated with CHRONIC EAR INFECTIONS, ALLERGIES, ASTHMA, and SLEEP APNEA. WebMD goes on to talk about all the different classes of drugs that actually cause Rhinitis (ANTIDEPRESSANTS, TRANQUILIZERS, BLOOD PRESSURE MEDS, ED DRUGS, ORAL CONTRACEPTIVES, NSAIDS, etc. Add another one to the list. The January 2015 issue of the journal Allergy & Rhinology (Association Between Chronic Acetaminophen Exposure and Allergic Rhinitis in a Rat Model). "Our study was the first to demonstrate a histologic association between chronic exposure to acetaminophen and rhinitis. The average number of allergic responses per animal was 13.2 in the acetaminophen group versus 6.2 in the control group. All the rats in the acetaminophen group (100%) had mast cells, whereas mast cells were detected in only 40% of the animals in the control group. The average number of mast cells per animal in the acetaminophen group was 134 versus 21 in the control group." BTW, Mast Cells are white blood cells that are most renowned for their immune system response in allergies.
- CURCUMIN IS AN ANTIDOTE FOR ACETAMINOPHEN-INDUCED LIVER DAMAGE: Curcumin (intimately related to Tumeric and Curry) is a cooking spice used heavily in India. Mitochondria are the part of the cell that make energy in the form of ATP. "Curcumin prevented in a dose-dependent manner, liver damage due to paracetamol-induced mitochondrial alterations. These results indicate that the protective effect of curcumin in PCM-induced hepatotoxicity is associated with attenuation of mitochondrial dysfunction."
Notice that these studies are largely from the last couple of months. If I would have spent some time going through decades worth of studies, this post would have shown Acetaminophen to be a veritable house of horrors. Should you be surprised? Of course not! Chemicals are bad news. Period. No; taking Tylenol probably won't kill you outright (it will do it slowly). But what it does to your offspring is freaky enough. And it's not like any of this is "new" information.
ESRD stands for End-Stage Renal Disease. In other words, the form of kidney failure that leads to death --- you're never getting off dialysis. Clear back in 1994, researchers from Johns Hopkins University published a study in the New England Journal of Medicine (Risk of Kidney Failure Associated with the use of Acetaminophen, Aspirin, and Nonsteroidal Antiinflammatory Drugs) that had some downright scary findings. "Heavier acetaminophen use was associated with an increased risk of ESRD in a dose-dependent fashion." If a person had taken 5,000 tablets of Acetaminophen [200 mg] in their lifetime, their chances of ESRD increased by 240%. For 5,000 tablets of NSAIDS, the increase was greater --- almost 900%. The authors ultimately concluded that, "People who often take acetaminophen or NSAIDs have an increased risk of ESRD." And the more you take, the greater your chances of something going south.
With a post like this, the question always arises; "But doc, what am I supposed to take when I have pain?" Let me first say that I think you are asking the wrong question. The question you should be asking yourself in most cases is why you are having pain in the first place? In other words, what's driving the INFLAMMATION? Figure that out and you are likely to cut your pain dramatically. If you really want to get to the bottom of your ill health and Chronic Pain, THIS POST is a great starting point.
CHRONIC LOW BACK PAIN AND NSAID EFFICACY
To break it down for you....
- Cochrane is universally considered to be the 'gold-standard' in meta-analysis ---- crunching data from numerous studies on a particular topic --- and making sense of it all.
- They are big and they are everywhere.
- They are independent. In our age of "EVIDENCE-BASED MEDICINE" this is critical --- especially considering the shenanigans, data fudging, lying, and outright fraud, taking place in a medical research community that is largely run by Big Pharma (see link above).
Listen to what the Cochrane Collaboration (sometimes referred to as the Cochrane Review) had to say about treating Chronic Low Back Pain with Non-Steroidal Anti-Inflamatory Drugs (NSAID's) just two short days ago (Non-steroidal Anti-Inflammatory Drugs for Chronic Low Back Pain). The paragraph below was cherry-picked from the abstract.
"NSAIDs reduced pain and disability in people with chronic low back pain compared to placebo. However, the differences were small: 3.3 points on a 100-point scale for pain intensity. Regarding disability, people receiving NSAIDs scored 0.9 points better on a 0 to 24 disability scale. The magnitude of the effects is small, and the level of evidence was low. Different types of NSAIDs did not show significantly different effects. Due to the relatively small sample sizes and relatively short follow-up in most included trials, we cannot make firm statements about the occurrence of adverse events or whether NSAIDs are safe for long-term use."
Even though NSAIDS are consumed like candy here in America, we see that for CHRONIC LOW BACK PAIN (one of the single most common reasons people take them) they really aren't benefiting very much. And as for the side-effects, we know from large meta-analysis that they are UNDER-REPORTED between 90% and 99% of the time. That's not me talking, it's what the research says. Furthermore, if there's one thing we do know about long-term use of NSAIDS --- something most studies (purposely) fail to address ---- is that side effects are both COMMON AND POTENTIALLY HARSH (even deadly).
"There was low quality evidence that NSAIDs are slightly more effective than placebo in chronic low back pain. The magnitude of the difference was small, and when we only accounted for trials of higher quality, these differences reduced."
If you really want to help yourself as far as your pain and disability are concerned, you'll have to deal with Inflammation at it's source. Instead of constantly using NSAIDS and CORTICOSTEROIDS to mop up the inflammation that is constantly being spilled on the floor, stop spilling it all over the floor in the first place. How do you go about doing this? HERE is a multi-pronged approach for dealing with the underlying Inflammation that is the root cause of almost every health problem you can name. Which is why dealing with Inflammation at it's source will not only help you with your Chronic Low Back Pain, but help you with THESE PROBLEMS as well.
DEPRESSED ABOUT YOUR ANTIDEPRESSANT?
YOU PROBABLY SHOULD BE!
"Antidepressants are drugs used for the treatment of major depressive disorder, dysthymia, anxiety disorders, obsessive compulsive disorder, eating disorders, chronic pain, neuropathic pain, dysmenorrhoea, snoring, migraine, attention-deficit hyperactivity disorder (ADHD), addiction, dependence, and sleep disorders."
