FHN Complementary Medicine Monthly Newsletter December 2004
“…let us not love with words or tongue but with actions and in truth.” 1 John 3:18
As we approach the business of this holiday season let’s remember the act of compassion, the time spent listening, the time holding that hand, last for more than the moment …in some cases into eternity.
May the Lord Bless you this holiday season.
From all of us at Complementary Medicine
Dr. Glenn, Dr. Julie, Dana, and Julie
Gastric Bypass Nutrition
The advent of the gastric bypass surgery for the treatment of obesity has brought about a whole new series of nutritional dilemmas. We are not going into the pros and cons of the procedures, but look at the type of things that need to be done post surgically.
There are several types of bypass surgeries currently being done, we are going to concentrate on the Roux-en-Y gastric bypass, as that is the procedure currently being performed here in Freeport.
In the Roux-en-Y gastric bypass - A small pouch is created to restrict food intake, and a Y shaped section of the intestine is attached to the pouch to allow food to bypass part of the intestine, (the duodenum and part of the jejunum). The bypass reduces the amounts of calories and nutrients the body is able to absorb.
In approximately 30% of patients a form of anemia develops. There are, however, other nutritional deficiencies that we need to consider. So let’s look at the function of some the areas we bypassed.
The small intestine consists of the duodenum, jejunum and ileum. The majority of carbohydrate and protein absorption takes place in the duodenum and jejunum. Fats and fat soluble vitamins, however are absorbed in the ileum. Bile salts are excreted from the liver into the duodenum; these are required for the absorption of long chain fatty acids and fat soluble vitamins in the ileum. Vitamin B12 binds to intrinsic factor (produced in the stomach) and is also absorbed in the terminal ileum.
Stomach absorbs 20% of the alcohol ingested, as well as some short-chain fatty acids.
Duodenum absorbs Vitamins A and B1, iron, calcium, glycerol, fatty acids, monoglycerides, amino acids, monosaccharides, and disaccharides.
Jejunum absorbs glucose, galactose, amino acids, glycerol and fatty acids, nonoglycerides, diglycerides, dipeptides, copper, zinc, potassium, calcium, magnesium, phosphorus, iodine, iron, fat-soluble Vitamins D, E, and K, most of the B complex, Vitamin C, and the rest of the alcohol.
The best-studied mechanisms of absorption are clearly for calcium and iron, deficiencies.
Active, transcellular absorption occurs only in the duodenum when calcium intake has been low. This process involves import of calcium into the enterocyte, transport across the cell, and export into extracellular fluid and blood. Calcium enters the intestinal epithelial cells through voltage-insensitive channels and is pumped out of the cell via a calcium-ATPase. So when we have bypassed this area this method of absorbtion no longer is viable.
Passive, paracellular absorption occurs in the jejunum and ileum, and, to a much lesser extent, in the colon when dietary calcium levels have been moderate or high. In this case, ionized calcium diffuses through tight junctions into the blood. Such transport depends on having HIGHER concentrations of free calcium in the intestinal lumen than in blood.
Iron is absorbed in the proximal duodenum. Efficient absorption requires an acidic environment, and antacids or other conditions that interfere with gastric acid secretion can interfere with iron absorption. Iron absorption seems to be enhanced by adequate vitamin C intake.
So with this in mind what do you do:
Take a good multiple vitamin to increase nutrient density.
Increase calcium to levels that will allow passive transport with an easily ionizable calcium ( ie calcitrate, gluconate, lactate….not carbonate)
Increase vitamin C to 500 mg /day
B1 and B12 are not going to absorb well so consider a sublingual source.
Vitamin A can improve hematological indicators and enhance the efficacy of iron supplementation.
A good organic source of iron.
Acidopholus Bacteria as the digestive bacteria (involving billions of cells) residing in the intestinal tract are an important source for several water-soluble vitamins, being renewed every four days.
EPA 3 Fish oils
These are the minimums that need to be done. Individually there may be other areas that may need to be addressed.
Sincerely
Dr. Glenn and Julie Smith
Complementary Medicine
Cox 2 inhibitors
Editors note: This was going to be my October newsletter before the news of Vioxx came out. Timing is everything.
