Monday, May 19, 2014

Ayurvedic Medicine: Ancient Insights in to Modern Health Care

Dr. Stuart Rothenberg
by Stuart Rothenberg, M.D.

For information about "Integrative Ayurveda for Personal Wellness and Professional Training," co-sponsored by University of Maryland Center for Integrative Medicine, please visit www.ayurveda-courses.org.

Ayurveda, the traditional medical system of India, is the world’s oldest system of natural medicine and the original mind-body science. There is currently an upsurge of interest in Ayurvedic medicine in the North America, both among health professionals and the general public. Ayurveda offers an extensive, individualized approach to prevention of disease not typically found in conventional medicine. In addition, Ayurveda has a holistic approach to treatment of chronic disease that includes mind, body, behavior, and environment.  Ayurveda also includes a classical system of pulse diagnosis that can be readily learned and applied in a contemporary setting.

The word Ayurveda comes from two Sanskrit roots: Ayus, meaning life or life span, and Veda, meaning knowledge or science. Ayurveda is therefore translated as "the science of life," which emphasizes its orientation toward prevention. The major textbooks of Ayurveda, the Charaka Samhita and Sushruta Samhita, cover the major branches of medicine under much the same headings as conventional allopathic medicine, though with a preventive and holistic orientation. The Ayurvedic pharmacopeia includes thousands of plants and plant products, many of which are now familiar therapeutic agents, such as rauwolfia and digitalis. 1-2

Unfortunately, over centuries of colonial rule in India when Ayurvedic institutions were not officially supported, and were even actively suppressed, much important clinical and theoretical knowledge became lost or unavailable. As a result, Ayurveda's effectiveness became limited, as practitioners did not have access to the full range of its comprehensive approaches. A modern revival of Ayurveda, taking into account all of these approaches in accordance with the classical texts, is known as Maharishi Ayurveda. This restoration has taken place under the direction of Maharishi Mahesh Yogi in collaboration with leading Ayurvedic physicians and scholars.3-4

The Ayurvedic Framework

Maharishi Ayurveda emphasizes host factors, particularly imbalances resulting from disruption of intrinsic self-repair and immune mechanisms, as the primary factor in the etiology of disease. The Ayurvedic paradigm is thus reminiscent of Louis Pasteur’s famous statement that “the invader is nothing, the terrain everything.” Ayurveda holds that underlying the functioning of the host’s innate homeostatic and “self-healing” mechanisms is an unmanifest (non-physical) field of biological intelligence, the body’s “inner intelligence” (Atma). Ayurveda places central importance on enlivening this most fundamental level of intelligence in order to promote health and healing from within.  It prescribes a variety of modalities, including mind-body approaches, to accomplish this goal.

The principle of biologic individuality is central to Ayurvedic diagnosis and treatment. In examining a patient, the practitioner trained in Maharishi Ayurveda takes into account the particular pathology, but also the constellation of unique psychophysiological characteristics that constitute the individual. Thus in Ayurveda, assessment begins with diagnosis of the individual’s constitutional type or “mind-body type,” which is the starting point for developing an effective prevention or treatment program. In this, Ayurveda presages the trend toward “personalized medicine” now emerging within conventional allopathic medicine. The principle is that foods, medicinals, behaviors, and lifestyle that may be therapeutic for one individual will be different from those that will be therapeutic for another individual, depending upon the individual’s psychophysiological make-up or constitutional type.

According to Ayurveda, three irreducible physiological principles called Doshas regulate the different functions of mind and body. These three fundamental physiological “operators” are understood as the three basic modes of expression of the underlying field of intelligence. In Sanskrit, the three doshas are called Vata, Pitta, and Kapha. Health depends upon achieving a state of functional balance of these three operators. Everyone is endowed at birth with some value of all three doshas, but in each person the exact proportions vary. This proportion determines the psychophysiological type. There are ten classic types, derived from the combinations of the three doshas.

The three doshas are further subdivided into numerous subdoshas with different locations and functions throughout the body. Imbalance in the doshas and subdoshas disrupts normal function and is responsible for various disorders. Since different subtypes of doshas and their combinations affect different organ systems, the practitioner can learn to correlate the Ayurvedic diagnosis with the disease classification of allopathic medicine.

