I will admit that most doctors don’t actually read medical journals. They may subscribe, but that doesn’t mean that they actually read them.
There are some specialists I tend to be more critical of when it comes to staying current with the medical research, but pediatricians usually top the list. Not only do they (I am using the term “they” here in a general sense–certainly there are top-notch pediatricians out there who have actually cracked a medical journal in the past 5 years…) not do things that are supported in the medical literature (like using vitamin D and probiotics to fight off infections), but they continue to recommend damaging treatments for infants IN THE FACE of medical literature that shows these interventions are therapeutically worthless and potentially very harmful.
Two perfect examples are:
- The use of acid-blocking drugs in infants. A recent study found that, out of a group of 567 pediatricians surveyed, only 1.8% followed guidelines. A full 82% were overprescribing this class of drugs in infants. All of this in light of research that is at least 6 years old finding that these prescriptions are used inappropriately.
- Antibiotic use in infants for conditions that are self-limiting. The most notorious of these being ear infections. Despite over THIRTY years of research screaming not to use antibiotics for this condition, pediatricians still aren’t getting the message.
Quite frankly, this is atrocious and inexcusable. Worse, these two treatments can produce irreparable harm to the little infant’s immune system. And yet, despite this, there was a recent article online about the treatment of bed wetting in children by chiropractors (based on several websites, NOT any type of study), slamming the treatment as being unscientific.
Talk about glass houses.
So what does all of this have to do with this particular article?
In it, researchers looked at the makeup of the bacteria in the gut of a group of 48 Bangladeshi infants at 6, 11, and 15 weeks of age and evaluated how the blend of bacteria in the gut affected the response to four different vaccinations: Oral polio virus (OPV), Bacille Calmette-Guérin (BCG-for tuberculosis), Tetanus toxoid (TT) and Hepatitis B virus.
The vaccines were then checked for effectiveness (using specific T-cell proliferation for all four, the delayed-type hypersensitivity skin-test response for BCG, and IgG response for OPV, TT, and hepatitis B virus). Here’s what they found:
- The presence of the bacteria Actinobacteria and B longum subspecies infantis led to a stronger immune response with vaccination.
- However, the presence of Enterobacteriales, Pseudomonadales and Clostridiales led to a weaker vaccine response.
Here’s the kicker. Antibiotic use has a tendency to increase the presence of the Clostridiales family of bacteria and throw off the balance of an infant’s gut. Herein lies to ultimate conundrum: Most pediatricians are militant about giving infants and children every vaccination recommended by the CDC and refuse to even consider that this might not be the best course of action for your little one’s health. At the same time, pediatricians have been very slow to adopt a policy that limits antibiotic use in all but the most serious of conditions.
It seems likely that these two practices negatively affect one another. The pediatrician who is staying current with all the research in his or her field (arguably, given that our knowledge of health is constantly changing, this is the ONLY acceptable type of pediatrician to take your child to) will understand that the unnecessary antibiotic may actually affect how well a vaccination works and avoid them as much as possible.
And NOT avoid antibiotics because he or she has a concern about “antibiotic resistance” but because antibiotics completely disrupt the delicate balance of the developing immune system of your little one. When you find THIS pediatrician, stick with him or her.
Everyone who has torn cartilage in the knee seems to think surgery is the only option. This couldn’t be further from the truth.
I had addressed this topic some time ago in a prior blog article that can be read by clicking here. And, just in case you’d really like a lot more to read on the issue, you can download my Knee Pain Answers eBook by clicking here.
What you’ll find in the eBook is lots of research debunking common beliefs about knee pain. Which is good, because these beliefs are held by most everyone. Twice today I had to have the “knee conversation” with patients. Patients who have knee pain should just stay away from X-rays and MRIs (unless there has been significant trauma) unless they are hell-bent on having surgery already. Otherwise, the information we get from imaging may be misleading.
Why? Because on a knee MRI, upwards of 88% of people over 50 have “findings” AND NO PAIN! Society is so damn stuck on the idea that, if we see something on an X-ray or MRI, it has to be the cause of the pain. This is so far from true.
I’m not saying that osteoarthritis does not cause knee pain. Rather, before you make a decision about whether your knee pain is strictly from arthritis you need to find a physician that really understands the soft tissues of the knee and how to treat them correctly. In addition, there’s another important thing you’re going to have to do.
If you’re overweight, you’re going to have to work on losing weight.
