Tag Archives: functional medicine

Fix your pain with your diet

Businesswoman Having Backache At Work

Inflammation is all the rage lately. And rightfully so. Research has shown that chronic inflammation is at the core of most, if not all, of the chronic diseases that affect Americans. But what about chronic pain? Could chronic joint pain, back pain, or muscle pain be caused by chronic inflammation? And can it be alleviated by changing your diet? The answer is yes.

What is Inflammation?

First, we must understand what inflammation is. Inflammation is the term given to describe the biological response that occurs as a result of tissue damage. Bacterial infections, trauma, chemical exposures and dying tissue may all start the inflammatory cascade. In human physiology there are two kinds of inflammation. First, there is the acute form. In this form of inflammation the body responds to an injury by creating an environment that is conducive to healing and tissue repair. The body does this by sending fluids and blood to the area. That’s why the injury swells, turns red and becomes warm to the touch. This is a necessary step after an injury. Acute inflammation is a good thing for the body.

The second type of inflammation, called chronic inflammation, is not a good thing for the body. Chronic inflammation is a lower grade inflammatory response, but it is persistent. Unlike acute inflammation, which resolves, chronic inflammation is a continuous phenomenon that persists silently for years on end. The chronicity of the response is precisely what makes it so problematic. It increases the risk of heart disease, cancer, Alzheimer’s disease, diabetes and many other conditions.

Chronic Inflammation and Pain

How does chronic inflammation affect your pain level? First, it’s important to remember the most widely used pain relievers in the world like ibuprofen, acetaminophen, and aspirin work by reducing inflammation, not by working directly on nerves. This should illustrate the importance of inflammation in producing pain in the human body. However, there are ways to reduce inflammation without resorting to medications, which have serious side-effect profiles, even when taken as directed. The diet is the key.

Dietary-induced chronic inflammation produces an assortment of inflammatory chemicals capable of sensitizing the pain pathways. Moreover, if this sensitization of the pain pathways persists, adaptive responses by the brain cause the sensation of the pain to become exaggerated or inappropriate. The key to fixing this is to reduce the chronic inflammation.

The Pro-Inflammatory Diet

In this country, most people eat a “pro-inflammatory” diet.  That is, they consume food that consistently feeds the inflammatory cascade in the body, leading to chronic inflammation.  As previously pointed out, chronic inflammation leads to tissue destruction and many disease states.  In order to fully understand why our diets lead to this state, we must understand the basics of fatty acids.

Fatty acids are individual molecules that make up triglycerides in our body.  Triglycerides are the storage form of fat that humans use for energy.  In human physiology there are three important fatty acids.  There are omega-3 (n-3), omega-6 (n-6) and omega-9 (n-9) fatty acids.  Omega-3 and omega-6 fatty acids are essential in the human diet.  This means that we must consume them in our diet in order to survive.  Omega-9 fatty acids are classified as non-essential because we are able to synthesize them from other unsaturated fats in our body.  It is the balance of these fatty acids that is critical for controlling and reducing inflammation in human physiology.

First, we must examine the role of fatty acids in our body when speaking about inflammation.  Fatty acids work to produce a variety of chemicals in the body called eicosanoids.  These chemicals are at the heart of the inflammatory cascade.  Some eicosanoids are beneficial while others can contribute to inflammation.  The harmful eicosanoids that contribute to the inflammatory cascade are related to an omega-6 fatty acid called arachidonic acid.  If arachidonic acid is incorporated into a specific eicosanoid then it becomes pro-inflammatory.  If it is not incorporated it becomes anti-inflammatory.  It is arachidonic acid that will fuel the inflammatory cascade, eventually resulting in the production of chemicals capable of sensitizing the pain pathways.

So, we must take a closer look at this specific fatty acid called arachidonic acid.  Arachidonic acid is found preformed in animal products, especially meat.  In addition, it is easily converted in the body from the fatty acids found in grains and vegetable oils like corn, safflower and sunflower oil.  Also, animals fed a steady diet of grain are exceptionally high in arachidonic acid.

Obviously, what we eat will determine our fatty acid profile and potentially contribute to chronic inflammation and pain.  One might think, based on the information given above, that becoming a vegetarian would significantly reduce one’s overall inflammatory load.  And it does make sense especially if we take into account that arachidonic acid is preformed in meat.  It has been shown, however, that the opposite is true.

The average American diet has unfortunately shifted to promote excessive production, storage and utilization of arachidonic acid.  This leads to the over-production of pro-inflammatory eicosanoids.  Research has shown that man evolved with a ratio of omega-6 fatty acids to omega-3 fatty acids of about 1:1.  Today, the average ratio in the diet is anywhere from 10:1 to 20-25:1.  This is disadvantageous because we know that omega-3 fatty acids are anti-inflammatory and have a wealth of other health benefits.  Plainly put, our diets have shifted to favor inflammation.

