PMS? Oral Contraceptives Not The Only Option!

PMSPre-menstrual syndrome (PMS) is thought to affect about 90 per cent of women at some point in their lives, with a significant proportion of these suffering regularly from severe and debilitating symptoms.  PMS is typically the result of abnormal hormone fluctuations, such as elevated prolactin levels, or low progesterone during the second half of the menstrual cycle.  Another possibility is estrogen dominance, where the liver has a difficult time metabolizing estrogen, leading to a disproportionate amount of estrogen in the system.  And these are just a few of the possible scenarios that can lead to PMS.

So why, then, does conventional medicine treat virtually every person with PMS the same?  Oral contraceptives are prescribed almost exclusively to treat this issue, regardless of the cause.  While oral contraceptives may be a magic bullet in some instances, the list of potential side-effects is long, and includes an increased risk of breast cancer, cervical cancer, stroke, acne, yeast infections, and weight gain.  Therefore, why subject so many people to these side-effects, when there may be other, more natural cures that not only alleviate the symptoms, but address the root cause?

One of the most established natural treatments for PMS is an extract of an exotic fruit known as Agnus castus. Research from Germany shows that Agnus castus (also known as Chasteberry, Monk’s pepper and Vitex) can reduce prolactin levels and increase the production of progesterone. These effects help to correct the hormonal imbalances common in PMS, thereby helping to ease its symptoms.

Earlier this year, the British Medical Journal (BMJ) published a study which proved the effectiveness of this natural remedy in the treatment of PMS. Over half the women in this study had significant improvement in their symptoms, and the treatment was found to be safe and generally free of side-effects. This recent study is not the only evidence which supports the use of Agnus castus in PMS. Last year, the Journal of Women’s Health and Gender Based Medicine published a study which examined the effect of Agnus castus in more than 1600 women. The study lasted three months, after which time 93 per cent of the women reported an improvement in or elimination of their PMS symptoms. Four out of five women rated themselves as ‘much better’ or ‘very much better’.

Naturopathic doctors can also perform specialized hormone testing that can help to pinpoint specific imbalances, which in turn can be corrected with nutritional and herbal therapies.  This allows each case of PMS to be treated uniquely, rather than treating everyone the same.  If PMS is something you’ve been suffering from for years, and birth control isn’t the answer you’re seeking, seek out a qualified naturopathic physician who can help to get your symptoms under control.

Why Will I Gain Weight If I’m Not Sleeping Well?

As bizarre as it sounds, how well we sleep can have a direct impact on the amount of weight we gain.  While doctors often talk about how poor sleep impacts immune function and stress hormones, we’re only more recently beginning to understand how hormones that control appetite are also affected.

Leptin and ghrelin are hormones in our system that regulate feelings of hunger and fullness.  Ghrelin, which is produced in the gastrointestinal tract, stimulates appetite, while leptin, produced in fat cells, sends a signal to the brain when you are full.  Lack of sleep leads to both a lowering of leptin levels (lack of satiety) and a rise in ghrelin (stimulated appetite).  The combined effects of these changes leads to overeating, followed by weight gain.

One example of this effect was demonstrated in a joint study between Stanford and the University of Wisconsin.  Those who slept less than eight hours a night not only had lower levels of leptin and higher levels of ghrelin, but they also had a higher level of body fat.  Those who slept the fewest hours per night weighed the most.

While this information is certainly promising, the relationship between these hormones and weight gain is still not entirely straightforward.  Some patients who have sleep apnea, combined with obesity, actually have high levels of leptin, rather than low.  It’s been speculated that some patients may become resistant to this hormone, so elevated levels mean their body isn’t responding to the signals of this hormone, still making them more prone to weight gain as a result of sleep apnea.

I think the bottom line is that diet and exercise aren’t the only factors when it comes to addressing weight gain.  Poor sleep or untreated sleep apnea should always be addressed with any weight loss program, if any level of success is to be achieved.

