The typical answer for sleep problems or anxiety is medication. But in no way do these drugs actually fix anything.
Rather, the underlying brain damage that stress causes is allowed to run amok, unchecked. And make no mistake–stress destroys your brain. Shrinks it. Kills off healthy brain cells. Shortens memory. Accompanying the brain damage is damage to the rest of your body as well. Increased risks of obesity, diabetes, heart disease and cancer.
In summary, not good.
In my opinion, stress is the leading cause of sleep problems. How is your body supposed to sleep when all the cortisol-based alarms in your head are screaming that there is a saber-toothed pacing in the hallway. Managing stress is key to anxiety and sleep problems. Exercise and eating right for your body. Meditation, self-hypnosis or biofeedback for your brain.
Using medication to cover this up is a recipe for disaster and is associated with over a half MILLION deaths per year. I’ve written about this in a previous blog article that can be found by clicking here. So, with this in mind, this particular article is nothing new and just reinforces this dangerous association and puts the damaging effects of stress on your health into perspective.
Here are the details of this study looking at 34,727 patients 16 years of age and older who were prescribed anxiolytic or hypnotic drugs and followed for an average of 7.6 years:
• Most common drugs were benzodiazepines (think diazepam) and the “Z” drugs (zaleplon, zolpidem, and zopiclone – think Ambien).
• Those taking one of these drugs had a 346% higher risk of dying in the study period.
• The higher the dose, the greater the risk.
• To put in more plainly, there were about four excess deaths for every 100 patients using one of drugs.
If this was not the first study to find an association between the use of these 2 types of drugs (for anxiety and sleep problems) we could maybe blow off the results. But we can no longer ignore the fact that taking a drug in this class WILL increase your risk of dying. Period. Maybe it’s the stress or maybe some aspect of the drugs themselves. Either way, it doesn’t change the outcome. Dead is dead regardless of how it happened.
I hate to beat a dead horse, especially if he dropped dead from too much aerobic exercise, but society just does not seem to be getting the point about aerobic exercise.
Quite frankly, we’re doing too much.
I know that many of you are disappointed to hear this. After all, in today’s rush-rush society everyone is getting the recommended 30 minutes minimum of aerobic exercise at least 3 times per week, right? Yeah. Reality check–most Americans still do not have regular exercise as part of their lifestyle routine. And, even if they are, it’s likely they are not doing the most beneficial type.
The research continues to support a short-burst, high intensity, aerobic activity rather than a single bout of light to moderate intensity workout. Personally, when I’m doing one of my short bursts on the treadmill or elliptical, I’m going all out for that 30 second session. It’s not a leisurely pace at which I could maintain a conversation on my cell phone to some out of the country customer service rep for my mortage. When I’m done with my burst, it takes some time (1-2 minutes) to recover somewhat from the oxygen debt I have accumulated.
This particular study is yet another one to chalk up for the short-burst aerobic crowd. This small study looked at 11 obese individuals (aged 18–35 years) who were prediabetic and had them performed differently on three different days:
1. Sedentary behavior with no exercise
2. Otherwise sedentary behavior with 1-hour of morning exercise at 60%–65% peak VO2
3. Same sedentary behavior with 12-hourly, 5-min intervals of exercise at the same intensity
Researchers than checked sugar and insulin levels in the bloodstream. Here are the results:
• Glucose levels were actually lower in the interval exercise and sedentary situations.
• Glucose levels were higher in the 1 hour exercise situation than in the sedentary situation for about 2.5 hours.
• Glucose levels were also higher in the 1 hour exercise situation than the interval exercise situation for about 4 hours.
• The production of insulin was 20% higher with the interval exercise when compared to the other two situations.
While this study was not on high-intensity aerobic activity, it does demonstrate the benefit of breaking up the exercise routine into small groups instead of a single time period.
How do YOU spend your time exercising??
I’ve had many people ask me about this “gluten free” thing and whether it’s “real.” Or is it just a fad?
First and foremost, the entity known as celiac disease is nothing new. The traditional acceptance of celiac disease is a condition where the immune system of the gut attacks the gluten containing portion of grains (namely wheat, but also to a certain degree in oats, barley and rye). This attack results in the lining of the gut (the villa) being flattened out. While a normal gut may have the area of a tennis court, in someone with celiac disease that eats gluten, the destruction of the lining of the gut leaves you with a ping pong table.
