Dear Friends and Patients:
A few years ago I was at a conference where one of the guest speakers was a physician from Duke University, my old alma mater. He told the audience that Duke was implementing a division of integrative medicine as part of its medical center. Their Chancellor for Health Affairs, Ralph Snyderman, MD stated that “many patients are falling through the cracks” of modern health care - especially those with chronic, debilitating, even fatal conditions for which standard medical options are limited. In 2001, the Institute of Medicine (IOM) issued a report stating our current health care system was in a terminal state and must be replaced. The IOM report also stated that the new health care system would have to include complementary and alternative medicine, as well as preventive measures. Most people agree that our current system of health care is reactive rather than proactive, disease-based rather than health-enhancing, physician-directed rather than patient-centered. Integrative medicine can perhaps best be understood as a response to this crisis, where there is a combination of state-of-the-art allopathic treatments with careful selections from a range of less mainstream therapies. These therapies are based in ancient Chinese traditions, such as acupuncture and herbal therapies, or stress management tools such as yoga and meditation, the benefits of which have been widely documented. Integrative medicine also utilizes nutritional therapies based on the basic sciences of physiology and biochemistry as pertains to humans. Integrative medicine brings patients and health care providers into a partnership that goes beyond acute medical interventions to seek the patient's optimal health and healing, even when a cure is not possible. Hippocrates put things this way: physicians and health care providers should seek to “cure sometimes, heal often, comfort always.” So when patients call the Center and ask “what type of medicine do you provide?”, we use the term “integrative medicine” rather than “alternative” or “holistic.”
There is also a growing awareness that drugs are not the answer to all health problems. It is wonderful that modern medicine has antibiotics or insulin, however, many drugs on the market are of marginal benefit. Gary Null's “Death By Medicine” states that the leading cause of death in this country is a combination of pharmaceutical, iatrogenic, and hospital-based causes. His work emphasizes the need to scrutinize our current system. Non-drug approaches are often times more congruent with a patients' personal beliefs regarding health and life. The consumer-led movement for persons to use kinder, gentler, more natural therapies has created the explosion in complementary and alternative approaches to health care that over 40% of our population uses. The controversy about integrative medicine is imbedded in the rift between standard, drug based medical practice and the patients it exists to serve. Patients are placed in the middle. Take for instance a cancer patient, with his or her life on the line. Cancer patients receive a set of recommendations from their oncology team. If they go to more than one cancer center or oncologist, they often obtain different recommendations. This can create uncertainty or confusion. Then they are inundated with information and suggestions from their family, friends, the Internet, or the media regarding an array of alternate options. These patients have no way of knowing what is safe, effective, or dangerous and they often have no one in the medical profession to turn to for guidance. Medical schools do not provide much, if any, training in complementary or alternative therapies for future physicians. And most physicians, in part because they are so time-pressured just to keep up with traditional medical knowledge and education, simply steer clear of it all and advise patients to do the same. This situation is clearly not in the best interest of the patient or our health.
Fortunately, there is a growing number of major University Medical Centers such as Duke University,
Harvard, the University of California at San Francisco, MD Anderson Cancer Center, the University of Arizona, Stanford University, and others, who now are offering some form of complementary or integrative medicine to their patients. Organizations such as ACAM (the American College for Advancement in Medicine) or ICIM (the International College of Integrative Medicine) sponsor semi-annual meetings where physicians and other health care providers can come together, exchange ideas and are educated on the latest evidence-based information available in the Integrative Medicine field. The Florida State legislature in its wisdom recognized that freedom of choice with type of health care, just as in freedom of choice with religion, is important and is guaranteed statutorily in the Patient Bill of Rights.
Chronic Toxic Metal Exposure
In March 2006, Dana Reeve, wife of Superman actor Christopher Reeve, died at age 44 with lung cancer. She was a non-smoker all her life and her death shocked many people. As I watched CNN interview her closest friends, one of them made a statement that caught my attention - namely, how hypocritical it was for our government to be alarmed at the epidemic of cancer in this country while ignoring the toxic pollution of our environment that is the cause of many of these cancers. And while we cannot say for sure if Dana Reeve's death is related to toxin exposure, one wonders why a 44 year old non-smoker would come down with this disease at such a young age.
