December 19, 2002 Research Update

James Bogash, D.C. Mesa, AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com

Co Q10 improves BP, glycaemic control: trial w/ type 2 diabetes

This study used a very reasonable dose of 200 mg/day of CoQ10 and showed favorable effects in diabetics. While this effect was small, keep in mind that CoQ10 supplementation will have a wide range of other beneficial effects (as opposed to pharmaceutical interventions, which typically have a wide range of deleterious effects) and that CoQ10 would only be one tool in the natural approach to diabetes and HTN.

Coenzyme Q10 improves blood pressure and glycaemic control: a controlled trial in subjects with type 2 diabetes

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Fitness, fatness, activity as predictors of bone density in older persons

This article may be surprising to some, but really fits right in with research that has been piling up in regards to exercise in our senior population. This study does not show a protective effect of light aerobic exercise on bone mass. This supports the need for weight/resistance training in all age groups. I've really began pushing the addition of this type of training in all my senior patients. I do find that the more exercise a patient does as they get older, the healthier, happier and less medicated they are. My favorite story I like to relay is about Jim, a patient in his upper 70's. He relays how much weight he lifts daily in the thousands of pounds (all added up, it's not an unrealistic number at all). He has arthritis but never feels it, no medications and is mentally as alert as any fifty year old.

Synergy Abstract

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Age-specific relevance of usual blood pressure to vascular mortality

An article like this can be a major eye-opener for many clinicians. I see many patients with "treated" hypertension in the area of 150 systolic. This has always bothered me, but pharmaceutical intervention does have its limits. This study finds that BP above 115 have a positive correlation with CVD and all cause mortality. This would suggest that much more effective approaches to HTN are needed and I would think this opens up the realm for alternative approaches, top of which is water only fasting (search previous updates), followed by exercise, dietary modification, magnesium, etc...

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An anthroposophic lifestyle and intestinal microflora in infancy

There is no longer any excuse for pediatricians to be unaware of the long term damaging effects of antibiotics and the importance of maintaining a healthy intestinal flora. There is too much evidence supporting their importance for a physician who is cognizant of his or her patient's well being to ignore. We need to understand how important healthy bacterial flora is an promote lifestyles that support their growth. This would include avoidance of antibiotics, whole grain foods, intake of fermented foods and possibly probiotic supplementation. I fully believe that this is one of the key reasons (coupled with an increase in vaccinations) why allergies and asthma are becoming so prevalent in our kids.

Synergy Abstract

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Blood Lead Levels and Dental Caries in School-Age Children

This article should come as somewhat of a shocker to those who have always supported water flouridation. Usually, these supporters are somewhat clueless as to the form that this flouride comes in. The hydrofluorosilic acid used is unquestionably regarded as a toxin, and yet communities blindly vote to put it in the water supply. Go figure. Anyway, it is well known that this toxin increases lead uptake in the body, mainly in children. This article supports the concept that the increased lead uptake due to the "flouridated" water leads to weakened teeth and greater cavities. Sound contrary to everything you've heard? Welcome to reality--water flouridation is, at best, a waste of money, at worst a toxic exposure to everyone drinking it.

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Treatment of the Common Cold with Unrefined Echinacea

A few comments here. First, most commercially available forms of echniacea are standardized for the active components (which is still up for debate...) and not given unrefined. The practitioners using unrefined herbs are very knowledgable and will use this herb as it was meant to be used--as one component to a multi pronged approach to strengthening the immune system. Personally, I never recommend echinacea. I usually tell patients to avoid refined carbs because they suppress the immune system, drink lots of water and take lots of Vit C (1 gram/hour to bowel tolerance).

Annals of Internal Medicine: Article

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The Diabetes Prevention Program

This large intervention trial was designed to see if lifestyle changes (which were actually pretty general and not nearly inclusive of what should be included) can impact progression to diabetes. The results were a whopping 58% reduction!! And this with only general recommendations. With stronger recommendations and some specific nutrient supplementation, I'm sure the number could skyrocket. Now, the question arises; with such a dramatic reduction available, why are diabetes rates still increasing across all age groups? I still come across patients who have not heard of refined carbs and do not realize that most of their diet consists of them. We need to strongly educate the public about the hazards of this class of processed foods with the ferocity of the new release of Celebrex...