The shrinkage of the area that is needed to absorb nutrients wreaks havoc long term and leads to most of the issues associated with traditional celiac disease (osteoporosis, neurological disturbances, shortened life span, etc…). This is the far end of the spectrum and is usually diagnosed via biopsy of the lining of the gut. Moving up the spectrum (from worst to less-worser), the blood markers anti-transglutaminase and anti-gliadin antibodies will be elevated and can be checked in a blood test.
This is generally where mainstream medicine stops at the definition of celiac disease. However, as I mentioned, it is a spectrum and not a set point. As you move away from the biopsy proven gluten allergy to the other end of the spectrum, “sensitivity” becomes a much better word to use. At this end, the number of people with sensitivity to gluten is quite high and it is very real.
And the numbers of people with gluten sensitivity keep going up. But why?
A portion of this may due to a cross reaction between a protein found in the yeast Candida albicans and a protein found in gluten. This means that a prescription for antibiotics, which will increase the number of yeast in your gut, can initiate the onset of celiac disease in genetically susceptible patients.
Combine the wanton use of antibiotics with conventionally grown grains given high amounts of nitrogen-based fertilizer (more nitrogen leads to more gliadin for the gut to react to) and you’ve got a recipe for more gluten problems.
But it turns out the story may be more complicated. This particular article looks at the role of glyphosphate (the principle component of the herbicide Roundup used heavily in GMO crops) and the realionship to celiac disease. While the article is quite complex, here are the high points:
• Fish exposed to glyphosate develop digestive problems that are similar to celiac disease.
• Glyphosphate triggers imbalances in gut bacteria (reduced Lactobacillus and Bifidobacterium, which break down gluten).
• Disrupts detox P450 enzymes, interrupting the activation of vitamin A and D, the maintenance of bile acid production as well as the breakdown of environmental toxins.
• Glyphosphate chelates and leads to deficiencies in iron, cobalt, molybdenum and copper.
• Glyphosphate leads to deficiencies in the amino acids tryptophan, tyrosine, methionine and selenomethionine.
• In addition, both celiac patients and glyphosphate exposure increase risk of non-Hodgkin’s lymphoma.
• Both are associated with reproductive issues like infertility, miscarriages, and birth defects.
Making matters worse, glyphosphate residues in wheat and other crops are likely increasing due to the growing practice of crop desiccation just prior to the harvest.
So, is it glyphosphate toxicity or gluten sensitivity? I’m pretty sure that this article didn’t entirely clear things up for many of you. The bottom line is that the answer likely lies somewhere in between. Either way, it would seem smart to take away two needed changes from this article. First, living a naturally gluten-restricted diet is a good idea. This does NOT mean buying the same types of foods you have always eaten but just buying them gluten-free. Not a good idea.
Second, if you do take in any gluten-containing grains, make sure they are organic or at least GMO free to reduce the likelihood that you will be exposed to glyphosphate.
Ezetimibe, aka Zetia, hit the market in 2002 based on its ability to lower LDL cholesterol levels. Scripts skyrocketed 180 TIMES over the next 6 years.
In the US in 2002, 6 out of 100,000 people were given prescriptions for Zetia; by 2008, this number vaulted to 1082 per 100,000 persons. A mind blowing increase for a drug that had not yet been shown to save lives, just shown merely to lower LDL cholesterol. In Canada, over similar timeframes, use jumped from 2 per 100,000 to 495, an even more massive increase of 247.5 TIMES as many prescriptions. Again–for a drug that really hadn’t been shown to do anything just yet.
And it is chiropractors who are sometimes accused of being unscientific.
This should have all changed in 2008 with the release of the data from the ENHANCE trial. In the ENHANCE trial, ezetimibe was added to a statin (the combination being called Vytorin) to further force cholesterol levels down, because that is really all that is important. Disappointingly, the trial showed no benefit from ezetimibe.
Just in case this wasn’t enough, in 2009 in the ARBITER 6–HALTS trial, the combination was actually shown to INCREASE plaguing in the carotid arteries of the neck. Not a good thing. Surely, by this point prescriptions for Zetia fell to nonexistent levels, right?
This particular study looked at how much the publication of the ENHANCE trail data affected physicians’ use of ezetimibe in both the US and Canada. In the US, after the publication of these two trials, prescriptions fell from the aforementioned 1082 per 100,000 people down to 572, a drop of 47.1%. In Canada, however, the increase in the number of prescriptions slowly and steadily moved up (from 2 to 495 per 100,000 people) even after the publication of the trials.
