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.

 

Are Annual Exams Really Necessary?

I hear it at least every week, if not more.  “My doctor gave me a clean bill of health.”  OK.  So maybe the annual battery of tests and exams didn’t reveal any serious underlying diseases, but that hardly equates to being healthy.  Unfortunately, we’ve become so accustomed to physical exams, even the insurance companies consider them “preventive care.”  The chief cited rationale is that the annual offers a regular opportunity to address risk factors and health or life concerns.  There may be some truth to this, but both insurance companies and doctors could be doing so much more to provide preventive care for patients.

“There’s little evidence that a routine physical exam and a standard 20-30 item chemical panel improve outcomes,” said Allan Goroll, MACP, a professor of medicine at Harvard Medical School and practicing general internist.  In 1979, a Canadian government task force officially recommended giving up the standard head-to-toe annual physical based on studies showing it to be “nonspecific,” “inefficient” and “potentially harmful,” replacing it instead with a small number of periodic screening tests, which depend in part on a patient’s risk factors for illness.  Yet, doctors and patients both continue to be dependent on “screening tests” that are thought to rack up an unnecessary cost of $325 million annually.

Instead of strictly focusing on “disease prevention”, our model of healthcare needs to move in the direction of teaching people how to be healthy.  It’s great if your test results are “normal”, but what changes can you be making to truly improve your health?  As doctors, we need to make it a point to not give people a false sense of security by sticking to the current standards of the annual physical exam.  This only reinforces bad habits, and most likely makes people more prone to chronic disease in the long-run.  As more and more doctors begin to move away from testing and towards individualized lifestyle counseling, patients will come to expect this with their annual exams, hopefully changing the standards altogether.

But that’s not what happens in many primary care practices, Dr. Prochazka and fellow researchers found in a 2005 survey published in Archives of Internal Medicine. Nearly half of the physician respondents, despite evidence to the contrary, still believed in annual mammography, lipid panels, blood glucose levels, CBCs and urinalysis.

“In general, there’s a bit of a disconnect,” he said. “Many patients wish for tests and think that’s what a physical actually means. And many physicians think that the traditional annual is necessary and of proven value.”

Ateev Mehrotra, an assistant professor at the University of Pittsburgh School of Medicine, has estimated that unneeded blood tests during physical exams alone cost $325 million annually.  And the over-screening for some occurs in a country where 50 million people are uninsured and receive little medical attention. More than half of uninsured adults in the United States did not see a doctor in 2010. Fifty percent of Americans are not up to date with the few screening tests that are recommended — like a colonoscopy once every 10 years for those over 50 — because of high costs, said Karen Davis, president of the Commonwealth Fund.

Intensive screening can prove useless for a number of reasons, experts say: Tests can have high rates of “false positives,” signaling that there may be disease, when further tests and procedures reveal none. Likewise, they can screen for conditions where early detection does not alter the course of the disease, either because the body might heal itself or because there are no effective remedies. In either case they can lead to aggressive procedures to clarify the diagnosis or provide treatment, which themselves can be harmful.

Ultimately, I think broader policy changes will need to be made to allow doctors the freedom to spend more time with their patients, especially since most insurance companies determine the definition of “preventive” services.  But if doctors can start emphasizing that “healthy” involves far more than just normal blood results, I expect that great progress will be made in our health care system.

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!

 

School Lunch Reform

This article discusses how corporations are willing to sell out the health of our kids for financial interests. “Food companies have spent more than 5.6 million so far lobbying against the proposed rules.” Really, food companies? I’m sure you can find other ways to make money without promoting obesity and illness-disgusting!

http://www.nytimes.com/2011/11/02/us/school-lunch-proposals-set-off-a-dispute.html?scp=1&sq=school%20lunch&st=cse

Vitamins and Death? Not So Fast . . .

A lot of hype and negative press has been surrounding the recent study that demonstrated the supposed risks of taking supplements.  This is a reprint of an editorial written by Alan Gaby, M.D. that exposes the faults of this study, and why it should be taken with a grain of salt!
An observational study published in the Archives of Internal Medicine found that women using multivitamins or certain other common vitamin and mineral supplements had higher mortality risk over 22 years. However, while it achieved widespread media coverage, it did not provide any convincing evidence that nutritional supplements are harmful. Researchers calculated the mortality rates were by manipulating the data, and nothing in the study contradicts decades of controlled research showing healthful benefits of these vitamins and minerals.

What the study said

In this study, 38,772 women from Iowa, whose average age was 62 years, filled out questionnaires three times over an 18-year period regarding dietary supplement use.

After a total of 22 years, researchers followed up and report that the risk of dying from any cause appeared to be 6% higher among women who took a multivitamin supplement than among women who did not take a multivitamin. Additional supplemention with vitamin B6, folic acid, iron, magnesium, zinc, and copper was also said to be associated with increased mortality rates.

Two factors should be taken into consideration while interpreting these results, the method used for calculating the results and the type of study.

Interpreting mortality risk methodology

The media coverage did not note a potentially serious problem with this study: that researchers looked at “adjusted” mortality rates rather than actual mortality rates in the population of women who took supplements, adjusting for a wide range of factors including caloric intake, cigarette smoking, body mass index, blood pressure, educational level, diabetes, use of hormone-replacement therapy, physical activity, and intake of fruits and vegetables.

Studying health events to find patterns in a population (epidemiology) is a relatively inexact science, and it is quite possible that the assumptions upon which the researchers based their adjustments were not entirely correct. When they adjusted the data only for age and caloric intake, there was no statistically significant difference in mortality rate between supplement users and nonusers.

Observation only tells part of the story

The study was observational, meaning that while it might show a relationship between certain supplements and mortality, it does not provide evidence that one causes the other.

