Light Therapy Not Just For Seasonal Affective Disorder

Since it was first described by psychiatric journals in 1984, artificial light therapy has been used successfully to treat seasonal affective disorder (SAD).  This therapy is meant to simulate exposure to sunlight in winter months, preventing people with SAD from suffering as much during periods where exposure to sunlight is more limited.  In the past few years, more evidence has suggested that light therapy may be beneficial for other types of depression as well.  In 2005, for example, a study in the American Journal of Psychiatry reported that the effects of light therapy are comparable to those found in many clinical studies of antidepressant drug therapy for mood disorders.

Since our bodies are programmed to be in sync with nature’s rhythms, this concept makes total sense.  If you’re suffering from depression, you will ideally want to make it a point to get outside on winter days for at least 15 minutes at a time.  Otherwise, you can acquire a light box that mimics the rays of the sun, and expose yourself to this light for 20 minutes or more every morning.  Dawn simulators are also a great tool, as you can program them to automatically turn on each morning, gradually getting brighter to replicate the rising of the sun.

Other tools to help get your body in sync with nature’s natural rhythms may also be helpful for depression, anxiety, and other mood disorders.  For example, taking physiological doses of melatonin (1 mg or less) at the onset of evening darkness can prepare your body for sleep (without being sedating).  Looking at cortisol and other hormonal fluctuations can also be helpful, as abnormalities in the diurnal output of these hormones can be corrected with natural interventions, making you less prone to mood changes that may be associated with these problems.

Does this mean that if you’re taking antidepressants, you can just go outside for a few minutes every day and be cured? Absolutely not!  You will need to work with your doctor to start implementing light therapy and some of the other recommended changes, and hopefully with time, be able to cut back on your medication.  I think the take home message is that more and more evidence is demonstrating how a disconnection with nature and it’s rhythms can have a profound effect on our mood and overall health.

 

Celiac Disease or Gluten Intolerance?

When people are experiencing nutritional deficiencies, anemia, weight changes, and/or other symptoms that seem to be of an unknown origin, it’s fairly common practice for doctors to rule out the presence of celiac disease with a small intestinal biopsy. While this is certainly considered the “gold standard” for identifying the pathological changes associated with celiac disease, many experienced physicians are finding that patients can still have a sensitivity to gluten containing grains, making celiac disease and gluten intolerance separate entities altogether.  This led experts at the recent International Celiac Disease Symposium to define the term gluten insensitivity for patients who don’t meet the criteria for celiac disease or wheat allergy, yet improve dramatically when following a gluten-free diet.

The incidence of Celiac disease has doubled since 1974, and gluten sensitivity alone is estimated to be 6 times the prevalence of celiac disease. Fortunately, for patients and doctors who have recognized this phenomenon for quite some time, there is finally a more established definition of gluten sensitivity. Some of the criteria being used to separate gluten sensitivity from wheat allergy and celiac disease include: Negative testing for the presence of IgE antibodies to wheat; Negative endomysial and ttg antibodies (typically present with celiac disease); Negative small intestinal biopsy; Resolution of symptoms following as gluten-free diet. Researchers have concluded that the genetic makeup and immune response of gluten sensitivity patients is unique, and may be more enzyme mediated (like lactose intolerance), rather than immune based.

Since objective testing is still lacking, people who are symptomatic should consider implementing a gluten-free diet. Some of the most common symptoms associated with gluten sensitivity include abdominal pain, rashes, headaches, “brain fog”, fatigue, depression, anemia, and joint pain. If your doctor tells you that celiac testing is negative, don’t give up hope!

 

Neuropathy and Natural Medicine

Neuropathy, whether it’s diabetic or idiopathic, is often challenging to treat, with any modality. However, I do find that the combination of acupuncture and naturopathic interventions tend to be much more successful than the “standard” protocol (which usually includes gabapentin and various cocktails of prescription painkillers). A recent study from the journal Diabetes Care (2011 July 25) discovered that 600 mg/day of the nutrient alpha-lipoic acid lead to a clinically significant improvement in patients with diabetic neuropathy. Clinically, I’ve also found that other forms of neuropathy often respond well to alpha-lipoic acid therapy as well. Other treatments that help to enhance peripheral circulation and restore nutrition to damaged nerves, such as acetyl-l-carnitine, mixed bioflavonoids, and B-vitamins, can also be beneficial in the treatment of peripheral neuropathy.

