Vitamin K is needed for osteocalcin, a protein, to transport calcium from the blood and connect it to the bones.  Without adequate vitamin K, this important process doesn’t occur and the crippling effects of osteoporosis go unchecked.  Calcium if it is not taken up to form bone mass, in the vitamin K deficient state, instead deposits into the arterial wall.  Thus, we see aging adults with hardened arteries, brittle bones, osteoporosis, and deficient of calcium.

Bone is a dynamic tissue that is in constant formation through a process called remodeling.  Remodeling is highly regulated by both hormonal and growth factors to preserve bone mass.  Other factors that can contribute to osteoporosis are vitamin D absorption, abnormal bone matrix or phosphorus deficiency which is most likely rare in the American diet.  In the absence of these conditions as a cause for osteoporosis, perhaps vitamin K is a treatment option you should discuss with your doctor.

European studies demonstrated vitamin K2 was superior to K1.

Digestive disorders include Irritable Bowel Syndrome,  GERD, and  Inflammatory Bowel Disorder to name a few.  Where do they come from and why? Infection? Food allergy? Stress?  It seems in recent years, the number of people suffering from gastrointestinal disorders continues to increase.  It is estimated that 20% of the U.S. population (or around 60 million individuals) suffer from irritable bowel syndrome, or IBS, and an additional 1.4 million individuals suffer from inflammatory bowel disorder, or IBD. Another estimated 7 million suffer from GERD, or gastroesopageal reflux disease.

Sometimes the cause of digestive disorders can seem elusive.  While there can be genetic links causing predisposition, there are several environmental factors that may also play a role.  In some individuals there seems to be a link with a previous gastroenteritis (prior intestinal infections such as salmonella, e. coli, etc.).  Previous antibiotic use can also be a risk factor for the development of intestinal symptoms.  For others, the cause of symptoms may be related to food allergy, either along with previous intestinal infections, or as a sole cause.  Another related issue seems to be alteration in gut microflora, or a change in the bacteria and other organisms that make up the intestinal ecosystem.  We call this “dysbiosis.”

In Part I of this series, I would like to focus on dysbiosis and how it can be related to intestinal symptoms.  Dysbiosis is defined as a state of altered microbial ecology that causes or contributes to disease/dysfunction.  Organisms of low intrinsic virulence, such as bacteria, yeast and protozoa/parasites, induce disease or dysfunction by altering the nutrition, neuroendocrine and/or immunologic responses of a person.

There are normally around 100 trillion bacterial cells in the human intestinal tract along with a smaller number of yeast colonies (that are kept in check by the bacteria) that are part of our normal flora. These organisms are vitally important to the development and maintenance of a healthy immune system. Some of their “jobs” include: warding off pathogens, decreasing allergic responses, and helping in the excretion of toxins.  A fact you may not know is that 80% of the body’s immune system is located in the lining of the small intestine—allowing alterations in the intestinal ecology of bacteria and yeast (=dysbiosis) to have far-reaching impacts on our overall immune system function. When the natural microbial balance is disrupted, illness can result.

You may be wondering  what causes dysbiosis? Well, there are many factors.  For one, frequent or prolonged antibiotic use can have long-standing effects on the intestinal ecosystem because antibiotics destroy good bacteria as well as the target infection.  This fact is becoming increasingly well-known, as probiotics are becoming more commonly used as a method to replace the good bacteria in the intestinal tract. Unfortunately, sometimes probiotics are not enough, and further evaluation and treatment is necessary when intestinal symptoms start after frequent/prolonged antibiotic use.

Other medication related causes of dysbiosis can include use of oral steroids, as well as proton-pump inhibitors or acid-blocking medications.  Other infectious causes of dysbiosis involves parasitic infections. While we generally associate parasites with travel abroad, it is possible to pick up a parasite without leaving the country, just by drinking contaminated water or eating contaminated food (at a restaurant, etc.).   Finally, it has been shown that stress in and of itself, can cause imbalances in intestinal flora.

Fortunately, there are ways to detect and treat some of these hidden causes of dysbiosis.  In many instances, digestive symptoms can be greatly alleviated, if not resolved, with some detective work and the appropriate treatment.