Also, for those of you who are web savvy , we have a BLOG (weB LOG for those of you who aren’t) with all the old newsletters on it. Log on to www.mrdrpilot.blogspot.com
We often get asked if there is any alternative to the vioxx and celebrex that patients are taking for their arthritis pain. While they might be getting some pain relief many did not like the side effects of the drug. With the worst being GI and respiratory. The other problem are the studies that show long term use may actually increase the arthritic degeneration.
We have a product called Zyflamend that we have been using that is a combination of 10 herbs all with some cox 2 activity. Being whole herbs each one also have synergistic activity involved.
The herbs are listed as follows with some of the synergistic properties:
Holy Basil reduces inflammation and supports liver detox pathways by increasing glutithione S- transferase.
Tumeric anti inflammatory antioxidant. Also works with green tea in cell protection. (ie chondrocytes)
Ginger anti inflammatory and helps other herbs absorb.
Green Tea highly anti inflammatory and supports joint function
Rosemary anti inflammatory and supports liver detox function
Hu Zhang anti inflammatory and has reseratorol (the healthy ingredient in red wines.)
Barberry anti inflammatory ,cell protection and anti viral activity
Chinese Goldthread similar to Barberry
Oregano anti inflammatory supports normal platelet function
Scutellaria anti inflammatory , antioxidant and aids in detox pathways.
The herbs are in a capsule in an olive oil base.
Additionally to the joint pain usage there is a study with this product showing reduction in prostate inflammation and tumor reduction.
We hope this helps some of the pain management for people especially in light of the Vioxx news.
Sincerely
Drs. Glenn and Julie Smith
Complementary Medicine
FHN Complementary Medicine Monthly Newsletter September 2004
Does Vit E Cause heart failure?
Vitamin E has had a long and controversial history as a potential treatment for heart disease. While there are some large scale studies that have shown Vit E to be beneficial, there are others that haven’t. The HOPE trial is the first to suggest that Vit E may actually increase certain types of heart disease.
All the studies for heart disease have used alpha tocopherol or dl alpha tocopherol. Vitamin E in nature has four isomers; alpha , beta, gamma, and delta tocopherols.
More and more research is showing that it is the gamma tocopherol that has cardioprotective effect. Furthermore large doses of alpha tocopherol results in a decline in serum gamma tocopherol. Epidemiological studies of natural (from food, mixed tocopherols) versus synthetic(alpha alone) Vit E have shown that natural works synthetic doesn’t.
So before you stop taking your Vit E try a mixed tocopherol in proportions that are found in food.
Drs. Glenn and Julie Smith
Complementary Medicine
FHN Complementary Medicine Monthly Newsletter August 2004
Chronic Fatigue and Thyroid Medications
At Complementary Medicine we see a lot of patients that are fatigued, chronically and otherwise. Many of them have normal TSH levels and some are already taking a levothyroid product. Some are even taking a combination of levothyroid and T3 therapy.
We work with those patients from a nutraceutical standpoint (containing no active thyroid hormone) many times supporting the adrenal gland function. While we have success with some of those patients there are times when some don’t respond.
So let’s talk TSH and ….Armour Thyroid, I can hear gnashing of teeth already.
While TSH has become the ”Standard” for thyroid function measurement I don’t believe it tells the whole story. Interestingly enough the American Association of Clinical Endocrinologists has recommended that the upper limit of TSH be changed from 5.0 to 3.04mU/L. Which means that over 15% of the population who were formally “normal” are overnight hypothyroid. If the TSH is normal and we still have clinical symptoms we need to look farther, including running a reverse T3 along with T4 , T3, Anti TG, and Anti TPO. In addition determining basal metabolic rate (basal temps, or electronic measurement) will add light to the picture.
As I stated before a percentage of the population don’t get symptomatically better using the current T3 and T4 analogs, even when the TSH returns to normal. For those who don’t get better Broda Barnes M.D. has found that over 80% felt better using Armour thyroid. So let’s look at some of the objections to Armour thyroid.
It’s hard to dose because of variations between natural thyroid sources.
That may have been true 50 years ago, however manufacturing processes and quality control methods now produce a product that is consistent dose to dose. In fact a study of two year old product still was consistent with the initial assay.
Using T3 containing preparations causes serum T3 concentration to rise to supraphysiological levels.