- Writing for How Stuff Works (Health), Jane McGrath told her readers back in 2008 that, "In 2007, the Centers for Disease Control and Prevention made an intriguing announcement. Antidepressants were the most frequently prescribed drug, overtaking the runner-up, high blood pressure medications, by five million prescriptions. The study reported that doctors racked up 118 million prescriptions for antidepressants."
- In October of 2011, Peter Wehrwein, writing for the Harvard University's Health Blog, wrote that, "the rate of antidepressant use in this country among people ages 12 and older increased by almost 400% between 1988–1994 and 2005–2008."
- Quoting a study from the Mayo Clinic, the June 20, 2013 edition of the CBS News stated that, "Nearly one in four women ages 50 to 64 were found to be on an antidepressant, with 13 percent of the overall population also on antidepressants."
- In the November 1, 2014 issue of Scientific American, Julia Calderone revealed that, "Doctors commonly use antidepressants to treat many maladies they are not approved for. In fact, studies show that between 25 and 60 percent of prescribed antidepressants are actually used to treat nonpsychological conditions."
- On August 12 of 2013, The New York Times carried a story by Roni Caryn Rabin stating, "a recent study suggests another explanation: that the condition is being overdiagnosed on a remarkable scale. The study, published in April in the journal Psychotherapy and Psychosomatics, found that nearly two-thirds of a sample of more than 5,000 patients who had been given a diagnosis of depression within the previous 12 months did not meet the criteria for major depressive episode as described by the psychiatrists’ bible, the Diagnostic and Statistical Manual of Mental Disorders (or D.S.M.)"
- Writing for the September, 2014 issue of the Psychiatric Times (Are Antidepressants Really 'Over-Prescribed' in the US?), Dr. Ronald Pies took the opposite viewpoint (does anyone remember the ABSURD NOTION that we should be putting antidepressants in the water supply?). "So . . . have we really become a kind of Prozac Nation, to reference the title of Elizabeth Wurtzel’s 1994 memoir? By and large, I don’t think so." By the way, that 'absurd idea' really was an 'absurd' idea (HERE)!
When you factor the "INVISIBLE & ABANDONED" studies on Antidepressant meds into the equation, you quickly see what a house of cards it really is. Especially interesting in light of what I have been reading about CBT (Cognitive Behavioral Therapy) for years --- namely that it doesn't work very well (most doctors have phoo phooed this approach for decades). And now we have studies giving us "moderate evidence" that when it comes to treating MDD (Major Depressive Disorder), both CBT and Antidepressants are equally as effective (or ineffective as the case may be).
Not surprisingly, one of the biggest reasons that CBT is now being touted as an equal to Antidepressants, has to do with side effects. I can't imagine CBT, which involves working with and talking to a counselor of some sort, having many. On the other hand, Antidepressants are renowned for their side effects --- side effects which tend to be UNDER-REPORTED by much as much as 99%. The American College of Physicians (ACP), which is currently involved in creating guidelines / standards of care for treating Depression, put it another way, describing said side-effects as, "underrepresented". This month's issue of the Annals of Internal Medicine (the official journal of the ACP) devoted a great deal of space to this topic, by carrying two studies and an editorial.
- Comparative Benefits and Harms of Antidepressants, Psychological, Complementary, and Exercise Treatments for Major Depression: An Evidence Report for a Clinical Practice Guideline From the American College of Physicians
- Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice Guideline From the American College of Physicians
- Seize the Day to Implement Depression Guidelines
The studies touted screening all Americans for Depression, just like I wrote about the other day (HERE). One of the many risk factors they suggested specifically targeting with their screening? I'm not making it up folks; "adolescence in girls". With recommendations like this, I guess I shouldn't be surprised at the conclusions the ACP came to.
Researchers looked at all the studies done between 1990 and 2015 that met their criteria. Some of them pertained to St. Johns Wort, some were about using exercise (several previous studies have said good things about using this approach), others were about CBT and Antidepressants (together), while still others pertained to everything from diet, to yoga, to acupuncture, to Fish Oil, etc, etc, etc. Although the mainstream has been bashing St. John's Wort for a very long time, these authors found that it was equally as effective as medication (52% versus 54%). Despite this, what did their final guideline ultimately look like?
"ACP recommends that clinicians select between either cognitive behavioral therapy or second-generation antidepressants to treat patients with major depressive disorder after discussing treatment effects, adverse effect profiles, cost, accessibility, and preferences with the patient (strong recommendation, moderate-quality evidence)."
Their excuse for not recommending the Wort was laughable. They said that it was impossible to find herbs of the proper, "purity and potency in this country." They are correct if you only consider grabbing the cheapest thing you can find from Mal Wart or the local health food store. What makes this one of the worst all-time justifications for prescribing drugs is that there are any number of fantastic companies that use stringent quality control to create pharmaceutical-grade products (STANDARD PROCESS' sister company Medi-Herb comes immediately to mind).
Which all begs the question of how much these studies be really be trusted? Plainly stated; they can't. Committees of physicians continue to PICK AND CHOOSE THE EVIDENCE not so much based on what really works, but based on what will make the most money. Think I'm overstating my position? Listen to what the authors say about the research. "Study limitations included small sample sizes, high dropout rates, poor assessment of adverse events, and different antidepressant doses between studies."
We've already seen that adverse events are seriously under-reported (not to mention the fact that studies that turn out differently than researchers want are NEVER BROUGHT TO THE PUBLIC LIGHT). Furthermore, if those dropping out of the studies because of side effects are not calculated into the results, said conclusions are dramatically skewed to make the drugs appear far better than they really are. It's business as usual folks --- even though these studies used language like "best evidence" about a million times.
Dr Gary Maslow (Assistant Professor of Psychiatry and Behavioral Sciences, and Assistant Professor of Pediatrics at Duke University) and Dr. John Williams Jr (Professor of Medicine and Psychiatry, Director of the Durham VA Evidence Synthesis Program, and Associate Director for the Duke Clinical Research Training Program) sum things up nicely in their letter to the editor.
"Depression is treatable with a range of options that includes antidepressant medications, evidence-based psychotherapies, and complimentary therapies. Most persons with depression are initially diagnosed and treated in general medical settings. The US Preventive Service Task Force (USPSTF) and the American College of Physicians (ACP) are trusted sources of clinical practice guidelines and with good reason. The USPSTF reaffirms its 2009 recommendations to screen adolescents aged 12 to 18 for Major Depressive Disorder. This Grade B recommendation reflects 'moderate certainty of moderate net benefit'."