As mentioned earlier, it would seem that vegetarian diets would be most beneficial in creating an anti-inflammatory state because animal products are high in preformed arachidonic acid.  This hypothesis, however, has not held up in clinical studies.  It has been shown that vegetarians, in fact, have a higher plasma level of arachidonic acid and an essentially equal level of arachidonic acid found in red blood cells when compared to meat eaters.  The study also showed that vegetarians have lower levels of the protective and anti-inflammatory omega-3 fatty acids, specifically EPA and DHA. This suggests that  vegetarian diets shift people closer to an inflammatory state than they probably desire.

A diet high in fruits, vegetables and healthy proteins and fats it ideal for stopping and preventing chronic inflammation.  This type of diet will invariably be low glycemic.  The glycemic index refers to the effect on blood sugar that a particular food will have.  A food that has a low glycemic index (GI) will raise blood sugar much more slowly than a food with a high GI.  Foods with a low GI are much more beneficial for controlling inflammation because low glycemic foods cause a much smaller response from the hormone insulin.  Insulin is the hormone that’s required for most of the cells in our body to use and store sugar for energy.  Insulin, which is secreted from the pancreas, actually stimulates an enzyme that converts omega-6s into the dreaded arachidonic acid.  So a diet that is high glycemic will cause one’s body to over secrete insulin and further drive the inflammatory cascade.

So a diet high in fruits, vegetables, protein and healthy fat will lead to lower inflammation and greater pain control, but are there are other things you can add into your diet to help? As it turns out, there are. Certain spices have powerful anti-inflammatory effects. Turmeric, ginger, garlic and black pepper all have the potential to reduce inflammation when consumed in the diet. There are many other spices that have anti-inflammatory properties so go ahead, spice up your food! Your body may thank you for it.

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Your Cholesterol Matters Less Than You Think

Eraser deleting the word Cholesterol

The Cholesterol Hypothesis

The cholesterol hypothesis is the prevailing theory on why human beings develop heart disease. It goes something like this; elevated total cholesterol and, especially, elevated LDL cholesterol, is the primary cause of atherosclerosis and cardiovascular disease. Further, replacing saturated fat in the diet with vegetable oils lowers serum cholesterol and, therefore, lowers cardiovascular disease risk. This information is decades old and has become medical dogma. Unfortunately, it’s not true.

Much of this information comes from the Seven Countries Study originating in the 1950s, although data is still analyzed today to glean more knowledge from it. It tied fat consumption to heart disease. The lead author, Ancel Keys, found the more fat a society consumed the higher the rate of heart attacks. It seemed to be very convincing evidence. This observation helped shape health policies for governments and the medical field. In fact, to some degree, it still does today.

Missing or Unpublished Data

There was a problem with it, though. Data showed that there were populations of people who consumed lots of fat but had low heart attack rates. Conversely, there was data showing there were populations of people who consumed very little fat but had high rates of heart attacks. This information was omitted from the study. The study also failed to account for the fact that the people who consumed the most fat were also most likely to consume the most sugar. While nutrition science is notoriously difficult, these seem like variables that shouldn’t have been ignored.

Superimpose the above inconsistencies with interventional studies conducted in the same time period and you’ll quickly see you’ve been misled. Ancel Keys’ study was an observational study. This means he observed a connection between two sets of data. Observational studies cannot prove cause and effect. For example, imagine this headline; “New science has observed a connection between high heel wearing and breast cancer.” Does wearing high heels cause breast cancer? Of course not. It just happens that people who wear high heels (mostly women) also develop the majority of breast cancer. This silly example shows just how easily an observational study can get it wrong.

The gold standard for proving cause and effect is an interventional study where populations are randomized and given either an experimental intervention or are controls, generally receiving a placebo. In dietary trials, placebos are difficult, if not impossible, to give so participants diets are often left unchanged for the control population.

The Sydney Diet Heart Study and the Minnesota Coronary Experiment

Around the same time that Ancel Keys was doing his work, two interventional studies were conducted. One was called the Sydney Diet Heart Study and the other the Minnesota Coronary Experiment. Both of these studies were incompletely published (data was missing) or went completely unpublished for reasons no one really knows. It is likely because they contradicted accepted dogma and scientific journals were hesitant to put their reputations on the line for something they viewed with skepticism. We know about them now because a group of researchers recently uncovered the unpublished data, reanalyzed it with modern methods and found some shocking results. The reanalysis of both studies was published in the British Medical Journal.

