Flaxseed for Heart Healthy Nutrition

The use of flaxseed in food and beverages, functional foods and dietary supplements has risen dramatically. Such increased popularity is related to the increasingly recognized benefits of flax’s rich omega-3 fatty acid, lignans (powerful phytonutrient phytoestrogens/antioxidants) and fiber content.

A typical flax profile is approximately 40 percent fat, being mostly omega-3 as alpha linolenic acid (ALA); 28 percent dietary fiber; 21 percent protein; 4 percent mineral ash; and 6 percent carbohydrates.¹

And all the plant sources (see chart) are richer in omega 6 than omega 3, none having flax’s most desirable 3 to 1 omega-3 to omega-6 ratio.³

ALA, EPA, DHA

ALA is converted in the body to eicosapentaenoic acid (EPA) and, to a much lesser extent, docosahexaenoic acid (DHA).^4,5 EPA and DHA, as such, are found abundantly in fish oil. Both of these longer chain omega 3 fatty acids are known for their salubrious effects on cardio-vascular health.⁶ However, flaxseed has also demonstrated impressive support for its heart health promoting benefits.

ALA Improves Heart Health

Below is a small list of scientific studies supporting the benefit of a high ALA diet derived from plant sources.

Supplementation with 8g/day ALA resulted in significantly lower systolic and diastolic blood pressure levels. There was observed a hypotensive effect of ALA, which may constitute another mechanism accounting, in part, for the apparent cardio-protective effect of this n-3 fatty acid.⁷

To get an idea how omega-3 ALA rich flaxseed is compared to other ALA rich foods, the following should be instructive.

One and a half tsp. of ground flaxseed supplies 1,000 mg of ALA in 40 calories. One half tsp. of flaxseed oil supplies the same 1,000 mg ALA in 20 calories.

To get the same 1,000 mg of ALA, the following amounts of other sources are needed:

• Five walnut halves, providing 70 calories;

• two tsps. canola oil, garnering 80 calories;

• one tbs. of wheat germ or soybean oil, with 120 calories;

• two ounces salmon, herring, albacore, two ounces of sardine, rainbow trout, or eel, adding 100 calories;

• 9-12 ounces of most other fish, adding 300 calories or more;

• 5 cups cooked broccoli, providing 220 calories;

• 10 cups cooked spinach, with 280 calories;

• ¾ cup soy nuts, adding 285 calories and

• ¼ cup rice bran oil, tipping the scales at 480 calories.²

To compare the effects of ALA to EPA + DHA on cardiovascular risk markers in healthy elderly subjects, a randomized double-blind nutritional intervention study was done on thirty-seven mildly hyper-cholesterolemic subjects (fourteen men and twenty-three women, aged between sixty and seventy-eight years). During a run-in period of three weeks, subjects consumed an omega 6, oleic acid-rich (LN) diet. The following six weeks, ten subjects remained on the control diet, thirteen subjects consumed an ALA-rich diet (6.8 g/day) and fourteen subjects an EPA/DHA-rich diet (1.05 g EPA/day+0.55 g DHA/day). The researches concluded, in the European Journal of Clinical Nutrition, that, in healthy elderly subjects, ALA might affect concentrations of LDL-cholesterol and apoB more favorably than EPA/DHA.⁸

The Health Professionals Follow-up Study reported in the British Medical Journal a one percent increase in ALA as a percent of total calories was associated with a 40 percent risk reduction in non-fatal coronary heart disease.⁹

A 2001 article in the Journal of Nutrition Health and Aging noted that both Crete and Japan have the greatest life expectancy among the peoples of the first world. They also enjoy the highest levels of dietary ALA and the lowest intakes of saturated fat.¹⁰

The Lyon Diet Heart Study included as participants those patients who had survived a myocardial infarction (MI). The experimental group consumed a typical Mediterranean-style diet rich in ALA. The controls enjoyed diets low in ALA, typical of the Standard Amercan Diet (S.A.D.). Those in the experimental ALA group had a 75 percent reduction in non-fatal myocardial infarctions, and a 70 percent reduction in death from all causes compared to the S.A.D. group.¹¹

A number of studies have focused on the health benefits provided specifically by flax.