I know, I know. Losing weight is the GOAL, not the process, and too many physicians leave it at that. Like people who are overweight don’t know that weight loss will help the knees?? We make sure that, if you are truly motivated to lose weight, we can facilitate the process of weight loss, either through our in-office weight loss program (also available remotely for those who do not live near the office) or with changes to your current lifestyle that are contributing to being overweight.
This particular study just drives home just how important weight loss can be for the knees. Researchers followed 250 adults with no knee arthritis for 2 years. MRIs were done before and after to evaluate what effect weight loss or gain had on the height of the cartilage and overall pain in the knees. Here’s what they found:
- 18% of the group had medial meniscal tears.
- In those with medial meniscal tears, for every 1% gain in weight, there was a 0.2% increased loss of cartilage volume and 11.6% increase in pain.
- In those with no medial meniscal tear, weight changes had no effect.
The cartilage volume changes were not all that great, but the changes in pain levels with even a very small weight change was quite dramatic. This may have to do with the fact that, as you lose weight through healthy lifestyle changes, your body will be less inflamed. Less inflammation means less pain.
Overall, though, it is clear that weight plays a very large role in knee pain. If you are serious about avoiding ANY type of knee surgery (and you should be…) than getting closer to an ideal body weight is high on the list of things you need to do.
Vitamin D deficiency has been the rage for the past few years. Some of it hype, some solidly grounded in research and basic physiology.
Don’t get me wrong–vitamin D deficiency is a very real issue. And you can tell how well-versed your doctor is on the subject. Basically, if he or she actually checks your vitamin D levels…he or she is at least 5 years behind in the medical literature. I’ve covered this before, but we have reached a point where we can just accept that everyone is deficient and recommend supplementation. The cost is next to nothing (in our office vitamin D runs about $20 per year) and the safety margins are very wide.
But vitamin D is not a panacea. It’s not going to drop your blood pressure or cholesterol so don’t think you will just take your vitamin D and chase it down with a fast food meal. It’s not going to grow hair on your head (have you seen my profile photo??). It’s not going to do much to lower your risk of heart disease.
But some conditions vitamin D can have a pretty strong impact. These can include:
- Breast cancer
- Type 2 diabetes
- Type 1 diabetes
- Boost immune system and prevent infections
- Heart disease
- Multiple sclerosis
I could go on, but you get the idea. Now there is another condition that you can add to the list.
In general, vitamin D’s effect on the brain is positive. There is an association with vitamin D levels and other brain conditions such as depression and dementia. So the idea that vitamin D could have an impact on schizophrenia should not come as a big surprise, especially in light of the recent admission by the American Psychiatric Association that schizophrenia has an inflammatory component to it.
This particular review looked at a group of 19 studies on the relationship between vitamin D and schizophrenia. Here’s what they found:
- Vitamin D deficiency was present in 65.3% of schizophrenic patients.
- Vitamin D-deficient persons were 2.16 times more likely to have schizophrenia than those with normal levels of vitamin D.
Now, this is a big stretch from saying that we can use vitamin D to treat schizophrenia, but there is clearly a relationship buried in there somewhere. Overall, it is just another reason to supplement with at least 2,000 IU of vitamin D daily to make sure your levels are optimal (60-100 ng/ml) and not just “normal” (30 ng/ml).
So what are you waiting for??
Disorders of the mind have never been as easy to grasp for doctors. While therapists have a larger toolbox, most physicians are limited to medications.
For me, medications that screw with the essential way that your brain cells function in relationship to one another are a wee bit on the scary side. We really know so little about the brain so it seems that using medications to alter it would be akin to cavemen using rocks to fix an iPad.
But alas, this is all we do in modern medicine. The lucky ones will find their way to a good therapist and find tools to help.
But rarely does the topic of lifestyle changes come up. The prevailing attitude is the opposite—there is little that can be done in the way of diet and lifestyle to manage these conditions. But contrary to this opinion is an increasingly growing body of medical literature stating the opposite.
There is one key factor all these conditions and all this research have in common.
Yup, that all so subtle, lifestyle-driven state of immune dysfunction. It ranges from full-blown autoimmune conditions where the immune system is attacking tissues and organs it should not be to allergies and asthma when the immune system completely ignores the tissues inside and runs around like a Tasmanian devil trying to keep innocuous dust and particles at bay.