It’s not uncommon for people to be kept on medications for life when trying to deal with peripheral neuropathy pain, with the resulting relief being minimal at best. If this is something you have suffered from, don’t be afraid to seek alternatives, as there is enough clinical and research evidence to support the benefits.

Pregnant Moms and Genes

This is a great article discussing how chronic stress during pregnancy can cause behavioral problems in children, especially because of epigenetics, or how the child’s genes influence their stress response:

http://www.economist.com/node/18985981

Cell Phones and Cancer

This is a reprint of an article from the Journal of Naturopathic Medicine that was a response to a recent study published in JAMA (Volkow N, Tomasi D, Wang G-J, et al. Effect of cell phone radiofrequency signal exposure on brain glucose metabolism. JAMA. 2011;305(8):808-813).
The bottom line is that cell phone use does indeed appear to enhance brain activity, which can potentially pose risks for cancer or other neurological complications. There are still many unanswered questions with respect to cell phone use and cancer, but this study is further evidence that this issue needs to be addressed and payed attention to:

For years, medical experts and scientists have voiced concerns regarding
the questionable safety of cell phone use, but even with the evidence
mounting, this alluring technology is hard to resist. Humankind’s
increasing use of cell phones, 5 billion users worldwide, necessitates a
thorough, unbiased look at the risks.

The JAMA study documents that cell phone exposure affects the
brain by increasing brain glucose, a known measure of increased brain
activity. Though the study does not offer an explanation of the
underlying mechanism, we do know that in other biological systems of the
body, chronic increase in glucose can have a significant effect on the
local tissues, altering cell and gene function. Notably, the study
refutes the longstanding claim by both the Federal Communications
Commission and the cell phone industry that there are no biological
effects from non-thermal levels of cell phone radiation.

The studies published on cell phone use and the possible health risks (including tumors of the brain, as well as male infertility)
are numerous, and many repudiate any risks. Among the catalogue of
studies, often funded in part by the cell phone industry, a
meta-analysis published in the Journal of Clinical Oncology in 2006, involving 23 case-controlled studies and almost 38,000 participants, concluded there are increased health risks.
Recently a branch of the World Health Organization called The
International Agency for Research on Cancer (IARC) convened 31
scientists from 14 countries, including the United States, and evaluated
peer-reviewed studies regarding the safety of cell phones and issued a
statement that puts exposure to radiofrequency electromagnetic fields
from cell phone use in the same category as lead and car exhaust:
possibly carcinogenic. At what point do we acknowledge that precautions need to be taken? Our
current safety standards regarding cell phones are based on obsolete
research. They certainly don’t take into account the dramatic increase
in number of users, the increase in amount of time spent in use, and the
rise of cell phone use by young people. There not only needs to be
continued investigation into the effects on brain tissues, but also the
consequences of both heavy use and long-term exposure–parameters not yet
studied.

The concept of the precautionary principle encourages policy makers to
make decisions that protect the public from a policy or action that may
be harmful, in the absence of definitive data. In looking at the health
impacts of electromagnetic radiofrequencies from cell phones, the public
needs to be protected from the harm that may be caused by their use. It
calls to mind our history regarding tobacco, when medical professionals
awaited definitive trial data for decades, while millions of
individuals suffered predictable health consequences. By refusing to
acknowledge the possible health risks of cell phone use now, we may be
harming generations to come.

While we continue to gather information, we can counsel our patients on
the many ways to reduce overall electromagnetic radiation exposure:

  • Turn cell phones off when not in use. Cell phone emissions are
    occurring whenever the phone is on, whether it is being used or not.
  • Avoid cell phone use when the signal is weak. Emissions increase while the phone is searching for a tower.
  • Store cell phones away from the body in a purse, backpack, or briefcase.
  • Use a protective headset that puts distance between the phone and the brain, with corded earphones if possible.
  • Engage in texting in lieu of phone calls.