Vata dosha represents motion and flow. Physiologically, it is at the basis of respiration, circulation, and neuromuscular activity. Vata imbalance predisposes to diseases of the nervous system, chronic pain, cardiac arrhythmias, hypertension, degenerative arthritis, constipation, anxiety, and insomnia. Pitta dosha directs all metabolic activities, energy exchange, and digestion. Pitta imbalance predisposes to peptic ulcers, inflammatory bowel diseases, skin diseases, allergic reactions, and most inflammatory conditions. Pitta imbalance is also responsible for anger, hostility, and jealousy. Kapha dosha represents structure, cohesion, and fluid balance. Kapha imbalance predisposes toward congestive disorders, sinusitis, diabetes mellitus, obesity, atherosclerosis, and tumors. Kapha imbalance is also responsible for feelings of over-attachment and greed.

Knowing the psychophysiological type can help the practitioner diagnose existing disorders and predict risk for future illnesses. The practitioner trained in Ayurveda correlates both the Ayurvedic and allopathic findings and then develops a treatment or prevention plan integrating both modalities.

Diagnosis

Western practitioners training in Ayurvedic medicine learn a system of diagnosis similar in many respects to the conventional allopathic model. Termed the “3-fold” classical Ayurvedic approach, it includes careful observation of the patient, history taking, and physical examination. However, a special feature of Ayurvedic diagnosis is the meticulous attention given to signs and symptoms that are diagnostic of the patient’s constitutional type.

Another unique aspect of the Ayurvedic approach is pulse diagnosis (nadi vigyan). Through palpation of the radial pulse, advanced Ayurvedic practitioners are able to diagnose diseases not limited to the cardiovascular system, such as diabetes, musculoskeletal diseases, immune disorders, and asthma. However, even Western practitioners at much earlier stages of training can learn to detect physiological imbalances at incipient stages, when there may be no other clinical signs and when mild forms of intervention may suffice.

In Ayurvedic pulse diagnosis, the combinations of the doshas and subdoshas responsible for the patient's clinical status are felt as patterns of vibration in the radial artery. Vata, Pitta, and Kapha have different tactile vibratory qualities—as do their subdoshas. The presence and locations of these vibratory qualities in the pulse alert the practitioner to specific patterns of balance and imbalance that underlie and are responsible for the patient's condition. During training, the practitioner first takes his or her own pulse many times a day, becoming intimately familiar with how it changes under different circumstances. Following this initial stage of training, the practitioner learns to perform pulse examinations on others.

Therapeutics

The main emphasis of Ayurvedic therapeutics is to restore physiological balance, which equates with restoring balance to the doshas. In Ayurvedic terms, balance is defined as the condition that maximally enhances homeostatic and self-repair mechanisms. These strategies are divided into four main areas: mind, body, behavior, and environment.

Mind.—In the Ayurvedic framework, the body is viewed not merely as a sophisticated machine, but as a physical expression of the underlying abstract field of intelligence. Ayurvedic practitioners identify this underlying field as consciousness and locate consciousness at the basis of the physiology rather than as an epiphenomenon of the nervous system. Therefore, Ayurvedic practitioners use mental techniques for the treatment of diseases, reducing stress, and developing mental potential.

Chief among these techniques is Transcendental Meditation (TM), which has been the subject of over 350 peer-reviewed published studies, including a series of randomized controlled trials on TM and cardiovascular disease funded by over $25 million in grant support from the National Institutes of Health. During the process of Transcendental Meditation, there are metabolic changes indicative of a wakeful hypometabolic state (“restful alertness”). Published studies on this technique have reported associations between the use of Transcendental Meditation and reduced hospitalization and health care utilization; increased longevity and quality of life; significant reduction in death, heart attack, and stroke in heart patients; and reduced anxiety, hypertension, insulin resistance, and substance abuse. The American Heart Association, in a recent scientific statement, cited the Transcendental Meditation technique as the only meditation procedure that has been documented to reduce blood pressure, and recommended its consideration for inclusion in clinical programs for treatment of hypertension.5-11

Body. —These approaches include the use of diet, exercise, herbs, sensory modalities, and panchakarma (purification procedures that include medicated oil massages, herbalized heat treatments, and elimination therapies).

Therapeutic actions are maximally effective only if appropriate dietary measures are instituted to support the restoration of physiological balance. Ayurveda classifies all foods according to their effects on Vata, Pitta, and Kapha. With this knowledge, the physician can individually tailor a diet appropriate to the patient's type and imbalances. Recommendations are also based on other factors, including seasonal influences and digestive capacity.2-4

The practitioner trained in Ayurveda also prescribes herbal food supplements. Ayurveda's description of medicinal plants includes knowledge of action, timeliness of plant collection, storage, and steps of manufacture. One principle is paramount—the appropriate portion of the plant should be used in its entirety, not just the active ingredient. This is believed to produce a synergistic effect and prevent toxic side effects.12