In all these situations, the resources used to drive the inflammation leaves the inflamed patient fatigued and prone to infections. The constant insult to the body, the zapping of the body’s resources, the need to repair tissues again and again ultimately increases the risk for all chronic diseases, especially heart disease, dementia and many cancers.
But what does this inflammation do to the brain in the here and now?
It is very clear that current inflammation wreaks havoc on the brain. This little fact, however, has escaped the notice of psychiatrists for decades. Until now.
At this years’ (2014) annual meeting of the American Psychiatric Association the cat was let out of the bag by Dr. Eric Hollander of Montefiore Medical Center and Albert Einstein College of Medicine, New York City. During the next several presentations, Dr. Hollander and others covered several important examples that demonstrate the links between inflammation and psychiatric disorders.
Dr. Andrew Miller of Emory University School of Medicine, Atlanta discussed the relationship between depression and inflammation. He used these findings as proof:
- Several studies have demonstrated that patients with depression have higher levels of inflammatory messengers (cytokines) in their blood and cerebral spinal fluid (specifically IL-6, TNF-alpha and CRP).
- In treatment-resistant depression (about one-third of all depressed patients) there is an increase in inflammatory chemicals that have the ability to sabotage and deactivate the action of antidepressant therapy.
- In one of the first studies in psychiatry linking a biomarker to treatment response, the high-powered drug used to block TNF-alpha (infliximab) was used in those with treatment-resistant depression. Those patients who had high CRP levels had the best response to infliximab.
- In a related study, Miller’s team were able to tell, using gene expression profiles, which patients were going to responded to infliximab within 6 hours of the first infusion.
The topic of schizophrenia was addressed by Dr. Norbert Müller of Ludwig Maximilian University of Munich, Germany. Here were his points:
- Infections and inflammation play a role in the development of schizophrenia; prenatal and postnatal infections are risk factors for schizophrenia. The risk increases with the number of infections.
- A number of studies using anti-inflammatory cyclooxygenase-2 (COX-2) inhibitors in addition to antipsychotic medication have had positive effects.
- Timing is important: no benefit was seen in who had chronic schizophrenia, but anti-inflammatory therapies given early in the course of the disease were effective.
Dr. Hollander addressed the relationship between autistic spectrum disorders (ASD) and inflammation. He notes:
- Increases in inflammatory chemicals have been found both in the cerebrospinal fluid of patients with ASD and in brain tissue at autopsy in those with autism.
- The bacteria in the gut may play a large role (the gut “microbiome”).
- In support of the “hygiene hypothesis,” developed countries have higher rates of autoimmune conditions.
- Hollander and others have focused on affecting the microbiome using a medicalized parasite, Trichuris suis ova (TSO-the eggs of a porcine whipworm). Trichuris suis ova is safe in humans, does not multiply in the host, is not transmittable by contact, and is cleared from the system spontaneously. It works by balancing the inflammatory response to increase its survival. This balance in our system has shown some success in autoimmune diseases such as Crohn’s disease.
- His group has been carrying out a small study of TSO in 10 high-functioning adults with ASD for 3 months and have found a potential benefit.
- In another interesting study, researchers studied 10 children with ASD who were known to improve when they had fevers. The children spent alternate days soaking in a hot tub at 102°F (to mimic fever) or at 98°F (control condition), showing improvements on the hot tub days. It is believed that upping the body temp releases anti-inflammatory signals that positively affect behavior.
All of this information is a bit to swallow at once. However, the real take home message is that inflammation is very bad for the brain, whether it is related to one of the three conditions covered here or another one like migraines, epilepsy or dementia.
Brain health is all-encompassing. If you have no conditions it is still just as important to keep your brain healthy today for tomorrow’s brain health. Leading an anti-inflammatory lifestyle is critical. While the full nature of an anti-inflammatory lifestyle is beyond the scope of this article, you can better believe it involves exercise, stress management and a plant-based diet high in healthy fats.
It seems like everyone’s got thyroid problems these days. Luckily, there’s a prescription for that and you don’t need to worry your pretty little head over something as minor as a major organ going kaput in your twenties.
While I am, of course, being facetious, the attitude exists in medicine today that we can easily treat thyroid problems with thyroid replacement hormone like Synthroid or levothyroxine is completely backwards. If it was your heart or kidneys or lungs that just stopped working at 25 the medical establishment would run thousands of dollars in tests to determine why. For some reason the thyroid gland is treated completely different.