We can assume there will be continued development of the technology,
including safer phones and safer designs for towers. Ultimately, curbing
cell phone use–using our cell phones for truly important communications
and turning them off when they are not needed–may be the key to
reducing risk.

Small Intestinal Bowel Overgrowth and IBS

I’m posting a link here that explains in detail the symptoms of Small Intestinal Bowel Overgrowth (SIBO), and how it is often an underlying cause of IBS. In my clinic, I’ve diagnosed this several times, even after people have already consulted with their gastroenterologist, which indicates that SIBO is not “mainstream” enough for most doctors to pursue the appropriate testing. All that is required is a simple breath test-Once diagnosed, this condition is easily treatable, so talk to your doctor about performing the test if you’re experiencing recurring digestive symptoms, or have been diagnosed with IBS. 

http://www.medicinenet.com/small_intestinal_bacterial_overgrowth/article.htm

IBS and “Mindfulness”

A therapy that combines mindfulness meditation and gentle yoga may help soothe symptoms of irritable bowel syndrome, a small clinical trial suggests.

In a study of 75 women with the digestive disorder, researchers found that those assigned to “mindfulness training” saw a bigger improvement in their symptoms over three months than women who were assigned to a support group.

The findings, they say, suggest that the mindfulness technique should be an option for treating irritable bowel syndrome (IBS).

A doctor not involved in the study agreed.

“I think people with IBS should learn mindfulness skills,” said Dr. Delia Chiaramonte, director of education for the University of Maryland’s Center for Integrative Medicine in Baltimore.

Learning such skills, she said in an interview, is “100 percent safe,” and it could offer people a way to help manage IBS symptoms on their own, long term.

People with IBS have repeated bouts of abdominal cramps, bloating, constipation and diarrhea. The typical treatment includes diet changes, as well as anti-diarrhea medication and, for constipation, laxatives or fiber supplements. There’s also some evidence that regular, moderate exercise helps.

The exact cause of IBS is unknown, but anxiety and less-than-ideal coping strategies — like avoiding going out because of your symptoms — are thought to make IBS worse for many people.

Because of that, psychological counseling is sometimes used. The best-studied form is cognitive behavioral therapy, which tries to change the unhealthy thinking patterns and behaviors that contribute to people’s health problems.

For the new study, Susan A. Gaylord and colleagues at the University of North Carolina, Chapel Hill, looked at a different approach to managing the “brain-gut” connection — known as mindfulness-based stress reduction.

The researchers randomly assigned 75 women with IBS to either undergo the mindfulness training or attend an IBS support group once a week for eight weeks.

The training included lessons on meditation, gentle yoga postures and “body scanning,” in which people focus their attention on one body area at a time to detect muscle tension and other sensations.

Gaylord’s team found that three months after the therapy ended, women who’d undergone mindfulness training were faring better than the support group.

On average, their scores on a standard 500-point IBS symptom questionnaire fell by more than 100 points, with a 50-point drop considered a “clinically significant” improvement.

In contrast, women in the support group averaged a 30-point decline, according to results in the American Journal of Gastroenterology.

Chiaramonte said the trial was “tremendously well-designed,” and set up to address the common criticisms of studies of mind-body therapies. Testing mindfulness training against a support group, for example, helps control for the fact that people involved in any form of therapy may simply expect to get better — and, therefore, do.

In surveys, the researchers found that women in the support group were as likely to expect benefits as those in the mindfulness group.

“And still, the mindfulness group did better,” Chiaramonte said. “So it’s not just the contact with another human being, or not just that they expected to get better.”

It also makes sense that mindfulness training would help people with IBS, according to Chiaramonte. “Part of the problem in IBS,” she explained, “is the attention people give to the physical discomfort, and what the mind then does with that.”

With mindfulness training, the goal is to help people become aware of what they are feeling, but then “let it go” instead of ruminating, and potentially making the physical symptoms worse.

