|Issue #92 - May 2010|
PRENATAL VITAMINS DON’T HELP ENOUGH
70% of pregnant women in the United States are not getting enough Vitamin D. The very best quality prenatal vitamins may raise Vitamin D levels during pregnancy, but it is becoming clear that many women (and their babies) need higher doses.
Adit Ginde, MD, MPH, from University of Colorado Denver School of Medicine, lead author of the study said, "We already know Vitamin D is important for bone health of the mother and infant, but we are just starting to scratch the surface about the many potential health benefits of Vitamin D during pregnancy."
This new study shows that many pregnant women in the United States have insufficient vitamin D levels. For these women, prenatal vitamins do not provide enough vitamin D, and higher doses are needed to raise levels. Women with darker skin, those who cover their skin for religious or cultural reasons, and those living further north during winter months are at particularly high risk for lower Vitamin D levels.
"Prenatal vitamins do help raise vitamin D levels, but many women start taking them after becoming pregnant. Although research is ongoing, I think it's best for women to start a few months before becoming pregnant to maximize the likely health benefits," said Ginde.
An increasing body of evidence shows that Vitamin D levels have fallen below what's considered healthy in the overall population. Most likely this is due to decreased outdoor activity and the medical recommendation to limit sun exposure. Meanwhile, vitamin D has reemerged as an important nutritional factor in maternal and infant health. Vitamin D deficiency early in life has been linked to increased risk of respiratory infections and childhood wheezing. Lower levels in adults have been linked to cardiovascular disease and specific types of cancer.
The study team from University of Colorado School of Medicine, Massachusetts General Hospital and Children's Hospital Boston analyzed nationally representative data from 928 pregnant and 5,173 non-pregnant women of childbearing age collected by the Centers for Disease Control and Prevention.
May 2010 issue of the American Journal of Obstetrics and Gynecology
DR. PAIS’S COMMENTS: This newest study underlines the need for preventive Vitamin D testing. If you are of childbearing age, get a Vitamin D test done to determine levels. Work with your naturopath to match the appropriate Vitamin D dose to your test results. Then, if/when you become pregnant you have had a significant amount of time with beneficial Vitamin D levels. This will help you and your baby be healthier.
ANTIBIOTICS INCREASE DISEASE
Children with inflammatory bowel disease (IBD) are nearly three times more likely to have been prescribed antibiotics in the first year of life than children without IBD, researchers report.
"Still, we are the first group in North America to find this important association," which may offer clues into the causes of IBD, says Souradet Y. Shaw, a PhD candidate at the University of Manitoba in Winnipeg. "Despite intense research on IBD, its causes remain elusive." The motivation for the current study, is recent research suggesting that imbalances in normal intestinal bacteria underlie some forms of IBD. "Infancy is the important developmental period for these bacteria, and antibiotic use can affect the development of the bacteria."
Up to 1 million Americans have inflammatory bowel disease; the main types are ulcerative colitis and Crohn's disease. A similar process underlies both—the inner lining of the intestines becomes inflamed and damaged, causing diarrhea (often bloody), abdominal pain, rectal bleeding, and weight loss.
Using a database of all Manitobans diagnosed with IBD, the researchers identified all 36 children age 11 and younger diagnosed with IBD in that province between 1996 and 2008. Their average age was 6 1/2; about evenly matched between girls and boys.
Overall, nearly 60% of the children with IBD had received one or more prescriptions for antibiotics in the first year of life compared with about 40% of the children without IBD.
"This translated into an almost three times increased chance of developing IBD if antibiotics were used in infancy," Shaw says.
Boys with IBD were nearly seven times more likely to have been prescribed antibiotics in infancy than boys without IBD.
Additionally, the study doesn't show cause and effect. It could be that infants who require antibiotics may be predisposed to developing IBD for some other reason, Shaw says.
If the findings are confirmed, that does not mean that antibiotics should be withheld during infancy, says. But
Given the current problem of antibiotic overuse leading to resistant strains of bacteria, Deborah Procter, MD, a gastroenterologist at Yale University says this may be one more reason to "think twice before prescribing them."
Digestive Disease Week 2010
DR. PAIS’S COMMENTS: I think the big picture needs to be examined here. That is, the appropriate use of antibiotics. Where they are consistently prescribed for conditions that have been shown to be non-responsive, like ear infections and sinusitis, their use should be actively dissuaded. When antibiotics are given for conditions that make no sense to use them for, like the common cold (colds are viruses and are not treated by antibiotics), their use should be curtailed. If only one child is prevented from getting IBD, they would thank you.