Women who consumed 50g of milled flax a day (1/8 cup) for four weeks garnered total blood and LDL-cholesterol level reductions of 9 percent and 18 percent, respectively.¹²

The Journal of Nutrition reported, in 2004, that two ways ALA may protect the heart are through (1) improvements in abnormal heart rhythms and (2) a reduction of blood platelet stickiness and resultent.¹³

Also in 2004, data from the Nurses Health Study demonstrated the higher the ALA intake, the lower the plasma concentrations of C-reactive protein (CRP).¹⁴ The year following, the European Journal of Clinical Nutrition reported that a diet high in ALA dramatically decreased CRP in men and women with high cholesterol levels.¹⁵ In 2005, the American Heart Association presented studies showing ALA lowers C-reactive protein (CRP), an even more important biomarker of inflammation.

Indeed, lowering C-reactive protein may be as important as reducing LDL cholesterol for heart attacks and stroke prevention.¹⁶ Fifty percent of all strokes and MI in the United States and Canada happen to persons with normal cholesterol findings. Twenty percent of all major cardiovascular events happen to folks with no major risk factors!¹⁷

Even more recently, the American Journal of Physiology-Heart and Physiology Circulation shared that, in rabbits with hypercholesterolemia, dietary flaxseed inhibited vascular contraction and atherosclerosis formation.¹⁸

Lanzmann and Petithory, in a review of studies focusing on flax and ALA, concluded that this ALA rich essential fatty acid (EFA) source may reduce ventricular fibrillation.¹⁹

The above research is leading to a consensus that flaxseed has very beneficial effects in the prevention of cardiovascular disease.^20,21 It is apparent, even from this briefest of introductory reviews, that the cardio-protective benefits of a flaxseed rich diet comes from numerous salubrious mechanisms. Furthermore, this research also demonstrates these many benefits despite differences in study populations, length of follow-up, outcomes, and methods of statistically analyzing the study data.

ALA RDA?

At the present time, there is no Recommended Dietary Allowance (RDA) for EFA’s in the U.S. However, the National Academy of Sciences’ Institute of Medicine (IOM) recommends 1.6g/day of ALA for men and 1.1g/day for women.²²

Excellent Source of Dietary Fiber

Numerous health benefits are derived from consuming ALA in flax. Not to be overlooked is flaxseed’s dietary fiber content of about 28 percent, which grants added health benefits. The American Dietetic Association has cited fiber’s “significant impact” on obesity, cardiovascular disease and type 2 diabetes prevention and management.²³

Flax has a ratio of soluble to insoluble fiber that can vary in a ratio of between one part soluble to four parts insoluble, to fourparts to six parts, respectively.²⁴ Insoluble dietary fiber supports healthy elimination and colon health, and may even have protective effects against colon cancer.²⁵ The soluble dietary fiber fraction of flax is found primarily as mucilage gums, which have been shown to play a role in lowering serum cholesterol levels.²⁶

John H. Maher, D.C., oversees physician and consumer education for BioPharma Scientific, creators of NanoGreens10. Dr Maher maintained an active chiropractic practice for 25 years. He has taught nutrition to health professionals nationally for the past 15 years. Dr. Maher is past post-graduate faculty of NYCC Academy of Anti-Aging Medicine, a Diplomate of the College of Clinical Nutrition, and a Fellow of the American Academy of Integrative Medicine. To learn more, visit www.nanogreens.com.

References

1) http://www.flaxcouncil.ca/english/index.php?p=n3&mp=newsline#Good

2) http://www.flaxcouncil.ca/english/index.php?p=n3&mp=newsline#Good

3) http://www.annecollins.com/dietary-fat/omega-3-efa-6-chart.htm

4)       Harper, CR, Edwards, MJ, DeFilipis, et al. 2006. Flaxseed oil Increases the Plasma Concentrations of Cardioprotective (n-3) Fatty Acids in Humans. J.Nutr. 136:83.

5)       Burdge, GC, Wootton, SA. 2002. Conversion of alpha-linolenic acid to eicosapentaenoic, docosapentaenoic and docosahexaenoic acids in young women. Brit. J.Nutr. 88:411-420.

6)       http://www.flaxcouncil.ca/english/pdf/FFtsheet_Fish_Flax_R2.pdf

7)       Paschos GK, Magkos F, Panagiotakos DB, Votteas V, and Zampelas A, Dietary supplementation with flaxseed oil lowers blood pressure in dyslipidaemic patients. European Journal of Clinical Nutrition (2007) 61, 1201–1206.

8)       Goyens P L L and Mensink R P, Effects of alpha-linolenic acid versus those of EPA/DHA on cardiovascular risk markers in healthy elderly subjects. European Journal of Clinical Nutrition (2006) 60, 978–984.

