Wisdom Wednesday: Barefoot Running

Barefoot running or “natural running” is growing in popularity in the modern world. However, it is the way we all ran until the Romans starting building roads and it is still the way many people run in third world countries.

When you run wearing a modern shoe, the heel tends to strike the ground first. Although this is thought to be a more efficient way to run, it transmits tremendous shock to the body. Therefore, modern running shoes have cushions soles that are thickened in heel to absorb this shock. The soles are also quite stiff, resisting movement.

When you run barefoot the natural tendency is to land on your mid-foot or even on the outside of the mid-foot. This minimizes the forces transmitted to the body. People that run in this fashion can adapt to even hard surfaces like roads and sidewalks and are able to run without discomfort.

As I have aged, I have gradually shifted my running from the road to grassy fields and the beach. It helps that I live about a half a mile due west of the Atlantic Ocean. I have not, nor do I intend to learn to run barefoot on the pavement, but I really prefer to run barefoot on the beach.

I schedule my beach runs to coincide with low tide. The beach is much closer to level and more hard packed along the water’s edge at low tide. When I was training for my one and only marathon, I found that the angle of the beach inflamed by ITB (iliotibial band) if I exceeded 5 miles. The angle at high tide will stress the ITB in just a couple of miles.

Acetaminophen During Pregnancy May Up Risk of ADHD in Kids

Pregnant women who take acetaminophen – best known as Tylenol – might raise the risk that their child will develop behavioral problems such as attention-deficit/hyperactivity disorder (ADHD), a new study suggests.

Acetaminophen is generally considered safe in pregnancy – so safe, in fact, that at least two-thirds of women turn to it while expecting, according to the American Academy of Family Physicians.

But when pregnant women in Britain used the pain reliever, it appeared to increase the risk of behavior problems cropping up in their children by the time they turned 7, said lead researcher Evie Stergiakouli, a lecturer in genetic epidemiology at the University of Bristol.

Still, the study couldn’t prove cause-and-effect, and Stergiakouli believes that women should still take the drug if needed.

In the study, taking acetaminophen between 18 and 32 weeks in pregnancy was associated with a 42% increased risk of behavior problems in children and a 31% increased risk of hyperactivity, the researchers found.

No similar association cropped up in mothers who used acetaminophen after delivery, nor did it occur if the father used the over-the-counter drug, the findings showed.

“Only acetaminophen used during pregnancy has the potential to cause behavioral problems in the offspring,” Stergiakouli said.

These findings jibe with two other large-scale studies that have suggested acetaminophen may have an adverse effect on a baby’s brain during pregnancy, said Dr. Andrew Adesman. He is chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center in New Hyde Park, N.Y.

Tougher U.S. Air Standards Would Be Lifesavers

Curbing two types of air pollution could save thousands of lives in the United States every year, a new study contends.

Research by the American Thoracic Society (ATS) says that reduced airborne levels of ozone and fine particles would also prevent many serious illnesses and significantly reduce missed days of school and work. The ATS recommendations are lower than current U.S. Environmental Protection Agency standards.

Specifically, the ATS said 9,320 lives could be saved each year with an eight-hour ozone standard of 0.060 parts per million, rather than the EPA’s 0.070 standard. So would a fine particle annual standard of 11 mcg/cubic meter, rather than the EPA’s 12 mcg standard.

Stricter standards would reduce serious health events such as heart attacks, hospital admissions and emergency room visits by 21,400 a year, the ATS said. The reduced pollution would also cut 19.3 million days that severe breathing problems leave Americans unable to go to work, school or be physically active each year, the group said.

The study was published online in the August issue of the journal Annals of the American Thoracic Society.

“While there is information available about counties in the United States that exceed EPA air pollution standards, there has not been a similar source of information about how that air pollution actually affects the health of people living in those areas,” study lead author Kevin Cromar said in a society news release.

The pollution levels recommended by the ATS are based on national and international animal and human studies, the group said.

According to the ATS, the 10 urban areas that would benefit most from lower levels of these air pollutants are: Los Angeles, Riverside, CA, New York City, Phoenix, Pittsburgh, Fresno, CA, Bakersfield, CA, Houston, Cleveland, and Cincinnati.