SLEEP LOSS RELATES TO DIABETES
Subsequent nights with partial sleep restriction result in a decreased ability to handle blood sugar or glucose. According to this new study, just one night of short sleep duration can induce insulin resistance, a component of type 2 diabetes.
"Sleep duration has shortened considerably in western societies in the past decade and simultaneously, there has been an increase in the prevalence of insulin resistance and type 2 diabetes," said Esther Donga, MD of the Leiden University Medical Center in The Netherlands and lead author of the study. "Our findings show a short night of sleep has more profound effects on metabolic regulation than previously appreciated."
Previous studies have found that reductions in sleep duration over multiple nights result in impaired glucose tolerance, but this is the first study to examine the effects of only a single night of partial sleep restriction on insulin sensitivity.
Researchers examined nine healthy subjects, once after a night of normal sleep duration (approximately eight hours), and once after a night of four hours of sleep. Insulin sensitivity of each study participant was then measured. "Our data indicate that insulin sensitivity is not fixed in healthy subjects, but depends on the duration of sleep in the preceding night," said Donga. "In fact it is tempting to speculate that the negative effects of multiple nights of shortened sleep on glucose tolerance can be reproduced, at least in part, by just one sleepless night."
A Single Night of Partial Sleep Deprivation Induces Insulin Resistance in Multiple Metabolic Pathways in Healthy Subjects. Journal of Clinical Endocrinology & Metabolism, 2010; 2009-2430
DR. PAIS’S COMMENTS: As I’ve written about in these pages before, many of my patients don’t sleep a sufficient number of hours. Sometimes this is due to a waking habit based on a past work schedule. Sometimes their sleep is consistently disrupted by a light, noise, animal, or person. If you combine this lack of sleep pattern with a tendency towards diabetes, or ongoing blood sugar problems, you’re eventually going to see negative results. It’s not necessarily cool, special, industrious, or healthy to deny yourself the possibility of longer duration sleep. Sleep more, not less.
FIVE CASES OF CHRONIC PAIN
These are all uncontrolled case studies. 5 patients with chronic pain resulting from burns, spinal stenosis, carpal tunnel syndrome, fibromyalgia, or cervical disc herniation were treated. Combinations of the omega 3 essential fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic (DHA) were given totaling 2400-7200 mg/day depending on pain severity. In all cases, significant reductions in pain were reported.
Case one involved a patient with a cervical disc herniation accompanied by spinal narrowing. A combined EPA+DHA dose of 4800 mg/day for 8 months led to a 42% increase in grip strength, a 92% increase in triceps extension strength, and a total elimination of pain. Improvement began after 2 ½ weeks.
Case two involved a patient with thoracic outlet syndrome and fibromyalgia. A combined EPA+DHA dose of 2400 mg/day for 7 months led to a 43% reduction in pain and a 60% increase in grip strength on the affected side. A 13-month follow-up measurement revealed a 70% reduction in pain from baseline and an 80% reduction in pain scores.
Case three involved a patient suffering from an accident-triggered cervical disc protrusion. X-rays also revealed evidence of moderate-to-severe narrowing of the cervical spine. A combined EPA+DHA dose of 4800 mg/day later increased to 7200 mg/day for a total of 17 months led to a 90% reduction in the Pain Detect Questionnaire score, a 65% reduction in pain as measured by the McGill pain questionnaire, and an 8% increase in grip strength on the affected side.
Case four involved a patient with pain from carpal tunnel syndrome. A combined EPA+DHA dose of 3000 mg per day for 8 months led to a 41% reduction in a global symptom score. The patient improved to the point where surgery was not needed. The patient was able to return to a fulltime work schedule.
Case five involved a patient with 1st and 2nd degree burns on 30% of the total body surface. A combination of EPA+DHA ("1200 mg per 23 kg body weight") led to 25-53% reduction in pain scores.
Omega-3 fatty acids for neuropathic pain. Clin J Pain 2010;26:168-72.