 

Recognizing Lyme Disease and Related Infections

Although we live in a state where Lyme disease is endemic, the diagnosis and treatment of this condition continues to be controversial.  Unfortunately, the political landscape surrounding Lyme disease has steered many doctors away from treating it altogether, putting many patients at risk for developing long-term complications.  It’s not uncommon for me to see patients who have been told that their testing for Lyme disease and other co-infections is negative, so therefore there is no possible way that these infections can be responsible for their symptoms.  This information can be extremely misleading, since the validity of testing is dependent on what stage of the disease they are performed.  Doctors who are well informed about Lyme will typically treat based on clinical criteria (outlined by the CDC), with the argument being that the risk of putting uninfected individuals on antibiotics is not outweighed by the risk of long-term Lyme complications.

Since there is so much variability from one physician to the next, the most important point is for patients to recognize the most common symptoms of Lyme disease and other co-infections, so they can consider seeking out a second opinion if they’ve been told their symptoms are unrelated, yet their health continues to decline.  Symptoms to watch for include the following:

Lyme Disease: Fatigue, headaches, cognitive difficulties, roaming muscle pain that comes and goes, intermittent paresthesias (numbness, tingling).

Babesia: Fever, chills, night sweats, “pressure” headaches, insomnia, “air hunger”, easy bruising.

Ehrlichia: High fevers, low WBC and platelet counts, elevated liver enzymes.

Bartonella: Fatigue, “ice pick” headache, cognitive difficulties, lymph node swelling, pressure behind eyes, seizures, painful feet (especially upon waking), sensitivity to light.

Other key points to consider:

-While known history of a tick bite is helpful, how often will you notice something the size of a poppy seed hanging around?

-Lyme disease can suppress many subsets of your immune system, so recurring viral infections and other signs of immune compromise can be another clue.

-If you do find a tick, don’t throw it away! You should save it, and have the tick tested for Borrelia.

-Exposure history (hiking, wooded areas, occupational hazards, etc.) and previous response to antibiotics (did symptoms improve or worsen) can be useful indicators.

-There are no definitive tests for Lyme disease!

If you’re suspicious of Lyme or related co-infections based on this summary, seek out a physician who has experience with diagnosing and treating these conditions.  Be persistent, and don’t be discouraged by negative test results, particularly if you continue to suffer!

Rethinking Fat in the Diet

With all the hype surrounding statin medications this past week (see http://www.nytimes.com/2012/03/05/opinion/the-diabetes-dilemma-for-statin-users.html), it’s a perfect opportunity to take a step back and discuss some basic diet fundamentals.  For the past 40 or more years, the “benefits” of low-fat diets have been ingrained in our consciousness, and advocated by a majority of the medical community.  The thinking behind this was simple: high fat in the diet must lead to a buildup of fat and plaque in the arteries, so the less fat you eat, the better.  In recent years, research evidence has overwhelmingly refuted this concept, yet it continues to be the mainstream recommendation for preventing heart disease.  Even the “Dairy” section in the USDA’s “My Plate” emphasizes low or non-fat sources of dairy.

A scientific analysis of 21 earlier studies showed “no significant evidence” that saturated fat in the diet is associated with an increased risk of coronary heart disease.  In fact, the dietary evidence collected from these thousands of participants found no difference in the risk of coronary heart disease, stroke, or coronary vascular disease between those individuals with the lowest and highest intakes of saturated fat.  The bigger issue appears to be the added amounts of sweeteners and carbohydrates that people are eating instead of fats.  More and more evidence is suggesting that it’s this continuous increase in carbohydrate consumption that is truly responsible for an increased risk in diabetes and coronary artery disease.

I think the main take-away message from this information is that you don’t have to be afraid of good quality sources of saturated fat.  We’ve been so trained to be suspicious of it for so long that it becomes difficult to change our perception of how healthy it can be.  Now, does this mean you should be eating nothing but cheese, bacon, and beef for the rest of your life?  Of course not!  If you’re already consuming low-fat sources of dairy (skim milk, low-fat yogurt, etc.), switch to organic whole milk sources, and use butter instead of margarine or other processed forms of fat.  In general, try to limit your saturated fat intake to 10% of your total diet, while discontinuing the consumption of hydrogenated oils, artificial sweeteners, and high-glycemic carbohydrates.  By doing this, and continuing to emphasize fruits and vegetables as a mainstay, you’ll be much better off in the long run!

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!

 

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)

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