DR. KEITH’S BLOG


Chiropractic Care Works!!

Posted in Chiropractic, Health by Administrator on the April 30th, 2013

Dr. Keith has found a peer-reveiwed article published in the prestigous journal, Spine, that helps reinforce the treatment chiropractors give to their patients! Hopefully, this type of research will continue to comfort patients that they are doing the right thing by seeking out a chiropractor for acute low back pain as well as most all aches and pains associated with neuromusculoskeletal problems. Thanks for reading:

Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients With Acute Low Back Pain: Results of a Pragmatic Randomized Comparative Effectiveness Study
Goertz, Christine M. DC, PhD*; Long, Cynthia R. PhD*; Hondras, Maria A. DC, MPH*; Petri, Richard MD†; Delgado, Roxana MS‡; Lawrence, Dana J. DC, MMedEd, MA§; Owens, Edward F. MS, DC¶; Meeker, William C. DC, MPH‖

AbstractStudy Design. Randomized controlled trial.

Objective. To assess changes in pain levels and physical functioning in response to standard medical care (SMC) versus SMC plus chiropractic manipulative therapy (CMT) for the treatment of low back pain (LBP) among 18 to 35-year-old active-duty military personnel.

Summary of Background Data. LBP is common, costly, and a significant cause of long-term sick leave and work loss. Many different interventions are available, but there exists no consensus on the best approach. One intervention often used is manipulative therapy. Current evidence from randomized controlled trials demonstrates that manipulative therapy may be as effective as other conservative treatments of LBP, but its appropriate role in the healthcare delivery system has not been established.

Methods. Prospective, 2-arm randomized controlled trial pilot study comparing SMC plus CMT with only SMC. The primary outcome measures were changes in back-related pain on the numerical rating scale and physical functioning at 4 weeks on the Roland-Morris Disability Questionnaire and back pain functional scale (BPFS).

Results. Mean Roland-Morris Disability Questionnaire scores decreased in both groups during the course of the study, but adjusted mean scores were significantly better in the SMC plus CMT group than in the SMC group at both week 2 (P < 0.001) and week 4 (P = 0.004). Mean numerical rating scale pain scores were also significantly better in the group that received CMT. Adjusted mean back pain functional scale scores were significantly higher (improved) in the SMC plus CMT group than in the SMC group at both week 2 (P < 0.001) and week 4 (P = 0.004).

Conclusion. The results of this trial suggest that CMT in conjunction with SMC offers a significant advantage for decreasing pain and improving physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute LBP.
© 2013 Lippincott Williams & Wilkins, Inc.

Arsenic in Our Rice?!

Posted in Uncategorized by Administrator on the November 30th, 2012

“Consumer Reports has sounded the alarm that specific foods we eat, in the case of arsenic tainted rice, will cause serious health effects.
.
I must confess when I first read about the “Arsenic in Rice” from the 2012 November issue of Consumer Re- ports, I was pretty depressed. I thought “Really, more toxins?” But as I got my bearings I realized that Consumer Reports had just done us a big favor.
First, let me reemphasize my deep sadness when I learned the amount of arsenic in rice. The reaction I’ve seen by friends and family has been one of extreme discouragement. With many who are gluten sensitive, rice has been a great alternative, but once more the options we thought we had for healthy food are shrinking. But are we really surprised? We know the monumental amounts of pesticides and herbicides dumped on our soil have an effect on our biological sys- tem in some way.
Arsenic is used as a neurologic agent against the bugs. So where does it all go? Some of it ends up in our waterways and since rice is grown in water it tends to accumulate in this grain more than other grains. Why did you say that Consumer Reports did us a big favor? For years, we’ve preached to our patients about the need to eat clean food, increase their consumption of plants and do periodic detoxification to download some of the toxins which accumulate. Even medical colleagues may have scoffed at our wellness concepts. Recognize that Consumer Reports just vindicated and amplified our position. Here, an independent organization, “Consumer Reports has sounded the alarm that specific foods we eat may cause, and in the case of arsenic tainted rice, will cause serious health problems.”
And I think we can all agree there are other health is- sues that although not on our immediate radar are just as important. We have serious concerns with our food supply: Roundup ready corn, soy and alfalfa, BT Corn, mercury in the fish, bad fats, hormones and antibiotics in beef and chicken and 70% of the processed foods in the grocery store which have been estimated to contain GMO derivatives.
Consumer Reports also published an article in January 2012 revealing arsenic in apple and grape juice. Here’s the big idea on this subject. We can use the Consumer Reports article to have a serious “heart to heart” talk with everyone about their long term health. I am always looking for ways to engage people to take responsibility for their health and for me this article is an excellent place to start.
Dr. Vasquez, a well-known lecturer on autoimmunity, gave a talk on healthy living. He continues to emphasize living a lifestyle that is life enhancing yet by its nature provides ample modes of detoxification for unknown toxins like the “arsenic in rice” scenario.
In other words our diets and the supplementation we use to support our diet should be geared to repair the damage done by the chemicals and heavy metals that we are unknowingly ingesting. Heavy metals inactivate enzymes in the body and increase free radical damage which can lead to an increase of cardiovascular disease, autoimmunity and some forms of cancer.
Symptoms of chronic arsenic toxicity include: dermatitis, respiratory tract infection, muscle aches, headaches, weakness, convulsions, neuropathy, anemia, pigmentation of nails, drowsiness and confusion.
So, what can I do as a clinician? First I need to be able to help people reduce exposure as well as identify ways to reduce risk and how to chelate excess arsenic. Along with a detox regiment, you as a patient can take a high potency multiple vitamin that has the ample bio-available nutrients to support the detoxification pathways.
We want to get rid of heavy metals at a faster rate than we are accumulating them. As you know, “Selenium displaces arsenic and vice versa. Periodic mineral evaluations to assess selenium status can be helpful for those that consume more than three rice meals per week.”
This scenario drives home why clinicians rely on quality control for the supplements they carry. Ten years ago there was a rice shortage in the States and they looked offshore for another supplier. They found a source that mixed well, tasted great and had a clean certificate of analysis from the supplier. When they did their due diligence they found toxic levels of lead and cadmium. Obviously they rejected the material and sent it back the supplier.
Who by the way repacked it and sold it to another company, who unfortunately, sold it to unsuspecting customers. Safe products may cost a bit more but they are definitely worth the investment.
Would you want to take a rice protein that has lead and cadmium in it?
Please get a copy of the November 2012 Consumer Reports and study it. Make sure to have copies available for your patients and staff. Practicing true preventative health care and handling tough subjects like this compassionately, without promoting fear, shows that we care. People come to us when they know we care, and isn’t it true.
That’s how we build relationships that last a lifetime.
Thanks for reading this edition. To Your Health!!!!!

Migraine Headaches Respond Well to Chiropractic Care

Posted in Chiropractic by Administrator on the January 31st, 2012

In the following article referenced, you will see some exciting results about treatment by chiropractors and other conservative management providers can help those suffering from headaches. This information is intended to give those people who are suffering some refreshing insight and possible relief of their symptoms. Good Luck and if any questions do arise please call our office.

The Journal of Headache and Pain
Official Journal of the “European Headache Federation” and of “Lifting The Burden – The Global Campaign against Headache”
© The Author(s) 2011
10.1007/s10194-011-0296-6

Review Article
Manual therapies for migraine: a systematic review
Aleksander Chaibi1 , Peter J. Tuchin2 and Michael Bjørn Russell1, 3

(1) Head and Neck Research Group, Research Centre, Akershus University Hospital, 1478 Lørenskog, Norway
(2) Department of Chiropractic, Macquarie University, Sydney, NSW, 2109, Australia
(3) Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, 1474 Nordbyhagen, Norway

Aleksander Chaibi
Email: alch79@gmail.com

Received: 4 November 2010 Accepted: 14 January 2011 Published online: 5 February 2011

Abstract
Migraine occurs in about 15% of the general population. Migraine is usually managed by medication, but some patients do not tolerate migraine medication due to side effects or prefer to avoid medication for other reasons. Non-pharmacological management is an alternative treatment option. We systematically reviewed randomized clinical trials (RCTs) on manual therapies for migraine. The RCTs suggest that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine. However, the evaluated RCTs had many methodological shortcomings. Therefore, any firm conclusion will require future, well-conducted RCTs on manual therapies for migraine.
Keywords Manual therapies – Massage – Physiotherapy – Chiropractic – Migraine – Treatment