Behavior.— The Ayurvedic texts predated contemporary knowledge of circadian and circannual cycles. According to psychophysiological type, each patient is instructed in daily and seasonal health routines to maintain the integrity of key biologic rhythms. These include simple instructions for rising and retiring early, moving the bowels on awakening, eating the main meal at lunchtime, and exercising properly according to constitutional type.3-4

Environment. —Ayurvedic texts emphasize the importance of collective health and the interrelationship between the health of the individual and that of society. Therefore, collective and environmental health measures to maintain the health of society and to construct a healthful environment for living and working play an important role. Analysis of psychophysiological type is important in many of these prescriptions, as individuals differ in their responses to environment and types of occupations.3-4

Applying Ayurveda to Allopathic Medicine

Ayurveda adds several new elements to medical practice. Its system of patient typology provides useful information for predicting risk factors and tendencies toward specific diseases. Its emphasis on psychophysiological balance as the key to enhancing the body's own healing mechanisms and its therapeutic methods to modify dietary, behavioral, and environmental determinants of disease can add new depth to the practitioner’s approach to a wide variety of disorders.

The training program in Ayurvedic Medicine is co-sponsored by University of Maryland Center for Integrative Medicine and Maharishi Ayurveda Association of America. It is available in two tracks:
            ·         Health Professionals track: a 66-hour certificate training program for physicians and other healthcare providers to enable them to incorporate Ayurveda into their practices
            ·         Wellness Educator track: a 56-hour certificate training program for individuals who wish to be trained as Ayurveda wellness educators, or who wish to take the program for their own enrichment and knowledge.

Both tracks include training in pulse diagnosis, body-type assessment, and prescription of individualized prevention and treatment programs, including nutrition, detoxification, stress reduction and other non-pharmacological approaches to promote health and healing from within. Both tracks may be taken online in a distance learning format as well as live onsite in weekend modules. 

For further information about the training program in Ayurvedic Medicine offered at the University of Maryland, Baltimore, visit www.ayurveda-courses.org/umd.html. Or you may email info@ayurveda-courses.org or call (877) 540-6222.

References:

1.  Bodeker G. Evaluating Ayurveda. Journal of Alternative and Complementary Medicine 2001;7(5): 389-392.

2.  Mishra LC (ed.): Scientific Basis for Ayurvedic Therapies. CRC Press (USA); 2003.

3.  Sharma HM, Clark C, Micozzi M: Ayurvedic Healing: Contemporary Maharishi Ayurveda Medicine and Science. Singing Dragon Press, 2012.

4.  Rothenberg S, Belok S, Fields JZ. The Maharishi Vedic Medicine Chronic Disorders Program: Introduction and Case Histories. Alternative and Complementary Therapies 2003;9(4):183-190.

5.  Anderson J.W., Liu C., and Kryscio R.J., Blood pressure response to transcendental meditation: A meta-analysis. Am J Hypertens 2008; 21:310-316.

6.  Paul-Labrador M., Polk D., Dwyer J.H., et al., Effects of a Randomized Controlled trial of Transcendental Meditation on components of the Metabolic Syndrome in Subjects Coronary Heart Disease. Archives of Internal Medicine, 2006, 166:1218-1224. 

7.  Schneider, R.H., Alexander, C.N., Staggers, F., Rainforth, M., Salerno, J.W., Hartz, A., Arndt, S., Barnes, V., and Nidich, S., Long-term effects of stress reduction on mortality in persons > 55 years of age with systemic hypertension. American Journal of Cardiology, 2005. 95(9): 1060-1064.

8.  Eppley, K., Abrams, A.I., and Shear, J., Differential effects of relaxation techniques on trait anxiety: A meta-analysis. Journal of Clinical Psychology, 1989. 45(6): 957–974.

9.  Orme-Johnson D.W. and Herron R.E. ,Reduced medical care utilization and expenditures through an innovative approach. Am J of Managed Care 1997; 3:135–144.

10.  Schneider RH, Grim CE, Rainforth MA, Kotchen TA, Nidich SI, Gaylord-King C, et al. Stress reduction in the secondary prevention of cardiovascular disease: Randomized controlled trial of Transcendental Meditation and health education in blacks. Circulation: Cardiovascular Quality and Outcomes. 2012;5(6):750-8.

11.  Brook, R. D., Appel, L. J., Rubenfire, M., et al (2013). Beyond medications and diet: Alternative approaches to lowering blood pressure : A scientific statement from the American Heart Association. Hypertension: Journal of the American Heart Association 2013: Vlm. 61.