In both of these experiments, totaling about 10,000 participants, saturated fat was removed from the diets of the experimental group and replaced with vegetable oils. This is precisely what the American Heart Association says you should do. What did they find? They found that by removing saturated fat, the participants’ cholesterol went down. This is not unexpected. What they didn’t expect to find was that in both studies the low saturated fat group experienced more cardiovascular disease, more coronary heart disease, and an increase in all-cause mortality.

So let’s summarize; Removing saturated fat and replacing it with vegetable oils lowers cholesterol. But lowering cholesterol raised the risk of heart disease? Yes. This puts an enormous, truck-sized hole in the cholesterol hypothesis. In fact, in the Minnesota Coronary Experiment for every 30 points a person’s cholesterol dropped their risk of death increased by 22%.

This information is counter to everything nutrition science says. Three other randomized controlled trials have confirmed the results. Couple this with another very recent study evaluating over 68,000 elderly people which found an inverse relationship in those over 60 between LDL level and mortality, and I think we seriously need to evaluate the cholesterol hypothesis.

The Real Cause of Heart Disease

If cholesterol doesn’t cause heart disease, what does? It’s quite simple actually – endothelial damage. The endothelia are the cells that line your blood vessels. There are things that are known to damage this lining – high blood pressure, inflammation, high blood sugar, smoking, oxidative stress, and aging. These triggers, and pursuant damage, set into motion a cascading set of events that allows your immune system (in the form of white blood cells) to infiltrate the lining of the vessels. Only after they do this do they begin the process of engulfing cholesterol, which eventually leads to arterial plaque formation. Control those triggers and you will never develop heart disease. If you do not control those processes, it doesn’t matter how low your cholesterol is. You will still develop heart disease. I hear you saying, “But how do I control aging?” That is more difficult as we will all age, but living a healthy lifestyle helps with all of those factors, including aging. Plus, aging alone is unlikely to be a significant cause of heart disease.

It’s important to recognize that cholesterol is not your enemy. Sedentary lifestyle, smoking, a diet high in refined food, the excess consumptions of sugar, and poor stress management are much more serious concerns. Lowering cholesterol for the sake of lowering it has no beneficial effect on your heart. As a matter of fact, the research shows it could be downright dangerous for it. So if you’ve been told you have high cholesterol and that lowering it will lower your risk, you might want to consider the information above and seek an alternative.

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3 Things That Happen To Your Brain With Leaky Gut

Gut health is essential for overall health. That connection is fairly easy to make. But what about your brain? Can the health of your gut really affect your brain? The answer is a resounding yes! Here are three things that happen to your brain when you have a leaky gut.

  1. Depression – the bacteria that naturally exist in our GI tract are mostly beneficial. However, if metabolic byproducts and cell constituents are able to escape the gut they cause a potent inflammatory response. This happens through a “leaky gut.” The resulting response alters levels of inflammatory hormones called cytokines. These cytokines have the ability to communicate with the brain and eventually change neurotransmitter levels. This change in neurotransmission actually begins to rewire the brain leading the changes in how we think and feel. Most often, people begin to feel depressed. 3.02-brain-on-fire
  2. An Inflamed Brain – through the mechanisms just mentioned, not only do your neurotransmitters and thoughts/feelings change, your brain becomes inflamed. This signals the immune cells within the brain, called glial cells, to become very active. This may sound like a good thing, but it’s not. As a result of being activated glial cellsgenerate more inflammation and create oxidative stress. This means the glial cells begin breaking down the brain. This may increase your risk of brain fog, fatigue, depression, anxiety, cognitive decline, and possibly even neurodegenerative disorders like Parkinson’s disease and Alzheimer’s disease.
  3. Blood Brain Barrier Breakdown – there is a barrier than exists that separates what is circulating in our blood from our brain. Only things that are beneficial for the brain are supposed to have access to it. The blood brain barrier is an exceptionally important structure. With increased inflammation from a leaky gut and glial activation, the blood brain barrier breaks down. Now toxic byproducts, inflammatory hormones, and other noxious chemicals have free access to the brain. This is a disastrous consequence that interferes with brain function leading to a multitude of symptoms which include depression, brain fog, anxiety, and more. Leaky gut leads to a leaky blood brain barrier!

Gastrointestinal health is essential for brain health. Knowing how to fix the gut can lead to dramatic improvements in how you feel cognitively and emotionally.

For much more information and strategies to improve your gut and brain health join me for a FREE webinar on Tuesday, November 10th at 7:30PM called “The Gut-Brain Connection – Mood, Food, and More!” We’ll explore the amazing connection between gut health and brain health and give you tips and tricks to make both healthy.