Maybe it’s because we have medications that seem to do a great job replacing the lost or diminished hormone levels. The scary thing is that the reasons for thyroid hypofunction or failure can be very serious and if your doctor does not spend the time to dig for answers (or worse–is not even aware there are answers…) your health can be at risk.
I have heard Dr. Jeffrey Bland refer to the thyroid as the “yellow canary of the human body” when it comes to environmental toxicity. This means that, when you are exposed to toxic chemicals, whether from heavy metals, flame retardants, stress, food allergies or pesticides in your water supply, your thyroid is the gland screaming out to you that something is wrong first. It’s your early warning to clean up your body and restart your thyroid.
But alas, we ignore that and medicate. Even worse, we treat labs values and not the patient themselves. How often have you heard from friends or family members that his or her doctor said the lab numbers (usually only TSH is checked) were good and so there was no reason to adjust thyroid hormone levels? Yet the patient is constipated, depressed and dragging his or her feet every hour of the day. Doesn’t seem to make sense.
The studies linking environmental toxins and thyroid dysfunction are quite common (you can read about many of them in previous blog articles that can be read by clicking here). But of particular concern is the compound ammonium perchlorate in drinking water. It is used in the manufacture of rocket fuel, ammunition and fireworks and has been discarded in large quantities in Nevada since the 1950s. This has led to contamination of the Colorado River as it picks up perchlorate from the soil. From there, it can last in water for long periods of time.
Unfortunately, perchlorate is known to block the action of thyroid hormone. This obviously creates a problem and has been shown to create thyroid problems. Luckily, you can just take your Synthroid and ignore the fact that a known environmental toxins continues to run through your bloodstream and body tissues.
Just to demonstrate that the approach that most physician take for thyroid problems is dead wrong, I present this particular study. In it, researchers looked at the pregnancies of 21,846 women. Of these, 487 were hypothyroid during pregnancy. In these 487 women, first trimester perchlorate levels were evaluated. In those who showed the highest 10% of perchloarate levels, the children’s IQ was assesses at 3 years of age. Here’s what they found:
- Perchlorate was detectable in all women and iodine levels were low.
- Those moms in the highest 10% of perchlorate levels had a 314% higher risk of having her child’s IQ being in the lowest 10%.
- Here is the important point: thyroid hormone therapy did not have an impact of perchlorate on offspring IQ.
This article is not about the IQ levels of the children. This article illustrates that merely medicating the lab findings of an altered TSH does nothing to fix the problem. With the thyroid, there is a very high likelihood that something is wrong. Whether it’s prediabetes, stress, nutritional deficiencies or exposure to common toxic chemicals, it needs to be identified and addressed.
Maybe you can’t manage to get all the flame retardants out of your life (besides–who wants to risk bursting into flames at work?), but paying attention to where your exposures are and doing your darnedest to reduce these exposures is still going to pay off. This is the only way to address it.
So, the next time your doctor tells you that you have thyroid problems and you ask him or her for what environmental exposures might be causing the problem and all you get is a blank stare, it might be time to find a new doctor.
I was at a marketing event this week and ended up having a conversation about a teenage girl who had epilepsy. Natural remedies for seizures came up in conversation.
The seizures had begun about a year ago right around the time that her menstrual cycles started, and her seizures were tied to her menstrual cycles (the term for this type of seizure is “catamenial”). The answer from the “specialists” was to put her on anti-seizure meds as well as the birth control pill. Sounds great on the surface, but when you look a little deeper, you’ll see that this is not the best approach.
Progesterone is a hormone produced by both the adrenal glands and (in women), the ovum released by the ovary. While it has a long list of actions in the human body, one of the most important features of progesterone on the brain deals with allopregnanolone. Allopregnanolone is a hormone that your body produces from progesterone that has a very potent ability to calm the brain. Specifically, it works on the GABA receptors. Phenobarbital and the benzodiazepienes (like Valium, Ativan and Xanax act) on GABA receptors, so you probably have an idea of what GABA does.
Having healthy levels of progesterone is therefore important for brain health, especially where seizures are involved. Even more important is to avoid rapid changes in progesterone levels. For this reason, managing menstrual cycles of women with epilepsy is critical.
Managing menstrual cycles does NOT include using the birth control pill. The birth control pill does not fix anything. Even worse, the synthetic progesterone (called progestin) does NOT convert to allopregnanolone, so the brain loses out on the opportunity to make this protective compound. Because of this, using the birth control pill to help manage seizures in an adolescent is a bad idea and does nothing to fix the actual problem.