12.  Williamson, EM (ed.): Major Herbs of Ayurveda. Churchill Livingstone, 2002.

Tuesday, May 6, 2014

The Power of Touch

By:  Rebekah Frizzelle Owens, LMT, NCTMB, CPMT, CIMI


Touch is not just a sense – it is a part of us that makes us human and makes us whole.  When a friend or family member is sad, instinctively we offer a hug or a hand to hold.  When you get a minor bump, you touch or rub the injured area.  When a small child is crying, we pat the little one on the back.  All these things are using touch to comfort and heal.  Saul Schanberg, an internationally renowned neuroscientist and physician, once said, “Touch is ten times stronger than verbal or emotional contact … we forget that touch is not only basic to our species, but the key to it.”  Touch really is a key, maybe the key, to who we are as humans.
Each of us needs to be touched to grow and thrive, to be our best.  In a 2013 article featured in Infant Behavior and Development, authors Abdallah, Badr, & Hawwari wrote, “The sense of touch is the fastest-developing sense in the infant following birth and is particularly important for the growing and developing preterm infants who are often deprived of gentle human touch.”  In their study, these researchers found that preterm infants who received massages from their mothers had significantly lower pain levels after the massage and at discharge and had higher cognitive scores at 12 months than did infants who did not receive massages.  In this study, massage was systematic touch by human hands that stimulated the infant’s tactile sense – something anyone can learn to do.  Other researchers, like Moskowski and Stack in a 2007 article in Infant and Child Development, found that touch can also establish strong physical and emotional connections between the caregiver and the baby, as well as play a powerful role in communication and affect regulation.
This extends into the adult population, too.  In A Natural History of the Senses, author Diane Ackerman wrote, “In the absence of touching and being touched, people of all ages can sicken and grow touch starved.”  Certified nursing assistants (CNAs) were taught to give “tender touch” massage to their elderly patients in one study by Sansone and Schmitt published in 2000 in Geriatric Nursing.  Over 70% of the CNAs thought giving the massage improved their ability to communicate with their patients and 62% believed it alleviated the patients’ anxiety levels. In addition, pain scores and anxiety scores decreased for majority of the patients.  All the tender touch massage entailed was the “the systematic, structured use of slow, gentle massage, stroking, and touching certain areas of the body that included the forehead neck, shoulders, back, and hands”  for 15 minutes twice weekly.  An easy feat for most caregivers – especially since it provides so many benefits.
Massage therapist Andrea Peri Ronsenfield once wrote, “The immediacy of communicating with another person by touching them in a nurturing and comforting and therapeutic way, with one’s hands, seems to lend itself so beautifully to evoking a sense of well-being.”  In fact, a 2010 study in the Journal of Alternative and Complementary Medicine looked at the biological effects of massage and touch and found that touch increased oxytocin (the “bonding” or “love” hormone) and decreased adrenal corticotropin hormone, which is often produced in response to biological stress.  This study showed that touch helps people bond and feel more at ease, and reduces the effects of stress.  That is certainly putting one on the path to wellbeing!
There are an ever-increasing number of studies showing the benefits of touch.  Recent research studies have shown that touch, in particular massage, can help with cancer-related fatigue and pain in cancer patients, low back pain, osteoarthritis of the knee, reducing post-operative pain, lowering blood pressure, reducing headache frequency, easing alcohol withdrawal symptoms, and decreasing the symptoms of carpal tunnel syndrome.
At the University of Maryland Center for Integrative Medicine’s Patient Care Clinic, newly named “The Center for Integrative Health and Healing,” we have a new massage therapist, three Reiki practitioners, and a reflexologist.  This team of “touch therapists” and energy workers would be a good place to start to learn more about the benefits of touch and to find out what touch could do to help you.  To schedule an appointment with one of them, please call 410-448-6361 or check out our website at www.compmed.umm.edu/patient_clinic.asp.  The Center for Integrative Health and Healing is also having an Open House on June 20 (1pm – 5pm) and June 21 (9am – 1pm).  Please call 410-448-6361 or visit http://www.compmed.umm.edu/open-house/ for more details.