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Introduction
Migraine is usually managed by medication, but some patients do not tolerate acute and/or prophylactic medicine due to side effects, or contraindications due to co-morbidity of myocardial disorders or asthma among others. Some patients wish to avoid medication for other reasons. Thus, non-pharmacological management such as massage, physiotherapy and chiropractic may be an alternative treatment option. Massage therapy in Western cultures uses classic massage, trigger points, myofascial release and other passive muscle stretching among other treatment techniques which are applied to abnormal muscle tissue. Modern physiotherapy focuses on rehabilitation and exercise, while manual treatment emphasis postural corrections, soft tissue work, stretching, active and passive mobilization and manipulation techniques. Mobilization is commonly defined as movement of joints within the physiological range of motion [1]. The two most common chiropractic techniques are the diversified and Gonstead, which are used by 91 and 59% of chiropractors [2]. Chiropractic spinal manipulation (SM) is a passive-controlled maneuver which uses a directional high-velocity, low-amplitude thrusts directed at a specific joint past the physiological range of motion, without exceeding the anatomical limit [1]. The application and duration of the different manual treatments varies among those who perform it. Thus, manual treatment is not necessarily as uniform as, for instance, specific treatment with a drug in a certain dose.

This paper systematically review randomized controlled trials (RCTs) assessing the efficacy of manual therapies on migraine, i.e., massage, physiotherapy and chiropractic.

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Method
The literature search was done on CINAHL, Cochrane, Medline, Ovid and PubMed. Search words were migraine and chiropractic, manipulative therapy, massage therapy, osteopathic treatment, physiotherapy or spinal mobilization. All RCTs written in English using manual therapy on migraine were evaluated. Migraine was preferentially classified according to the criteria of the International Headache Societies from 1988 or its revision from 2004, although it was not an absolute requirement [3, 4]. The studies had to evaluate at least one migraine outcome measure such as pain intensity, frequency, or duration. The methodological quality of the included RCT studies was assessed independently by the authors. The evaluation covered study population, intervention, measurement of effect, data presentation and analysis (Table 1). The maximum score is 100 points and ≥50 points considered to be methodology of good quality [5–7].
Table 1 Criteria list of methodological quality assessment of randomized controlled trials (RCTs) [7]
1.
Study population (30 points)

(a)
Description of inclusion and exclusion criteria (1 point). Restriction to a homogeneous study population (1 point)

(b)
Comparability of relevant baseline characteristics: duration of complaint (1 point), value of outcome measures (1 point), age (1 point), recurrences (1 point), and radiating complaints/associated symptoms (1 point)

(c)
Description of the randomization procedure (2 points). Randomization procedure which excluded bias, i.e., random numbers table (2 points)

(d)
Description of dropouts for each group and their reasons (3 points)

(e)
Loss to follow-up: <20% loss to follow-up (2 points), or <10% loss to follow-up (4 points)

(f)
Sample size: >50 subjects in the smallest group after randomization (6 points), or >100 subjects in the smallest group after randomization (12 points)

2.
Interventions (30 points)

(g)
Correct description of the manual intervention (5 points). All interventions described (5 points)

(h)
Pragmatic study: comparison with an existing treatment modality (5 points)

(i)
Co-interventions avoided in the design of the study (5 points)

(j)
Comparison with a placebo control group (5 points)

(k)
Mention of the experience of the therapist (5 points)

3.
Measurement of effect (30 points)

(l)
Placebo controlled studies: patients blinded (3 points), blinding evaluated and fully successful (2 points) or pragmatic studies: patients fully naive, evaluated and fully successful (3 points), time restriction of no manual treatments for at least 1 year (2 points)

(m)
Outcome measures: pain assessment (2 points), global measure of improvement (2 points), functional status (2 points), spinal mobility (2 points), medical consumption (2 points)

(n)
Each blinded outcome measure mentioned under item M earns 2 points

(o)
Analysis of post-treatment data (3 points), inclusion of a follow-up period longer than 6 months (2 points)

4.
Data presentation and analysis (10 points)

(p)
Intention-to-treat analysis when loss to follow-up is <10% or intention-to-treat analysis as well as worst-case analysis for missing values when loss to follow-up is >10% (5 points)

(q)
Corrected presentation of the data: mean or median with a standard deviation or percentiles for continuous variables (5 points)

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Results
The literature search identified seven RCT on migraine that met our inclusion criteria, i.e., two massage therapy studies [8, 9], one physiotherapy study [10] and four chiropractic spinal manipulative therapy studies (CSMT) [11–14], while we found no RCTs studies on spinal mobilization or osteopathic as a intervention for migraine.

Methodological quality of the RCTs
Table 2 shows the authors average methodological score of the included RCT studies [8–14]. The average score varied from 39 to 59 points. Four RCTs were considered to have a good quality methodology score (≥50), and three RCTs had a low score.
Table 2 Quality score of the analyzed randomized controlled trials (RCTs) using manual therapies for treatment of migraine
Study
a
b
c
d
e
f
g
h
i
j
k
l
m
n
o
p
q
Total

Hernandez [8]
2
2
4
0
0
0
10
0
5
0
5
0
6
0
0
0
5
39

Lawler [9]
2
3
4
3
4
0
10
0
5
0
5
0
6
0
3
5
5
55

Marcus [10]
2
3
2
3
4
0
10
5
0
0
0
0
6
0
5
5
5
50

Parker [11, 12]
2
5
2
3
4
0
10
5
5
0
0
0
6
0
3
0
0
45

Nelson [13]
2
4
4
3
0
6
10
5
0
0
5
0
6
0
3
0
5
53

Tuchin [14]
2
5
4
3
4
0
10
5
5
0
0
0
8
0
3
5
5
59

The letters corresponds with letters from the criteria list (Table 1)
Randomized controlled trials
Table 3 shows details and the main results of the different RCT studies [8–14].
Table 3 Randomized controlled trials (RCTs) of massage therapy, physical therapy and chiropractic spinal manipulative therapy for migraine
Country
Year
Study population
Participant
Method
Intervention
Results

Massage therapy

USA [8]
1998
Chronic migraine for at least 6 months diagnosed by a questionnaire

Mean years with headache 20.7
26 volunteers

Age 24–65

Mean 29.9 years
RCT of 5 weeks duration

5 weeks treatment

Questionnaire pre- and post-treatment for intervention and control group

Assessment on the first and last day of the 5 weeks study
Massage therapy (n = 12)

30 min twice a week focusing on muscle in the neck

control group (n = 12) not receiving treatment

Drop outs (n = 2)
Pain intensity was statistically significantly reduced from pre- to post-treatment in the massage group, while the change was not statistically significant in the control group

The massage group experienced mean pain intensity was reduced 71% from prior to the first massage and after last massage, while the control groups mean pain intensity was unchanged

New Zealand [9]
2006
Migraineurs diagnosed by questionnaire
48 volunteers

(8M, 40F)

Age 12–60 years

Mean 41.3 years
RCT of 13 weeks duration, i.e.,

4 weeks baseline

6 weeks treatment

3 weeks follow-up

Comparison of baseline, treatment and follow-up

Headache diary recordings
Massage therapy (n = 23)

45 min once every week, focusing on neuromuscular and trigger-point framework of the back, shoulders, neck and head

Control group (n = 23) kept headache diary

Drop outs (n = 4)
Migraine frequency was significantly reduced in the massage group from baseline to treatment (p < 0.01) and baseline to follow-up (p < 0.05), while it was unchanged in the control group

On average migraine frequency was reduced 34% during treatment and 30% during follow-up in the massage group, while similar figures in the control group was 7 and 2%

Physical therapy

USA [10]
1998
Migraineurs with at least one migraine attack per week or a total of 5 migraine days per month diagnosed by a neurologist
73 women

Age 20–58 years

Mean age 37 years
Study 1

RCT of 13.5 months duration, i.e.,

2 weeks baseline

4 weeks treatment

3,6,12 months follow-up

Comparison of baseline, post-treatment and follow-up
Physical therapy (n = 30)

Two home sessions daily of about 30 min duration each

Relaxation (n = 39)

Muscle relaxation, breathing exercise and thermal bio feedback. Two home sessions daily of about 20–30 duration each

Drop outs (n = 4)
The relaxation group had statistically significantly more persons with 50% reduction or more in headache severity than the physical therapy group (p < 0.001)