Wisdom Wednesday: Berberine

Berberine is a yellow-colored alkaloid compound found in several different plants, including European barberry, goldenseal, goldthread, Oregon grape, philodendron, and tree turmeric. It has antibacterial, anti-inflammatory, and immune-enhancing properties. It can be used topically on cuts and other wounds, and it’s perhaps most commonly used to treat gastrointestinal issues, including traveler’s diarrhea and food poisoning.

However, in recent years berberine has become a very popular research topic. Over a third of the approximately 2,800 studies on berberine listed on PubMed were published in the last 5 years. These studies indicate berberine may have a wide range of clinical applications.

Much of the benefit from berberine appears to be from its activation of adenosine monophosphate kinase (AMPK). AMPK is a cellular enzyme often called the “metabolic master switch” because it plays an important role in regulating metabolism.

AMPK regulates an array of biological activities that normalize lipid, glucose, and energy imbalances. Metabolic syndrome occurs when there AMPK-pathways are turned off, triggering a syndrome that includes hyperglycemia, diabetes, lipid abnormalities, hypothyroidism, and energy imbalances.

The hormones leptin and adiponectin also activate AMPK. So berberine can have some of the same effects as exercise, dieting, and weight loss – the lifestyle modifications considered beneficial for a range of maladies. On the other hand, AMPK suppression can have similar effects to those of eating a high-calorie diet while leading a very sedentary lifestyle.

One of the most interesting studies on berberine compared taking 500 mg of the compound 2-3 times per day for three months with the diabetes drug Metformin. Berberine was able to control blood sugar and lipid metabolism as effectively as Metformin, with researchers describing berberine as a “potent oral hypoglycemic agent”. Berberine stimulates the uptake of glucose into the cells, improves insulin sensitivity and reduces glucose production in the liver.

6 Million Americans Drink Water Tainted with Toxic Chemicals

Millions of Americans are exposed to unsafe levels of dangerous chemicals in their drinking water that may trigger a host of health problems, researchers report.

Those health problems can range from cancer to higher cholesterol levels to compromised immune systems and hormonal disruptions, the scientists said.

The levels of these chemicals, known as polyfluoroalkyl and perflouroalkyl substances (PFASs), exceed government-recommended safety levels for at least 6 million people in the United States, the study found.

“These chemicals may have complicated names, but people are exposed to them in nonstick cookware and packaging – things we use in our lives,” said lead researcher Cindy Hu, from Harvard T.H. Chan School of Public Health’s department of environmental health.

Although some of these chemical were phased out a decade ago, they linger in the environment, Hu explained, and other types of these chemicals are still used in manufacturing and in foam used to fighting fires.

Hu added that exposure to PFASs is probably even greater than reported in this study. For example, drinking water that serves nearly 100 million Americans isn’t even tested for PFASs, she noted.

Unless people have their water tested, they have no idea whether they are being exposed to high levels of PFASs, Hu said. In addition, the health effects of these chemicals can build up over time, as they tend to remain in the body.

Regular treatment methods used at water plants do not remove these chemicals from the water, Hu added. She doesn’t think drinking bottled water is a good alternative either, because it has its own problems, such as chemicals from the plastic bottles leaching into the water.

Study Links Sleep Problems to Stroke Risk, Recovery

Too little or too much sleep may be a risk factor for stroke and might hinder recovery, new research suggests. The review of 29 previously published studies found that sleep disorders such as insomnia and sleep apnea are related to stroke risk and recovery.

“Sleep disturbances are more prevalent in stroke patients, even more than in the general population,” said lead researcher Dr. Dirk Hermann. He’s a professor of neurology at University Hospital Essen in Germany.

Evidence has existed for a number of years that sleep apnea, a sleep-related breathing disorder that is common in elderly patients and especially so in those who’ve had a stroke, is a risk factor for stroke, he said.

Some studies show that sleep apnea was present before the stroke and may have contributed to the risk. Further, patients with more severe sleep apnea may have more severe strokes, the researchers said.