With the advent of the industrial revolution, the presence of toxic metals in the environment has increased dramatically, especially lead and mercury. Natural releases of metals such as mercury into the environment occur with volcanic eruptions and forest fires. Huge amounts of mercury are also released into the environment as a by-product of coal firing electrical plants. Mercury is also used in industry and even still in the dental industry in so-called “silver filings”, which are really 50% mercury. In fact, dental clinics are, for the most part, unregulated when it comes to disposal of mercury into municipal wastewater systems. The dental industry uses over 40 metric tons of mercury a year in the U.S.. Cadmium tends to bio-concentrate in tobacco and also used in nickel-cadmium batteries. Arsenic is used in industry, in treated lumber, mining, insecticides and fungicides. Lead is still present in many older homes with lead-based paints and was previously used in gasoline for years. As we neglect our environment, we are now paying the price in increased diseases of aging, autoimmune disorders, vascular and heart disease, neurodevelopmental diseases, autism spectrum disorders, learning disabilities and cancers.
In spite of what the EPA (Environmental Protection Agency) and other governmental health agencies would have us believe, there is no such thing as a “safe” amount of toxic metal because microscopic amounts of these poisons affect us on a cellular level. Although our understanding of all the mechanisms of action that metals affect is incomplete, we do have knowledge about several mechanisms. In a brilliant, but very technical report Metals In Medicine by Robert A. Nash, M.D. (published in Alternative Therapies July/August 2005. Vol. 11. No. 4), twelve different mechanisms of damage to our health were outlined. Toxicant metals can cause bioelectrical short circuits, damaging body function. Metals can combine with proteins creating metal-protein complexes that our body's immune system sees as a foreign invader. This results in our immune systems attacking our own tissues, resulting in autoimmune disorders and allergies. Toxic metals act to deplete glutathione and vitamin C, our two most important anti-oxidants that help prevent cancer and keep our immune systems strong. They alter brain function. Mercury, in particular, causes neurofibrillary tangles identical to those seen in Alzheimer's disease. Mercury and lead also cross the placental barrier, allowing these poisonous metals into the unborn baby. Toxic metals decrease dopaminergic brain activity leading to degeneration of nerve and brain cells. Toxic metals also affect DNA directly and can lead to cancer.
Acute toxicity from mercury, cadmium, lead and other heavy metals is rare, and most traditionally trained physicians have no awareness of how to look for bio-accumulation from low dose chronic exposures to these metals. Because the metals are joined with the tissues in the body, they do not show up in blood tests or urine tests, and require a special type of testing either of hair or urine after a provocative chelating agent is given to release them from the tissues.
Lead in children causes developmental disorders and behavioral problems, which can occur at relatively low levels. We see low IQ, hearing loss, and poor growth as a consequence. Lead can also cause impairment of vitamin D metabolism, depression of red blood cell production and anemia, high blood pressure, headaches, metallic taste in mouth, tremors, loss of appetite, tingling or numbness in the extremities (neuropathy), and brain disorders.
Mercury in low levels can result in decreased senses of touch, hearing, vision and taste, as well as a metallic taste in the mouth. Fatigue, lack of appetite, impaired memory, numbness in the extremities, headaches, hypertension, irritability and excitability, immune suppression, and anemia can also occur. It can also cause a lack of libido and sexual response. In severe cases, psychosis, manic behavior and autoimmune dysfunction, as well as renal failure are seen. An association also exists between dental amalgams that contain mercury and intra-oral cancers. Childhood vaccines that contain a mercury preservative (Thimerosal) are associated with autism in genetically susceptible children.
Action to take: To find out what your toxic metal load is, we first recommend a screening hair analysis to look at toxic metals and essential body minerals. This is followed by the collection of 2 timed urine specimens, before and after a provocative chelating agent is given. The urines are sent to a special lab for spectrophotometric analysis. If there is an increased body burden of toxic metals, an individually designed program to detoxify the metals is needed, based on factors such as the persons age, weight, liver and kidney status, etc.
Minerals and Human Health - Part III
In the December 2005 and March 2006 Newsletters I gave an overview of minerals and human health. We'll pick up here where I left off and finish this discussion with additional minerals.