Read the paragraph again and tell me if what is being promoted is a good thing? Even though THE RIAT ACT has shown beyond the shadow of a doubt that children get the short end of the stick when it comes to side effects of Antidepressant Medications, the band plays on as all children (not just girls) from sixth grade and up are RECOMMENDED TO BE SCREENED. And if you give your children the drugs that will invariably be prescribed, the very best you can hope for is a moderate certainty of moderate net benefit. Gulp!
In case you've forgotten, adolescence can be tough. Little things get blown completely out of proportion. You got a D on an algebra test. You don't have a clue about the opposite sex. You didn't make the basketball team. You backed into the neighbor's car. You've got acne. Your parents grounded you, and (if you're a female) you're feuding with your best friend. You're not sure what you want to do with the rest of your life. I could go on here ad infinitum. Daniel Powter tells the story in his 2005 hit song, Bad Day. "Where is the moment we needed the most. You kick up the leaves and the magic is lost......"
There's a better way to deal with Inflammation and the wide array of diseases it causes. Attack it at its source. How do you go about doing this? I've actually created a post to get you started (HERE). And I'm not even trying to sell you anything. It's information folks. Nothing more. Take it or leave it. But rest assured; bring it up to your doctor (I completely suggest you do) and you'll be made to feel like an idiot chasing a rainbow.
THE NIGHTMARE KNOWN AS WHIPLASH
Back in the winter of 2013, "Roger" was REAR-ENDED by a full-sized pickup truck, while sitting with his wife at a stoplight. A carphile, he was driving a much smaller and lighter Renault Clio (IV), which was totaled. Although Roger had dealt with periodic episodes of LOW BACK PAIN for the previous decade and had suffered through a number of SPORTS INJURIES from his days as an athlete (he also had MIGRAINE HEADACHES about three or four times a year from the time he was in grade school), these episodes had always been short-lived. They rarely caused him to miss work, bouncing back and returning to "normal" within a day or two.
The 2013 injuries were different, and rapidly became a big deal. Roger found himself missing more and more work. He could feel himself being dragged into the world of Chronic Pain via a WHIPLASH INJURY. Unfortunately, it's a story I have seen over and over and over again in my 25 years of practice.
After the accident, Roger was the model patient. He did exactly what his doctors told him to do --- namely take CERTAIN MEDICATIONS and go to the PHYSIOTHERAPIST, whose directions he followed religiously as well. Instead of getting better, he found himself getting worse. He went to several specialists who told him things like, "just lose some weight," "it's just one of those things that happens to people at 40," and my all-time favorite, "I can't really find anything wrong with you that explains why you're having this much pain".
And of course there was the imaging --- X-RAYS, CT, MRI, with all of them showing essentially the same thing --- that there was nothing really wrong (a low back MRI done a few years prior to the accident was not substantially different than a low back MRI done post-accident --- even though his pain is worse by several orders of magnitude). By Memorial Day, Roger --- a successful physician with a thriving 15 year practice --- could no longer work. Let me take you back to the time before the accident.
Because Roger is a doctor, he was prone to go to his doctor if he had problems or questions pertaining to his health. Thus the reason he had received imaging on his lumbar spine pre-accident. And because of the work he did (surgery), he was required to sit in a very specific position and bend forward for much of the day. Certainly not anything out of the ordinary for any number of professions, but something that can certainly aggravate a low back.
Due to the FORWARD POSTURE, his neck would also get stiff and sore, which he mentioned to his doctor on a couple of occasions. Not that it was a primary concern --- the main reason for the visit --- or that he was asking to have anything really done about it, but was instead asking if there was anything he could be doing on his own (i.e EXERCISES / STRETCHES) to prevent future problems. Unfortunately, this made it into his doctor's notes as 'neck pain', which became part of his permanent record and is now being used against him as a pre-existing condition.
After finding our site on one of his many sleepless nights, Roger began to realize there was more going on than what his doctors were telling him and decided to contact me. Having told him that his low back problem sounded like a CLASSIC CASE OF HERNIATED DISC and that it was unlikely I could help him with his problem, he decided to come anyway. Other than the fact that he was dealing with lots of pain and his spinal RANGES OF MOTION were all in the toilet, his examination findings were fairly unremarkable for what he was going through.
His main question to me was "How can my two low back MRI's appear almost the same even though I have vastly greater amounts of pain now?" Most of it has to do with the difference between Functional Problems -vs- Pathology. Although I have covered this topic before (HERE and HERE), it is important to grasp the difference. One of the 'dirty little secrets' in medicine is that a top reason people visit doctors is for something called MUPS (Medically Unexplained Physical Symptoms). Throw in the fact that the "Disc Theory" of back pain has been increasingly falling out of favor for years; probably more like decades ---- at least in the SCIENTIFIC COMMUNITY --- and you begin to get a sense of Roger's frustration.
Using TISSUE REMODELING to break down the SCAR TISSUE / DENSIFICATION that was occurring in numerous places (as well as to STIMULATE FIBROBLASTIC ACTIVITY), I treated the FASCIAL ADHESIONS that were restricting normal motion of his NECK and BACK, as well as his SHOULDER. For the record, it is my opinion that Roger probably has TYPE II PAIN, without CENTRALIZATION. How much was I able to help him? Some, but certainly not completely.
I cannot leave this post without at least mentioning the neurological or "BRAIN" aspect of these sorts of injuries. Intense whiplash --- NO MATTER THE CAUSE --- can result in BRAIN INJURIES (MTBI). Unfortunately, every study that comes out on this subject is scarier than the one before it. Stop and think for a moment about what's going on in the NFL right now. I would also like to mention that whether your particular problem is Functional or Pathological, one of the single most important things you can do to help your cause is to control INFLAMMATION (no, not THAT WAY). In case you are not versed as to the best way(s) to accomplish this, I created SEVERAL POSTS that will at least point you in the right direction.
PRESTIGIOUS MEDICAL JOURNAL TAKES ON
STANDARDS OF CARE FOR DEALING WITH CHRONIC PAIN
"During the late 1980s and early 1990s, it was argued, largely on moral grounds, that opioids should be available for treating chronic pain, and physicians were persuaded that addiction to opioid treatment would be rare. The correct dose of an opioid was whatever dose provided pain relief, as measured by a pain-intensity scale.... A focus on pain-intensity scores has had unfortunate and harmful consequences." From the study being discussed today
- "Only an idiot might conclude that one can dismiss the effects of living with a healthcare problem that reminds you of its' presence with every move you make."