“Treating sleep apnea with a continuous positive airway pressure machine (CPAP), which prevents the airway from collapsing during sleep, may reduce the risk for stroke,” Hermann suggested.

“Stroke patients should be diagnosed for sleep apnea and also treated, which is not systematically done,” he said.

Other sleep disorders, such as insomnia and hypersomnia (excessive sleep), are also risk factors for stroke, Hermann added. “Wakeful sleep can raise blood pressure, which can increase the risk for stroke,” he explained.

In addition, sleep problems can affect recovery from a stroke, according to the report.

Wisdom Wednesday: Bitters

Dr. Ronda Nelson recently wrote a blog about bitters that prompted me to do some research. She is one of my mentors and I have attended several of her seminars in the last few years.

The literature is very confusing about the original and use of bitters. This is primarily because the medicinal use of bitters morphed into a social practice for drinking alcohol in the eightieth century Europe.

The earliest reference to bitters I could find was about 1500 BC in Ayurvedic medicine in India. Certain herbs, like wormwood were extracted in alcohol and used for medicinal purposes. The use of alcohol in herbal preparation is the basis for Western herbal medicine today. However, the term “bitters” is used to describe a specific group of herbs generally taken before meals to stimulate and aid in digestion.

Today, it is still very popular in England to have “bitters” with afternoon tea in preparation for the evening meal.

Italy and France developed specific bitters for social consumption. In Turin, Italy, 1796, Antonio Carpano created the first recipe for vermouth – probably the most commonly known aperitif. Later this was called sweet vermouth as the French developed a dry vermouth a few years later. The word aperitif comes from the Latin word aperire, meaning “to open”. Aperitifs have a bittersweet flavor that “opens up” the appetite, preparing your taste buds for a delicious meal.

Clinically, I use a combination of herbs as an aperitif to aid in digestion. Medi-Herbs produces a product call DiGest Phytosynergist that stimulates gastric juices, cleanses the liver, enhances immune function and promotes a normal response to environmental stress.

If you have read some of my blogs on liquid herbs, you will be familiar with some of the ingredients: Chamomile flower, Dandelion root, Echinacea root, Milk Thistle seed and Gentian root.

Sugary, High-Fat Western Diet Tied to Denser Breast Tissue

Overweight and obese women who eat a Western-style diet may develop more dense breast tissue, possibly increasing their risk for breast cancer, Spanish researchers report.

The women were about 41% more likely to have denser breast tissue than women who ate a Mediterranean-type diet.

High-fat dairy products (whole mild, high-fat cheeses and ice cream), processed meats (bacon, ham and salami) and refined grains (white bread, pasta and white rice) are prime examples associated with this increased risk. Other examples include sweets and sweetened drinks, convenience foods (pizza, French fries and chips) and sauces (mayonnaise and ketchup), said study co-author Dr. Marina Pollan. She is a cancer epidemiologist at the National Center of Epidemiology in Madrid.

Women who ate such a diet had a 46% higher risk of developing breast cancer, Pollan added, although these study findings do not prove that diet causes breast tissue to become denser.

A Mediterranean diet is characterized by a high intake of fish, vegetables, legumes, boiled potatoes, fruits, olives and vegetable oil and a low intake of juices, she said.

For the study, Pollan and her colleagues collected data on more than 3,500 women who were part of a breast cancer screening program between October 2007 and July 2008.

Is Non-Celiac Gluten Sensitivity Real?

Gluten sensitivity appears to be a real medical problem, and not a figment of the popular imagination conjured up by the gluten-free craze, a new study contends.

Some people suffer changes within their bodies after eating gluten that are separate and distinct form those that accompany either celiac disease or wheat allergy, researchers report.

“We don’t know what is triggering this response, but this study is the first to show that there are clear biological changes in these individuals,” said senior researcher Armin Alaedini. He is an assistant professor of medicine at Columbia University in New York City.

People with non-celiac what sensitivity appear to suffer from a weakened intestinal barrier, which leads to an immune response after they eat foods that contain the gluten protein – typically wheat, rye or barley.