Of course, naturopathic medicine automatically takes “mindfulness” into account, so this is nothing new from my perspective. By always assessing people’s mental/emotional state, along with implementing diet and lifestyle changes, it’s not uncommon for me to see people’s IBS symptoms improve dramatically. It’s unfortunate to see so many patients who come to me after undergoing multiple symptomatic treatments (steroids, anti-spasmodics, etc.), only left to be feeling worse. 

Once again, this study demonstrates what naturopathic med
icine already practices-The impact of the mind on physical health cannot be avoided!

SOURCE: http://bit.ly/lfYimf American Journal of Gastroenterology, online June 21, 2011.

Doctors and Drugs

U.S. doctors are too quick to reach for their prescription pads, according to a new report urging them to think more about side effects and non-drug alternatives.

“Instead of the latest and greatest, we want fewer and more time-tested drugs,” said Dr. Gordon Schiff, associate director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital in Boston, a non-profit organization that studies ways to improve safe practices in healthcare.

“We are really trying to promote a different way of thinking about practicing,” added Schiff, whose report appears in the Archives of Internal Medicine.

Nearly half of all Americans have used at least one prescription drug in the past month, according to the Centers for Disease Control and Prevention, and experts say overprescribing is rampant.

By definition, that means people are being exposed to side effects, sometimes fatal, without the benefits that would justify those risks.

“Often what is really bothering them is not cured with a pill, but rather through exercise, physical therapy, or diet changes,” Schiff told Reuters Health.

Yet many doctors are quick to prescribe a drug, partly because they have limited time to deal with individual patients or because they and their patients have been bombarded with ads from the pharmaceutical industry.

As for prevention and non-drug alternatives, Schiff said, “there are no drug reps coming to my office pushing that.”

In an editorial in the same journal, researchers describe how opioid painkillers like Vicodin and Percocet have become increasingly common without good evidence that they help patients in the long run.

The evidence of harm, on the other hand, is clear, write Dr. Deborah Grady of the University of California, San Francisco, and her colleagues.

In 2007 alone, for instance, there were nearly 11,500 deaths related to prescription opioids — “a number greater than that of the combination of deaths from heroin and cocaine,” according to the researchers.

Some four million prescriptions for long-acting opioids are written every year, with side effects ranging from addiction to constipation to sleepiness.

To counter some of this overprescribing, Schiff and colleagues urge doctors to think beyond drugs and to prescribe new ones much more cautiously.

When it first hits the market, new medicine has usually only been tested in a few thousand patients, often healthier and younger than the ones doctors see in their offices.

That leaves a lot of questions about safety, especially since patients often are taking several drugs at the same time. More than a third of people over 60 take five or more drugs, for instance, and the number of prescriptions continues to rise.

But Dr. Lisa Schwartz and her husband Dr. Steven Woloshin, both of Dartmouth Medical School in Hanover, New Hampshire, told Reuters Health it’s difficult for doctors to get unbiased information about new drugs.

“We need to be making this information much more easily accessible to doctors,” said Schwartz, an expert in risk communication. “There are billions of dollars being spent on new drugs with unproven benefits.”

Schwartz and Woloshin said one way to do this would be to have the U.S. Food and Drugs Administration, which approves new drugs, send out simple summaries about the medications.

They also emphasized that overprescribing, while real, goes hand in hand with underprescribing of drugs to high-risk patients.

“We have both problems in this country,” Schwartz told Reuters Health.

According to Schiff, patients also have a role to play.

“Patients need to ask critical and skeptical questions, too,” he said. “They really should learn about the side effects of the drugs they are taking and be on the lookout for them.”

Schiff’s “Principles of Conservative
Prescribing” study was funded by government grants supporting consumer healthcare education and healthcare quality research.

SOURCE: http://bit.ly/lwuNm0 Archives of Internal Medicine, June 13, 2011.