- "It seems the current agenda is chronic pain suffers need only accept & learn to live w/pain all would be well. If we lived in Never Never Land it might be true."
- "The authors would like us to believe that NPS initiatives are in place, reducing suffering and brain-seizing pain, when they ask the ludicrous question, “But is a reduction in pain intensity the right goal for the treatment of chronic pain?” I guess that life-altering and debilitating chronic pain must not be such a burden after all."
- "People are dying because they can't get treated. Great job. I will be going into the coffin business thanks to these believers that people should suck it up. How NEJM even recognizes these people as doctors and not quacks is beyond me."
- "With heart disease we treat the heart, with lung disease we treat the lungs, with kidney disease we treat the kidney. Why with chronic pain disease would we not treat the pain?"
- "Their assertion that increased use of opioids for chronic pain has produced “no demonstrable reduction in the burden of chronic pain” is not supported by the source they cited, and is clearly a statement of the authors’ opinions – not a statement of fact."
- "ANYBODY THAT AGREES WITH THESE AUTHORS CAN NOT BE DOCTORS. THEY ARE BOTH PAID A LOT OF MONEY FROM RPOP AND PHOENIX HOUSE. IF THEY WORKED FOR PERDUE PHARM, THEY WOULD SAY OXYCONTIN IS A GODSEND. THEY ARE THE WRONG PEOPLE TO LISTEN TO."
- "This is an object lesson in the shambles that invariably result when the government declares a 'war' on something. That result is human misery on a massive scale. Taking away the very thing that helps a person cope with the unrelenting never ending pain is grotesque and may well lead to a surge in the number of suicides."
- "If you wouldn't take insulin from a diabetic because it is a proven treatment and just tell them to suck it up and eat right why would you take pain medication from a chronic pain patient?"
- "You say that patients need to accept their pain and involve themselves in activities that render better quality of life despite the pain, just deal with it; Really? What kind of quality of life can one expect to have if they are having thoughts of suicide because every moment every thought is spent in agony and the individual is consumed body and mind by this pain."
- "Chronic pain patients are worse off now because many doctors refuse to treat them; one result of unintended consequences from recent opioid abuse deterrent policies."
These were only a few comments from the first page (there were three more pages). As you might guess, the authors were addressing AMERICA'S EPIDEMIC OF OPIOID ADDICTION. Because INFLAMMATION is the root of most Chronic Pain, it's not surprising that some estimates put the number of Chronic Pain sufferers in our country at over 100 million. It's why we have been referred to by many medical experts as "INFLAMMATION NATION". How did we get here from there?
It's tough to argue that our government has its hands in all sorts of things it was never intended to have its hand in (HERE, HERE, and HERE are examples) --- things that seem to backfire and blow up in its face. Let me show you another. About the time I was in Chiropractic College (1988-1991), our government began creating an emphasis (most would today argue an overemphasis) on "Pain Scales" --- you know; the number line from zero to ten, with 10 being the worst pain ever, and zero being no pain (the VAS or Visual Analogue Scale is the most well known of dozens). This emphasis on pain was so huge that many clinics / hospitals started referring to it as "the 5th vital sign" (the other "vitals" are TEMPERATURE, pulse, respiration, and BLOOD PRESSURE).
Medical Standards of Care dictate that if something is out of range as far as vital signs go, it must be dealt with ASAP. By putting PAIN on the same level of importance as other vital signs, this forced doctors to do something about it --- even if the results were temporary at best. What was the result of this policy? Something that has been headlining in the news for the past year -- a national epidemic of Opioid Addiction. Even though prescription drug addiction was already a significant problem (HERE), these new Medical Standards allowed it to take on epic proportions.
Being dubbed "Pharmageddon" in the press, CDC statistics tell us that in 2014, the medical community wrote 260 million prescriptions for opioids. These same stats reveal that overdoses leading to death increased by nearly 15% from 2013. In a recent article (The Attack of Opioids), Dr. JC Smith put it this way....
"Increases in opioid prescription painkillers are the biggest driver of the drug overdose epidemic. There were over 47,055 overdose deaths reported in 2014, which equates to 128 deaths each day. According to the CDC’s data published in CDC’s Morbidity and Mortality Weekly Report, from 2000 to 2014 nearly half a million Americans died from drug overdoses. In 2014, there were approximately one and a half times more drug overdose deaths in the United States than deaths from motor vehicle crashes."
Despite the crazy numbers of addiction to prescription and non-prescription opioids, has this policy done anything to help those in pain --- particularly Chronic Pain? Although the commenters at the top would argue the affirmative, NEJM says (probably correctly) not. "For three decades, there has been hope that more liberal use of opioids would help reduce the number of Americans with unrelieved chronic pain. Instead, it produced what has been termed an epidemic of prescription-opioid abuse, overdoses, and deaths — and no demonstrable reduction in the burden of chronic pain." Which itself begs the question of what these authors recommend for pain. Glad you asked.
Not surprisingly, the authors of the NEJM study recommend, an "evidence-based multimodal approach" that includes things like (cherry-picked), "self-management and interdisciplinary treatments, coping and acceptance strategies, engagement in valued life activities, behavioral, physical, and integrated medical approaches, conversation between a patient and a clinician, empathy, encouragement, mentorship, hope" and ultimately, "a willingness to accept the pain". I know what you're thinking and I totally agree --- most of this is touchy feely mumbo jumbo that still fails to address pain's underlying causes.
The hard reality is that sometimes --- especially once you understand TYPE III PAIN --- it is virtually impossible to fix these sorts of problems because the pain can become locked into the brain, playing it's unholy loop over and over and over again. For THESE PATIENTS, I have only two recommendations. Firstly, do whatever it takes to cut Inflammation out of your life (HERE are some steps for doing so). Secondly, go see someone who understands the brain.
I realize that you've already been to half a dozen neurologists. Medical neurologists understand one thing --- gross pathology. That is why I would suggest you see a Functional Neurologist trained by TED CARRICK. For those of you dealing with an obvious (or sometimes not-so-obvious) musculoskeletal problem ("tissue damage") caused by underlying FASCIAL ADHESIONS (often times I refer to this in my clinic as SCAR TISSUE, although FIBROSIS or DENSIFICATION might be more accurate), pay attention and listen to what the good doctors tell us.