Vanadium is a mineral critical for controlling blood sugar. To avoid a deficiency of vanadium, it is estimated that over 100mcg/day is required. In general, this can be derived from the diet. Evidence is lacking that amounts greater than 250 - 500 micrograms are required by humans. There is a risk associated with intake of higher levels of vanadium and it is recommended that dietary supplements not contain more than 250 -350 micrograms. The best form of vanadium appears to be vanadyl sulfate. The best food sources of vanadium include mushrooms, shellfish, dill, parsley, and black pepper.
Phosphorus is an essential mineral needed for bone development. Nutritional deficiencies of this substance are rare, and both plant and animal foodstuffs are rich in phosphorus. However, a vitamin D deficiency may reduce absorption of phosphorus. The RDA for phosphorus is between 800 - 1200mg daily, depending upon age and gender.
Boron is a mineral important for optimal bone health and calcium absorption and utilization. It has only recently been established to be significant to humans and animals. An intake between 1 to 4 milligrams a day of boron is appropriate for optimal health. Most persons eating a Western diet consume between 0.1 to 0.5 milligrams of boron a day. Supplementation of 3 milligrams of boron a day in the diets
of postmenopausal women has been shown to improve both calcium and magnesium retention. There are other studies that show optimal intakes of boron can enhance memory and cognitive function, and also a resistance to dental caries. Some fruits, such as apples, are rich in boron but this varies widely depending upon the boron content of the soils where the food was grown. There is no RDA for boron.
Cobalt is best known for its remarkable magnetic properties. It is an essential trace element and is required in the formation of vitamin B12. When we get hair analyses on patients and their hair cobalt is very low, they often are found to have a corresponding vitamin B12 deficiency. Cobalt is also involved in the metabolism of fatty acids and in the synthesis of hemoglobin. No deficiency of cobalt in humans has been reported in the literature and excessive cobalt intake can result in goiter, congestive heart failure, and myxedema. “Beer drinkers cobalt cardiomyopathy” was first reported in 1967 following hazardous levels of cobalt sulphate being added to beer as a defoaming agent. There is no RDA for cobalt.
Lithium is the lightest of all metals and occurs in the soils and in foods such as tomatoes, potatoes, and green peppers. In 1949, a researcher named Cade found that lithium in the form of lithium carbonate helped patients with a type of mental illness called manic-depression, and today lithium carbonate is widely used at prescription doses. By the mid-1970s, an additional role was found for lithium in human health where it was found to play a protective role in treating sodium imbalances that contribute to heart disease in humans. Lithium is very similar chemically to potassium, and potassium also helps regulate sodium levels. During the 1970's, researchers in Texas discovered that the levels of lithium found in water were inversely associated with the incidence of admissions and readmissions for psychiatric disorders in 27 Texas state mental hospitals. Later studies showed that the incidence of homicides, rapes and suicides were significantly higher in countries where there was little or no lithium in drinking water. The researchers suggested a dose of 2mg a day be considered as the effective dose in lowering aggressive or self-destructive behavior. Although it is apparent that lithium is required by the brain, there is no RDA at this time. Lithium may also be useful in treating NIDDM (non insulin dependent diabetes mellitus), in glucose metabolism, and in the treatment of alcoholism. We carry LI Zyme, which is an organic form of lithium. Each tablet contains 50 micrograms of lithium. Many of our patients have observed they sleep better and feel calmer taking this low dose formula.
Sodium is not found in nature in pure form as any amount of moisture or air converts it into one of its compounds. It is the principle mineral in the serum of the blood and is essential to regulate extracellular fluid volume, maintain acid-base balance, and maintain membrane potential of the cells. Sodium is constantly being pumped out of cells in exchange for potassium. Lithium can accumulate in the body if sodium levels are depleted. Sodium deficiency can occur in renal disease, adrenal insufficiency, vomiting, diarrhea, wound drainage, excessive sweating, burns, and with diuretic use. Sodium chloride (salt) is the primary source of sodium in humans.