Understanding Chronic Sinusitis

Once again, time has proven naturopathic medicine to be way ahead of the game when it comes to effectively treating a condition before modern medicine finally acknowledges the truth. In this case, we’re talking about chronic sinusitis. As long as I’ve been practicing, we’ve always addressed this largely as an inflammatory condition. By removing underlying triggers of inflammation (food and environmental allergens in particular), and using natural anti-inflammatory treatments, along with treatments to help facilitate sinus drainage, patients almost universally have long-lasting relief. Now, modern medicine is recognizing that chronic sinusitis is indeed an inflammatory issue, rather than having a whole lot to do with infectious causes. If you’re stuck in a cycle of repeated antibiotics for recurring sinus infections, definitely consult with a naturopath for treatment advice. 

As a reference, please visit the following article: http://www.nytimes.com/ref/health/healthguide/esn-sinusitis-ess.html

Eczema and Kids

The discovery that DHA (docosahexaenoic acid) from breast milk promotes healthy brain, eye, and nervous system development was an important step towards understanding why breast milk is a perfect first food for babies. DHA is now commonly added to infant formulas, but it’s not the only fatty acid that is important for developing babies. A new study shows that other fatty acids in breast milk may protect them from allergies.

The sharp rise in allergic diseases like asthma, eczema, food allergies, and hay fever might be explained in part by a shift in the fatty acid balance in our diets. The widespread use of vegetable oils and the comparatively low intake of omega-3 fatty acids (mostly from fish) have tipped the scales in favor of omega-6 fatty acids, which contribute to inflammation in the body.

Does breast milk affect eczema?

As part of the KOALA Birth Cohort Study, scientists investigated the composition of breast milk and its relationship to eczema and allergy development in 310 infant-mother pairs. Based on earlier findings that organic dairy seems to protect against eczema during the first two years, some of the women included led “alternative lifestyles,” meaning that they ate organic foods and breast-fed for an extended period. Researchers were interested to see how the fatty acid composition of their breast milk compared with that of moms who ate a more conventional diet.

Information related to breast-feeding, eczema, and other allergic diseases was gathered from the women while they were pregnant and during the first two years after birth. Blood samples were taken from the babies at one and two years to determine the presence of allergies to things like hen’s eggs, cow’s milk, peanut, tree and grass pollen, dust mites, and cats and dogs.

Babies benefit from fatty acid combo

Compared with the conventional diet group, the breast milk of moms with alternative lifestyles had somewhat higher concentrations of the omega-3 fatty acids EPA (eicosapentaenoic acid), DPA (docosapentaenoic acid), and DHA. The breast milk from this group was also higher in ruminant fatty acids (those derived primarily from dairy fat), including the immune-enhancing fatty acid, CLA (conjugated linoleic acid).

“Differences in fatty acid status between mothers may modify the protective effect of breastfeeding,” said Dr. Carel Thijs, lead author of the study from the Department of Epidemiology at Maastricht University in the Netherlands. “This may explain inconsistencies between studies in different populations with different intakes of fish, ruminant fats, and trans fatty acids from other sources.”

More interesting results:

By age two, 31% of the babies had parent-reported eczema, and 42% of the children with eczema also had allergies as determined by blood tests.

The risk of eczema and allergies at one year was lowest among babies whose mothers’ milk was highest in omega-3 fatty acids.

The risk of eczema and allergies also decreased with increasing concentrations of ruminant fatty acids, independent of the effect of the omega-3 fatty acids.

“Ruminant fatty acids deserve further investigations for their role in early immune development and are potential candidates to explain the protective effects of dairy fat as well as organic dairy and possibly unpasteurized farm milk on the development of atopic (allergic) conditions in early life,” the researchers concluded.

How to protect your baby from eczema

Breast-feed, if you can. For some women breast-feeding isn’t feasible, but it’s worth it for your baby’s health if you’re able to.

Eat more fatty fish. This is important during pregnancy and while breastfeeding. Avoid high-mercury fish including swordfish, shark, albacore tuna, king mackerel, tile fish, grouper, marlin, and orange roughy.

Make it creamy. The latest study adds to a growing body of evidence of the inflammation-fighting potential of full-fat dairy products.

(The study comes from Allergy 2011;66:58-67)