DR. PAIS’S COMMENTS: This is the first report I’ve seen that looked at the effects of omega-3 fatty acids on such chronic nervous system pain. Even though these are isolated case studies without the use of controls the results are compelling. Quality omega 3 essential acids are safe to take. If their use can help patients with such debilitating chronic pain conditions I can think of no reason not to give a therapeutic trial. Why wait?
GOOD BACTERIA REDUCE INFECTION
This was a randomized, double blind, placebo controlled study. 1,072 volunteers greater than 70 years of age were researched. Each were given 200 g/d of a fermented dairy product containing L Casei or an unfermented control dairy product and followed during the 3-month intervention period and for one additional month. The daily total intake of colony-forming units was 20 billion L Casei plus 2 billion of the combination of Streptococcus thermophilus and L. delbrueckii subspecies bulgaricus.
Illnesses such as colds, infectious sore throats, flu, pneumonia, bronchitis, and other common (mostly respiratory) infectious diseases along with their duration and severity, immune parameters, were looked at.
Average length of all common infectious diseases was 6.5 days in the probiotics group versus 8 days in the control group. The possibility that this result was solely due to chance was less than 1%. The cumulative duration of all upper respiratory infections was 3 days shorter in the probiotics group versus the control group—the possibility that this result was due to chance was less than 1 in 3000.
Br J Nutr 2010:103:580in
DR. PAIS’S COMMENTS: We have seen before that the consumption of probiotics is known to boost immune function in elderly adults. In another recent blinded randomized trial, a statistically significant reduction in the duration of colds and flu was reported in children (Pediatrics 2009;124:e172-e179). Other blinded randomized trials have reported reduced duration, severity, and/or incidence of colds in adults not limited to the elderly population (Clin Nutr 2005;24:481-91; J Clin Gastroenterol 2008;42 (Supp3 part 2):S224-33).
The consistent positive outcomes, the frequency of upper respiratory infections, and the safety of probiotics collectively suggest that it is time for conventional healthcare practitioners to use probiotics to treat patients with colds or flu.
As far as probiotic strain dose goes, the tens-of-billions-per-dose used in the current trial is in line with some other trials that have been successful. High doses are often necessary to account for attrition of bacteria in passing through the acidic human stomach.
In summary, most probiotics help victims of such infectious diseases at least by shortening the length of disease, a variety of common strains seem to be effective, and effective doses appear to be high--in the tens of billions of colony-forming units (CFU) per day.
Here are some pages that are of particular interest:
Store: There are 257 products from Emerson listed on this page. If yours isn’t one of them please let me know and I will add it so you can order online. This is particularly convenient after hours or on the weekend. Of course, you can always order by phone from Emerson at 800-654-4432.
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Help me bring information, news, and stories about natural medicine to the Facebook community. Check out the latest Discussion posting http://www.facebook.com/topic.php?uid=320294469971&topic=13885 on how best to take your Vitamin D supplement.
For those of you who don’t know, Facebook is a social networking website. Users can add friends and send them messages, and update their personal profiles to notify friends about themselves. Additionally, users can join networks organized by city, workplace, and school or college.
Facebook pages help you discover new artists, businesses, and communities as well as those you already love. On my fan page www.facebook.com/NaturalDoc I post discussions that you can join in with and relay breaking health news related to disease prevention, clinical nutrition, and ways to make you healthier.
I’m looking forward to exploring this community with you. See you there!
LET ME HELP YOU MAKE WISE SUPPLEMENT CHOICES
As is often the case, a recent new patient asked if I would review their choice and use of supplements and herbs. Why does this happen so often? For many, taking a vitamin or herb is their introduction to natural medicine. Their desire to be healthier drives them to take supplements and herbs. The death, pain, discomfort, and side effects experienced with over the counter and prescription drugs compels people to look elsewhere. It’s very different with supplements and herbs which, when used correctly, have an incredibly low risk of harm.
Some people take this to an extreme and take every supplement or herb that someone tells them is ‘good for them’. It might be a clerk, an internet ‘expert’ source, or a friend who is marketing the latest or greatest fad. Most of these individuals or companies have no professional training or experience in the medical use of the supplements or herbs that they’re selling. The people they’re selling to come into my office with 5,10, 15, or more supplements that they’re taking. Sometimes it’s been so long since they started taking them that they don’t remember why they’re doing it. When I ask, they can’t tell me what, if anything, a particular product is doing for them. Yet, they can be quite fearful of stopping any of these items, as if their health would careen off a precipice without them.