In the dosages found in normal desiccated thyroid (9mcg T3 per 60 mg ) this has not been found to be the case. It was found that the T3 levels only rose marginally high when the total thyroid dosage was too high. Cutting back on the total dose took care of the problems.
So what’s the bottom line of this newsletter? We are not advocating using armour thyroid for every one. In fact in thyroid suppressive therapy this does not work well.
We are saying that, in some cases, where clinical symptoms warrant Armour may solve the problem. Of course the patient needs to be closely monitored by their physician to make sure that the dose is correct.
FHN Complementary Medicine Monthly Newsletter July 2004
Leaky Gut!!!
One of the factors that natural medicine looks at while assessing health is the permeability of the intestinal wall. AKA….leaky gut. Leaky gut can cause symptoms ranging from indigestion, heartburn, gas, bloating, constipation, diarrhea, to allergies, anemia, fatigue, arthritis, eczema, and more serious autoimmune diseases.
In leaky gut the small intestine wall becomes inflamed causing a breach in the “tight junctions” between the cells of the gut wall and damage to the cells ability to passively diffuse nutrients through them. These two kinds of damage can allow for larger molecules to pass through the gut causing a cascade of immune and inflammation responses to occur and (in the case of loss of cellular diffusion) nutrient deficiencies even though you are taking all your supplements and ”eating right” !
As this “cascade “ of inflammation continues we start to see joint pain (arthritis) and muscle pain (myofascitis and fibromyalgia), and even asthma.
So what causes this all to start?
There are two major causes
1. Overgrowth of pathogenic bacteria, parasites, and fungi.
2. Use of NSAIDS, antibiotics, corticol steroids, and hormone therapy.
At Complementary Medicine we use a urine test to assess the degree of permeability. We have you ingest a small molecule sugar and a large molecule sugar. One is normally diffused through the cell and one is usually blocked at the cell junctions. We then measure excretion in the urine to assess gut function.
Treatment can vary depending on the cause ( i.e. bacteria ,etc.) But in general we are going to restore normal gut flora with pro and prebiotics, help gut cellular energy with L-glutamine and butyric acid and supplement with enzymes and natural anti-inflammatories.
Sixty percent of human antibodies are produced in the intestine. It is important for your health that it works correctly.
Sincerely
Drs. Glenn and Julie Smith
Complementary Medicine
FHN Complementary Medicine Monthly Newsletter June 2004
With the advent of new machines being advertised for treatment of back problems we thought it would be prudent to look at what they are and what they do.
Lets look at 2 of the major devices out on the market ,Vax D and DRX systems, and a osteopathic /chiropractic technique called flexion distraction. (Cox F and D)
All of these devices ( the Vax-D and the DRX System) are traction devices, according to the FDA. Their FDA product code is "ITH", which is "powered traction equipment".
The Vax-D manufacturers claim a proprietary cycling mechanism that is actually simply a pre-programmed intermittent traction mode. You cannot perform cervical traction or adjust the table's position in flexion/extention, lateral bending or rotation with the Vax-D.
The patient holds onto bars to stabilize the upper body. The Vax-D protocol recommends traction be given in the prone position.
The DRS protocol is in the supine position, with the pelvis posteriorly tilted. The treatment mode is intermittent, with a 60 second on, 30 second off cycle. You cannot perform cervical traction or adjust the table's position in flexion/extension, lateral bending or rotation. There are some extra patient comfort features such as headphones and a blue lamp for relaxation.
Cox flexion distraction is a manual technique where the doctor will hold a spinous process (the back part of the vertebra that feels like a "bump" on your spine) to isolate a single segment for treatment. The distraction manipulation is applied manually by the doctor to the patient's low back at the levels of the spine to be treated or that are painful. The patient lies on a table that is built to traction the spine and also to produce motions that are normal for the spine. To attain these motions, the table goes "up and down" (flexion and extension), goes "side to side" (lateral flexion), or moves in a circular motion (circumduction). All movements are slow. This technique can be applied anywhere in the spine including the cervical spine.
Traction research using the Vax-D machine shows a decrease in intradiscal pressure. Why is this important? Decreased intradiscal pressure causes a suction force inside the discs of the spine. If a herniated disc is present, this suction force can decrease the herniation. Any traction protocol that uses the right amount of force and protocol will have the same positive results shown in the research. In other words, the decompression phenomenon is not unique to the Vax-D, but can be replicated on any traction machine that is able to produce the protocols described in the literature.