Check back for the next part to this series.

Lebowitz, M and Kapadia, A.,  “Body Restoration: An Owners Manual” ; 2011.

Galland, L., “ The Four Pillars of Healing”,  New York: Random House; 1997.

uptodate.com (topics: IBS, IBD)

http://medinfo.ufl.edu/~gec/coa1/gerdfaq.html

Source: Abstract from Postgraduate Medicine, Volume 121, Issue 1, January 2009, ISSN-0032-5481, e-ISSN-1941-9260

Author : Kent Holtorf, MD,  Holtorf Medical Group, Inc,  Torrance, Ca.

Due to the ongoing debate regarding safety and efficacy of bioidentical hormones (estradiol, estriol, and progesterone), this paper aimed at evaluating evidence comparing the same to commonly used  synthetic hormones and HRT.  Utilizing published papers identified from PubMed/MEDLINE, Google Scholar and Cochrane databases, evidence was collected regarding compared effects for physiologic actions on breast tissue, risks for breast cancer and cardiovascular disease, clinical outcomes and in vitro results.

Reported was patient satisfaction with HRT that contained progesterone compared to synthetic progestin.  Bioidentical hormones have “distinctly different, potentially opposite, physiological effects compared to synthetic counterparts, which have different chemical structures.”   While research indicated increased risk for synthetic progestin, conversely, progesterone consistantly is associated with diminished risk for breast cancer. Four articles were cited for progestin and seven articles for progesterone.   Regarding cardiovascular disease, progestins carry a variety of negative effects which may be avoided with progesterone.  Estriol has some unique physiological characteristics from estrogen counterparts and while it is expected to carry less risk for breast cancer, no randomized controls have been documented.

The effects of progesterone compared with progestins included a 30% reduction in sleep problems, a 50% reduction in anxiety, a 60% reduction in depression, a 30% reduction in somatic symptoms, a 25% reduction in menstral bleeding, a  40% reduction in cognitive difficulties, and a 30% improvement in sexual function resulting in 65% of women who felt HRT combined with progesterone was better than the HRT combined with progestin.

The conclusion of this article, based on thorough review of medical literature is support for the claim that bioidentical hormones  have some effects distinctly different or opposite of their synthetic  counterparts.   More randomized control trials of substantial size and length will be needed to determine these differences.

Dr. Holtorf discloses no conflicts of interest.

The fast-twitch muscle fiber recritied during high-intensity, low-endurance movements such as weight lifting and sprinting are mostly affected by creatine deficiency.  There is plenty of research found to support that creatine in supplemental form can improve some of the physiological changes in aging.

After exercise, free radical production increases, a potentially negative effect if the body can’t manage them.  Creatine may help modulate inflammation due to some anti-inflammatory properties by reducing cell damage caused by exercise.

One of the most profound ways creatine affects individuals is improving the cell’s ability to raising ATP status in the mitochondria thus resulting in improved energy.  In vegetarians and non-vegetarians alike, creatine has been shown to improve brain function in healthy adults.  It may work better when combined with other nutrients such as chromium and alpha lipoic acid.

Usual dosages range from 2-3 grams in the healthy adult and those with muscle loss or brain injury may benefit from 5-10 grams per day.  A good source is often found in whey products.

Osteoarthritis is the loss of articular cartilage (the cartilage covering bones) which thins and eventually wears out, resulting in a “bone against bone” joint, reduced motion accompanied with pain.  Progression includes concurrent subchondral bony sclerosis (located just below the cartilage) and bony proliferation at the joint margins and growth of osteophytes or bone spurs.

Osteoarthritis affects  the joints exposed to high stress and is therefore considered the result of “wear and tear” rather than a true disease.

The symptoms of osteoarthritis are a gradual onset of perhaps one or a few joints.  Pain ensues that is deep, aching, worse with movement and better with rest and warmth.  Stiffness is identified as worse in the morning upon rising and after periods of rest but improves with movement.  Patients incur sleeping issues related to pain and stiffness.   Cartilage in the joint spaces begins to wear and weakness of the joint when weight bearing is seen.  Chronic conditions have acute flare-ups of pain, swelling, and stiffness.