Menstrual irregularities in women frequently stem from imbalances between estrogen and progesterone. Prediabetes and environmental estrogen exposures (BPA, phthalates, flame retardants, etc…) are two of the biggest factors that throw off menstrual cycles and lead to a reduction in the amount of progesterone released from the ovum (inadequate luteal production of progesterone, or ILP).
Seizures that are related to the menstrual cycles (catamenial) need to be addressed from the standpoint of progesterone and menstrual irregularities. One of the tools that can be used for catamenial epilepsy is progesterone, given either orally or as a suppository.
It makes sense. It’s inexpensive, has an excellent safety profile compared to seizure drugs and it makes sense because it just supports the brain’s natural anti-seizure tools. But progesterone is a tool that is rarely used by neurologists for catamenial epilepsy.
The use of progesterone for seizures took a hit a few years back when Dr. Andrew Herzog, the most prominent researcher in the field of progesterone for seizures, had the results of a progesterone trial on temporal lobe epilepsy published. This trial did not find a benefit to the use of progesterone on temporal lobe epilepsy.
This was enough to support the neurologists’ opinions that progesterone use was worthless. But, it turns out the story wasn’t complete.
If you consider that progesterone for seizures is going to be the most effective for women who have catamenial epilepsy, the use of progesterone for all women might not make sense. Enter this particular study. In it, Dr. Herzog teased apart the data between women with catamenial epilepsy and those who did not.
Specifically, the study looked at the use of cyclic natural progesterone therapy for intractable seizures (non-responsive to medication) in 294 women. Turns out that the women who had more seizures around their menstrual cycle (3-fold or greater increase in average daily seizure frequency) had a much better response to the progesterone compared with women who had more seizures during other periods of their cycles (midfollicular and midluteal phases).
The bottom line is, used in an appropriate patient, progesterone can be a very powerful tool to help control seizures naturally. The problem is that few doctors will use even recognize the catamenial aspect of seizures (or migraines, for that matter), let alone understand that progesterone can be used in these scenarios.
For years now I have written about the health dangers of chemicals in plastics such as BPA. It is clear that plastics are not good for your health.
Here is how it went in my household…
Being a very strong advocate for tea, we had been drinking tea for years (you can read how we prepare tea in a prior blog post that can be read by clicking here). Our preferred brands were Republic of Tea and Teavana and we went through a lot of tea.
I think, in the back of my mind, if I had taken the time to think of it, I would have known that the pesticide levels in tea are among the highest you can find. Coffee and tea, to be specific. The coffee part we already had covered—we only buy organic coffee for the home and office.
But it took a blog post by Vani Hari (aka the Food Babe) to wake me up to the fact that pesticide levels in tea were a grave concern. In a review of certain brands of tea, some 98% of Teavana samples had pesticides detected. I posted this concern on Teavana’s Facebook page and, while they did answer, you could hear the tap dancing in the background as they avoided answering the actual question.
So this led to a shift to only organic teas, which became a problem because the flavors available were not nearly as good. Tazo has a few that are fantastic, but the selection is limited. Luckily, I recently found ESP teas with a very large selection of organic teas (white, black, herbal and rooibos) in great flavors.
Prior to the discovery of ESP, as an alternative, we added in sparkling water. LaCroix, Seagrams, Perrier, Safeway brand. The concept is great. No calories, no artificial sweeteners (although you DO have to be careful not to be tricked into buying the ones with artificial sweeteners) and still provides that exciting fizz.
This is the way it went for the next 2 years or so until the next epiphany.
My son, who is currently 8, was looking for ways to generate some additional revenue besides his salary for feeding the dogs and vacuuming, s0 we discussed saving aluminum cans. This was when I realized just how many cans we were actually going through in any given week.
And started to realize just how high the potential BPA exposure was from this consumption. You see, many cans, both aluminum and steel, are coated with BPA on the inside to create a lining between the food product and the can itself.
In a blog post I did a little while back on BPA exposure from credit card transaction receipts (which can be read by clicking here), one of the participants in the study had to be excluded because his BPA level was over 27 TIMES higher than everyone else’s after drinking 4 cans of beverages.
This is obviously a concern and created quite a conundrum in our family.