13% (n = 4) had 50% reduction or more in mean headache severity in the physical therapy group, i.e., 16% decrease in mean headache severity

51% (n = 20) had 50% reduction or more in mean headache severity in the relaxation group, i.e., 41% decrease in mean headache severity

Follow-up headache recordings at 3, 6 and 12 months on those with 50% reduction or more in mean headache severity
Drop outs at 3, 6 and 12 months follow-up

Physical therapy (n = 1, 1 and 2)

Relaxation (n = 2, 4 and 6)
Treatment effect was maintained in both group at 3, 6 and 12 months

Migraineurs with at least one migraine attack per week or a total of 5 migraine days per month by a neurologist
45 women
Study 2

Participants that did not had a 50% reduction in mean headache severity in study 1 were offered the alternative treatment

Comparison of baseline, post-treatment and follow-up
Physical therapy (n = 11)

Relaxation (n = 19)

Drop outs (n = 15)
55% (6/11) had 50% reduction or more in mean headache severity in physical therapy group, i.e., 30% decrease in mean headache severity

47% (9/19) had 50% reduction or more in mean headache severity in the relaxation group, i.e., 38% decrease in mean headache severity

Follow-up headache recordings at 3, 6 and 12 months
Drop outs at 3, 6 and 12 months follow-up

Physical therapy (n = 2, 3 and 3)

Relaxation (n = 5, 7 and 10)
The relative high number of drop outs makes it difficult to judge the treatment effect at follow-up, but it seems that the effect lasted in the physical therapy group, while it was quite fluctuating in the relaxation group

Chiropractic spinal manipulative therapy (CSMT)

Australia [11]
1978
Migraineurs diagnosed by a neurologist

At least 4 migraine attacks within 2 months
85 volunteers

(33M, 52F)

Age 12–55 years

Mean age 41 years
RCT of 6 months duration, i.e.,

2 months baseline

2 months treatment

2 months follow-up

Comparison of baseline, post-treatment and follow-up

Headache diary recording
All received a maximum of 2 treatments per week

Cervical manipulation by chiropractor (n = 30) (11M, 19F)

Cervical manipulation by physician or physiotherapist (n = 27) (14M, 13F)

Cervical mobilization by physiotherapist or physician (n = 28) (8M, 20F)

Drop outs (n = 3)
No statistically significant difference were found between the three groups

The mean reduction in attack frequency, intensity and duration pre- and post treatment were 40, 43 and 36% in the first cervical manipulation group, 13, 12 and 8% in the second cervical manipulation group and 34, 15 and 20% in the cervical mobilization group. No statistically significant effect differences were found between the three groups

Australia [12]
1980
See above

9.7 mean migraine attacks within 2 months
84 volunteers
Follow-up at 20 months post trial (see above) by a questionnaire
All received a questionnaire

Drop outs (n = 11)
The mean reduction in attack frequency from pre trial to 20 months post trial follow-up was 58, 29 and 54% in the cervical manipulation by chiropractor, cervical manipulation group by physiotherapist or physician and the cervical mobilization group by physiotherapist or physician

USA [13]
1998
Migraineurs with at least 4 headache days per month for at least 1 year

diagnosed by chiropractor
218 volunteers

(46M, 172F)

Age 18–65 years

Mean age 38 years
A RCT of 4 months duration, i.e.,

1 month baseline

2 months treatment

1 month follow-up

Comparison of baseline, post-treatment and follow-up

Headache diary recording
CSMT (n = 77) by diversified technique. A total of 14 treatments over a 8 weeks period

Amitriptyline (n = 70). Initial dose 25 mg/day was increased weekly by 25 up to 100 mg/day. Patients were seen three times during the 2 months period.

Combined CSMT and Amitriptyline (n = 71)

Drop outs (n = 59)
Mean intensity was reduced from baseline to last 4 weeks treatment and from baseline to 4 weeks post-treatment by 40 and 42% in the CSMT group, 49 and 24% in the amitriptyline group and 41 and 25% in the combined CSMT and amitriptyline group

Mean frequency was reduced from baseline to last 4 weeks treatment and from baseline to 4 weeks post-treatment by 32 and 33% in the CSMT group, 48 and 22% in the amitriptyline group and 39 and 22% in the combined CSMT and amitriptyline group

Australia [14]
2000
Migraineurs diagnosed by a questionnaire followed by diagnoses by chiropractor

At least one migraine attack per month

Mean migraine attack were 7.2 per months
127 volunteers

(39M, 86F, 2?)

Age 10–70 years

Mean age 39 years
A RCT of 6 months duration, i.e.,

2 months baseline

2 months treatment

2 months follow-up

Comparison of baseline, post-treatment and follow-up

Headache diary recording
CSMT (n = 83) (25M, 59F)

2 months of diversified technique, maximum of 16 sessions

Control group (n = 40) (14M, 27F)

Detuned interferential therapy

Drop outs (n = 4)
The average response was statistically significantly better in the CSMT than the control group regarding migraine frequency (p < 0.005), duration (p < 0.01), disability (p < 0.05), and reduction in medication use (p < 0.001)

The frequency and duration was reduced from baseline to follow-up by 35 and 40% in the CSMT group, and 17 and 20% in the control group

Massage therapy
An American study included 26 participants with chronic migraine diagnosed by questionnaire [8]. Massage therapy had a statistically significant effect on pain intensity as compared with controls. Pain intensity was reduced 71% in the massage group and unchanged in the control group. Interpretation of the data is otherwise difficult and results on migraine frequency and duration are missing.

A New Zealand study included 48 migraineurs diagnosed by questionnaire [9]. The mean duration of a migraine attack was 47 h, and 51% of the participants had more than one attack per month. The study included a 3 week follow-up period. The migraine frequency was significantly reduced in the massage group as compared with the control group, while the intensity of attacks was unchanged. Results on migraine duration are missing. Medication use was unchanged, while sleep quality was significantly improved in the massage group (p < 0.01), but not in the control group.

Physical therapy
An American physical therapy study included female migraineurs with frequent attacks diagnosed by a neurologist according to the criteria of the International Headache Society [3, 10]. Clinical effect was defined as >50% improvement in headache severity. Clinical effect was observed in 13% of the physical therapy group and 51% of the relaxation group (p < 0.001). The mean reduction in headache severity was 16 and 41% from baseline to post-treatment in the physical therapy and relaxation groups. The effect was maintained at 1 year follow-up in both groups. A second part of the study offered persons without clinical effect in the first part of the study, the other treatment option. Interestingly, clinical effect was observed in 55% of those whom received physical therapy in the second round who had no clinical effect from relaxation, while 47% had clinical effect from relaxation in the second round. The mean reduction in headache severity was 30 and 38% in the physical therapy and relaxation groups. Unfortunately, the study did not include a control group.

Chiropractic spinal manipulative treatment
An Australian study included migraineurs with frequent attacks diagnosed by a neurologist [11]. The participants were divided into three study groups; cervical manipulation by chiropractor, cervical manipulation by physiotherapist or physician, and cervical mobilization by physiotherapist or physician. The mean migraine attack duration was skewed in the three groups, as it was much longer in cervical manipulation by chiropractor (30.5 h) than cervical manipulations by physiotherapist or physician (12.2 h) and cervical mobilization groups (14.9 h). The study had several investigators and the treatment within each group was beside the mandatory requirements free for the therapists. No statistically significant differences were found between the three groups. Improvement was observed in all three groups post-treatment (Table 3). Prior to the trial, chiropractors were confident and enthusiastic about the efficacy of cervical manipulation, while physiotherapists and physicians were doubtful about the relevance. The study did not include a control group although cervical mobilization is mentioned as the control group in the paper. A follow-up 20 months after the trial showed further improvement in the all three groups (Table 3) [12].

An American study included 218 migraineurs diagnosed according to the criteria of the International Headache Society by chiropractors [13]. The study had three treatment groups, but no control group. The headache intensity on days with headaches was unchanged in all three groups. The mean frequency was reduced equally in the three groups (Table 3). Over the counter (OTC) medication was reduced from baseline to 4 weeks post-treatment with 55% in the CSMT group, 28% in the amitriptyline group and 15% in the combined CSMT and amitriptyline group.

