May 23, 2002 Research Update

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

Manipulation of the neck and stroke: time for more rigorous evidence

I'm not sure how many people have managed to be exposed to this particular article as well as a recent one in Canada, but I thought I might address it anyway. These two articles suggest that the risk of stroke with cervical manipulation "occurs regularly." I will address some issues, but be sure to read the editorial in this same journal ( eMJA: Manipulation of the neck and stroke: time for more rigorous evidence

http://www.mja.com.au/public/issues/176_08_150402/bre10066_fm.html). First of all, by all standards there are no comparisons as to the safety of spinal manipulation (with possible exception of acupuncture). NSAIDs alone cause 16,000-19,000 deaths per year. Risk of vasular incidents with cervical manipulation is real, although the incidence has recently been cited to be as low as 1 in 5-6 million manipulations. And I firmly believe that the incidents that have been recorded in the medical literature (fewer than 100 in the recorded literature) are a matter of the DC being in the wrong place at the wrong time doing the wrong thing. The article firmly addresses other issues that show the poor methodology used in recent articles against cervical spinal manipulation. Incidently, in my five years of practice I have given roughly 10,000 adjustments with no adverse effects (with exception of some post-treatment soreness).

eMJA: Manipulation of the cervical spine: a systematic review of case reports of serious adverse events, 1995–2001

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Vitamin D Receptor As an Intestinal Bile Acid Sensor

This article suggests a mechanism for the observed effects of Vit D lowering risk of colon cancer. Vit D upregulates production of an enzyme system needing to detoxify lithocholic acid, a bile acid with hepatoxic and carcinogenic properties. I just hope the milk people don't get ahold of this one...we'll never hear the end of it...

Science -- Abstracts: Makishima et al. 296 (5571): 1313

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Impaired glucose tolerance: GPs' knowledge and perceptions

Anyone who's even read this newsletter just once can probably grasp the medical fact that increased insulin resistance is probably the number one health concern in Western societies because of its impact on human health and chronic disease. So every physician should keep this entity #1 in their minds when evaluating any patient with CVD, hypertension, diabetes, obesity, menstrual disorders and a hoard of other conditions, right? WRONG...very wrong. The results of this survey of 34 PCPs in England gives us an indication that many have not cracked a journal in about 6 years. Or that pharmaceutical companies don't sponsor seminars on insulin resistance. This is a sad, sad state of affairs for a condition that has strong potential to be managed with lifestyle interventions and affecting a major chunk of current chronic diseases in any physician's practice.

bmj.com Wylie et al. 324 (7347): 1190

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Cancer incidence in the USA could double by 2050, report predicts

While many would view this with a pessimistic attitude, reports like this always encourage me to continue to hop up on my soapbox and educate patients on how to lower their risk of cancer. We now have so much info on prevention for all the major cancers that rising cancer incidence is unacceptable. Major organizations like the American Cancer Society need to drop all the political fecal material and start to push prevention. A cure is important, but lets face it--prevention is much, much easier, cheaper and safer.

The Journal : Current Issue

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Mg Levels and Ca/Mg Ratios in Women With Menstrual Migraine

Although this is a small study, the correlations with magnesium deficiency during menstrual migraines is pretty powerful. I definately intend on implementing magnesium supplementation for any patients with menstrual migraine.

Synergy Abstract

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Manual Therapy, Physical Therapy, or GP Care for Neck Pain

Of course I like to see results like this in the medical literature, but do not confuse manual therapy with manipulation. Manipulation is a procedure that takes a joint into the paraphysiologic space (NOT past the anatomical barrier) to stimulate mechanoreceptors in the joint capsule. Mobilization (as in this article) does not achieve this. Any results found with mobilization will generally be greater with manipulation. Also, keep in mind that in many states it is illegal for PTs to perform manipulation--it is a procedure reserved for physician use only.

Annals of Internal Medicine: Abstract

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Statins and risk of polyneuropathy

This article adds more weight to the clinical observation of statin drugs having polyneuropathy as a side effect. A few important things to consider here...the statins lower activity of HMG CoA reductase (one of the enzymes responsible for cholesterol synthesis). They also lower synthesis of CoQ10 at the same time. This is well documented. I've always been stumped at this one--CoQ10 is vital for high respiratory tissues such as the heart and skeletal muscle. Hence some of the side effects of the statins are muscle aches. I would guess that the polyneuropathy is also related to reduced CoQ10, which could easily be fixed with supplementation (which any patient on the statins should be put on). The other scary part is recent recommendations that are designed to increase the number of patients that should be on cholesterol lowering meds (three guesses as to who funded THAT study!!). This would increase the side effects we see in this class of drugs.

Neurology -- Abstracts: Gaist et al. 58 (9): 1333

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Risk-Reducing Salpingo-oophorectomy in Women w\ BRCA1 or BRCA2

The sad part about situations like this is that the women undergoing these surgeries (along with bilateral prophalactic mastectomy) were probably never informed that there are countless other ways to lower your risk of certain types of cancer that do not remove the potential target. It just seems absolutely crazy--in no way whatsoever does this change the underlying biochemical defect that led to the increased risk in the first place! A perfect example is the ApoE4 genotype. Five years ago these people were basically given a death sentence from either heart disease or Alzheimer's. Now, with additional information, we realize that patients with this genotype just need increase antioxidant protection to bring their risk down. Hopefully these patients did not have their brain or heart removed...

NEJM -- Abstracts: Kauff et al. 346 (21): 1609

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Predicted Mercury Concentrations in Hair From Infant Immunizations

For those parents blindly leading their little sheep to the slaughter, this article should raise some very, very important concerns. Essentially, no one ever thought to look at the levels of mercury that infants were exposed to in their 22 vaccinations in the first 18 months. Turns out the levels would be considered extrememly toxic for adults, let alone children. And keep in mind that infants do not have a blood brain barrier that is able to keep this mercury out. With this in mind, does anyone think that the rapid increase in ADD/ADHD and autism might be related to this neurotoxic exposure in suseptable infants???

Predicted Mercury Concentrations in Hair From Infant Immunizations: Cause for Concern

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