Dia Care -- Abstracts: The Diabetes Prevention Program Research Group 25 (12): 2165

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Ultrasound-Guided Needle Therapy Effective for Tennis Elbow

This is an excellent article and strongly supports what I talk about in my office. For everyone out there who thinks steroid injections are a useful procedure, think again. Articles in the past have supported the concept that it is not the steroid that heals (quite the contrary--it inhibits the formation of collagen crosslinks, resulting in weaker connective tissues!), but rather the damage created by the needle that produces injury and bleeding that promotes the healing. This is right in line with many manual therapies that I use in my office--ligaments and tendons are actually injured in the therapy process, resulting in an inflammatory response that heals the lesion.

RSNA 88th Scientific Assembly: Abstract 1449. Presented Dec. 5, 2002

A new minimally invasive treatment that combines the skills of a radiologist and a sports medicine physician effectively reduced pain and restored function in 65% of patients with a range of injuries, from tennis elbow to jumper knee, according to Levon N. Nazarian, MD, professor of radiology at Jefferson Medical College, Thomas Jefferson University, in Philadelphia, Pennsylvania.For years, sports medicine specialists have been injecting injured elbows and knees with either anesthetics or corticosteroids to treat minor tears, said Dr. Nazarian, "but we are combining ultrasound with needle therapy so that the needle is carefully guided to the point of injury." He presented the study here at the 88th Scientific Assembly and Annual Meeting of the Radiological Society of North America.While standard "needle therapy" either draws fluid out of a joint or injects something into the injured joint, the ultrasound-guided needle therapy allows the sports medicine specialist to use the needle as a very tiny surgical instrument "to either break up scars or poke holes in an injured ligament so that bleeding occurs. The blood cells carry precursors to collagen, which eventually develops into collagen to replace the damaged tissue," Dr. Nazarian said.All patients are initially injected with an anesthetic into the injured area. "This serves as a useful test to determine if the pathology visualized on ultrasound is the actual cause of the patient's pain. If the pain disappears after anesthesia we know we are on the right track," said Dr. Nazarian. But once the anesthesia is injected, the patient may be treated with just "needle surgery" or may receive corticosteroid injections or additional anesthesia. "The advantage to this procedure is that it is so minimally invasive that restoration of function is very rapid, much more so than even arthroscopic surgery," said Dr. Nazarian. This offers a surgical option for patients who have "tears or abnormalities that are so small that they cannot be fixed by surgeons and yet they are not responding to conservative treatment of rest, ice, and support." So far, Dr. Nazarian has accumulated more than 300 patients in his series, but he presented data on 273 patients who ranged in age from 13 to 82 years (mean age, 39.8 years). About half of the patients were men and all of the patients had failed conservative management. Patients were treated from December 1999 through January 2002 and all received ultrasound-guided needle therapy using a phased array linear transducer (7.5 MHz to 13 MHz).Two hundred forty-six patients underwent ultrasound-guided corticosteroid injection combined with needle debridement. The range of pathology treated included tendonopathy, tendon tear, muscle tear, bursitis, tenosynovitis, ligamentous injury, and plantar fasciitis. The most common anatomic areas were the common extensor tendon at the lateral elbow and the patellar tendon. The remaining 27 patients were treated with needle debridement without corticosteroid injection.The average procedure time was one hour. Patients were instructed to perform only light stretching for the first two weeks, strengthening exercises from weeks 2 to 6, and then a gradual return to higher-level activities. Symptom relieft was reported by 65% of patients within 2 to 12 weeks, while 35% were unchanged. "But these patients still had all options open to them. Since we didn't treat with traditional surgery, no bridges were burned," Dr. Nazarian said. Moreover, even patients who did not improve didn't have worsening of symptoms. There were no complications from bleeding, infections, or the procedure itself.According to Michael A. Sullivan, MD, associate chairman of the department of radiology at Ochsner Clinic Foundation in New Orleans, Louisiana, using ultrasound to guide needle therapy is a major advance. "For years people have been injecting joints blindly: if it hurts here, inject here. That can be successful, but it can also cause more harm than good. This is really a logical way to improve that approach."