The second Australian study was based on questionnaire diagnoses on migraine [14]. The participants had migraine for mean 18.1 years. The effect of CSMT was significant better than the control group (Table 3). The mean reduction of migraine frequency, intensity and duration from baseline to follow-up were 42, 13, and 36% in CSMT group, and 17, 5, and 21% in the control group (data calculated by the reviewers based on figures from the paper).

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Discussion
Methodological considerations
The prevalence of migraine was similar based on a questionnaire and a direct physician conducted interview, but it was due to equal positive and negative misclassification by the questionnaire [15]. A precise headache diagnosis requires an interview by a physicians or other health professional experienced in headache diagnostics. Three of the seven RCTs ascertained participants by a questionnaire, with the diagnostic uncertainty introduced by this (Table 3).

The second American study included participants with at least four headache days per months [13]. The mean headache severity on days with headache at baseline varied from 4.4 to 5.0 on a 0–10 box scale in the three treatment groups. This implies that the participants had co-occurrence of tension-type headache, since tension-type headache intensity usually vary between 1 and 6 (mild or moderate), while migraine intensity can vary between 4 and 9 (moderate or severe), but usually it is a severe pain between 7 and 9 [16, 17]. The headache severity on days with headache was unchanged between baseline and at follow-up, indicating that the effect observed was not exclusively due to an effect on migraine, but also an effect on tension-type headache.

RCTs that include a control group are advantageous to RCTs that compare two active treatments, since the effect in the placebo group rarely is zero and often varies. An example is RCTs on acute treatment of migraine comparing the efficacy of subcutaneous sumatriptan and placebo showed placebo responses between 10 and 37%, while the therapeutic effect, i.e., the efficacy of sumatriptan minus the efficacy of placebo was similar [18, 19]. Another example is a RCT on prophylactic treatment of migraine, comparing topiramate and placebo [20]. The attack reduction increased along with increasing dose of topiramate 50, 100 and 200 mg/day. The mean migraine attack frequency was reduced from 1.4 to 2.5 attacks per month in the topiramate groups and 1.1 attacks per month in the placebo group from baseline, with mean attack frequencies varying from 5.1 to 5.8 attacks per month in the four groups.

Thus, interpretation of the efficacy in the four RCTs without a control group is not straight forward [9–12]. The methodological quality of all seven RCTs had room for improvement as the maximum score 100 was far from expectation, especially a precise migraine diagnosis is important.

Several of the studies relatively include a few participants, which might cause type 2 errors. Thus, power calculation prior to the study is important in the future studies. Furthermore, the clinical guidelines from the International Headache Society should be followed, i.e., frequency is a primary end point, while duration and intensity can be secondary end points [21, 22].

Results
The two RCTs on massage therapy included relatively a few participants, along with shortcomings mentioned in Table 3 [8, 9]. Both studies showed that massage therapy was significantly better than the control group, by reducing migraine intensity and frequency, respectively. The 27–28% (34–7% and 30–2%) therapeutic gain in migraine frequency reduction by massage therapy is comparable with the 6, 16 and 29% therapeutic gain in migraine frequency reduction by prophylactic treatment with topiramate 50, 100 and 200 mg/day [20].

The single study on physiotherapy is large, but do not include a control group [10]. The study defined responders to have 50% or more reduction in migraine intensity. The responder rate to physical therapy was only 13% in the first part of the study, while it was 55% in the group that did not benefit from relaxation, while the responder rate to relaxation was 51% in the first part of the study and 47% in the group that did not benefit from physical therapy. A reduction in migraine intensity often correlates with reduced migraine frequency. For comparison, the responder rate was 39, 49, 47 and 23% among those who received topiramate 50, 100 and 200 mg/day and placebo as defined by 50% or more reduction in migraine frequency [20]. A meta-analysis of 53 studies on prophylactic treatment with propranolol showed a mean 44% reduction in migraine activity [23]. Thus, it seems that physical therapy and relaxation has equally good effect as topiramate and propranolol.

Only one of the four RCTs on chiropractic spinal manipulative therapy (CSMT) included a control group, while the other studies compared with other active treatment [11–14]. The first Australian study showed that the migraine frequency was reduced in all three groups when baseline was compared with 20 months post trail [11, 12]. The chiropractors were highly motivated to CSMT treatment, while physicians and physiotherapist were more sceptical, which might have influenced on the result. An American study showed that CSMT, amitriptyline and CSMT + amitriptyline reduced the migraine frequency 33, 22 and 22% from baseline to post-treatment (Table 3). The second Australian study found that migraine frequency was reduced 35% in the CSMT group, while it was reduced 17% in the control group. Thus, the therapeutic gain is equivalent to that of topiramate 100 mg/day and the efficacy is equivalent to that of propranolol [20, 23].

Three case reports raise concerns about chiropractic cervical SMT, but a recent systematic review found no robust data concerning the incidence or the prevalence of adverse reactions following chiropractic cervical SMT [24–27]. When to refer migraine patients to manual therapies? Patients not responding or tolerating prophylactic medication or who wish to avoid medication for other reasons, can be referred to massage therapy, physical therapy or chiropractic spinal manipulative therapy, as these treatments are safe with a few adverse reactions [27–29].

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Conclusion
Current RCTs suggest that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally efficient as propranolol and topiramate in the prophylactic management of migraine. However, a firm conclusion requires, in future, well-conducted RCTs without the many methodological shortcomings of the evaluated RCTs on manual therapies. Such studies should follow clinical trial guidelines from the International Headache Society [21, 22].

Conflict of interest None declared.
Open Access
This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution and reproduction in any medium, provided the original author(s) and source are credited.

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References
1. Esposito S, Philipson S (2005) Spinal adjustment technique the chiropractic art. Craft Printing, Alexandria

2. Cooperstein R, Gleberson BJ (2004) Technique systems in chiropractic, 1st edn. Churchill Livingstone, New York

3. Headache Classification Committee of the International Headache Society (1988) Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the International Headache Society. Cephalalgia 8 (suppl 7):1–96

4. Headache Classification Subcommittee of the International Society (2004) The international classification of headache disorders, 2nd edn, Cephalagia 24 (suppl 1):1–160

5. Ter Riet G, Kleijnen J, Knipschild P (1990) Acupuncture and chronic pain: a criteria-based meta-analysis. J Clin Epidemiol 43:1191–1199

6. Koes BW, Assendelft WJ, van der Heijden GJ, Bouter LM, Knipschild PG (1991) Spinal manipulation and mobilisation for back and neck pain: a blinded review. BMJ 303:1298–1303

7. Fernandez-de-las-Penas C, Alonso-Blanco C, San-Roman J, Miangolarra-Page JC (2006) Methodological quality of randomized controlled trials of spinal manipulation and mobilization in tension-type headache, migraine, and cervicogenic headache. J Orthop Sports Phys Ther 36:160–169

8. Hernandez-Rief M, Dieter J, Field T, Swerdlow B, Diego M (1998) Migraine headache reduced by massage therapy. Int J Neurosci 96:1–11

9. Lawler SP, Cameron LD (2006) A randomized, controlled trial of massage therapy as a treatment for migraine. Ann Behav Med 32:50–59

10. Marcus DA, Scharff L, Mercer S, Turk DC (1998) Nonpharmacological treatment for migraine: incremental utility of physical therapy with relaxation and thermal biofeedback. Cephalalgia 18:266–272

11. Parker GB, Tupling H, Pryor DS (1978) A controlled trial of cervical manipulation of migraine. Aust NZJ Med 8:589–593

12. Parker GB, Pryor DS, Tupling H (1980) Why does migraine improve during a clinical trial? Further results from a trial of cervical manipulation for migraine. Aust NZJ Med 10:192–198

13. Nelson CF, Bronfort G, Evans R, Boline P, Goldsmith C, Anderson AV (1998) The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. J Manipulative Physiol Ther 21:511–519

14. Tuchin PJ, Pollard H, Bonello R (2000) A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. J Manipulative Physiol Ther 23:91–95

15. Rasmussen BK, Jensen R, Olesen J (1991) Questionnaire versus clinical interview in the diagnosis of headache. Headache 31:290–295

16. Lundquist YC, Benth JS, Grande RB, Aaseth K, Russell MB (2009) A vertical VAS is a valid instrument for monitoring headache pain intensity. Cephalalgia 29:1034–1041

17. Rasmussen BK, Olesen J (1992) Migraine with aura and migraine without aura: an epidemiological study. Cephalalgia 12:221–228