Dr. Vreeland is a nationally recognized expert and author in functional medicine and will present information that will be life changing! You don’t want to miss this event!

Click here to register: http://www.anymeeting.com/PIID=EC51D98085463A

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Omega-3: Intervention for childhood behavioral problems? — ScienceDaily

At the forefront of a field known as “neurocriminology,” Adrian Raine of the University of Pennsylvania has long studied the interplay between biology and environment when it comes to antisocial and criminal behavior. With strong physiological evidence that disruption to the emotion-regulating parts of the brain can manifest in violent outbursts, impulsive decision-making and other behavioral traits associated with crime, much of Raine’s research involves looking at biological interventions that can potentially ward off these behavioral outcomes.

A new study by Raine now suggests that omega-3, a fatty acid commonly found in fish oil, may have long-term neurodevelopmental effects that ultimately reduce antisocial and aggressive behavior problems in children.

He is a Penn Integrates Knowledge Professor with appointments in the School of Arts & Sciences and the Perelman School of Medicine.

Along with Raine, the study featured Jill Portnoy a graduate student in the Department of Criminology, and Jianghong Liu, an associate professor in the Penn School of Nursing. They collaborated with Tashneem Mahoomed of Mauritius’ Joint Child Health Project and Joseph Hibbeln of the National Institute on Alcohol Abuse and Alcoholism.

It was published in the Journal of Child Psychology and Psychiatry.

When Raine was a graduate student, he, his advisor and colleagues conducted a longitudinal study of children in the small island nation of Mauritius. The researchers tracked the development of children who had participated in an enrichment program as 3-year-olds and also the development of children who had not participated. This enrichment program had additional cognitive stimulation, physical exercise and nutritional enrichment. At 11 years, the participants showed a marked improvement in brain function as measured by EEG, as compared to the non participants. At 23, they showed a 34 percent reduction in criminal behavior.

Raine and his colleagues were interested in teasing apart the mechanisms behind this improvement. Other studies suggested the nutritional component was worth a closer look.

“We saw children who had poor nutritional status at age 3 were more antisocial and aggressive at 8, 11 and 17,” Raine said. “That made us look back at the intervention and see what stood out about the nutritional component. Part of the enrichment was that the children receiving an extra two and a half portions of fish a week.”

Other research at the time was beginning to show that omega-3 is critical to brain development and function.

“Omega-3 regulates neurotransmitters, enhances the life of a neuron and increases dendritic branching, but our bodies do not produce it. We can only get it from the environment,” Raine said.

Research on the neuroanatomy of violent criminals suggested this might be a place to intervene. Other brain-imaging researchers have shown that omega-3 supplementation increases the function of the dorsolateral prefrontal cortex, a region Raine found to have higher rates of damage or dysfunction in criminal offenders.

Raine’s new study featured a randomized controlled trial where children would receive regular omega-3 supplements in the form of a juice drink. One hundred children, aged 8 to 16, would each receive a drink containing a gram of omega-3 once a day for six months, matched with 100 children who received the same drink without the supplement. The children and parents in both groups took a series of personality assessments and questionnaires at the start.

After six months, the researchers administered a simple blood test to see if the children in the experimental group had higher levels of omega-3 than those in the controls. They also had both parents and children take the personality assessments. Six months after that, the researchers had parents and children take the assessment again to see if there were any lasting effects from the supplements.

The assessments had parents rate their children on “externalizing” aggressive and antisocial behavior, such as getting into fights or lying, as well as “internalizing” behavior, such as depression, anxiety and withdrawal. Children were also asked to rate themselves on these traits.

While the children’s self-reports remained flat for both groups, the average rate of antisocial and aggressive behavior as described by the parents dropped in both groups by the six-month point. Critically, however, those rates returned to the baseline for the control group but remained lowered in the experimental group, at the 12-month point.

“Compared to the baseline at zero months,” Raine said, “both groups show improvement in both the externalizing and internalizing behavior problems after six months. That’s the placebo effect.

“But what was particularly interesting was what was happening at 12 months. The control group returned to the baseline while the omega-3 group continued to go down. In the end, we saw a 42 percent reduction in scores on externalizing behavior and 62 percent reduction in internalizing behavior.”

At both the six- and 12-month check-ins, parents also answered questionnaires about their own behavioral traits. Surprisingly, parents also showed an improvement in their antisocial and aggressive behavior. This could be explained by the parents taking some of their child’s supplement, or simply because of a positive response to their child’s own behavioral improvement.

The researchers caution that this is still preliminary work in uncovering the role nutrition plays in the link between brain development and antisocial behavior. The changes seen in the one-year period of the experiment may not last, and the results may not be generalizable outside the unique context of Mauritius.