This is not the first example of mainstream medicine ignoring the evidence that is supposed to guide the practice of medicine. But this one seems particularly bothersome. This drug launched itself from zero to near superstar status on pretty much nothing but the ability to lower a single lab value 20%. And, I might add, this particular lab value is LDL cholesterol, which has now lost favor as a lab value that has any real ability to predict risk of heart disease.
The bottom line is that you should ONLY see a physician who keeps up with the medical literature. Maybe not to the DSM-V worthy level that some of us do, but at LEAST the basics. If you doctor has written you a prescription for either Zetia or Vytorin, he or she is not in this group.
Now, before I state that our office does very well with disc bulges in the neck, I need to preface this with the fact that we’ve had 2 patients in the past 6 months end up in surgery.
That being said, the vast majority of patients who have cervical disc bulges accompanied by pain in the arm due to that disc bulge that are seen in our office recover nicely. Because back and leg pain are more widely publicized, there is more knowledge about sciatica from back pain; patients frequently come in stating that his or her “Atica” or “schizophrenia” is flared up. Most of these cases are not actually true sciatica (despite what he or she has been told) but are either local pain (no leg pain) or a referred pain from the hip or sacroiliac joint.
Pain in the arm originating from the neck is also very common, but less patients who walk through the door seem to be aware of this relationship. The typical patterns of disc pain in the arm or leg follow a very typical pattern called dermatomes. The problem is that there are many other things that also cause pain into the arm such as the rotator cuff, problems in the forearm such as carpal tunnel and problems stemming from the muscles around the neck such as the anterior scalene or pec minor.
Because there are so many causes of pain into the arm, it can be challenging to nail down exactly what may be causing your problem. For me, sometimes the answer isn’t clear on the first visit or two, but rather, takes some time to clarify exactly what’s causing the pain. Disc bulges in the neck causing pain in the arm can look an awful lot like a rotator cuff referral into the arm. If I work on the rotator cuff for a visit or two and nothing changes, we shift gears towards a treatment of a disc bulge.
Treatment of a cervical disc bulge in our office involves soft tissue work (Graston, stretching, fascial work), chiropractic adjusting and traction. I’m a big fan of home traction devices as well that can allow you to treat the disc bulge several times a day (we recommend this one from Amazon: Instapark® Cervical Neck Traction).
With this approach, the vast majority of patients respond well. This particular study supports this position. In it, chiropractic researchers looked at a group of studies to get a better idea of how long it takes someone to recover from a cervical disc herniation. Here’s what they found:
• On the down side, they found that complete recovery could take as long as 24-36 months.
• Luckily, patients were already noting substantial improvements within the first 4-6 months.
• Overall 83% of patients resolved completely.
• Patients with a workers’ compensation claim appeared to have a poorer prognosis.
Before you start getting depressed about the 4-6 months timeframe, in our office, if we are going to be able to help a disc pain patient, improvement starts within a few visits and usually progresses forward from there. The use of the traction device helps.
As for the worker’s compensation portion of the equation, I wonder if the poorer prognosis has to do with less of these patients making it into chiropractic offices in a timely matter. Many primary care doctors don’t consider chiropractic for disc problems and will usually use medications and pain injections first.
One of the concerns from new patients in for chiropractic care centers around movements and activities that could make the condition worse.
Quite frankly, it’s rare that the typical low back pain patient will be made worse in the long run by activities that they may do, provided that the activity wouldn’t produce low back pain in a patient who does not have low back pain. In other words, lifting and twisting while carrying a 100 pound object is not a good idea whether you have low back pain or never have in your life.
A large chunk of patients who come in with a new episode of low back pain don’t recall doing anything to bring about the episode. Sometimes the aggravating event is not as obvious (new shoes, side sleeping without a pillow between the knees, new chair, etc…) and sometimes, the patient is in my office, not because of what they did, but because of what they are NOT doing. As in moving around.
It is very common for the mere act of being a couch potato to create low back pain. So, when the new patient comes into my office and is concerned that movement may make his or her back pain worse, I reassure them that movement is a good thing. Sacroiliac conditions, for example, do way better when the patient is moving around and keeping the joint “lubricated.”
A frustrating aspect of practice for me is how often chronic low back pain patients, or those who have a tendency to “throw out” their backs, have been told to “take it easy” and limit activity by an orthopedic doctor, family practice doctor, physical therapist or even my own colleagues.
Fear of movement. It’s never a good thing.
This particular study drives this point home. Researchers looked across 17 clinical studies to see how much of an effect fear avoidance behaviors (as measured by the Fear Avoidance Beliefs Questionnaire (FABQ) or the Tampa Scale of Kinesiophobia (TSK)) had on whether or not treatment was effective. Here’s what they found:
• In patients who had up to 6 months’ duration of low back pain, high fear avoidance beliefs were associated with more pain and / or disability and a lower likelihood of returning to work.