18. Ensink FB (1991) Subcutaneous sumatriptan in the acute treatment of migraine. Sumatriptan International Study Group. J Neurol 238(suppl 1):S66–S69

19. Russell MB, Holm-Thomsen OE, Rishoj NM, Cleal A, Pilgrim AJ, Olesen J (1994) A randomized double-blind placebo-controlled crossover study of subcutaneous sumatriptan in general practice. Cephalalgia 14:291–296

20. Brandes JL, Saper JR, Diamond M, Couch JR, Lewis DW, Schmitt J, Neto W, Schwabe S, Jacobs D, MIGR-002 Study Group (2004) Topiramate for migraine prevention: a randomized controlled trial. JAMA 291:965–973

21. Tfelt-Hansen P, Block G, Dahlöf C, Diener HC, Ferrari MD, Goadsby PJ, Guidetti V, Jones B, Lipton RB, Massiou H, Meinert C, Sandrini G, Steiner T, Winter PB, International Headache Society Clinical trials Subcommittee (2000) Guidelines for controlled trials of drugs in migraine: 2nd edn. Cephalalgia 20:765–786

22. Silberstein S, Tfelt-Hansen P, Dodick DW, Limmroth V, Lipton RB, Pascual J, Wang SJ, Task Force of the International Headache Society Clinical Trials Subcommittee (2008) Guidelines for controlled trials of prophylactic treatment of chronic migraine in adults. Cephalalgia 28:484–495

23. Holroyd KA, Penzien DB, Cordingley GE (1991) Propranolol in the management of recurrent migraine: a meta-analytic review. Headache 31:333–340

24. Khan AM, Ahmad N, Li X, Korsten MA, Rosman A (2005) Chiropractic sympathectomy: carotid artery dissection with oculosympathetic palsy after chiropractic manipulation of the neck. Mt Sinai J Med 72:207–210

25. Morelli N, Gallerini S, Gori S, Chiti A, Cosottini M, Orlandi G, Murri L (2006) Intracranial hypotension syndrome following chiropractic manipulation of the cervical spine. J Headache Pain 7:211–213

26. Marx P, Püschmann H, Haferkamp G, Busche T, Neu J (2009) Manipulative treatment of the cervical spine and stroke. Fortschr Neurol Psychiatr 77:83–90

27. Gouveia LO, Gastanho P, Ferreira JJ (2009) Safety of chiropractic intervention. A systematic review. Spine 34:E405–E413

28. Ernst E (2003) The safety of massage therapy. Rheumatology 42:1101–1106

29. Zeppos L, Patman S, Berney S, Adsett JA, Bridson JM, Paratz JD (2007) Physiotherapy in intensive care is safe: an observational study. Aust J Physiother 53:279–283

B-VITAMINS ARE VERY HELPFUL FOR THE NERVOUS SYSTEM

Posted in Health, Nutrition by Administrator on the September 22nd, 2010

The following article is one that seems quite applicable to the Woodinville Pain Relief Clinic’s mission due to the emphasis we put on long term health and quality of life. As a Neuromusculoskeletal specialist, I want to make sure that not only the muscles and bones are doing well, but also the nervous system which controls the function of our bodies. In that vein, I provide counseling on supplements to help our systems function optimally and the B-vitamins are certainly at the top of the list of ones I take as well as recommend for patients. If you have any questions about your health care needs please call my office. (425) 368 2003

B Vitamins Slow Brain Atrophy in People With Memory Problems
ScienceDaily (Sep. 14, 2010) — Daily tablets of certain B vitamins can halve the rate of brain shrinkage in elderly people who suffer from mild memory problems, an Oxford University study has shown.
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The two-year randomised clinical trial is the largest to study the effect of B vitamins on mild cognitive impairment, and one of the first disease-modifying trials in the Alzheimer’s field to show positive results in people.
Around 1 in 6 elderly people over the age of 70 has mild cognitive impairment, experiencing problems with memory, language, or other mental functions, but not to a degree that interferes with daily life. Around half of people with mild cognitive impairment go on to develop dementia — mainly Alzheimer’s disease — within five years of diagnosis.
Certain B vitamins — folic acid, vitamin B6 and vitamin B12 — are known to control levels of the amino acid homocysteine in the blood, and high levels of homocysteine are associated with an increased risk of Alzheimer’s.
So the Oxford team set out to see whether supplements of the B vitamins that lower homocysteine could slow the higher rate of brain shrinkage, or atrophy, observed in mild cognitive impairment or Alzheimer’s.
The study followed 168 volunteers aged 70 or over with mild memory problems, half of whom took high dose B vitamin tablets for two years and the other half a placebo tablet. The researchers assessed disease progression in this group by using MRI scans to measure the brain atrophy rate over a two-year period. The findings are published in the journal PLoS ONE.
The team found that on average the brains of those taking the folic acid, vitamin B6 and B12 treatment shrank at a rate of 0.76% a year, while those in the placebo group had a mean brain shrinkage rate of 1.08%. People with the highest levels of homocysteine benefited most, showing atrophy rates on treatment that were half of those on placebo.
Along with rate of brain shrinkage, the team from the Oxford Project to Investigate Memory and Ageing (OPTIMA) also monitored cognitive test scores, revealing that those with the slowest rate of shrinkage scored more strongly.
The team suggests that, since the rate of brain atrophy is known to be more rapid in those with mild cognitive impairment who go on to develop Alzheimer’s, it is possible that the vitamin treatment could slow down the development of the disease. Clinical trials to test this should now be carried out, they add.
‘It is our hope that this simple and safe treatment will delay the development of Alzheimer’s disease in many people who suffer from mild memory problems,’ said Professor David Smith of the Department of Pharmacology at Oxford University, a co-leader of the trial. ‘Today there are about 1.5 million elderly in UK, 5 million in USA and 14 million in Europe with such memory problems.
‘These are immensely promising results but we do need to do more trials to conclude whether these particular B vitamins can slow or prevent development of Alzheimer’s. So I wouldn’t yet recommend that anyone getting a bit older and beginning to be worried about memory lapses should rush out and buy vitamin B supplements without seeing a doctor,’ he said.
Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust, which co-funded the study, said: ‘These are very important results, with B vitamins now showing a prospect of protecting some people from Alzheimer’s in old age. The strong findings must inspire an expanded trial to follow people expected to develop Alzheimer’s, and we hope for further success.
‘We desperately need to support research into dementia, to help avoid the massive increases of people living with the condition as the population ages. Research is the only answer to what remains the greatest medical challenge of our time.’
Professor Chris Kennard, chair of the Medical Research Council’s Neurosciences and Mental Health Board which co-funded the study, said: ‘This MRC-funded trial brings us a step closer to unravelling the complex neurobiology of ageing and cognitive decline, which holds the key to the development of future treatments for conditions like Alzheimer’s disease. The findings are very encouraging and we look forward to further research that is needed in order to test whether B vitamins can be recommended as a suitable treatment.’

Chokeberry Extract Found to Regulate Weight Gain, Blood Glucose, and Inflammation in Rats

Posted in Health, Nutrition by Administrator on the July 27th, 2010

ScienceDaily (July 24, 2010) — Chokeberry bushes have for centuries been residents of eastern deciduous forests where their bright red and dark purple fruits continue to be favorite snacks of local bird species. Native Americans have also traditionally eaten dried chokeberries and prepared teas from parts of the plant, and several domesticated varieties now grace contemporary lawns and gardens from coast to coast. However, the chokeberry (Aronia) is enjoying a new claim-to-fame as a potentially powerful antioxidant, and can now be found for sale in the dietary supplement and “health food” aisles of your local pharmacies and grocery stores.

See Also:
Health & Medicine
•Diet and Weight Loss
•Obesity
•Cholesterol
•Seeds
Reference
•Vegetable
•Cherry
•Polyphenol antioxidant
•Blood sugar
What makes the humble chokeberry so healthful? Scientists think the answer lies in their unusually high levels of substances called anthocyanins (from the Greek anthos + kyanos meaning dark blue). There are many different anthocyanins in these colorful berries, but they all function as antioxidants — originally protecting the chokeberry seed from sunshine-induced oxidative stress. And when we eat them, they also appear to protect our bodies from a variety of damaging situations, including exposure to pollution and metabolically-derived free radicals. Indeed, a growing body of scientific literature has shown promising effects of chokeberry consumption on diseases ranging from cancer to obesity. These health-promoting effects may be due to the potent anti-inflammatory properties of anthocyanins, as uncontrolled inflammation is now universally recognized as a common thread in many of our most prevalent and deadly diseases. In addition, certain anthocyanins — including those found in chokeberry — have also been shown to improve blood sugar and the function of insulin.