Many patients find relief with improved diet and addition of supplements.  Suggestions include glucosamine, chondroitin, MSM, vitamin E, calcium, magnesium, vitamin C, essential fatty acids and bosweillia acid, and cetyl myristoleate.

A few weeks ago I was listening to a radio talk show and a gentleman in the car business called in responding to a woman with the same frustration.  He said to use automobile buffing compound and fine steel wool as instructed on the can to successfully clean  shower doors.  I just tried it and I am excited to report it does a great j0b.  After all these years, having suffered with multiple chemical sensitivity in the past, I find this is very low odor and seemingly non-toxic.  Within  30 t0 45 minutes my shower was sparkling clean looking almost new.  It also cleaned the brass and floors as well.

You will need:

Rubbing Compound
Gloves
Fine steel wool
A pale of water
Rags

Instructions are to clean a small area at a time with the steel wool as an applicator.  Do not allow the compound to dry.  Instead, once applied and rubbed for desired amount of time,  wipe it off with a damp cloth.  You will want to rinse out your rags as you go.  Change the steel wool as you need but do not get it wet.

A word of caution;  do not use any other clean in conjunction with the rubbing compound.   Spraying the shower with a bleach or mildew cleaner,  for example,  will result in toxic fumes.

Break down of fatty acids in an abnormal fashion causes an inflammatory load which does unhealthy things to body tissue. If you expose cartilage, cancer, arthritic tissue to a specific signal of inflammation called alpha, they will always respond as if they are under attack.  Chronically exposed poor dietary input can cause or predispose a downward spiral in the body upset.  For example, the problem may be a missing array of essential fatty acids.  Over nutrition seems to be a problem and not sufficient oils or anti-inflammatory products.  If the body can stabilize with eating right, exercise, not smoking or drinking, then the body becomes more stable. 

With a wound you would expect a short term inflammation situation which is a good thing.  The brain is just like other tissue.  We need to replace at least at the same pace as old stuff carrying off. The human brain also experiences changes related to inflammatory factors.  The brain wants to heal with growth of new neurons, a normal response of learning that deals with activity where they grow and dispose of old stuff. 

 Conventional approaches to control of body fat includes weight loss and exercise.  MRI can identify the infiltration of visceral fat around and in specific tissue, but Michael Glade suggests the use of a laboratory test called C Reactive Protein (CRP) to get some inkling that inflammation is present.  There may be a balance between CRP and the oil EPA (Eicosapentaenoic Acid).  Normal  ranges are tested with a group of norms which may be difficult to identify.  What is normal within a group since the control group could represent those in the elevated portion of the population?  We just don’t know. (A test we may use is a genetic test which identifies inflammation from a hereditary factor, particularly when trying to decide if the influence may be environmental rather than hereditary.)

 One of the markers for longevity is control of abdominal fat which is identified as the visceral load.  An inflammation marker is a practical approach of getting the belly fat down.  The dual nature of obesity is that if there is an imbalance in the body, then there is going to be an unintended consequence.  The goal needs to be met to control and modify abdominal fat load. 

A few of the suggestions he gives are as follows:

*Our food supplies have become disconnected from nature.

*Learned failure is when you change lifestyle and then over-exercise. If the patient losses 10 pounds but hurts and is fatigued from over exercising,  they will have an excuse to not stay the course.

*When failure of weight loss occurred due to calorie restriction becoming very aggressive with omega 3 fats using  3-5 tablespoons of flax or fish oil would give good results.  The body wouldn’t change weight but it would reshape.

*Efficiently operating digestive tract is important.

*Activity needs to be increased.  Failures often are because activity isn’t high enough.

*Cause is heightened inflammation- imbalance can be tipped either way and neither may be the most beneficial.

*Anti-inflammatory medications often are mild poisons that push the body back into less inflammation-Dr. Glade questions if this is a good thing.

*Structural fats do very important replacement of fatty acid membranes.