Why do I think my approach is any different? Partly, it’s because of my background. I’ve literally been working with nutritional supplements since 1974. That’s 35 years assessing the quality and effectiveness of supplements. Starting in 1980 I started working with Western and Chinese herbs. The quality of herbs used and how they’re combined together has the greatest effect on the efficacy of the final product. Because I’ve grown, identified, harvested, and produced medicinal herbal products I recognize a good formula when I see one.
Licensed naturopaths like me receive the most extensive academic and clinical training in the use of nutritional supplements and herbal medicines of any professional in the United States. Nothing can substitute for such hands on experience, especially when you see, and are responsible for, the results of your treatments. Very different from the clerk in the store, or coworker who’s part of a MLM scheme.
What I’m offering to is easy access to this experience and training. Both for you and your family. If you have questions about the supplements or herbs you are taking, or are thinking about taking, now is the time to ask. Send me an email with the brand and name of the product you’re taking. Let me know that you want to bring the bottles in at your next visit, so I can see what you’re taking. Start a discussion on my Facebook fan page. Either way I’ll give you honest feedback about what I think is good, or what isn’t. We’ll fine tune what you’re taking to maximize effect and eliminate waste.
Let me hear from you and we’ll get started.
GET YOUR VITAMIN D TEST WITH ZRT LABORATORY
It just happened again the other day. A patient sent me a copy of the Vitamin D test she just had done. With frustrating results. The wrong test was done. After all these years, and all the information available, MDs and laboratories still order the wrong test. What a waste of money and time.
For a long time I looked for a home Vitamin D test. One that would be simple, easy, and accurate to do on your own. I finally found one. ZRT Laboratory in Beaverton OR. ZRT emphasizes research and technological innovation.
Until now, venipuncture blood serum has been the standard medium for testing Vitamin D. ZRT has developed and refined Vitamin D testing in blood spots. A few drops of blood from a quick and nearly painless nick of the finger, placed on a filter paper to dry are all that is needed. The total 25 (OH) Vitamin D is then determined by liquid chromatography/tandem mass spectrometry (LC-MS/MS). This method has been shown to be as accurate as the assay standard.
Ordering A Vitamin D Test
ZRT allows anyone to order a Vitamin D test kit for $95 plus shipping and have it sent to their home. ZRT will let me prepay for kits and send them to my office for $55 each. I am charging $65 per kit for patients to cover my overhead and analysis of results.
If you are interested in getting a Vitamin D test done through my office please prepay so I can order you a kit. Then you can either pick it up at my office or have it shipped to your home. Once you’ve taken the sample and sent it back to ZRT it’s only a matter of time before your results are sent back to me. I can even look at them online before the mail arrives.
If your doctor has refused to order a Vitamin D test or worse, ordered the wrong one, this is the fastest, least expensive, most accurate way to do it ourselves. Once we know what your Vitamin D levels are, the next step is making sure that you achieve optimum levels for prevention of disease and maintenance of health.
ITHACA OPTIMAL HEALTH
I’m excited to announce that I have opened a new office in Ithaca, New York. Why Ithaca? We feel very drawn to the area—socially, culturally, and politically. Now with the help of some friends we’re practicing there. Joy Weber, a massage therapist, has graciously opened her massage space to me, every 2nd Saturday of the month. I’ll be seeing patients there starting August 8. If you have any friends or family in the area let them know.
My Ithaca office address is 329 South Geneva St., Ithaca NY 14850.
I am often asked what supplements I recommend. Many of you have been surprised to discover that I favor food over pills; lifestyle changes over fads. I have been working with nutrition for over 30 years, herbs for over 20 years. Where and when appropriate I recommend them to my patients. I strive to act from knowledge, experience, and research.
Emerson Ecologics (800-654-4432) carries almost all of the nutritional supplements and botanical extracts that I think are useful. Their customer service is excellent and their delivery is reliable (often only 2-3 days to this region). It’s a great way to get physician quality products at reasonable prices.
To offset the cost of shipping, reference my name when you establish your account and receive a 10% discount on every order. If you have any questions about these items feel free to email me.
That’s it for this issue of Naturopathic News. If you’ve thought a bit extra or learned something new, then I achieved my goal. As usual, if you have questions or concerns brought up by these subjects, let me know.
Gregory Pais, ND, DHANP
580 E. 3rd. St.
Williamsport PA 17701