• However, if patients were able to show a decrease in fear avoidance beliefs during treatment there was less pain and disability.
• Interventions that addressed fear avoidance beliefs led to better outcomes.
• The results were not as strong in chronic patients.
I had recently been asked to participate in a chronic pain panel for the Arizona Corporation Commission. This involved looking at case studies of chronic pain patients to see how guidelines could be effectively applied for treatment. However, I had such a hard time being non-biased looking at these studies because so many of the cases of chronic pain are actually failed cases of acute pain.
And in Arizona, very few patients ever make it into chiropractic offices in the early stages, when manipulation can be the most powerful. Most end up medicated and / or put into physical therapy. Considering that the cost of going into physical therapy treatment for non-surgical spinal conditions first here in Arizona is almost TRIPLE the cost of chiropractic care, it may be that fear avoidance behaviors are addressed intuitively by chiropractors, lowering the chance of a condition becoming chronic.
Of course, this also means that, should you come across a chiropractor who uses fear (i.e. subluxation kills and without adjusting your nervous system can’t flow) to sell you on more care, it may be time to work on your short burst activity and run the other way.
The side effects of diarrhea are pretty well played known. Diarrhea and antibiotic resistance top the chart.
I have not exactly been silent about my position that the above two concerns are minor side effects and that the destruction of the normal, protective bacterial flora in the gut is of one of the most horrendous, underappreciated side effects of wanton antibiotic use. Nothing will destroy the delicate balance of the immune system like throwing the bacterial flora off kilter with antibiotics.
But this is a story for another time. This particular article raises a very, very disturbing concern that I had not been aware of until now.
Azithromycin (think Zithromax and the Z-pak) and levofloxacin (Levaquin) are very commonly used antibiotics for just about everything. While the aforementioned antibiotic-associated diarrhea still remains a concern, researchers in this article found a new side effect that occurred within the first 5 days of using one of these antibiotics.
Arrhythmias and fatal heart attacks. Now, maybe I’m overreacting, but to me, it seems like death as a side effect from taking antibiotics for a viral respiratory infection seems a little unbalanced.
To put this in perspective, one of the researchers noted that 50% of patients continue to receive antibiotics, especially broad-spectrum antibiotics, for illnesses such as “acute cough.” This means that, “if it is assumed that 50% of the 40 million outpatient prescriptions for azithromycin written in 2011 were unnecessary, then based on the data, it may be reasonable to estimate 4560 deaths were caused by antibiotic alone.”
Here are the specifics from the study:
• This study looked at 1.6 million antibiotic prescriptions among Veterans.
• Those who received azithromycin had a 48% higher risk of death.
• They also had a 77% higher risk of cardiac arrhythmias.
• This occurred in the first five days of treatment (but, since azithromycin is a short course, this is somewhat irrelevant).
• Those who received levofloxacin had a 149% higher risk of death and 143% higher risk of cardiac arrhythmia in the first five days.
• The risk were not as bad, but still present on days 6-10, at 95% and 75% higher, respectively.
• The risks were greater for those with existing prolonged QT interval, low blood levels of potassium or magnesium, those with bradycardia or those currently taking antiarrhythmic medications. Further, elderly patients and those already at high risk for heart disease were also at higher risk.
Lest you think that you are entirely safe, other macrolide antibiotics that are like azithromycin such as erythromycin and clarithromycin, have also been shown to up risk of QT-interval prolongation, torsades de points, and polymorphic ventricular tachycardia.
What does this mean? Overall, it really doesn’t change the story. Antibiotics, from my perspective, have always been a dangerous class of drugs to use except when absolutely necessary. However, this concern is largely due to the long term effects of destroying immune balance that will show up years later. This study makes long term side effects irrelevant if you happen to be dead from a heart attack.
The answer to chronic low back pain is NOT nothing. Choices for care include chiropractic manipulation or physical therapy.
I know that it seems intuitive that rehab exercises for chronic low back pain would be a good idea. However, I can’t say that I’ve ever been completely on board with this idea. While not every case of chronic low back pain does well in our office, we do pretty darn well with the vast majority of cases that come through. From years of experience, I firmly believe that advanced soft tissue techniques in competent physicians’ hands combined with manipulation is one of the strongest tools for management of chronic low back pain.