Their symptoms involve bloating, abdominal pain and diarrhea, but also include fatigue, headache, anxiety, and problems with memory and thinking skills, the study showed.

These people don’t have celiac disease, a genetic disorder in which immune cells attack the lining of the small intestine following exposure to gluten. They also don’t have a wheat allergy, which usually prompts allergic reactions such as hives, itchy eyes or difficulty breathing, but does no long-term damage to the small intestine.

The analysis of 80 patients with non-celiac wheat sensitivity shows they did not experience an autoimmune reaction. And, they didn’t have T-cells – a specific form of white blood cell – attacking living cells in the body, as occurs in celiac disease, Alaedini explained.

Wisdom Wednesday: Neuropathy

Neuropathy or nerve pathology is a term used to describe damage to a nerve as opposed to pain and inflammation. The signs of neuropathy are numbness, tingling and/or loss of strength but often these symptoms are overshadowed by pain.

Think of neuropathy as a loss of nerve function. If the damage is to the afferent nerve (signals going to the brain) supply, then the loss is sensory. If the efferent nerves (signals coming from the brain) are damaged, then a loss of motor control ensues.

Let’s look at sciatica, where the pain runs from the spine down the back of the leg. True sciatica effects approximately 5% of the population but many physicians continue to call all leg pain “sciatica”. When the nerve is just inflamed, treatment is fairly straight forward – correction of all injury reflexes, reduction of inflammation with supplementation and spinal/pelvic manipulation will resolve most cases is a couple of weeks.

However, if the sciatic neuralgia (nerve pain) is complicated by neuropathy, the prognosis is less favorable. In addition to the treatment described above, the nerve must also heal. Unfortunately, peripheral nerves are the slowest healing tissue in the human body.

The most common cause of neuropathy is diabetes. Over 50% of all Americans are either diabetic or pre-diabetic. About half of that number are developing neuropathy but currently are asymptomatic. The other half are well aware of their neuropathy symptoms.

It is said that all diabetics develop sciatica and are never cured. While that statement is certainly not true there is some truth in that statement.

I rely on two herbs and a former B vitamin to support healing from neuropathy. If a sciatic patient has no objective findings of neuropathy, I prefer to concentrate on reducing inflammation. However, once the inflammation is under control, if the patient is not responding well, it’s time to consider treating for neuropathy even if all the findings are symptomatic.

CDC Awards $16M in Fight Against Zika

Health officials are urging pregnant women to avoid a Miami neighborhood where mosquitoes are apparently infecting people with the Zika virus. The number of local transmissions of the virus has apparently increased to 14, Gov. Rick Scott said Monday.

While infection with the Zika virus is harmless to most people, it can cause terrible birth defects – particularly microcephaly, which results in babies born with small heads and underdeveloped brains.

In response to the news out of Miami, the U.S. Centers for Disease Control and Prevention said Monday it was sending an eight-person team to assist local officials.

On Tuesday, the CDC said it had awarded more than $16 million to 40 states and territories to create “information-gathering systems” to quickly detect microcephaly. This money is a “stopgap diverted from other public health resources until Zika funds are provided by Congress,” the agency said in a news release.

President Barack Obama has asked Congress to allocate $1.9 billion to combat the Zika threat, but federal lawmakers have yet to act on the request.

The CDC has said repeatedly that it expects to see cases of local transmission of the mosquito-borne Zika virus this summer in warm, humid southern states such as Florida, Louisiana and Texas. The virus is typically transmitted through the bite of Aedes mosquitoes.

But U.S. officials said they don’t expect to see a Zika epidemic in the United States similar to those in Latin America. The reason: better insect control as well as window screens and air conditioning that should help curtail any outbreaks.

High Doses of Fish Oil Might Help Healing After Heart Attack

Heart attack patients who took high doses of fish oil supplements for six months showed improved heart function and less scarring, researchers report.

In the study, 360 heart attack survivors were followed for six months. Half of them were give 4 grams of omega-3 fatty acid supplements daily for six months, while the other half were given placebo pills.