"But is a reduction in pain intensity the right goal for the treatment of chronic pain? Pain-intensity ratings aren't necessarily a reflection of tissue damage or sensation intensity in patients with chronic pain. The intensity of chronic pain can't be reliably predicted from the extent or severity of tissue damage, since chronic pain is not determined primarily by nociception. Functional neuroimaging studies and other prospective clinical studies have shown that what feels like the same pain is initially associated with the classic sensory “pain matrix” brain regions but is later associated with brain regions involved in emotion and reward. Thus, over time, pain intensity becomes linked less with nociception and more with emotional and psychosocial factors."
Part of the problem is that "tissue damage" is frequently overlooked by standard medical imaging techniques such as MRI (HERE). And now we're being told that pain reduction might not even be the goal ---- that it's a pipe dream.
Having previously dealt with nearly a decade of Chronic Pain myself (HERE), I believe that relief of (or at least diminishment of) pain must be the goal! If you have tried the diet and lifestyle changes I mention earlier without solid results, it might be in your best interest to try Tissue Remodeling. Despite it's INTENSITY (or may because of it) it gives you at least a chance of getting to the bottom of things and solving certain types of PAIN SYNDROMES. Although I see plenty of people that "Scar Tissue" is not their chief problem, I see LOTS OF PEOPLE that it is.
PICKING AND CHOOSING THE EVIDENCE
When you read studies or articles about studies, be prepared to see terms like "evidence, best evidence, evidence-based practice, EBM, or evidence-based medicine" over and over again --- often times to the point of being nauseating. As to why so much of the evidence is not being followed, there are billions of reasons --- all of them GREEN. I want to take a moment to show you a few of the places that "BEST EVIDENCE" are not being followed by the medical community.
- FLU SHOTS: In few arenas is the disregard for scientific evidence more blatant than with FLU VACCINES. In fact the problem is so blatant that my brother, an emergency room physician (MD), wrote an article for a medical journal on the topic (HERE). The latest meta-analysis' by the Cochrane Review (the gold standard for analyzing medical research) shows that FOR THE MEDICARE POPULATION, the flu vaccine is just over 1% effective in a normal year, and 4% effective in a "matched" year (matched years only occur about once a decade). FOR CHILDREN (those under 18) it's even worse, with the data revealing that said shots are no better than placebo (sugar pills). We shouldn't be surprised considering the FLU MIST was abandoned for being less than 3% effective for three years in a row. And this is just for starters (click first link in this bullet point). The fact is that according to peer-review, there is NO GROUP that benefits from flu vaccinations. Period. Despite this fact, we continue to plunge ahead with ASININE CAMPAIGNS to force people (HERE) into getting vaccinated DIRECTLY AGAINST BEST EVIDENCE. Big Pharma's favorite Flu Vaccine slogan? "Bend Over and Take One For the Team". Lucky for you I put everything pertaining to Flu Vaccination is one big post called TWENTY REASONS YOU MAY WANT TO RETHINK THAT FLU SHOT.
- ANNUAL PHYSICALS: To say anything unflattering about annual physicals is bordering on sacrilege. Yet despite the fact that annual physicals are still a staple of medical practice, THE EVIDENCE SAYS they shouldn't be; considering that since the decade of the 80's, researchers have consistently shown they are a waste of time, energy, and money. Hey; don't get mad at me --- I'm only telling you what peer-review says, and has been saying for at least three and a half decades. Of course your doctor disagrees; what did you expect (HERE)?
- ROUTINE PROSTATE EXAMS, BREAST EXAMS, FEMALE EXAMS, COLONOSCOPIES, CANCER SCREENINGS, BLOOD WORK, ETC: In like fashion to what we saw in the previous bullet point, we see something similar with PROSTATE EXAMS, MAMMOGRAPHY, ANNUAL FEMALE EXAMS, COLONOSCOPIES, etc, etc, etc. Despite the fact that this topic seems to be making the 6 o'clock news on a regular basis, people continue to be convinced (USUALLY BY THOSE WHO SHOULD KNOW BETTER -- THEIR DOCTORS) of the life-saving benefits of said tests (HERE). Oh, the same thing could be said of both MRI'S and CT SCANS (not to mention BLOOD WORK). The brutal truth is that these tests lead to death by OVERDIAGNOSIS & OVERTREATMENT about as often as they happen to save someone via early detection. In other words, for every person that the medical community or press holds up as a shining example of what early diagnosis can do, just as many others are dying as the direct result of messing with a problem that would have never been a problem in said person's natural lifetime (or just as commonly through the all-to-common phenomenon of "false positive tests". Although there are any number of things considered to be "PREVENTATIVE MEDICINE" click on the link to find out why more often than not, this is simply not true (the language has been hijacked), and why the practice of medicine as we know it has become totally UNSUSTAINABLE.
- BONE DENSITY SCANS: Almost since the time I entered practice in the very early 1990's, I have held the position that bone density scans are largely worthless, being used mostly as an effective scare tactic to sell women a lot of really crappy drugs. Crappy drugs? Am I saying that drugs used for osteoporosis are crappy? You see; the problem is that the drugs that women are being prescribed for OSTEOPOROSIS are actually causing more of the same --- Osteoporosis (HERE). The truth is, the drugs-causing-what-they're-supposed-to-be-curing is a fairly common theme in Evidence-Based Practice (HERE IS ANOTHER COMMON EXAMPLE). Case in point, the next bullet.
- STATIN DRUGS: There's no argument that Statins have some serious side effects. But what if I told you that it's worse than you could ever have imagined? What it you learned that the most current research available is pointing to this class of drug as a culprit (causal factor) in the epidemic of heart disease and hardening of the arteries (HERE)? Isn't it just peachy when the drugs you are prescribed by your physician cause the very problems they are supposed to be solving? Sure, they lower your cholesterol. Unfortunately, changing surrogate endpoints is being shown time and time again to have little if any bearing on morbidity or mortality.