Luckily, this problem was solved by the Soda Stream Crystal. I am wary of all plastics, so the typical Soda Stream containers were not a good option. But the Soda Stream Crystal is all glass, alleviating this concern.
So last week we became the proud owners of our new Soda Stream Crystal. And that’s when the fun began. We bought extra glass bottles to hold the sparkling water we made (the Soda Stream glass replacement bottles are quite pricey) and continue to find creative ways to add flavors.
Here’s a few ideas:
- Soda Stream sells My Essence, which are raspberry, orange and lemon-lime flavored essences.
- Organic vanilla extract
- Orange extract can also be purchased separately.
- Coconut extract
- We have yet to add pulverized fruits into the drink, but this can be done quite easily, so long as you limit it to just a small amount of the fruit for flavor only.
I’m sure in time I’ll have some more ideas. Overall, though, it’s been a fun experience, very inexpensive once the initial Soda Stream equipment is bought and most importantly, BPA-free.
Patients ask me all the time how to go about reducing exposure to toxic chemicals in their environment. The first step is identifying these exposures. The next step is doing something about it. Moving to the Soda Stream Crystal in addition to your organic tea consumption is a fantastic step in protecting your long-term health.
There has been some confusion in the media lately when it comes to eating breakfast, suggesting that maybe we don’t really need to eat breakfast.
But rarely does the press report all aspects of a study, leading to confusion of the part of the public about what they should do. “First they tell us one thing, then they tell us another thing.” Not eating fish due to pesticides and avoiding fat are just two examples of messages that confuse the public.
That being said, this particular study looked at the effects of breakfast on a group of people ages 21-60 on several markers of health, including:
- Resting metabolic rate
- The amount of calories burned during physical activity
- Caloric intake
- Blood sugar responses to food
This group of participants were given either a daily breakfast (of at least 700 calories) before 11 AM or refrained from eating before noon for 6 weeks. The idea was to see if the common notion that breakfast “revs up” your metabolism was true or not. Here’s what they found:
- Contrary to popular belief, there was change in the metabolic rate of those who ate breakfast.
- There was actually a small increase in the amount of calories eaten in the breakfast group (539 calories per day).
- There was no difference in body mass, fat mass or any markers of cardiovascular health.
- However, the calories burned with exercise was quite a bit higher in the breakfast group (442 calories per day).
- The breakfast group also had a slightly more stable blood glucose in the afternoon and evening by the final week of the study.
At first glance, it would seem that the breakfast group did not have much of an advantage over the group that skipped breakfast. While you may be surprised, I do have a few comments on this…
First of all, breakfast supplies your brain with the energy needed to function. If you do not feed your brain, it will use the hormone cortisol to break down muscle to provide glucose for the brain. This study was done over the course of 6 weeks. This is not long enough to follow the long-term damage caused by consistent, daily breakdown of muscle to replace the skipped breakfast.
Second, there was no mention at all about what types of foods were eaten for breakfast. Frosted Flakes for breakfast is going to have a much different effect on the body than whole grain bread with real peanut butter spread on top of it. I always steer patients towards a high fiber (6-7 grams or more) or protein-based breakfast (eggs, peanut butter, etc…). Processed junk for breakfast is likely not any better for you than skipping breakfast.
Third, creating a more stable afternoon blood sugar is going to prevent cravings in the afternoon and help you make wiser food choices for dinner.
Lastly, while the breakfast group did take in more calories for the day, this was almost offset by the better calorie-burning response to exercise. I would again point out that this was only a 6 week study and this is not enough time for patterns to fully change. It would be reasonable to surmise that eating breakfast would preserve more muscle mass which would, in turn, lead to more calorie burning during exercise. Given that it could take months to balance out the muscle-preserving effects of breakfast versus the muscle-destroying effects of skipping breakfast, it is likely that the effect on calories consumed and burning would favor the breakfast group over the course of months and years. But this cannot be shown from this study and is merely my educated opinion on the process.
Overall, I would never consider skipping breakfast for myself on a regular basis. In addition, ANY good parent would never let his or her child leave for school without eating a good quality breakfast. Shouldn’t that say it all?
As a practicing chiropractor here in sunny Mesa I can tell you that seeing injured workers in my office is a rare event.
Even rarer is a patient who was injured at work who was sent in by his or her HR department to my office for care. Almost always it is a current patient who was injured at work and wants to be seen in our office for care because they know how effective we are.