References:
Abdallah, B., Badr, L.K., & Hawwari, M. (2013 Dec).  The efficacy of massage on short and long term outcomes in preterm infants.  Infant Behavior & Development, 36(4), 662-669.
American College of Physicians. (2008) Massage Therapy May Have Immediate Positive Effect On Pain And Mood For Advanced Cancer Patients. Science Daily 16 September. http://www.sciencedaily.com/releases/2008/09/080915174534.htm.
Currin, J. Meister, E.A. (2008) A hospital-based intervention using massage to reduce distress among oncology patients. Cancer Nurs 31(3):214-21.  http://www.ncbi.nlm.nih.gov/pubmed/18453878?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Field, T., Diego, Miguel, Cullen, Christy, Hartshorn, Kristin, Gruskin, Alan, Hernandez-Reif, Maria, Sunshine, William. (2004). Carpal tunnel syndrome symptoms are lessened following massage. Journal of Bodywork and Movement Therapies. 8:9-14.  http://www.massagetherapyfoundation.org/pdf/Massage%20and%20carpal%20tunnel%20syndrome.pdf
Hernandez-Reif M, Field T, Krasnegor J, Theakston H, Hossain Z, Burman I (2000). High blood pressure and associated symptoms were reduced by massage therapy. Journal of Bodywork and Movement Therapies, 4, 31 – 38.
Moszkowski, R. & Stack, D.  (2007). Infant touching behavior during the mother-infant face-to-face interactions.  Infant and Child Development, 16, 307-319.
Perlman AI, Sabina A, Williams AL, Njike VY, Katz DL. (2006) Massage Therapy for Osteoarthritis of the Knee. Arch Intern Med. 166(22):2533-8.
Piotrowski, M., Paterson, C., Mitchinson, A., Kim, H. M., Kirsh, M., Hinshaw, D. B. (2003) Massage as Adjuvant Therapy in the Management ofAcute Postoperative Pain: A Preliminary Study in Men. Journal of the American College of Surgeons, 197(6), 1037-1046.
Preyde M. (2003) Effectiveness of massage therapy for subacute low back pain: a randomized controlled trial. Journal of Soft Tissue Manipulation, 8, 4 – 10.
Quinn C, Chandler C, Moraska A. Massage Therapy & Frequency of Chronic Tension Headaches. (2002) American Journal of Public Health. 92(10):1657-61.
Rapaport, M.H., Schettler, P., & Bresee, C.  (2010). A preliminary study of the effects of a single session of Swedish massage on hypothalamic-pituitary-adrenal and immune function in normal individuals.  J Alternative and Complementary Medicine,16(10).
Reader M, Young R, Connor JP. (2005) Massage therapy improves the management of alcohol withdrawal syndrome. J Altern Complement Med. 11(2):311-3. PMID: 15865498.
Rosenfield, A. P.  Massage for the elderly.  Massage Therapy J 1988 Spring:45-8.
Sansone, P. & Schmitt, L. (2000). Providing Tender Touch massage to elderly nursing home residents:  a demonstration project.  Geriatric Nursing, 21(6):303-8.

Author Bio

Rebekah Frizzelle Owens, LMT, NCTMB, CPMT, CIMI has been practicing massage for 10 years.  In addition to being trained in prenatal and therapeutic massage for adults, she is a certified pediatric massage therapist, a certified infant massage instructor, and an advanced Reiki practitioner.  She works full-time as the PR Specialist for the University of Maryland School of Medicine’s Center for Integrative Medicine in Baltimore, MD, where she also lectures about massage in the Integrative Medicine elective for fourth year medical students.

Exploring the Soy Controversy: A Review of the Research

A Summary of “Soy Foods and Supplementation: A Review of Commonly Perceived Health Benefits and Risks” by Chris D’Adamo, PhD and Azize Sahin, MD

By Erin Peisach, RD, LDN
           
Soy, originally cultivated in Asia to preserve nitrogen in soil, is now a mainstream food and food product in the US market.  It is primarily available as soymilk, textured soy protein, soybean oil, infant soy-formula, soy protein powders, and faux animal products. US sales of soy foods increased from $1 billion in 1996 to $4.5 billion in 2009. The vast increase in the use and consumption of soy in the American diet warranted a thorough review of its safety and potential health benefits. As a dietitian, many of my patients ask me questions about soy and whether it may help or harm specific health conditions. The soy confusion stems from contradicting reports often seen in newspaper headlines, news articles, and health magazines over the past decade. One may say, “Soy Heals All” while the next may report, “Soy is Evil!” With such contrasting messages, digging deeper into current soy research will help elucidate the issue.