To better understand how chokeberries influence health, Drs. Bolin Qin and Richard Anderson from the US Department of Agriculture in Beltsville, MD studied what happens when prediabetic rats are fed chokeberry extracts for an extended period of time. The results of their research were presented on April 25 at the Experimental Biology 2010 meeting in Anaheim, CA. This presentation is part of the scientific program of the American Society for Nutrition, home of the world’s leading nutrition researchers.

The researchers first made 18 male rats “prediabetic” or insulin insensitive by feeding them a fructose-rich diet for 6 weeks. Then they randomized the animals to continue drinking either pure water or water spiked with low or high levels of chokeberry extract (CellBerry®, Integrity Nutraceuticals International). After drinking this water for 6 weeks, the groups were compared in terms of body weight, body fat, blood glucose regulation, and molecular markers for inflammation.

Qin and Anderson found that at the end of the study the rats consuming the chokeberry-spiked water weighed less than the controls; both levels of chokeberry had the same effect in this regard. Similar beneficial effects of chokeberry consumption were found for body fat (specifically, that of the lower abdominal region). They also discovered that animals that had been drinking chokeberry extract had lower blood glucose and reduced levels of plasma triglycerides, cholesterol, and low-density lipoprotein (LDL) cholesterol when compared to the control animals. These alterations would theoretically lead to lower risk for diabetes and cardiovascular disease in humans. And to add even more evidence for a healthful impact of this super-berry, the researchers documented numerous alterations in expression of genes that would likely lead to reduced chronic inflammation and perhaps even lower cancer risk. For instance, drinking chokeberry extract lowered expression of the gene coding for interleukin-6 (IL-6), a protein that normally triggers inflammation following trauma or infection. Chronic overproduction of IL-6 has been documented in many diseases such as diabetes, arthritis, and atherosclerosis and is thought to be a partial cause of these conditions.

Of course, human studies will be needed before scientists can declare whether we derive the same health benefits from the chokeberry, but Qin and Anderson believe that their study “provides evidence that the chokeberry extract inhibits weight gain in insulin-resistant animals and that it modulates multiple genes associated with adipose tissue growth, blood glucose regulation, and inflammatory pathways.” A final word to the wise: raw chokeberries are exceptionally bitter, so don’t be tempted to harvest the shrubs in your backyard. Instead, look for this unassuming berry in fruit juice blends, jellies, and sweetened syrups.

Drs. Qin and Anderson are federal researchers in the Diet, Genomics, and Immunology Laboratory at the Beltsville Human Nutrition Research Center, a component of the US Department of Agriculture. This study was supported, in part, by Integrity Nutraceuticals International (South Spring Hill, TN).

Why Walking Flat-Footed Hurts Habitual High-Heels Wearers: The Effects of Wearing High Heels on Women’s Legs

Posted in Chiropractic by Administrator on the July 21st, 2010

Why Walking Flat-Footed Hurts Habitual High-Heels Wearers: The Effects of Wearing High Heels on Women’s Legs
ScienceDaily (July 16, 2010) — When it comes to shoes, some women will go through hell for a pair of Jimmy Choos. But what effect does wearing high heels have on our bodies? Clinicians have known for a long time that if you hold a limb in a shortened position over an extended period, the muscles shorten. High-heeled shoes push our heels up, which made Marco Narici from Manchester Metropolitan University wonder whether wearing heels on a regular basis could shorten our calf muscles.

According to Narici, there was some anecdotal evidence that something changed because secretaries in the 1950s complained about discomfort when they took their heels off and walked flat-footed. “I thought it was an experiment which was inadvertently being done by women. What we could do was test high heel wearers to see if we could find some changes in the calf muscle,” says Narici, who publishes his results on 16 July 2010 in the Journal of Experimental Biology.

At that time, Robert Csapo, from the University of Vienna, Austria, was visiting Narici’s Active Lifespan Lab, so Narici and Costis Maganaris asked Csapo to test the theory. Placing an advert in the Manchester Evening News asking for volunteers ranging in age from 20 to 50 years who had regularly worn 5·cm high heels for 2 years or more, Csapo attracted 80 recruits, which he whittled down to a final group of 11 who felt uncomfortable walking without their heels. Then he recruited a second group of women who did not wear high heels and teamed up with Olivier Seynnes to look at the internal workings of both groups’ calf muscles.

Measuring the size of the women’s calf muscles with MRI, the team found that the calf muscles of the high heel wearers were the same size as those of the women who preferred flat shoes; they hadn’t shrunk. “We were expecting slightly smaller muscle volumes in the high heel wearers because we thought that if the muscle is in a shortened position then you are loading it less and the muscle volume should be smaller,” explains Narici.

Next Csapo and Seynnes used ultrasound to measure the muscle fibre length in the women’s calf muscles, and this time they did see a difference. The high heel wearers’ muscle fibres were 13% shorter than those of the women who wore flat shoes. “This confirmed the hypothesis,” says Narici, “because when you place the muscle in a shorter position, the fibres become shorter.”

However, by shortening the fibres, the muscles would have to contract more to shorten by the same length, and if this was the case the high heel fans’ calf muscles could no longer function optimally and thus would produce less force than the flat shoe wearer’s calf muscles. Had the shortened muscle fibres made it more difficult for high heel addicts to walk efficiently?

The team turned their attention to the tendons that attach the calf muscle to the heel. Scanning with MRI, the team could see that the Achilles’ tendon was the same length in the two groups of women. The tendon had not lengthened to compensate for the shorter calf muscle. However, the high heel fans’ tendons were much thicker and stiffer than the flat shoe wearers’. Narici and his team realised that by thickening and stiffening, the Achilles’ tendon compensates for the shortened muscle fibres in the calf muscle, allowing the fashion addicts’ calf muscles to function optimally as they walk, but causing discomfort when walking on flat feet because the tendon cannot stretch sufficiently.

So should women give up wearing high heels? Narici doesn’t think so, but suggests that fashion addicts may want to try stretching exercises to avoid soreness when they kick off their heels at the end of the day.

More Than Half the World’s Population Gets Insufficient Vitamin D

Posted in Health, Nutrition, Uncategorized by Administrator on the July 20th, 2010

We realize that there are other areas of health to cover, and here at the WPRC, we will begin to post articles on many subjects, as well as plans on treatment of maladies, home remedies and protocols of how to take care of injuries, and home rehabilitative techniques that are utilized by our clinicians and can be useful tools and reminders for everyone.

ScienceDaily (July 19, 2010) — Vitamin D surfaces as a news topic every few months. How much daily vitamin D should a person get? Is it possible to have too much of it? Is exposure to the sun, which is the body’s natural way of producing vitamin D, the best option? Or do supplements suffice?

In the July 2010 issue of Endocrine Today, a monthly newspaper published by SLACK, Inc., to disseminate information about diabetes and endocrine disorders, Anthony Norman, a distinguished professor emeritus of biochemistry and biomedical sciences and an international expert on vitamin D, notes that half the people in North America and Western Europe get insufficient amounts of vitamin D.

“Elsewhere, it is worse,” he says, “given that two-thirds of the people are vitamin D-insufficient or deficient. It is clear that merely eating vitamin D-rich foods is not adequate to solve the problem for most adults.”

Currently, the recommended daily intake of vitamin D is 200 international units (IU) for people up to 50 years old; 400 IU for people 51 to 70 years old; and 600 IU for people over 70 years old.

“There is a wide consensus among scientists that the relative daily intake of vitamin D should be increased to 2,000 to 4,000 IU for most adults,” Norman says. “A 2000 IU daily intake can be achieved by a combination of sunshine, food, supplements, and possibly even limited tanning exposure.”

While there is now abundant data on vitamin D and its benefits, Norman believes there is room for more study.

“The benefits of more research on the topic justifies why this field of research deserves additional governmental funding,” he says. “Already, several studies have reported substantial reductions in incidence of breast cancer, colon cancer and type 1 diabetes in association with adequate intake of vitamin D, the positive effect generally occurring within five years of initiation of adequate vitamin D intake.”