It is rare for me to get frustrated over anything, but having a representative for a patient’s workman’s comp insurance tell me “we don’t refer to chiropractors” just irks me to no end. Even worse is an existing patient who comes in for care of a work injury and then is told, ILLEGALLY, that they can’t come into our office for care. The worker is scared to go against his or her employer, even after assurances by us that they can see us for treatment.
Here in AZ, with a few self-funded exceptions, patients all have a right to see the provider of their choice. They may be required to make a single visit to a provider that is chosen by the employer, but that is all they have to do. However, once they have seen a provider twice, that provider controls all care for the course of the injury.
So the patient sees the provider that the employer requires. That provider (which is almost always one of the two larger occupational or urgent care clinics that use PTs for treatment) then coerces the patient to come back for another visit under one pretense or another and they get them back in quick. Frequently the next day.
The patient ends up falling into the scheme and is NEVER given his or her rights, which would be to see a chiropractor if he or she chose to.
I would just be whining and complaining in this article if it weren’t for one important fact…
It’s a very, very bad idea to NOT see a chiropractor first or at least have one on the care team as soon as possible. Why? Here are a few of the reasons:
- The alternative is far more costly.
- Patients take longer to get back to work and are more likely to become disabled.
- Medications that actually promote chronicity are more likely to be used.
- Patients are generally not as happy with the care they receive.
As a chiropractor one would think that I’m just being petty and biased. But regular readers of the Rantings know that I can back up everything that I put in writing. This is no exception.
In this particular study, researchers looked at 14,787 injured workers over the course of 8 years to evaluate care patterns for low back pain. They identified 5 distinct patterns of care for the injured workers:
- Information and Advice (59% of injuries): The first 6 weeks basically consisted of information gathering or advice seeking but no overriding pattern. This included simple office visits, laboratory tests, emergency department or hospital visits, talk therapy, or visits involving imaging (x-ray, ultrasound, CT, or MRI) but no other procedures.
- Complex Medical Management (2% of injuries): Included more than a single visit to a physician for nerve blocks, surgeries, or comparable procedures. This is expensive and fragmented care and runs completely contrary to the way low back pain should be managed.
- Chiropractic (a paltry 11%): Self-explanatory. Used by the most intelligent injured workers (ok…so I made this part up).
- Physical therapy (11%): Self-explanatory.
- Dabble (17%): Workers who had one visit to a non-chiropractic physician, chiropractic physician or PT, or at most one visit to two or more of these categories.
Overall, being good at math, it looks like 89% of the injured population were not under the care of a chiropractor. Keep this in mind as we go through the rest of the study. I know that here in AZ, this low percentage is likely a result of steerage by the insurance company, HR employees who do not understand how effective chiropractic care is, as well as the schemes played at the patient’s expense by other providers that treat injured workers.
After identifying the 5 patterns, researchers looked at well accepted guidelines for the treatment of low back pain that is backed up by medical research. There were 11 guidelines that were used to evaluate the 5 treatment patterns, but here are some snippets to think about:
- Early use of (MRI) has been linked to prolonged disability, higher medical costs, and greater use of surgery at the same time finding no benefit on health or disability outcomes for low back pain.
- Chiropractic has been shown to lead to lower likelihood disability recurrence over non-chiropractic physicians and physical therapists.
- In addition, chiropractic care with shorter duration (likely meaning more effective chiropractic care that seeks to get the patient better ASAP) also leads to shorter disability duration.
- More frequent and stronger dosages opioids leads to longer claim durations. Worse, the likelihood for a catastrophic claim (total cost of $100,000 or more) when spinal surgical procedures were performed increased 10-fold when treatment included opioid use.
It goes without saying that chiropractic care is the antithesis of opioid use.
With all this in mind, here are a few snippets from the study:
- Care to injured workers that was in line with 10 of 11 guidelines led to lower total costs.
- Of the five patterns, complex medical management followed the guidelines the worst in regards to imaging, surgeries, and medications as well as having the highest total costs.
- Complex management was also linked to the highest rates of prescriptions for four of the seven drug classes—opioids, other pain medications, SSRI/SNRI/tricyclics, and anxiolytics/sedatives/hypnotics.
- The PT group was highest in NSAIDs, muscle relaxants, and oral steroids.
- Chiropractic care was on the opposite end of the spectrum, leading to the most alliance with accepted guidelines, lower total costs and the lowest prescription rates in all seven classes of drugs.