Chris D’Adamo, PhD, Assistant Professor at the University of Maryalnd School of Medicine in the Department of Family and Community Medicine and Director of Research in the Center for Integrative Medicine, and Azize Sahin, MD, University of Maryland School of Medicine Alumnus (’12), completed a comprehensive review of soy research to highlight its potential health benefits and risks. The article, recently published in the Alternative Therapies in Health and Medicine, focused on five perceived health benefits – relief of menopausal symptoms and prevention of heart disease, breast cancer, prostate cancer, and osteoporosis and five perceived health risks – increased risk of breast cancer, male hormonal and fertility problems, hypothyroidism, anti-nutrient content and harmful processing by-products. The authors reviewed and assessed the findings of scientific literature on soy through 2010. The findings revealed the following:

·         Perceived Health Benefits:
1.      Relief of Menopausal Hot Flashes: While women respond differently to soy consumption, some may benefit from the relief of menopausal symptoms.
2.      Protection Against Breast Cancer: The more soy foods consumed throughout one’s lifetime is inversely associated with the incidence of breast cancer
3.      revention of Prostate Cancer: There may be a reduction in prostate cancer risk in men who consume soy foods or soy supplements.
4.      Protection Against Coronary Heart Disease: Soy protein may be associated with a reduction in LDL cholesterol, with no impact on triglycerides, HDL and total cholesterol levels.
5.      Prevention of Osteoporosis: Soy does not appear to protect against osteoporosis.

·         Perceived Health Risks:
1.      Increased Risk of Breast Cancer:  There was no association found between soy phytoestrogen exposure and increased risk of breast cancer.
2.      Hormonal Imbalances in Men: There is no significant impact from soy consumption on male reproductive hormones, although more research is needed.
3.      Induction of Hypothyroidism: Soy supplements can unpredictably interfere with thyroid function and should be avoided in certain populations. 
4.      Adverse Outcomes from Antinutrients: Soy antinutrients include lectins, saponins, oxalates, enzyme inhibitors, phytates, and others.
§  Lectins- linked to food sensitivities, but almost entirely destroyed by heating
§  Saponins- may increase intestinal permeability which may contribute to autoimmune diseases; not removed by heating
§  Enzyme inhibitors- bind to enzymes which inhibit protein digestion and increases pancreatic function; maybe be the cause of pancreatic hyperplasia and adenomas; mostly destroyed by heating
§  Oxalates- may result in hyperoxaluria which may lead to kidney stones; binds calcium and other minerals reducing their absorption
§  Phytic acid- reduces bioavailability of vitamins A, B12, D, and E and minerals calcium, zinc, magnesium, and iron creating the potential for multiple nutritional deficiencies; destroyed when soy is fermented
5.      Harm From Soy Processing By-Products:
§  Soy is processed with alkaline solutions that creates unnatural amino acids, possibly contributing to digestive problems
§  Use of hexane, a volatile hydrocarbon with known neurotoxic effects, is used in soy processing; there are no studies or FDA limits on hexane exposure from soy

In conclusion, there are specific health benefits and health risks associated with soy for certain people. The evidence does not suggest significant health risks from moderate soy intake in generally healthy populations. However, the presences of antinutrients and problematic processing techniques in soy should prompt people to use caution with consuming high levels of processed, non-fermented soy products. 


For more information about soy or nutrition in general, please feel free to call me at the University of Maryland Center for Integrative Health and Healing at 410-448-6361 or email me at CIMClinicInfo@som.umaryland.edu.  Also, consider attending the Center for Integrative Health & Healing Open House on June 20 & 21.  See www.compmed.umm.edu/open-house/ for details.

Monday, February 17, 2014

Intravenous Infusion for Pain and Fatigue/Fibromyalgia

By William Rollow, MD

In January 2014, we began a new clinical service – the use of intravenous micronutrients (calcium, magnesium, trace minerals, Vitamin C, and B vitamins) for patients with pain and fatigue.  This therapy has been used for decades, and was popularized by a Baltimore physician named John Myers.

Micronutrients are vitamins and minerals that the human body requires in small quantities to efficiently operate basic functions of your metabolism.  A deficit of certain micronutrients can alter the metabolism and result in dysfunctions that may result in pain and fatigue.  Such deficits may not show up on standard blood tests.

Micronutrients are present in the diet, but sometimes are not well-absorbed, and giving them as supplements may upset digestion.  Furthermore, oral intake of micronutrients may not result in blood levels that are high enough to correct deficiencies.  Intravenous infusion can raise the blood levels of these substances directly and push them rapidly into cells where they can impact metabolism.

There are many anecdotal reports of the benefits of IV micronutrient infusion in patients with pain and fatigue/fibromyalgia.  There are also some published studies, including one controlled trial, in which symptomatic improvement was achieved.  A reference list can be found below.  We view this therapy as potentially useful in conjunction with other treatments, including dietary changes, herbal therapies, mind-body techniques, regular exercise, and more.

Insurance does not generally cover this treatment, so we offer it as a self-pay service for which we will provide a receipt that includes diagnosis and treatment codes that you can submit to your health plan.  The charge for the treatment is $140.  You can expect to need to do at least two or three infusions, at weekly intervals, before being able to determine whether the therapy is helpful to you.  If it helps, we’ll schedule a couple of additional infusions before reducing their frequency of administration.