The cost of these procedures can run from around $40 per session for the Cox F and D to 5 to 10 times that amount for the Vax D and DRX systems.
Both Complementary Medicine and Healthworks have been using Cox F and D for many years with excellent success at a fraction of the cost of the other systems.
Sincerely ,
Drs. Glenn and Julie Smith
FHN Complementary Medicine Monthly Newsletter June 2004
With the advent of new machines being advertised for treatment of back problems we thought it would be prudent to look at what they are and what they do.
Lets look at 2 of the major devices out on the market ,Vax D and DRX systems, and a osteopathic /chiropractic technique called flexion distraction. (Cox F and D)
All of these devices ( the Vax-D and the DRX System) are traction devices, according to the FDA. Their FDA product code is "ITH", which is "powered traction equipment".
The Vax-D manufacturers claim a proprietary cycling mechanism that is actually simply a pre-programmed intermittent traction mode. You cannot perform cervical traction or adjust the table's position in flexion/extention, lateral bending or rotation with the Vax-D.
The patient holds onto bars to stabilize the upper body. The Vax-D protocol recommends traction be given in the prone position.
The DRS protocol is in the supine position, with the pelvis posteriorly tilted. The treatment mode is intermittent, with a 60 second on, 30 second off cycle. You cannot perform cervical traction or adjust the table's position in flexion/extension, lateral bending or rotation. There are some extra patient comfort features such as headphones and a blue lamp for relaxation.
Cox flexion distraction is a manual technique where the doctor will hold a spinous process (the back part of the vertebra that feels like a "bump" on your spine) to isolate a single segment for treatment. The distraction manipulation is applied manually by the doctor to the patient's low back at the levels of the spine to be treated or that are painful. The patient lies on a table that is built to traction the spine and also to produce motions that are normal for the spine. To attain these motions, the table goes "up and down" (flexion and extension), goes "side to side" (lateral flexion), or moves in a circular motion (circumduction). All movements are slow. This technique can be applied anywhere in the spine including the cervical spine.
Traction research using the Vax-D machine shows a decrease in intradiscal pressure. Why is this important? Decreased intradiscal pressure causes a suction force inside the discs of the spine. If a herniated disc is present, this suction force can decrease the herniation. Any traction protocol that uses the right amount of force and protocol will have the same positive results shown in the research. In other words, the decompression phenomenon is not unique to the Vax-D, but can be replicated on any traction machine that is able to produce the protocols described in the literature.
The cost of these procedures can run from around $40 per session for the Cox F and D to 5 to 10 times that amount for the Vax D and DRX systems.
Both Complementary Medicine and Healthworks have been using Cox F and D for many years with excellent success at a fraction of the cost of the other systems.
Sincerely ,
Drs. Glenn and Julie Smith
FHN Complementary Medicine Newsletter April 2004
Like most Americans, including many physicians and dentists, most of us thought that fluoride's only effects were beneficial - reductions in tooth decay, etc. We believed assurances of safety and effectiveness of water fluoridation. To say the least there is a growing controversy regarding this practice. I think some headlines from around the world might illustrate the issues.
“EPA knew that a significant number of children develop moderate to severe dental fluorosis, but since it had deemed the effect as only cosmetic, EPA didn't have to set its health-based standard at a lower level to prevent it.”
“These hazards include acute toxic hazard, such as to people with impaired kidney function, as well as chronic toxic hazards of gene mutations, cancer, reproductive effects, neurotoxicity, bone pathology and dental fluorosis.”
“…two epidemiology studies from China that show decreases in I.Q. in children who get more fluoride than the control groups of children in each study. These decreases are about 5 to 10 I.Q. points in children aged 8 to 13 years.”
“…fluoride accumulates in the pineal gland and inhibits its production of melatonin.”
“New research of bone cancer figures has shown a 40% elevated rate in Republic of Ireland (fluoridated) compared to Northern Ireland (unfluoridated).(1) The bone cancer in question called osteosarcoma is one of the most prevalent cancers in young males, aged 9-20. There are both animal and human studies linking osteosarcoma and water fluoridation/fluoride.”