* Use omega oils generally for inflammatory condition.  These are not generally stored or used in the body as caloric intake as the fundamental function of fatty acids in many ways is to restore balance.  They don’t suppress or stimulate inflammation.  Balancing inflammation is what they do and are essentially not drug like, they don’t turn off signals.  

*Suggested Ratio EPA:DHA  EPA 3,000 mg of product  4,000 mg DHA to renormalize triglycerides in the system.  This information is recognized by the drug industry.

Other products:

*Diet: avoid process starches and fatty acid meat and increase fruit and veggies.

* Development of brain is dependent upon DHA and is not found in most any place other than fish. 

* Berries, diversifying your response system is appealing.Recommended are 10 servings of fruit and vegetables per day. Salads are encouraged before meals.

* Starchy vegetables are off the menu. 

*Manganese, selenium, and other trace minerals can only come from our soil.  We are at a point of having to resort to food supplements.  Even if the soil is fortified, the soil is exhausted.  Consequently, trace mineral supplements are absolutely essential.

    - Selenium 100 mcg-anti cancer effective-balance with iodine

     – Chromium 1,000 mcg for sugar regulation of the body

*Boron 2 mg- places a role in digestion -good for inflammation in digestive tract and central nervous system

*Carnatine and acetyl-carnatine- heart and skeletal-less free-radical production

*Co-Q10 increases efficiency of fat burning and make systems more efficient-less free radical production resulting in feeling and moving better. 

Calcium-drop dairy because it causes inflammation-calcium supplement, vitamin D- Take optimum dose over 5-6 times per day for absorption.

Dr. Glade notes slim people fidget 2-3 hours more times per day and are always moving.

www.cemmed.com

www.healthwatchcentral.biz

I became acquainted with his work through a DVD given to me by NeuroScience.  We have use NeuroScience protocols with great success; a company that focuses on “Target Amino Acids” as a means to address healing of the adrenal gland and balance neurotransmitters for the treatment of many symptoms including anxiety, sleep maintenance and insomnia, depression, and memory loss.

Dr. Glade is a Certified Nutritional Specialist (CNS) with degrees from the Massachusetts Institute of Technology (MIT) and Cornell University and teaching and research experience at Rutgers University, the University of Maryland, Northwestern University and at the Nutrition Institute of the University of Bridgeport. [1] 

Dr. Glade contends that when a patient has obesity for 5 years or more, the cellular mechanism is disrupted and regulation is thrown off through nutritional and other influences.  Cancer, arthritis, allergy, digestive literature look for a common thread which is traditionally separate in peoples minds as separate diseases, but it is looking more and more that they are individual symptoms manifested in an individual similarly condition.  It starts with people who eat improperly and once the  condition of unregulated inflammation develops, then under that umbrella,  one could end up with all the listed above common disease.

Insulin resistance falls under this umbrella where something goes arye in the metabolism of glucose within muscle cells.  People don’t get better, they get worse.  It doesn’t cure or arrest with the use of any existing medications. Control of diabetes II and insulin is not cured or suppressed by any existing treatment medications.  The premise is that people who have insulin resistance will slowly but surely deteriorate.  Dr. Glade believes there is something missing in that model.  We are treating a blood level of insulin but not the disease. He suggests that something, possibly environmental is the missing piece.

Research suggest abdominal fat in the visceral organ (around organs inside) appears to be genetically different from much of the than other fat in the body.  It is the most insulin responsive part of the body. In insulin resistance patients, the insulin is not responsive on the muscle whereas the belly fat stores is over reactive and sucks the insulin up.  The degree of hypersensitive reflects as the more inflamed they become.  The more inflamed they are the more tendencies they have to over-store abdominal fat.

Insulin control in the pancreas is disturbed when the body is carrying a high amount of an inflammatory formed, abnormal cytokine molecules produced by the body so one part of the body can communicate with another part. Overreactions throughout the body because of  lifestyle, environment, diet, result in tissue not normally responsive, but will then activate due to an overexposure of inflammation.  This will force the organ to over-respond.  This condition is not well monitored or regulated in the body.  The blood has an almost unlimited capacity to carry these inflammatory molecules in the body.  This response is what needs to be brought under control and can only be accomplished by improved lifestyle, environmental factors, detoxification, and a healthy diet.