9)       Ascherio, A., Rimm, E.B., Giovannucci, E.L., et al. 1996. Dietary fat and risk of coronary heart disease in men: Cohort follow-up study in the United States. Br.Med. J. 313:84-90.

10)    Renaud, S., de Lorgeril, M., Delaye, J. et al. 1995. Cretan Mediterranean diet for prevention of coronary heart disease. Am. .J Clin.Nutr. 61(Suppl):1360S-7S.

11)    http://www.americanheart.org/presenter.jhtml?identifier=4655

12)    Cunnane, S.C. et al. 1995. Nutritional attributes of traditional flaxseed in healthy young adults. Am. J. Clin.Nutr. 61(1):62-68.

13)    Lopez-Garcia, E, Schulze, MB, Manson, JE, et al. 2004. Consumption of n3 fatty acids is related to plasma biomarkers of inflammation and endothelial activation in women. J. Nutr. 134:1806-1811.

14)    Ibid 13

15)    Bemelmans,W.J.E., Lefrandt, J.D., Feskens, E.J.M. et al. 2004. Increased alpha-linolenic acid intake lowers C-reactive protein, but has no effect on markers of atherosclerosis. Eur. J. Clin. Nutr. 58:1083-89.

16)    American Heart Association. Inflammation, Heart Disease and Stroke: The Role of C Reactive Protein. http://www.americanheart.org/presenter. October 26, 2005.

17)    Simopoulos, A.P. 1999. Essential fatty acids in health and chronic disease. Am. J. Clin. Nutr. 70(Suppl):560S-569S.

18)    Dupasquier C.M.C., et al, Effects of dietary flaxseed on vascular contractile function and atherosclerosis during prolonged hypercholesterolemia in rabbits Am J Physiol Heart Circ Physiol 291: H2987-H2996, 2006

19)    Lanzmann-Petithory,D. 2001. Alpha-linolenic acid and cardiovascular diseases. J. Nutr.Health Aging. 5(3):179-183.

20)    Renaud SC, Lanzmann-Petithory D. 2002.The beneficial effect of a-linolenic acid in coronary artery disease is not questionable (letter). Am. J. Clin.Nutr. 76: 903-904.

21)    Vos E, Cunnane SC. 2003. a-Linolenic acid, linoleic acid, coronary artery disease, and overall mortality (letter). Am. J. Clin.Nutr. 77: 521-522.

22)    Anon. Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Protein and Amino Acids (Macronutrients). 2002. National Academy of Sciences, Institute of Medicine, Health and Human Service’s Office of Disease Prevention and Health Promotion (U.S.).

23)    American Dietetic Association. 1997. Health implications of dietary fiber—Position of American Dietetic Association. J. Am. Diet. Assoc. 971157-1159.

24)    Hadley,M., Lacher, C.,Mitchell-Fetch, J. 1992. Fiber in Flaxseed. Proc. Flax Inst. 54:79-83

25)    Ibid. 24

26)    Ibid 24

The Whey to Enhancing Glutathione

GLUTATHIONE is widely found in all forms of life nad plays an essential role in the health of organisms, particularly aerobic ones. In humans, animals, and plants, glutathione is the predominant non-protein sulfhydryl group and functions most especially as an antioxidant, keeping its own sulfhydryl (-SH) groups and related proteins in a reduced (non-oxidized) condition.1, 2

Though there are undoubtedly multiple functions for glutathione yet to be appreciated, we do know that glutathione is:

• a co-factor for the glutathione peroxidases, which are crucial selenium-containing antioxidant enzymes.

• a co-factor for glutathione S-transferases, enzymes which are involved in the detoxifi cation of xenobiotics, including carcinogens.

• involved in the regeneration of ascorbate (Vitamin C) from its oxidized form, dehydro-ascorbate.3

Glutathione, itself, is a non-essential nutrient composed of three amino acids: glutamic acid, glycine and cysteine or, more exactly, the tripeptide L-gamma-glutamyl-L-cysteinylglycine. Availability of cysteine is a limiting factor in the liver’s synthesis of glutathione.