There is a correlation with excessive intake of salt and hypertension. In northern Japan, where it is estimated 38% of the population is hypertensive, the average sodium intake is 28 grams per day. In Alaskan natives, there is a low incidence of hypertension, and their average sodium intake is around 4 grams a day. However, these studies may be flawed as the average potassium intake wasn't considered at the same time. Numerous studies have shown that potassium can limit the toxic effects of high sodium intake. By simply eliminating salty processed foods (e.g. pretzels, potato chips, etc.) a person's average salt intake would be between 3 to 5 grams. It is important to recognize that some individuals with hypotension (low blood pressure) would benefit from added salt. The RDA of sodium is 500 milligrams a day.
A Non-drug Alternative Therapy for ADD/ADHD
There is an effective treatment available for ADD/ADHD that you may not be familiar with called neurotherapy or neurofeedback. Neurotherapy can be used in treating some types of learning disorders, depression, anxiety, substance abuse, and in certain head injuries where there has been brain trauma. Neurotherapy is a form of biofeedback (a method of using one's will and mind to influence the automatic functions of our body) through which a person learns to change his or her brainwave patterns. It is a safe, non-invasive form of therapy where the patient sits in front of a computer with several EEG sensors attached to the head, and the patient learns to manipulate representations of his or her brainwave patterns on the monitor.
In ADHD the frontal lobes of the brain produce excessive slow (about 85% of cases) or fast (about 15%) brain waves. Neurofeedback training allows the person to alter brain wave patterns and reduce or even eliminate the ADHD symptoms. Unlike traditional stimulant drug therapy used in the treatment of ADD/ADHD, the benefits of neurofeedback remain once the treatment is discontinued. It also avoids drug side effects. Dr. Joel Lubar (University of Tennessee) has followed children for more than 10 years after the discontinuation of treatment and found the treatments to remain effective. Not only that, he also found that there was an average increase in IQ of 12 points following successful treatment.
Dr. Douglas Starr is a licensed psychologist who is providing this service. If you would like more information about neurofeedback, Dr. Starr may be contacted at (352) 374-5600, extension 8103.
Success Story
Mrs. L is a beautiful 41 y.o. married lady who came to see me in the fall of 2005 with complaints of memory loss, fatigue, and constant aches and pains. Her memory problems started in her late 20's. She finally went to see a neurologist where nothing specific was found. “I am struggling to remember the basics” and she was at the point where her memory was so bad she was afraid to socially interact with people or drive her car. She also “hurt all over” and over the past 5-7 years, this progressively worsened. It was taking her 1 _ hours to just get out of bed in the mornings. She also noted her body temperatures were below normal when she felt worse. She felt very fatigued.
Mrs. L underwent a comprehensive exam and kinesthetic testing at the Center. Traditional lab work did not reveal any abnormalities except for a hormonal imbalance which was corrected using bio-identical hormonal replacement therapy. Clinically, Mrs L. also had fibromyalgia. But what was the fibromyalgia due to? Further evaluation with a SpectraCell analysis (intracellular vitamin analysis) and hair analysis (for evaluation of body minerals and toxic metals) revealed multiple nutritional deficiencies and an elevated hair mercury. The patient had previously had her mercury dental amalgams removed and did not eat a lot of seafood.
Different treatment options were discussed and a series of 4 Myer's nutritional IV's with Glutathione were started at 2 week intervals. By the 3rd IV, the patient was feeling dramatically better, with improvement in her energy, memory, and almost complete resolution of her body aches. After the 4th nutritional IV, the patient stated “I almost feel like my old self.” She has started a series of chelations to detoxify the increased body stores of mercury.
The “Myer's Cocktail” is named after the former Dr. Myer's, a physician who gave IV vitamin therapies to his patients with a wide-ranging variety of disorders back in the 1980's. He realized that patients might have an impaired ability to absorb or utilize oral supplements. This formula contains vitamin C, B vitamins and B12, calcium, and magnesium. Glutathione is a triple amino acid the body produces within the cells, primarily in the organs of excretion (liver, lungs, kidneys), and helps the body detoxify toxic chemicals, metals, and drugs, and is also critical for immune system function. This substance is destroyed by toxic metals. Oral Glutathione is destroyed by stomach acid for the most part, but the IV form is very effective in supporting the detoxification pathways of the body.
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