In observational studies, scientists correlate various lifestyle factors with health outcomes. Such studies help researchers develop hypotheses that can be investigated further, but the only type of study that can prove cause and effect is a randomized controlled trial, in which participants are randomly assigned to receive either a particular treatment or a placebo (an inert dummy pill) without knowing whether they are getting the treatment or not.

In the history of medical research, results of observational studies have sometimes eventually been contradicted by randomized controlled trials. In a famous example, numerous observational studies suggested that the use of hormone-replacement therapy by postmenopausal women prevents heart disease, but subsequent randomized controlled trials demonstrated that hormone-replacement therapy either has no effect or actually increases the risk of heart disease.

Should women stop taking supplements?

The new study does not negate previous research demonstrating that vitamins and minerals can have a wide range of health benefits. However, as with all substances that can affect your health, talk to your doctor about which dietary supplements are right for you.

(Arch Intern Med 2011;171:1625–33)

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

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.

Work Causes Heart Disease

People who regularly work long hours may be significantly increasing their risk of developing heart disease, the world’s biggest killer, British scientists said Monday.

Researchers said a long-term study showed that working more than 11 hours a day increased the risk of heart disease by 67 percent, compared with working a standard 7 to 8 hours a day.

They said the findings suggest that information on working hours — used alongside other factors like blood pressure, diabetes and smoking habits — could help doctors work out a patient’s risk of heart disease.

However, they also said it was not yet clear whether long working hours themselves contribute to heart disease risk, or whether they act as a “marker” of other factors that can harm heart health — like unhealthy eating habits, a lack of exercise or depression.

The study, published in the Annals of Internal Medicine journal, followed nearly 7,100 British workers for 11 years.

“Working long days is associated with a remarkable increase in risk of heart disease,” said Mika Kivimaki of Britain’s University College London, who led the research. He said it may be a “wake-up call for people who overwork themselves.”

Cardiovascular diseases such as heart attacks and strokes are the world’s largest killers, claiming around 17.1 million lives a year, according to the World Health Organization (WHO). Billions of dollars are spent every year on medical devices and drugs to treat them.

The findings of this study support previous research showing a link between working hours and heart disease.

For this study, men and women who worked full time and had no heart disease were selected, giving 7,095 participants.

The researchers collected data on heart risk factors like age, blood pressure, cholesterol, smoking and diabetes and also asked participants how many hours they worked — including work during the day and work brought home — on an average weekday.

During the 11-year study, 192 participants had heart attacks. Those who worked 11 hours or more a day were 67 percent more likely to have a heart attack than those with fewer hours.

Of course, heart disease is a multi-factorial issue, but those working more than 11 hours per day need to take even further precautions to lower their heart disease risk. Talk to your naturopathic doctor about laboratory studies that can help to identify numerous cardiovascular risk factors, so the proper steps can be taken to help prevent heart disease and stroke in the future. 

Elderberry and Infections

As many of my patients are already well aware, I often rely upon Elderberry extract, especially in the treatment of influenza and other viral infections. This recent study demonstrates evidence as to why this treatment is effective.

In a study designed to examine the effects of a standardized extract of black elderberry (Sambucus nigra L.) on 3 Gram-positive bacteria and one Gram-negative bacteria responsible for upper respiratory tract infections, as well as two different strains of influenza virus, the extract was found to possess antimicrobial activity against both Gram-positive bacteria of Streptococcus pyogenes and group C and G Streptococci, the Gram-negative bacteria Branhamella catarrhalis, and human pathogenic influenza viruses. The results of this study suggest that elderberry extract such as the one used in this study may be an effective tool for helping to combat various types of upper respiratory tract infections.


Reference: “Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses,” Krawitz C, Mraheil MA, et al, BMC Complement Altern Med, 2011 Feb 25; 11-16. (Address: Institute for Medical Microbiology, Justus-Liebig-University, Frankfurter Strasse 107, 35392 Giessen, Germany. E-mail: Stephan.Pleschka@mikro.bio.uni-giessen.de ).

PCOS Patients Benefit From Exercise and Acupuncture

Acupuncture and physical exercise improve hormone levels and menstrual bleeding pattern in women with polycystic ovary syndrome (PCOS), reveals research from the University of Gothenburg, Sweden. 

PCOS is a common disorder that affects up to 10% of all women of child-bearing age. Women with PCOS frequently have irregular ovulation and menstruation, with many small immature egg follicles in the ovaries. This causes the ovaries to produce more testosterone which, in turn, leads to troublesome hair growth and acneObesity, insulin resistance and cardiovascular disease are also widespread among these patients. 

In the current study, published in the American Journal of Physiology-Endocrinology and Metabolism, a group of women with PCOS were given acupuncture where the needles were stimulated both manually and with a weak electric current at a low frequency that was, to some extent, similar to muscular work. A second group was instructed to exercise at least three times a week, while a third group acted as controls. All were given information on the importance of regular exercise and a healthy diet. 

“The study shows that both acupuncture and exercise reduce high levels of testosterone and lead to more regular menstruation,” says docent associate professor Elisabet Stener-Victorin, who is responsible for the study. “Of the two treatments, the acupuncture proved more effective.” 

Although PCOS is a common disorder, researchers do not know exactly what causes it. “However, we’ve recently demonstrated that women with PCOS have a highly active sympathetic nervous system, the part that isn’t controlled by our will, and that both acupuncture and regular exercise reduced levels of activity in this system compared with the control group, which could be an explanation for the results.” 

In my experience, women I’ve seen with PCOS respond extraordinarily well to nutritional, botanical, and dietary interventions. Plus, conventional medical treatments tend to be very “piecemeal”, treating each component of PCOS as individual symptoms, rather than addressing the body as a whole. As this study confirms, exercise and acupuncture are other treatments that can be implemented to successfully reverse PCOS.