Because vitamin D is found in very few foods naturally (e.g. fish, eggs and cod liver oil) other foods such as milk, orange juice, some yogurts and some breakfast foods are fortified with it. The fortification levels aim at about 400 IU per day.

Norman, who holds the title of Presidential Chair in Biochemistry-Emeritus, has been researching vitamin D for nearly 50 years. In 1967, his laboratory discovered that the vitamin is converted into a steroid hormone by the body. Two years later, his laboratory discovered the vitamin D receptor (or VDR), an essential receptor for the steroid hormone form of vitamin D that is present in more than 37 target organs of the body that respond biologically to the vitamin.

“There is now irrevocable evidence that receptors in the immune, pancreas, heart-cardiovascular, muscle and brain systems in the body generate biological responses to the steroid hormone form of vitamin D,” he says.

Do I Really Need Vitamin D?

Posted in Health, Nutrition by Administrator on the March 19th, 2010

The hottest topic in medicine isn’t the newest drug or the latest surgical device: It’s vitamin D.
Now, before we get into the bulk of the article, there are a few disclaimers which affect how vitamin D should be viewed especially here in the Northwest. We do have the ability to activate vitamin D through sulight exposure. But, during the winter months in Seattle the sunlight is not intense enough to cause this activation. So, you either have to supplement with vitamin D, or migrate like a bird for the winter.

What brought the simmering debate to a boil was a 2007 study showing that people taking normal vitamin D supplements were 7% less likely to die than those who didn’t take the daily supplements.
A year later, a major study found that when women with low vitamin D levels get breast cancer, they have a much higher chance of dying from their cancer than women with normal vitamin D levels.

That was surprising news. But just as surprising is the fact that many men, women, and children have insufficient blood levels of this important vitamin. How many? Data suggest many of us don’t get the vitamin D we need. For example, a 2007 study of childbearing women in the Northern U.S. found insufficient vitamin D levels in 54% of black women and in 42% of white women. These findings led the American Academy of Pediatrics to double the recommended amount of vitamin D a child should take — and have led many doctors to advise their adult patients to up their vitamin D intake.

Your health may depend on knowing the answers to these important questions:

Why do I need vitamin D?
How can I get enough vitamin D?
Will a vitamin D test tell me if I need more vitamin D?
Which foods contain vitamin D?
How much vitamin D do my children and I need?
Can I get too much vitamin D?
What kind of vitamin D is best?
Does vitamin D interact with other medications?

Why do I need vitamin D?
Your body must have vitamin D to absorb calcium and promote bone growth. Too little vitamin D results in soft bones in children (rickets) and fragile, misshapen bones in adults (osteomalacia). You also need vitamin D for other important body functions.

Vitamin D deficiency has now been linked to breast cancer, colon cancer, prostate cancer, heart disease, depression, weight gain, and other maladies. These studies show that people with higher levels of vitamin D have a lower risk of disease, although they do not definitively prove that lack of vitamin D causes disease — or that vitamin D supplements would lower risk.

The Vitamin D Council — a scientist-led group promoting vitamin D deficiency awareness — suggests vitamin D treatment might be found helpful in treating or preventing autism, autoimmune disease, cancer, chronic pain, depression, diabetes, heart disease, high bloodpressure, flu, neuromuscular diseases, and osteoporosis. However, there have been no definitive clinical trials.

The best known benefit of vitamin D is its role in helping calcium build strong bones. But that’s far from the whole story. Vitamin D helps regulate the immune system and the neuromuscular system. Vitamin D also plays major roles in the life cycle of human cells.

Vitamin D is so important that your body makes it by itself — but only after skin exposure to sufficient sunlight. This is a problem for people in northern climates. In the U.S., only people who live south of a line drawn from Los Angeles to Columbia, S.C., get enough sunlight for vitamin D production throughout the year.

Dark skin absorbs less sunlight, so people with dark skin do not get as much vitamin D from sun exposure as do light-skinned people. This is a particular problem for African-Americans in the northern U.S.

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How can I get enough vitamin D?
Thirty minutes of sun exposure to the face, legs, or back — without sunscreen — at least twice a week should give you plenty of vitamin D.

But this much direct sun exposure might also expose you to potentially dangerous levels of cancer-causing UV radiation. And unless you live in the South or Southwest, you probably won’t get enough sunlight during the winter months for your body to make enough vitamin D. The American Academy of Dermatology recommends against getting vitamin D from unprotected exposure to sunlight.

It’s probably a better idea to get vitamin D from foods or from supplements.

Will a vitamin D test tell me if I need more vitamin D?
Yes. As part of your regular blood test, your doctor should order a test for 25-hydroxyvitamin D (25-OHD).

Everyone agrees that anyone with a 25-OHD level of less than 15 ng/mL or 37.5 nmol/L (depending on the units reported by a lab) needs more vitamin D. A 2002 study found that 42% of African-American women of childbearing age had vitamin D levels below 15 ng/mL.

The U.S. National Institutes of health notes that 25-OHD levels over 30 ng/mL are optimal, and that there is “insufficient data” to support recommendations for higher levels.

The Vitamin D Council considers the ideal 25-OHD level to be between 40 ng/mL and 70 ng/mL.

Which foods contain vitamin D?
Surprisingly few foods contain vitamin D — unless it’s added to the food. That’s because your body is built to get vitamin D through your skin (from sunlight) rather than through your mouth (by food). But once your body has enough, it doesn’t matter whether you got it through your skin or through your stomach.

There are three vitamin D super foods:

Salmon (especially wild-caught)
Mackerel (especially wild-caught; eat up to 12 ounces a week of a variety of fish and shellfish that are low in mercury)
Mushrooms exposed to ultraviolet light to increase vitamin D
Other food sources of vitamin D include:

Cod liver oil (warning: cod liver oil is rich in vitamin A; too much may be bad for you)
Tuna canned in water
Sardines canned in oil
Milk or yogurt — regardless of whether it’s whole, nonfat, or reduced fat — fortified with vitamin D
Beef or calf liver
Egg yolks
Cheese
Nearly all milk in the U.S. is fortified with vitamin D. So are many brands of orange juice, yogurt, margarine, and ready-to-eat breakfast cereals.

How much vitamin D do I need?
The current recommended daily dose of vitamin D is 200 IU for people up to age 50, 400 IU for people aged 51 to 70, and 600 IU for people over age 70.

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That’s not enough, Boston University vitamin D expert , MD, PhD, tells WebMD. Holick recommends a dose of 1,000 IU a day of vitamin D for both infants and adults — unless they’re getting plenty of safe sun exposure.

In 2008, the American Academy of Pediatrics recommended that breastfed infants receive 400 IU of vitamin D every day until they are weaned. This doubled the AAP’s previous recommendation.

The AAP also recommends 400 IU/day of vitamin D for children and teens who drink less than a quart of vitamin D-fortified milk per day.

The Vitamin D Council recommends that healthy adults take 2,000 IU of vitamin D daily — more if they get little or no sun exposure.

There’s evidence that people with a lot of body fat need more vitamin D than lean people.

The Institute of Medicine’s Food and Nutrition Board is currently updating its 1997 vitamin D recommendations. A report is scheduled for May 2010.

high blood calcium level, which could result in nausea, constipation, confusion, abnormal heart rhythm, and even kidney stones.

It’s nearly impossible to get too much vitamin D from sunlight or from foods (unless you take way too much cod liver oil). Nearly all vitamin D overdoses come from supplements.

The Institute of Medicine’s Food and Nutrition Board’s 1997 recommendations — scheduled for a May 2010 update — suggest that 2,000 IU per day oCan I get too much vitamin D?
Too much of any good thing is a bad thing. Too much vitamin D can cause an abnormally f vitamin D is safe for adults and that 1,000 IU per day is safe for infants up to 12 months of age.

However, the relatively small doses of vitamin D in daily vitamin pills are not enough to correct serious vitamin D deficiency. A 2009 study suggested that the best regimen for treating vitamin D insufficiency is 50,000 IU of vitamin D3 taken three times a week for six weeks. This time-limited regimen did not result in vitamin D toxicity.

How much vitamin D is too much? That’s controversial. According to the National Institutes of Health, the maximum upper limit for vitamin D is 25 micrograms (1,000 IU) for children up to age 12 months and 50 micrograms (2,000 IU) for everyone else.