Part 2 will address what can be done about this dynamic problem.

[1]Dr. Michael Glade emphasizes  specific dietary plans and supplement protocols, especially in programs targeted at brain function, weight reduction, smoking cessation, and life extension for the terminally ill.  Dr. Glade lectures extensively across the US and Europe. Dr. Glade is a noted researcher who is deeply appreciated in the nutritional and scientific communities for providing a significant body of peer-reviewed substantiation for multiple health claims that have been approved by the FDA.

What it does not mean is what your doctor thinks is beneficial or necessary.  No, the insurance company decides if recommendations meet community standards which are encompassed in the field of traditional medicine or medical literature reviewed by peers only.

If you see the doctor for a condition or illness that does not include a primary diagnoses, the service cannot be billed at a level that meets coding requirements and will be denied.

Conditions such as yeast infections, sometimes (depression, anxiety, psychiatric codes), heavy metal burden, multiple chemical sensitivity, erectile dysfunction and many others are not primary diagnoses codes.  Irritable Bowel Syndrome is a primary code (criteria must be met for this as with diarrhea and constipation.)  Gas and bloat are not primary.

Some patients arrive at the doctors office with a short list, wanting only a specific condition addressed.  When this happens, it may automatically set the course for denial by the insurance company.  The insurance company wants to see primary diagnoses codes which are define by a coding standard.  Requirement for correct billing is an appropriate ICD-9 code or billing code and a primary CPT code.  

Uncovered codes are patient responsibility if waiver is signed.  Before you leave the clinic with a laboratory test, we will provide you with the cost of the test and the extent of what we believe your insurance will pay.  That amount will be collected at the time of service.   We cannot guarantee your benefit amount because your insurance will not guarantee the information received when we call and verify benefits.  They state and our business agreement states that you solely are responsible for bill regardless of your insurance coverage.

Sample Profiles (list not complete for covered and uncovered tests):

Pesticide Panels:   You must provide a payment for the total billed to the laboratory.  We can then bill your insurance company, later refunding you if coverage is accomplished. 

Amino Acid Assays, Nutritional Based Assays-most insurance companies do not pay these items, however, through an agreement with the laboratory, we can accomplish quality assays for amino acid serum, RBC mineral, organic acid and fatty acid profile for a very low cost.

Genetic Testing-.While this is not a covered expense at this time, there is talk that it may be in the future.  You should consider, if that benefit becomes available, the consequences your genetics may have on life insurance, for example.  

Comprehensive Detoxification Panel:  Portions of this tests are not covered by insurance, therefore, unbilled portions are paid to the patient.  We notify you what we believe your responsibility will be.

DMPS Chelation Therapy and Metals Challenge Test-Does not meet medical necessity and is therefore paid by the patient.  See next segment.

EDTA Chelation Therapy and Metals Challenge Test-We use this therapy for reducing specific heavy metal burden.  Because the conditions we treat are due to chronic exposure, only on rare occasions does insurance ever pay.  Payment is always due date of service.  Toxicity is defined by blood test only and is rarely seen in patients with acquired body burden.   The appropriate test in this case usually will not qualify you to meet medical necessity.  Payment in full is required by the patient.

Environmental Pollutants-We will not bill for this service as most of it is not covered by insurance, therefore, paid in full by the patient.

Food & Inhalant Testing-covered if qualified.  Qualifying a patient includes ages under four, autoimmune disease and chronic skin conditions such as eczema or psoriasis where the doctor believes skin testing may worsen the condition, chronic use of antihistamines without benefit and steroid use.

Hair Analysis-We will not bill for this service as  it is not covered by insurance, therefore, paid in full by the patient.

Vitamin Mineral IV’s-generally not covered and PPO insurances requires that you provide documentation after the service is performed to see if it meets medical necessity.  Therefore, we require payment upfront with a waiver.  In almost every case, insurance does not cover.  

Other tests such as the ION and TRIAD panel by Metametrix is payable in advance.  We will then bill your insurance company and refund any portions paid.  

Stool Testing:  Payable if criteria is met.

Center for Environmental Medicine

Health Watch Central