Chronic pain and chronic fatigue can be helped by a variety of therapies, and we believe that micronutrient infusion has a place in the treatment approach.  We will be collecting self-reported data on its impact to support learning and research in this area.

For more information or to schedule an appointment, please call the University of Maryland Center for Integrative Medicine Clinic at 410-448-6361 or email CIMClinicInfo@som.umaryland.edu.


References:
1. Harakeh S, Jariwalla RJ, Pauling L. Suppression of human immunodeficiency virus replication by ascorbate in chronically and acutely infected cells. Proc Natl Acad Sci U S A 1990;87:7245-7249.
2. Okayama H, Aikawa T, Okayama M, et al. Bronchodilating effect of intravenous magnesium sulfate in bronchial asthma. JAMA 1987;257:1076-1078.
3. Sydow M, Crozier TA, Zielmann S, et al. High-dose intravenous magnesium sulfate in the management of life-threatening status asthmaticus. Intensive Care Med 1993;19:467- 471.
4. Gaby AR. Intravenous nutrition therapy: the “myers’ cocktail.” Alt Med Review 2002;7(5):389-403.  
5. Ali M. Intravenous Nutrient Protocols for Chronic Fatigue States. The Canary and Chronic Fatigue. 
6. Reed JC. Magnesium therapy in musculoskeletal pain syndromes — retrospective review of clinical results. Magnes Trace Elem 1990;9:330. 
7. Ali A, et al. Intravenous Micronutrient Therapy (Myers’ Cocktail) for Fibromyalgia: A Placebo-Controlled Pilot Study. J Alt & Comp Med. Vol 15.3. p247-257.
8. Massey PB. Reduction of fibromyalgia symptoms through intravenous nutrient therapy: results of a pilot clinical trial. Alternative Therapies 2007;13(3):32-34. (14*)
9. Consumer Alerts: Myers’ Cocktail. Fibromyalgia Network. Retrieved July 23, 2013, from, http://fmnetnews.iraherman.com/coping-resources/consumer-alerts/product-8
10. Shealy CN, Cady RK, Veehoff D, et al. Magnesium deficiency in depression and chronic pain. Magnes Trace Elem 1990;9:333.  
11. Hauser RA, Lyons KE, McClain T, Carter S, Perlmutter D. Randomized, double-blind, pilot evaluation of intravenous glutathione in parkinson’s disease. Movement Disorders 2009;24(7):979-983.  
12. Sechi GianPietro, Maria G. Deledda, Guido Bua, Wanda M. Satta, Giovanni A. Deiana, Giovanni M. Pes, and Giulio Rosati: Reduced intravenous glutathione in the treatment of early Parkinson’s Disease. Prog. Neuro-Psychopharmacol & Biol. Psychiat.1996;20:1159-1170.
13. Dyckner T, Wester PO. Ventricular extrasystoles and intracellular electrolytes before and after potassium and magnesium infusions in patients on diuretic treatment. Am Heart J 1979;97:12-18.
14. (2013, April 13). Myers’ (Intravenous) Cocktail. Hyperemesis Education & Research. Retrieved July 22, 2013 from http://www.helpher.org/health-professionals/myers-cocktail.php. 
15. Selby, J. (2009, April 3). Glutathione Therapy- An Interview with Dr. Perlmutter [Web log post]. Retrieved July 22, 2013, from http://thenaturalhealthguide.com.au/reviews/lifewave-glutathione-therapy/. 

Monday, February 3, 2014

Dietitian’s Recipe of the Week: Winter Minestrone

   
Serves 6

Ingredients
            2tbsp olive oil                            2 celery stalks, chopped

            2 carrots, chopped                   2 cup Swiss chard, chopped
            1 sweet potato, cubed             15oz can cannellini beans, rinsed and drained
            1 onion, chopped                      2 garlic cloves, minced
            14.5 oz can diced tomatoes    2, 14oz can low-sodium organic vegetable broth
            2 fresh rosemary sprits            ¼ cup flat leaf parsley, chopped
            Parmesan cheese, grated       Salt and pepper to taste

Directions
Heat oil over medium heat in a Dutch oven. Add onions, carrots, potato, celery, and garlic and cook for 10 minutes, stirring frequently. Add Swiss chard, salt and pepper and cook for 2minutes. Stir in tomatos and rosemary sprig. Bring mixture to a boil, and then reduce to a simmer and cook for another 10minutes. Meanwhile, blend ¾ of the beans with ½ cup of broth in a food processor or blender. Add pureed beans and remaining broth to the vegetable mixture and simmer for about 15minutes. Stir in the remaining beans and parsley. Discard rosemary stems and season with salt and pepper to taste. Serve soup with grated parmesan cheese on top.