Despite this, there is a belief that patients with chronic low back pain should go to physical therapy to get rehab exercises for his or her low back pain and many primary care physicians still continue to refer patients out for physical therapy.
Always happy to find out that my practice philosophy is not shared by my office alone, I present this particular article, looking at the outcomes of 12 weeks of treatment in 199 patients with chronic low back pain (defined as more than 6 weeks’ duration) using exercise versus manipulation.
Specifically, exercised consisted of high-dose, supervised low-tech trunk exercise. As a way of measuring outcomes, researchers looked at four motion parameters in the sagittal plane and two in the horizontal plane as well as the jerk index parameter.
The group that received manipulation changed in all of the parameters measured. In addition, the manipulation group had a smoother motion pattern (reduced jerk index) at the end of the study. The exercise group, however, only improved in half of the parameters measured and there were no improvements in the jerk index.
Based on this study, a patient with chronic low back pain would be much better off seeing a provider who can do spinal manipulation. Adding the aforementioned soft tissue techniques to manipulation gives you an even greater chance of finding relief where nothing else has helped.
Thyroid conditions are far too common. Mainstream medicine’s approach is to medicate with thyroid hormones.
From my perspective, I’m always looking for why an incredibly important organ in the human body would just up and get lazy. If this was your heart that stopped working at 28, your doctors would be up in arms trying to find an answer and fix the problem. But for some reason, because we have synthetic thyroid hormone that can be given, the thyroid going bad is no reason for alarm.
Before you follow this philosophy of medicating rather than clarifying, consider that the thyroid gland is generally considered the yellow canary of the human body (for those who don’t remember, canaries were used in the mines because they would up and die when methane levels began to climb; thus when the canary died it was time to run before the mine exploded). Stress, poor quality nutrition/prediabetes, toxic chemical exposures and food allergies top the list of things that negatively affect your thyroid.
Gluten, BPA in plastic water bottles, Teflon, flame retardants and heavy metals are all well documented to affect the thyroid. I don’t know that I have EVER had a patient come in who has a history of autoimmune thyroiditis (like Hashimoto’s or Graves) that were told that gluten sensitivity may be a huge factor in his or her thyroid dysfunction. And this includes patients who have had thyroids deliberately destroyed with radioactive iodine or surgically cut out.
But I digress.
In this particular study, researchers looked at a small group of hypothyroid patients who also had digestive complaints (another topic altogether and one that is beyond the depth of this article) to see whether the addition of 500 mg of vitamin C could have a positive effect. The results were pretty powerful:
• Levels of TSH, free T4 and T3 all improved while on vitamin C.
• TSH dropped an impressive average of 69.2%.
• TSH levels normalized in 54.8% of those in the study.
Given how challenging it can be to manage thyroid medication dosage, anything that can improve the effectiveness of thyroid hormones, especially with something as incredibly cheap and safe as 500 mg of vitamin C, is a very good thing.
It’s your child. The blinding pain of a headache is hard to ignore, so you do what you think is the right thing. Pediatrician, PCP, urgent care or ER, depending on the situation.
There’s a 50% chance this is a bad choice.
As a chiropractor who sees headache patients all the time, I can say with a high degree of confidence that, much like back pain, we should be the first stop. While not every time, it is very common for a child with headaches to leave our office after the FIRST visit with a drastic reduction in his or her headache. Add a few more visits after the initial treatment and most headaches are history. Certainly there are exceptions, but these are few and far between.
So what happens if you do NOT bring your child to a chiropractor first? This particular study looked at this question and the answers were disturbing enough to surprise even the researchers themselves. Narcotics are absolutely NOT the standard recommendation for any headache, let alone headaches in teenagers. While I think NSAIDs are almost as bad of an idea (because they don’t actually fix a darn thing as it relates to headaches), they are at least a better standard recommendation.
So when researchers looked at the insurance data from 8,373 13- to 17-year-olds who visited a clinician for headache (which is a common ailment in adolescents) researchers were sure that they would find that narcotic use was low. Instead, shocked researchers found:
• 46% of teens were given a prescription for a narcotic.
• 23% got two prescriptions.
• 29% got three or more prescriptions.
If the emergency room was involved, the likelihood of a narcotic being given were greater. Except in very limited situations, there is not a shred of evidence or any clinical practice guideline that suggests narcotics as the first line treatment for adolescent (or adult, for that matter) headaches.
So why and how does this happen? How can half of mainstream medicine be so distanced from the medical research as to give a child highly addictive pain medication for a condition that it should not be used for??
As a chiropractor treating these conditions without any drugs, I find that question even harder to answer.