Beyond these caveats, however, there is reason to further examine omega-3’s role as a potential early intervention for antisocial behavior.

“As a protective factor for reducing behavior problems in children,” Liu said, “nutrition is a promising option; it is relatively inexpensive and can be easy to manage.”

Follow-up studies will include longer-term surveillance of children’s behavioral traits and will investigate why their self-reports did not match the parental reports.

via Omega-3: Intervention for childhood behavioral problems? — ScienceDaily.

Dr. Court’s Comments:

Fortunately, science is finally studying and understanding that nutrition is a major factor in brain development. This development appears to have a critical window and if this window is missed, it increases the risk of adverse outcomes. As with many other aspects of our health, it is the combination of our unique genetics with our environment. It’s important to provide the best environment possible to give a child the best chance at a healthy life. Modern American diets are notoriously low in omega-3s. According to recent a recent study, the average American consumes between 100-149mg/day of omega-3s from seafood. This is lower than the world average of 163mg/day. All this despite having relatively easy access to foods that contain omega-3s. Don’t like seafood? Consider increasing your consumption of grass-fed products which tend to be high in omega-3s. Also consider taking a fish oil supplement.

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What is Functional Medicine?

I get this question a lot from perspective patients.  Routinely I will speak with potential patients on the phone before they schedule their appointment.  It allows me to get a general sense of the issues they are dealing with and whether or not I think I can help them.

Inevitably I end up using the term “functional medicine” somewhere in our conversation.  Most people don’t know what that means.  They’ve heard the term medicine before.  However, they always associate it with traditional medicine.  By that I mean going to your family doctor with a complaint and they give you some pill (pharmaceutical in nature) that takes away the symptom.

I’ve also spoken with many other types of physicians who don’t know what functional medicine is.  They assume there’s one way to treat disease and it’s with drugs.  Fortunately, that’s not true.  Modern medicine is a reactive practice.  They wait for disease to develop before treating it.  Here is a scenario that occurred today in my office:

Dr. Vreeland: “Hi Mrs. Smith, how are you today?”
Mrs. Smith: “I’m doing ok, but I brought some blood tests I’d like you to look at with me.”
Dr. Vreeland: “Sure, let’s have a look.  Well it looks like your blood sugar is running a little high.  This is suggestive of pre-diabetes.”
Mrs. Smith: “Yes, I saw that and asked my family doctor about it.  He said he wouldn’t treat it until diabetes developed fully.  I didn’t like that answer.”

This is a scenario that plays out over and over again in my office almost every day.  There is no proactive solutions given to most patients in modern medicine today.  Everything is about treat disease once it develops instead of preventing it in the first place.

Mrs. Smith will not go on to develop diabetes because she is now working with on her diet, exercise program and is going to take the appropriate supplements to prevent her from heading down the long, dangerous road that diabetes creates.

Traditional Medical Approach to  a Common Condition

Traditional medicine focuses on the symptoms of the health problems that one might face, not the cause of the symptoms.  For example, someone with fibromyalgia is almost always treated symptomatically.  They are given pain medications to help cover up the pain; they are given sleep medications to help them sleep at night; they are given reflux medication to reduce their reflux – the list goes on and on.  Unfortunately, none of those medications is addressing the causes of any of those symptoms.

Functional Medicine Approach to a Common Condition

Functional medicine wants to know why you are experiencing these issues.  The pain in fibromyalgia is caused by an aberrant processing of sensory information in the central nervous system.  Through a program of neurological rehabilitation you can change the way you brain interprets sensory information.  Over time this effectively reduces pain levels.  Sleep disturbances are often a result of low levels of serotonin in patients with fibromyalgia.  To correct this a supplement called 5-HTP is given.  This allows the body to replace the depleted stores of serotonin which is actually the cause of the problem.  Reflux may be caused by a hiatal hernia – a condition in which the stomach slips through the diaphragm.  Through a simple manual reduction this hiatal hernia can be reduced and the symptoms of reflux go away.  Providing a drug to these patients that reduces acid production does relieve the symptoms but does nothing to address the hiatal hernia so they become dependent on the drugs.

First and foremost functional medicine is about being proactive with regards to your health.  Should a condition develop functional medicine seeks to fix the physiology not cover up the symptom.  A person who has no symptoms because they are covered up by pharmaceutical agents is still a sick person, they just don’t know it.

My advice to most people is to be as preventative as possible when it comes to your health.  Do everything you can to prevent as much as you can.  The best way to treat a disease is to prevent it in the first place.  This is what functional medicine is about.

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