But some recent studies suggest that healthy adults can tolerate more than 10,000 IU of vitamin D per day. John Jacob Cannell, MD, executive director of The Vitamin D Council, notes that the skin makes 10,000 IU of vitamin D after 30 minutes of full-body sun exposure. He suggests that 10,000 IU of vitamin D is not toxic.

According to the National Institutes of Health, 25-OHD levels that are consistently over 200 ng/mL are “potentially toxic.”

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That’s not enough, Boston University vitamin D expert , MD, PhD, tells WebMD. Holick recommends a dose of 1,000 IU a day of vitamin D for both infants and adults — unless they’re getting plenty of safe sun exposure.

In 2008, the American Academy of Pediatrics recommended that breastfed infants receive 400 IU of vitamin D every day until they are weaned. This doubled the AAP’s previous recommendation.

The AAP also recommends 400 IU/day of vitamin D for children and teens who drink less than a quart of vitamin D-fortified milk per day.

The Vitamin D Council recommends that healthy adults take 2,000 IU of vitamin D daily — more if they get little or no sun exposure.

There’s evidence that people with a lot of body fat need more vitamin D than lean people.

The Institute of Medicine’s Food and Nutrition Board is currently updating its 1997 vitamin D recommendations. A report is scheduled for May 2010.

Can I get too much vitamin D?
Too much of any good thing is a bad thing. Too much vitamin D can cause an abnormally high blood calcium level, which could result in nausea, constipation, confusion, abnormal heart rhythm, and even kidney stones.

It’s nearly impossible to get too much vitamin D from sunlight or from foods (unless you take way too much cod liver oil). Nearly all vitamin D overdoses come from supplements.

The Institute of Medicine’s Food and Nutrition Board’s 1997 recommendations — scheduled for a May 2010 update — suggest that 2,000 IU per day of vitamin D is safe for adults and that 1,000 IU per day is safe for infants up to 12 months of age.

However, the relatively small doses of vitamin D in daily vitamin pills are not enough to correct serious vitamin D deficiency. A 2009 study suggested that the best regimen for treating vitamin D insufficiency is 50,000 IU of vitamin D3 taken three times a week for six weeks. This time-limited regimen did not result in vitamin D toxicity.

How much vitamin D is too much?
That’s controversial. According to the National Institutes of Health, the maximum upper limit for vitamin D is 25 micrograms (1,000 IU) for children up to age 12 months and 50 micrograms (2,000 IU) for everyone else.

But some recent studies suggest that healthy adults can tolerate more than 10,000 IU of vitamin D per day. John Jacob Cannell, MD, executive director of The Vitamin D Council, notes that the skin makes 10,000 IU of vitamin D after 30 minutes of full-body sun exposure. He suggests that 10,000 IU of vitamin D is not toxic.

According to the National Institutes of Health, 25-OHD levels that are consistently over 200 ng/mL are “potentially toxic.”

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What kind of vitamin D is best?
The recommended form of vitamin D is vitamin D3 or cholecalciferol. This is the natural form of vitamin D that your body makes from sunlight. Supplements are made from the fat of lambs’ wool.

However, a clinical study reported in 2008 suggested that vitamin D2 works as well as vitamin D3. Many supplements contain vitamin D as vitamin D2 or calciferol. It’s derived from irradiated fungus. Because this is not the form of vitamin D naturally made by your body, WebMD nutritionist Kathleen M. Zelman, MPH, RD, recommends using the D3 form for those taking vitamin D supplements. Because of its potency, different forms of vitamin D are used in prescription medications. If you have a prescription for one of these medications, do not switch to another form of vitamin D without checking with your doctor.

Does vitamin D interact with other medications?
Yes. Steroid medications such as prednisone can interfere with vitamin D metabolism. If you take steroid drugs regularly, discuss vitamin D with your doctor. The weight loss drug orlistat — brand names include Xenical and Alli — may cut absorption of vitamin D. So does the cholesterol-lowering drug cholestyramine (sold as Questran, LoCholest, and Prevalite). People taking these drugs should discuss vitamin intake with their doctors.
The seizure drugs Phenobarbital and Dilantin (phenytoin), affect vitamin D metabolism and affect calcium absorption. So do anti-tuberculosis drugs. On the other hand, cholesterol-lowering statin drugs and thiazide diuretics increase vitamin D levels.

Cannell, J.J. and Hollis, B.W. Alternative Medicine Review, March 2008; vol 13: pp 6-20.

Holick, M.F. Journal of Clinical Endocrinology and Metabolism, March 2008; vol 93: pp 677-681.

Autier, P. and Gandini, S. Archives of Internal Medicine, Sept. 10, 2007; vol 167: pp 1730-1737.

Holick, M.F. and Chen, T.C. American Journal of Clinical Nutrition, 2008; vol 87: pp 1080S-1086S.

Bordelon, P. American Family Physician, Oct. 15, 2009; vol 80: pp 841-846.

Rovner, A.J. and O’Brien, K.O. Archives of Pediatric and Adolescent Medicine, June 2008; vol 162: pp 513-519.

Pepper, K.J. Endocrinology Practice, 2009; vol 15: pp 95-103.

Muscle Pain Following Whiplash Injuries

Posted in Chiropractic, Health, Uncategorized by Administrator on the March 18th, 2010

MUSCLE PAIN FOLLOWING WHIPLSH INJURIES
One of the most common symptoms experienced after a motor vehicle accident, is head and neck pain especially when the occupant is struck from behind. Neck injuries associated with auto accidents have been studied for many years, recently a new study published in the prestigious medical journal Spine, was released that helped to explain the cause of this pain.
The impact experienced by an occupant in an auto accident produces a large amount of force over a very short period of time, lasting only milliseconds. A new research study explains that it is may be the short time frame that may play a larger role in neck injuries than once thought. When an occupant is struck from behind, the force travels from the back of the car through the occupant finally exiting through the front. In order to protect the body, the body muscles of the neck contract to prevent injury. The muscles have been shown to fire at 100 milliseconds post impact which is 25 milliseconds after the majority of damage has occurred to the ligaments in the neck. (1)
The conclusion of the study: The muscles of the neck fire too late in a rear end collision to prevent injury to the spine and ligaments.
Ligaments heal very slowly because they lack the blood supply that muscles have. Ligaments in the neck also do not get the rest needed due to the demands on the neck at we go about our daily activities. The muscles of the neck are required to support a greater portion of the weight of the head and therefore become tired and sore while supporting this weight.
When structures of the neck are injured, the once healthy tissue is replaced with scar tissue. This new tissue is not nearly as strong or flexible as its predecessor. Encouraging proper healing of these tissues requires maintaining the mobility through spinal manipulation and stretching. Once the injured areas become less painful, it is imperative to strengthen the supporting muscles that have been injured. These muscles will be responsible for supporting the neck and preventing exacerbations or flare ups.
Injuries in the neck can also produce symptoms of pain in areas other than the location of the injury, this is called referred pain. For example and injury that occurs in the neck from a motor vehicle collision can present at pain in the shoulder blade. Referral pain patterns have been mapped out in the neck by injecting a stimulus to a specific area in the spine with a stimulating agent and the patient is asked to identify any symptoms they are experiencing outside of the location of the injection.
Posted by Dr. Aaron Keith — Research Injuries on May 15, 2009

1. Vasavada AN, Brault JR, Siegmund GP. Musculotendon and fascicle strains in anterior and posterior neck muscles during whiplash injury. Spine 2007;32(7):756-765.

DR’S PERSPECTIVE

Posted in Chiropractic by Administrator on the May 8th, 2009

As a chiropractor, I focus on the cause and prevention of disease. Nutrition and lifestyle issues are very important and may contribute to areas of weakness and instability of the human body. I am excited to start a blog where I can talk about common healthcare needs, nutritional issues, and the benefits of chiropractic care.

Who am I? I have been a chiropractor in the Woodinville, Washington area for 6 years. I am an active member of the Woodinville Chamber of Commerce. In my leisure time I enjoy spending time with my family and cycling. In the past I provided coaching support for the Leukemia and Lymphoma Society’s Team in Training program.

If I can be of assitance in your health care in any way, please stop by or call. My door is always open.

WOODINVILLE PAIN RELIEF CLINIC
17419 139th AVE NE
WOODINVILLE, WA 98072

  • OFFICE 425-368-2003
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  • Email: dr_ahk@hotmail.com