- DIABETES: Speaking of not dealing with underlying causes, TYPE II DIABETES is an epidemic in this country that is not being dealt with in any meaningful fashion. It's also another area where all we are really doing with the drugs is changing surrogate endpoints. Sure people are being loaded up with drugs that do exactly what they are advertised to do --- lower their blood sugar. But the dirty little secret is that in similar fashion to Statins, Diabetes drugs don't really do what they are almost universally touted to do --- lower rates of heart attack, strokes, and/or death (HERE). What's the point? To change another surrogate endpoint (BLOOD SUGAR), of course.
- CHRONIC PAIN CAUSED BY FASCIAL ADHESIONS: Because it is the single most pain-sensitive in your body to begin with, fascial adhesions often times present what I call the "PERFECT STORM" of chronic pain. Not only is SCAR TISSUE as much as a thousand times or more pain-sensitive than normal tissues, it's not imaged well with standardized testing (HERE). In fact, if you are interested in seeing why fascia is such a big deal, I have a post called 25 REASONS WHY FASCIA...
- ANTIBIOTICS, GUT HEALTH, MICROBIOME & FMT: Firstly, we've erroneously convinced people that bacteria are not only "bad" but the chief cause of any number of diseases (HERE). Furthermore, depending on whose research you believe, as many as 75% of all ANTIBIOTIC prescriptions are unnecessary (HERE). These drugs are being causally linked to health problems like DEPRESSION, OBESITY, DIABETES, ASTHMA, HEART PROBLEMS, AUTOIMMUNE DISEASES, CHRONIC MUSCLE PAIN, as well as a WHOLE HOST OF OTHERS (or HERE). On top of that, they are the prime culprits in our national epidemic of DYSBIOSIS --- CANDIDA, H. PYLORI, etc, etc, etc. Another example of a drug that is supposed to do one thing ("boost" the immune system), while doing something altogether different (KILLING IT). This is nothing less than gross negligence. And considering that so little has changed in the two and a half decades I've been in practice, I'm not holding my breath that it's going to get substantially better. On top of all this, I have had several of my patients repeatedly end up in the hospital with C. DIFF., which is treated with the very meds that caused it in the first place --- Antibiotics. Although Standards of Care say that these patients are supposed to receive an FECAL MICROBIOTA TRANSPLANT after their third bout of C. Diff, I have yet to see this happen --- ever (especially grievous once you see how these are being used by the rest of the world to solve all sorts of chronic illnesses and inflammatory health issues). Fortunately, our government stepped in to save the day (HERE). If you are interested in seeing one post that puts our nation's antibiotic problem in perspective, HERE it is. For all of our posts on GUT HEALTH, just click the link.
- NUTRITION AND EXERCISE: When it comes to any number of health issues, there are only two things proven to actually change physiology --- and neither one is drugs (HERE). Despite the fact that DIET and EXERCISE are the hallmarks of creating real change in the disease states of patients, doctors continue to ignore both on whole-scale levels (HERE). And when advice of this sort is given, it's usually about 180 degrees off (HERE, HERE , or HERE).
- TENDINITIS / TENDINOSIS: Because doctors don't care to grasp the fact that nearly 100% of what is currently diagnosed as Tendinitis is actually Tendinosis, numerous patients continue to suffer and deal with the side-effects of the drugs they are given for a problem they don't actually have --- a problem that the medical research community largely says doesn't even exist (HERE). Oh, but be warned because ANTIBIOTIC-INDUCED TENDINOPATHES are common enough that media outlets are at least starting to talk about it.
- WHO KNOWS HOW MANY KINDS OF SURGERY: Back in 1995, the US government commissioned the actuarial firm Milliman & Robertson to research and create "Evidence-Based" guidelines for 25 of the most common types of surgery. I'll not go into detail, but suffice it to say that according to their conclusions, 60% of all surgical procedures in the US are unnecessary. Even if you cut this number in half, it means that nearly one out of three surgeries does not meet the criteria for having said surgeries. Have these numbers gotten better over the course of the last two decades? Surely you jest? Someday I might create a whole post just devoted to this topic (I already have SEVERAL on spinal surgeries), but lets simply look at knees. After several huge studies and meta-analysis, one of the most common surgeries for knees (using an arthroscope to "CLEAN THINGS UP" or repair torn meniscus) was shown to be no better than placebo. Hey; don't get mad at me --- I didn't do the studies.
- SPEAKING OF GUIDELINES: Suffice it to say that MEDICAL GUIDELINES should actually be called "Medical Suggestions" as in most cases they are totally optional. On top of this, the committees and individuals creating said guidelines are so financially conflicted, they make Hillary's multi-million dollar speeches look like a bargain. Think I'm being too harsh? Click the link! Speaking of our government.....
- THE INCESTUOUS RELATIONSHIP BETWEEN BIG PHARMA AND OUR GOVERNMENT: HERE it is folks; in all its blazing glory. If you really think you can TRUST THE DRUG COMPANIES TO POLICE THEMSELVES, I have this bridge in Brooklyn I'd love you to take a look at. This goes for the FDA, the USDA, the CDC, and any other organizations who go by their initials. Those who think the steady stream of industry payoffs doesn't effect the quality of your healthcare need to take a look at THIS. And if you were to start flipping through titles of our scores of posts on EVIDENCE-BASED MEDICINE, you'll not only see how bad this problem really is, but make sure to do so with a barf-bag handy as it will probably make you physically ill.
- ANTI-DEPRESSANT MEDICATIONS: Despite the fact that we know how much the research has been jimmied in this arena (OVER HALF of all studies on Depression are INVISIBLE & ABANDONED), doctors continue to prescribe this crap like candy. What does the "evidence" really say about these drugs? Plainly stated, it tells us that Depression is one of the many problems caused by Inflammation (HERE or HERE). But it's always easier (and more lucrative) to continue to cover symptoms instead of making even a half-hearted attempt to deal with underlying causes. Antidepressants are part of what I call "THE BIG FIVE" and if there is a more evidence-based-medcine-run-amok example of big pharma's big fraud than ANTI-DEPRESSANT MEDICATIONS, I'm not sure what it is. Just remember that it is this class of drugs that led to the RIAT ACT.
- NON-CELIAC GLUTEN SENSITIVITY: We've come to the point where most physicians recognize that Celiac Disease is a serious problem. Statistics tell us that Celiacs constitute about 3% of the American population. Yet despite the mountain of studies proving otherwise, most doctors refuse to recognize GLUTEN SENSITIVITY IN NON-CELIACS --- even though it's more common than CD by at least an order of magnitude (HERE).