Nutrition facts (per serving): 270calories, 5g fat, 34g carbohydrate, 7.5g fiber, 9g protein 

Chronic Inflammation: The Importance of Dietary Changes

By Erin Peisach, RD, LDN and William Rollow, MD


In the past month, we have seen many patients in our clinical practice who presented with a variety of symptoms, including pain, lack of energy, nausea, and irritability.  In conventional medicine, these symptoms often are evaluated independently with diagnostic tests for specific diseases, and many such patients have hypertension, diabetes, heart disease, migraines, etc.  In an integrative approach, we look at the whole person and for underlying issues that are capable of affecting multiple organ systems.  As a result of the comprehensive assessment, many times we suspect that the person has triggered a chronic inflammatory state.  

Inflammation is the process by which the body protects and heals itself in response to infectious, traumatic, or toxic insults.  Acute inflammation can be highly beneficial and necessary, although it may cause symptoms that are unpleasant—pain, swelling, fever, etc.  When the inflammation becomes chronic, however, these and related symptoms also become chronic, and the inflammation may contribute to the development of cardiovascular disease, arthritis, and other chronic illnesses.

Chronic inflammation results from persistence of the initial insult (e.g., infection or toxicity), but are also highly influenced by dietary and lifestyle factors.  Diet promotes chronic inflammation in several ways:
     • Sugar or high glycemic foods increase insulin and lead to obesity; fat cells make inflammatory             mediators
     • Saturated fats or inadequate intake of omega 3 fats promote inflammation
     • Foods that one is sensitive to, or that leak through the intestinal wall into the bloodstream                   cause inflammatory reactions 

In addition to diet, chronic stress, lack of physical activity, and poor sleep are controllable lifestyle factors that negatively impact the body’s inflammatory response.  Here are some tips to heal and prevent chronic inflammation in your body:

Work it out:  Exercise can be helpful in managing stress, improving sleep quality, and burning calories to promote weight loss.   150 minutes of moderate intensity exercise per week is recommended for those who have no medical contraindications.

Shop the perimeter:  Consuming a diet with excessive amounts of sugar and simple carbohydrates, hydrogenated and damaged oils, caffeine, and alcohol also promote chronic inflammation.  Purchasing from the perimeter of the grocery store is one useful strategy for avoidance—most packaged and shelf-stable foods found in the aisles of the grocery store contain potentially harmful ingredients. Conversely, food that comes from the produce, meat, seafood, deli, and dairy departments typically provides more nutrient-dense, less processed options. 

Embrace an “anti-inflammatory diet”:  Not only is it vital to avoid foods that cause inflammation, but it is also important to consume adequate anti-inflammatory foods and nutrients. Consume adequate omega 3 fatty acids from foods like wild salmon, sardines, chia seeds, and hemp seeds. Monounsaturated fatty acids from avocados, cold-pressed extra virgin olive oil, and macadamia nut oil are also important to control inflammation.  Consume a variety of organic, local and fresh vegetables and fruits such as dark leafy greens, berries, and cruciferous vegetables.  Eating at least 6 to 12-cups per day ensures the diet is plentiful in fiber, vitamins, minerals, and antioxidants. Cook your food with herbs and spices like ginger, rosemary, and turmeric to additionally boost its anti-inflammatory power. Lastly, it is crucial to identify and eliminate all foods that may promote an adverse food reaction (i.e. allergy, sensitivity, or intolerance). Common trigger foods include dairy, gluten, soy, and peanuts. 

One small change at a time:  Whether you “feel it” or not, inflammation is occurring inside us all. Making just one small change at a time will help you to achieve long, lasting change in the long run. Pick one aspect of your life that may cause inflammation and make a change today. Add in an extra vegetable serving at dinner to replace the usual starch.  Go to bed an extra hour early so you can attain at least 7-hours of sleep. Use garlic and rosemary on your chicken at dinner time and place it on top of a bed of spinach.  

Making changes can be hard, but they can have huge benefits for people with chronic inflammatory diseases.  The University of Maryland School of Medicine Center for Integrative Medicine clinic specializes in helping people make healthy changes.  To get help, talk with a practitioner or make an appointment directly with Erin Peisach, the clinic’s Registered Dietitian, by calling 410-448-6361 or emailing CIMClinicInfo@som.umaryland.edu