- Previous treatment choices by injured workers influenced future choices for another injury. This means that, if someone did NOT choose chiropractic care for an initial work injury, if they got injured again they were not likely to seek chiropractic care for the second episode.
There is really not much more to say. Except that maybe all of this information is not new and is consistent with the findings from a large handful of other studies. Hopefully you can understand my frustration with the care of injured workers here in Arizona, as well as the extreme confusion when it comes to chiropractic care being treated as the red-headed stepchild of healthcare when, in reality, we really rock when it comes to doing what we do.
By avoiding or discouraging chiropractic care for injured workers here in AZ, workers are not getting the best and most cost-efficient care possible. That, quite frankly, is a travesty.
I can honestly say that I have never been a fan of calcium supplementation. Or at least maybe not for the last decade or so.
It has truly been that long since the medical research began to change its opinion on using calcium supplements to strengthen bones. This is not to say that I don’t recommend calcium supplements, but it is a pretty rare situation and only when someone has been diagnosed (in our office or elsewhere) with severe osteoporosis. It has been a long, long time since I recommended calcium for anyone just to “build strong bones.”
Before we go any further, I do need to clarify something about calcium supplements for bone health. Tums are NOT a calcium supplement. It is a toxic product containing aluminum and artificial colors and should never, ever have been recommended to support bone health.
Any calcium supplement used for bone health should be a bone support formula, containing not only calcium, but other bone-supporting components like magnesium, boron and zinc. And the best form of calcium is NOT calcium carbonate. Higher quality forms like citrate are the preferred forms–especially when it matters.
Another thing that you may not realize is that your body is very selective as to how much calcium it will absorb at any given time. This is because calcium levels are very tightly regulated in the bloodstream. Too much or too little calcium can be fatal. As in rigor mortis, the ultimate calcium deficiency in the bloodstream. To keep this level constant, the gut keeps a very tight grip on how much calcium is absorbed at any given time. If you decide to down an entire bottle of calcium supplements at a single time, the gut will actually push back, resulting in even lower amounts of calcium being absorbed.
This is why, when you are taking calcium supplements, you should take them spread out throughout the day as much as possible.
But none of this really matters because of one important fact.
Vitamin D plays a very large role in regulating the amount of calcium you gut will absorb (it’s role is much bigger, but for the purposes of this particular line of discussion, this will suffice). With low levels of vitamin D (an all-too common problem in todays’ sun-fearing society) more calcium may not be enough to get the job done. On the flip side, having enough vitamin D flowing through your blood will make taking a calcium supplement pointless on top of a good quality diet.
Unfortunately, for years, doctors were telling their patients to take calcium supplements (frequently in the form of Tums) and given no recommendations on vitamin D. While that is changing, this particular study demonstrates how backwards this recommendation is.
In the study, researchers looked at 3448 men and 3812 women who were older than 50 years of age and broke them down into daily dietary calcium intakes of (1) less than 400 mg/d, (2) 400–799 mg/d, (3) 800–1199 mg/d, and (4) 1200 mg/d or greater. Overall, the average daily calcium intake was 470 mg/d.
They then measured bone density and compared it to average daily calcium intake. Here’s what they found:
- Those with calcium intake less than 400 mg/d had lower bone density (specifically, femoral cortical thickness and buckling ratio).
- In men, bone density was higher in those with calcium intakes up to 1200 mg/d.
- Importantly, these interactions disappeared when the 25-hydroxyvitamin D level was over 30 ng/mL (men) or 20 ng/mL (women).
So, while it can be argued that calcium is important for bone health, it pales in comparison to the effect of vitamin D, so much so that adequate (not even optimal) levels of vitamin D essentially protect against low calcium.
That’s not to say that you should deliberately deprive yourself of calcium while taking vitamin D just to see if it pans out. Rather, a solid diet with good calcium sources combined with vitamin D supplementation (starting at 2,000 IU / day) is the best way to go. Solid sources of dietary calcium include:
- Spinach and kale
- White beans
- Some fish like sardines, salmon, perch, and rainbow trout
- And there are foods that are calcium-fortified, such as soy milk, some orange juice, oatmeal, and breakfast cereal
You might notice the suspicious lack of dairy on the list. If you’re a regular reader of the Rantings you’ll know that I’m not a fan of dairy. Enough so that I compiled an eBook of research demonstrating that dairy is not the health food that we think it is that can be found by clicking here.