Using MRIs of the heart, the researchers found there was a 6% improvement in both heart function and scarring in undamaged parts of the organ among patients who took 4 grams of omega-3 fatty acids daily.

“What we need to study going forward is whether higher doses of omega-3 can reduce mortality rates. Can we do better than produce 6% heart improvement and 6% less scarring?” said senior author Dr. Raymond Kwong. He is director of cardiac magnetic resonance imaging at Brigham and Women’s Hospital in Boston.

Previous studies where lower doses of omega-3 fatty acids were given after heart attacks had yielded “mixed results.”

Kwong said he was prompted to conduct the study after improved MRI technology made it possible to take a closer look at heart function and scarring of undamaged parts of the muscle.

Omega-3 fatty acids may permit the hart to contract more easily and reduce swelling in undamaged regions, Kwong noted.

Wisdom Wednesday: My Future Me

Have you seen the add on TV for Puritan Pride fish oil? It speaks to taking fish oil now to create a healthier you in the future. Certainly, taking fish oil daily is one of my basic recommendations for a healthier you.

Almost without exception, my patients come to me about the here and now. Once in while I do get a new patient that is “healthy” and just wants to stay that way or maybe improve a little. But the vast majority have symptoms and illness that are chronic in nature. Even the patient with acute low back pain from an injury typically has ramped up inflammatory pathways from underlying chronic health issues that disallow a speedy recovery.

By contrast, most young children enjoy relatively good general health. That is evidenced by their response to care. The eight-year-old boy that injuries his elbow throwing in little league seldom exhibits excess prostaglandin inflammatory pathways. You adjust the elbow, he tests the range of motion instinctively and remarks “It’s OK now, the pain is all gone” and runs off to play.

As we mature and become adults, the production of growth hormone decreases and we go into maintenance mode. Unfortunately, most of us do a poor job of maintaining our bodies. This is reflected in my practice as patients too often do not make the transition from acute care to long term support.

If we look again at the acute low back case, the injury reflex resolves with initial treatment. Local injury reflexes and spinal stability can require two or three visits to normalize. It’s the systemic inflammation that most often delays full recovery. For about 60% of the cases, fish oil is the key to reining in prostaglandin inflammation. Initially, I use 4, 6 or even 8 pearls of fish oil per day to reduce prostaglandins (PG2). Once achieved, I impress on each and every patient – take two pearls per day as a maintenance dose.

However, many of these patients will return in six months or a year with another low back episode. Sure they tweaked their low back but they also stopped the fish oil a few months earlier and systemic inflammation has gone wild again preventing a quick recovery.

Patients will go through multiple episodes before finally deciding that maybe spending $15 a month on fish oil beats the pain, suffering, and cost of repeated care.

Menopause Hastens Aging

Menopause, and the insomnia that often goes along with it, can speed aging in women, two new studies suggest.

“For decades, scientists have disagreed over whether menopause causes aging or aging causes menopause,” said Steve Horvath, senior author of both papers. “It’s like the chicken or the egg: which came first? Our study is the first to demonstrate that menopause makes you age faster,” said Horvath, a professor of human genetics and biostatistics at the David Geffen School of Medicine at the University of California, Los Angeles.

He and his colleagues said they found that menopause boosts cellular aging by an average of 6%. “that doesn’t sound like much, but it adds up over a woman’s life span,” Horvath added in a UCLA news release.

For example, a woman who began early menopause at age 42 would be a full year older biologically at age 50 than a woman that same age who began menopause at age 50.

Insomnia, which often accompanies menopause, can also lead to faster biological aging, according to the second study. “Not getting restorative sleep may do more than just affect our functioning the next day; it might also influence the rate at which our biological clock ticks,” said Judith Carroll. She is an assistant professor of psychiatry at UCLA’s Semel Institute for Neuroscience and Human Behavior, and first author of the sleep study.

“In the women we studied, those reporting symptoms such as restless sleep, waking repeatedly at night, having difficulty falling asleep and waking too early in the morning tended to be older biologically than women of similar chronological age who reported no symptoms,” she said.