- CHILDHOOD EAR INFECTIONS & COLIC: I've already shown you that for most health problems, antibiotics are a huge "Fail". One of the great all-time examples of this is CHILDHOOD EAR INFECTIONS. For Pete's sake, the medical Standards of Care say to avoid giving kids (or adults for that matter) antibiotics! The chief statistical difference between kids that get antibiotics for ear infections and kids that don't is that the kids who get antibiotics tend to get recurrent infections. I promise that parents who have had their children on this MEDICAL MERRY-GO-ROUND will give me an amen and top it off with a hallelujah. What works in most cases --- without any side effects? Try THIS on for size. And considering doctors can't even tell you what COLIC really is, we could say the same thing about it as well. Speaking of side effects.........
- DRUG AND VACCINE SIDE EFFECTS: Another of those dirty little secrets that's so dirty you won't believe what I' telling you is true is that side effects of DRUGS and VACCINES are under-reported by on average of around 99% (HERE), and never less frequently than 90% (HERE and HERE). Although patients might be telling their doctors about said side effects; unless their doctors actually report these reactions to the proper governmental reporting agencies (VAERS for instance), nothing is ever done, and the side effect is never officially tallied as a side effect or AE (Adverse Event). Does not reporting to said agencies skew results in similar fashion to the Invisible & Abandoned Studies? You bet your sweet bippy it does (HERE)!
- ANTI-INFLAMMATION MEDICATIONS: NSAIDS and CORTICOSTEROIDS are typically prescribed in a manner that in no ways takes into account their crazy side effects or fact that they are massively degenerative. Truth be known, doctors rarely follow their own profession's Standards of Care with their prescriptions in this arena --- particularly with Steroids. What this means is that when using this class of drug for chronic problems, you are exchanging any short-term relief gained for long-term degeneration and dysfunction.
- VILIFICATION: Big Pharma (via their medical mouthpieces) will ignore any and all 'evidence' and vilify anything they don't like (i.e. 'alternatives' such as Chiropractic) --- HERE is a recent example from Forbes of all places. Who benefits from BASHING ALTERNATIVES to EBM? Certainly not the patient.
- LEAKY GUT SYNDROME: Although there are well over 10,000 peer-reviewed studies that deal directly with the phenomenon known as LEAKY GUT SYNDROME (the medical research community refers to this as Increased Intestinal Permeability, Gut Barrier Dysfunction, or any number of similar), by-and-large, practicing physicians refuse to acknowledge or even discuss it. Why? Not sure, as there are actually several good inexpensive tests for it that you can order yourself. Just remember that it's always more profitable to treat symptoms than to address underlying causes.
- AUTISM: Although most of the medical community vehemently denies a link between VACCINES AND AUTISM, this one is getting tougher and tougher to hide from the public --- especially with the landslide of insane information coming out on the most commonly used vaccine adjuvant on the planet, ALUMINUM.
- CHRONIC PAIN: Prescription drug addiction is literally exploding in America (HERE). Instead of helping patients attack pain at it's source, doctors tend to do one of two things --- neither of which are beneficial. Treat everyone as a drug-seeker and send them packing. Or simply give their patients pain meds without at least attempting to address the underlying causes of said pain.
- PROTON-PUMP INHIBITORS: This class of drug (given for heartburn, GERD, acid reflux, etc) not only has some freaky side effects (HERE and HERE), it's almost never the best way to treat patients struggling with these common symptoms. This is because it's virtually impossible to have too much or too strong Stomach Acid (HERE). Furthermore, if you will read the "trust us" warning labels, most of these drugs recommend not taking their product for more than two consecutive weeks --- tops, three times a year (in other words, six weeks total per annum). The FAQ page for one of the most common meds from this class says, "Do not take Nexium 24HR for longer than 14 days unless your healthcare professional directs you to do so. You can repeat a 14-day regimen once every four months." Many individuals taking these drugs haven't been off of them for decades.
- CORRUPT POLITICIANS & GOVERNMENT: It doesn't matter whether you are a democrat or republican, the fact that you can't trust politicians is a no-brainer. Unlike our founding fathers --- many of whom gave everything for this great nation of ours (lives, families, personal fortunes) --- today's politicians can't be trusted to do much of anything beyond padding their pockets and doing or saying whatever it takes to get elected or re-elected (HERE). As long as the money continues to flow from Big Pharma to both Washington and academia (HERE), you can kiss any sort of real reform goodbye. This has led to UTTERLY RIDICULOUS IDEAS being put forth to reform the healthcare system.
Folks; in case you haven't figured it out yet, you have to be your own health advocate. Despite their assertions to the contrary, our government is not going to save you (see previous link). Furthermore, it's both scary and empowering to realize that your doctor isn't going do do it for you either. They can't. Drugs rarely solve anything. The reality is that your health is up to you (HERE is the story of someone who came to that realization last spring and turned their life around, and HERE are dozens of others like her). If you are struggling with Chronic Health Conditions of nearly any sort, at least browse some of THESE suggestions.
LEARN WHY PALEO IS THE BEST DIET FOR CHRONIC PAIN,
AUTOIMMUNITY, CHRONIC ILLNESS, WEIGHT LOSS, ETC, ETC, ETC
WHAT SEPARATES PALEO FROM LOW CARB?
In an era when doctors, researchers, and professors were promoting FAT FREE DIETS, Dr. Robert Atkins --- a practicing cardiologist --- was a voice crying out from the wilderness. His method worked. The first time I saw this up close and personal was in a 65 year old male who was about 150 lbs overweight. He not only lost the weight in a relatively short amount of time, but got his blood work in order ---- by eating forbidden foods like red meat, cheese, fried eggs & bacon, etc, etc. Atkin's principle was simple; control blood sugar by limiting carbs, and you control your insulin levels. CONTROL YOUR INSULIN LEVELS and you can solve any number of problems. Sort of.
The problem is, Low Carb Diets only take care of half the equation --- the BLOOD SUGAR portion. Don't get me wrong, there's powerful evidence that virtually all chronic health issues have their roots in Blood Sugar Dysregulation. However, this is only one side of the coin. On the other side of the coin we have INFLAMMATION driven by food sensitivities --- the two most common of these being WHEAT and DAIRY.