"the assessment indicates that infants below the age of four months are exposed to doses of fluoride that exceed the recognised no observable effect level…. bottle-feeding parents are still overdosing their infants with fluoride from the tap water. “
Hope this gives you something to think about!
Sincerely,
Drs. Glenn and Julie Smith
Complementary Medicine
FHN Complementary Medicine Monthly Newsletter February 2004
7 Keto DHEA
It is the time of year when people go on the latest diet and exercise program to lose the holiday cookies! There is NOTHING that can replace reasonable exercise and dietary regimes. There are some people who need extra help with increasing their metabolism. Many of you turned to ephedrine HCL containing products to do that. The dangers of that have been well documented. The other products coming on the market to replace them have similar problems using other stimulants such as extremely high doses of caffeine or guarana. High doses of both have damaging effects on your adrenal gland , BP, etc.
We have used a product called 7- KETO LEAN, which is a metabolite of DHEA. 7-KETO LEAN has been shown to be a remarkably effective weight loss aid in a randomized, double-blind, placebo-controlled clinical trial conducted by the Department of Medicine at Greenwich Hospital, Greenwich, Conn. Study participants who combined 7-KETO with a healthy diet and exercise lost an average of one pound per week while the placebo group lost less than one-fourth of a pound per week - weight loss was due to a loss of body fat, not water weight or muscle tissue. Results of the study are attributed to raised levels of thyroid hormone T3, which increases basic metabolic rate. 7-KETO Lean combines clinically studied 7-KETO, the improved, safe form of DHEA, with seven other powerful natural compounds to support thyroid function and metabolism.
The biggest concern over DHEA supplementation repeatedly raised in the DHEA scientific literature is the issue of androgen/estrogen production from DHEA. Various tissues can locally convert DHEA to either androgens (testosterone, dihydrotestosterone, androstenedione) or estrogens (estrone, estradiol). Many DHEA studies report significant androgen increases in women, even at the relatively low dose of 50 mg. Increased androgen levels in women may relate not only to the mild effects of excess facial hair and acne, but to the more serious issues of abdominal obesity, hyper-glycemia and insulin resistance. One report found a decreased testosterone level in men, combined with an increase in estradiol, hardly ideal for a man's health. Fortunately, a natural metabolite of DHEA( 7 keto DHEA), normally found in the human body, and which CANNOT be bio-transformed into androgens or estrogens, is now available. And preliminary evidence indicates this "new" DHEA metabolite may be even more potent than DHEA.
7-Keto Lean is an energy enhancer, anti-cortisol stress reducer, and general revitalizing agent. It just may be a help to some where diet and exercise is not enough.
Drs. Glenn and Julie Smith
Complementary Medicine
January 2004
The other day we had a patient come into the office taking a proton pump inhibitor (Prilosec) and an SSRI (Prozac). At face value that is not all that unusual, it actually is quite common as there are no listed interactions between these drugs. She was obviously having GI and depression symptoms that her physician thought would benefit from both medications. If you look at nutrient depletions by these drugs you have another story!
Prilosec has been shown to deplete both vitamin B12 and folic acid….and prozac has been shown that it needs folic acid and B12 to activate it’s usage, thus the combination of drugs were much less efficient than they could have been. Let’s look at some of the reasons for this.
The proton pump inhibitor acts by decreasing the HCl secretions in the parietal cells of the stomach. These same cells secrete a substance called intrinsic factor, which is required for B12 absorption in the intestine.
(Which is why oral B12 supplements without intrinsic factor don’t work well.) As we decrease the HCl output we also decrease the activation and absorption of folic acid.
In several studies involving fluoxetine (Prozac) patients received 500 micrograms of folic acid (a very conservative dose) versus a placebo. The folic acid treated patients had a 26-34% increase in improvement of symptoms and a 17% reduction in side affects. Part of this may be due to the fact that folic acid is needed in the synthesis of a substance called SAMe which has been shown to help depression and mood swings.
There are several studies that show B12 levels are directly proportional to mood , depression, and anxiety levels.
We also know that folic acid is essential in reducing homocystiene which can reduce cardiovascular risks.
So if we are going to use these drugs especially in combination with each other, supplementation with B12 (with intrinsic factor or IM) and folic acid are a must.
Sincerely
Drs. Glenn and Julie Smith
Complementary Medicine