First, let me say that you might not have a problem with either of these food groups. Secondly, let me say that if you do, you probably don't realize it. Let me give you an example. I saw a patient earlier this week (a 35 year old female) whom no one would accuse of being overweight. She is active, fit, and appears --- at least on the surface --- to be quite healthy. She was, however, having trouble holding adjustments (chronic mid-back pain) despite having done some TISSUE REMODELING. A few months ago I suggested that she look at my website concerning the benefits of Paleo and its effects on Inflammation. She did.
When I saw her the other day, I could not tell any visible difference. She looked the same to me. However, she began telling me that she had gone Paleo right after her last visit to see me. She said that the difference in her life had been profound. For her, the biggies were that she had much more energy, and way less pain (that chronic SUBLUXATION between her shoulders went away). And interestingly enough, her unintentional ELIMINATION DIET sealed it for her. Although she did not do her Elimination Diet by the book, when she started cheating over the holidays, she started feeling crappy again.
A FEW DIFFERENCES BETWEEN LOW CARB AND PALEO
- MEAT: Most Low Carbers and all of those doing Paleo eat meat --- THERE'S NOTHING INHERENTLY WRONG WITH THIS. However, there is a huge difference between animals raised on ANTIBIOTICS and ESTROGEN-BASED HORMONES, and those that are not. Let me show you just one example here. The ratio of Omega 3 fatty acids to Omega 6 fatty acids is a big deal. Why? Because the 3's tend to be anti-inflammatory, while the 6's tend to promote inflammation. Grass fed beef has about a 1 to 5 ratio of 3's to 6's, while feedlot-raised beef (or even "Grain Finished" beef) has a ratio closer to 1 to 45. That, folks, is a nine-fold difference. This doesn't even touch on the chemicals (see previous two links) being used for the sole purpose of weight gain in the form of fat. It's one of the reasons we love VENISON so much. Bottom line: there really is a difference in the way your meat (and poultry and eggs) is raised, as well as a difference in the quality of the fats you consume.
- GRAINS: Grains are what we feed farm animals to fatten them up for slaughter. Grains --- especially CORN --- accomplish this by jacking blood sugar in a similar fashion to table sugar (HERE). For many, Gluten (wheat protein) is huge driver of Inflammation. Not only is it heavily related to Autoimmunity (HERE), but the fact that you didn't test positive for Celiac Disease in no ways means you're out of the woods (HERE). As far as grains go; I have figured out that I can eat some quinoa without having problems --- that's about it. All I can tell you is that for me, the small step from Low Carb to Paleo paid huge dividends in every area of my health. Beans are one of those gray areas. Yes, they contain lectins that can adversely affect some people. I find, however, that many people tend to tolerate them quite well --- particularly in moderation. Also, for those of you thinking about going Paleo; it is absolutely critical that you understand GLUTEN CROSS-REACTORS.
- DAIRY: Again, I don't feel that dairy is necessarily bad. The problem is that heavily commercialized cow's milk not only contains antibiotics, and hormones, but is pasteurized (this kills all the GOOD BACTERIA) and homogenized. On top of all this, milk's purpose is to put big-time weight on an animal that grows up to be many times our size. If you are going to drink milk, consider finding someone you can get raw goat's milk from. Easy to do in our area, but not so easy in most urban areas. Oh; and for those of you who believe that strong bones can only be had from milk, you might want to READ THIS. Because of the Elimination Diet, I have figured out that as long as I don't get too crazy with it, I can handle cheese just fine --- even though liquid milk or ice cream cause me issues.
- VEGETATION: This is a good time to talk about the difference between organic and not, as well as GMO's vs non-GMO's. In our neck of the woods, it's pretty easy to eat organic / non-GMO in season --- especially if you GARDEN (we do). However, it can be both difficult and expensive to follow this in the winter time. I tend to be one of those pick-your-battles types, and this is not a battle that I am personally not as invested in AS OTHERS. When it comes down to brass tacks, I am more interested in having food that is herbicide and pesticide free than worrying about whether or not something was GMO (I realize I will catch flak for this position --- I'm OK with that).
- SNACKS: The difference between Low Carb and Paleo snacks can be huge. I recommend sticking to essentially the same sorts of snacks you might eat for a meal. This is because many of the "Low Carb" snacks are loaded with MSG, ASPARTAME, or other fun chemicals that actually cause both health problems and weight gain. On top of that, I find most "Gluten Free" snacks to be just as bad as their gluten-containing brethren --- excepting the fact they don't contain gluten (HERE).
The truth is, labels are often detrimental. Technically speaking, I can't really call myself "Low Carb" because I eat so many sweet potatoes and apples. On the other hand, I can't technically refer to myself as "Paleo" since I eat beans, butter, and cheese, as well as GMO's (not to mention, some of our meat comes from the butcher shop). I can say, however, that for some of you reading this ---- especially those of you who could be considered nothing short of extremely sick --- you may need to be stricter than I am. For instance, LESLEY controls her Lyme's by being all-in and virtually never cheating.
As long as you are eating a diet based on WHOLE FOODS with a negligible amount of THIS SORT OF JUNK CARBS (and feeding your GUT BACTERIA), it is likely to be a huge improvement over what you are currently doing. As for those of you who are struggling with funky neurological issues or certain chronic health conditions (PCOS, TYPE II DIABETES, TBI, ALZHEIMER'S, PARKINSON'S, SEIZURE DISORDERS, etc), it might behoove you to at least do some research into the very Low Carb Diets known as KETOGENIC DIETS. If the research resonates with you, think about a short (30 to 90 day) trial run.
For those who are chronically ill, you may want to see some of the other factors that could be adversely affecting your health (HERE). And if you're enjoying our site, why not share it with others. Besides just forwarding it on to those you love or care about, one of the best ways to reach those same people is to like us or share on FACEBOOK.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
Brain Based Therapy
Can You Help
Cardio Or Strength
Cold Laser Therapy
Death By Medicine
Degenerative Joint Disease
D's Of Chronic Pain
Evidence Based Medicine
Gluten Cross Reactivity
Ice Or Heat
Jacks Fork River
Leaky Gut Syndrome
Number One Health Problem
Platelet Rich Therapy
Post Surgical Scarring
Re Invent Yourself
Rib And Chest Pain
Scar Tissue Removal
Sleeping Pills Kill
Stay Or Go
Stretching Post Treatment
Tensegrity And Fascia
The Big Four
Thoracic Outlet Syndrome
Whole Body Vibration