Chronic functional glutathione defi ciency is associated with immune disorders, an increased incidence of cancer and, in the case of HIV disease, probably accelerated pathogenesis of the disease.4, 5

Acute manifestations of functional glutathione defi ciency can be seen in those who have taken an over-dosage of acetaminophen (Tylenol). A vital role of glutathione is the maintenance of a normal redox state of the liver. An overdose of acetaminophen leads to its metabolism into large quantities of N-acetyl-benzoquinoneimine (NABQI) in the liver. NABQI depletes hepatic glutathione stores, placing an enormous oxidative stress on the liver, leading to liver failure.6

N-acetyl-L-cysteine

N-acetyl-L-cysteine (NAC) is integral to the treatment of acetaminophen overdose. This is due mainly to its ability to regenerate liver stores of glutathione. NAC is a bioavailable delivery form of L-cysteine, which serves as a major precursor to the antioxidant glutathione, but its half-life is only thirty minutes.7,8 Therefore, its use as a supplement to enhance glutathione levels is limited.

Alpha Lipoic Acid

Alpha-lipoic acid (ALA), which is synthesized in mitochondria and also requires L-cysteine, appears to participate in the recycling of glutathione.9 There is extensive animal work showing that lipoic acid, by supporting glutathione levels, can exert signifi cant protective effects against oxidant damage related to ischemia-reperfusion injury.10 More research may be needed to further elucidate these mechanisms and determine whether these results will apply in humans.

Reduced Glutathione

Glutathione, as such, is present in the diet in amounts usually less than 100 milligrams daily. It does not appear that much of the oral intake is absorbed from the intestine into the blood, at least in humans. However, there is an occasional study that does show an increase in circulating glutathione after oral administration of reduced glutathione.11,12,13,14 There is greater evidence that glutathione may be absorbed into the enterocytes, where it may help repair damaged cells.15 Patents have been submitted for reduced glutathione in a liposome claiming enhanced absorption.16

Organic L-Selenomethionine

Glutathione formation requires an adequate level of selenium. Selenium belongs to the sulfur group of elements which includes oxygen, tellurium and polonium. It is an essential trace element in human and animal nutrition. L-selenomethionine or L-selenocysteine are selenoproteins necessary to the endogenous production of glutathione peroxidases (GSHPx 1-4).17,18

There appears to be an inverse relationship between coronary heart disease and selenium intake. The possible anti-atherogenic activity of selenium may be accounted for, in part, by its antioxidant activity. Glutathione peroxidase may protect low density lipoprotein (LDL) from oxidation, thereby inhibiting atherogenesis and platlet aggregation. (Lipoperoxides impair prostacyclin synthesis and promote thromboxane synthesis).19

Undenatured Whey Protein and Colostrum

Undenatured whey and colostrum proteins’ antioxidant, detoxication and immunological effects are in no small part likely related to the glutamylcysteine groups which act as the substrate for glutathione (GSH) synthesis. These cystine groups needed for the intracellular conversion to cysteine are in whey and colostral sub-fractions.20 However, this highly bioavailable, double bonded cystine portion is very thermo-labile. Denaturization by heat will, therefore, greatly inhibit the ability of whey proteins to act as precursors to GSH synthesis, though not affecting the biological value (BV) of whey as a protein nutrient, as such. 21

Conclusions

Reduced glutathione is the major endogenous antioxidant and detoxication peptide. Its hepatic production and intracellular levels may be enhanced in the following ways:

• NAC, 200 mg, 3 or 4 times daily

• Reduced glutathione, in liposome: 50-200 mg, once or twice daily

• Selenium, which is abundant in garlic, onion, broccoli, whole grains and, most especially, Brazil nuts, has an optimal daily dosage at perhaps 200 mcg a day.22

• Whey protein, undenatured, 10-15 gm, 1 to 3 times a day

• Colostrum, whole, 2 gm, 1 to 3 times a day.

A palatable functional food formula of undenatured whey and/or colostrum, combined with some of the above nutraceuticals, may be both the most clinically effi cacious and nutritionally complete way to enhance endogenous glutathione production.

John H. Maher, D.C., oversees physician and consumer education for BioPharma Scientifi c, creators of Nano- Greens10. Dr Maher maintained an active chiropractic practice for 25 years. He has taught nutrition to health professionals nationally for the past 15 years. Dr. Maher is past post-graduate faculty of NYCC Academy of Anti-Aging Medicine, a Diplomate of the College of Clinical Nutrition, and a Fellow of the American Academy of Integrative Medicine. To learn more visit www.nanogreens.com.

The Many Clinical Faces of Protein Deficiency

If the Chiropractic Profession were to “Discover the Secret” of improving protein digestion and assimilation, it could transform the health care marketplace almost overnight! That is not an exaggeration. Almost impossible to detect in its early stages with ordinary lab tests such as blood work, protein deficiency is behind many of the most persistent chief complaints for which patients enter your office. I estimate that at least 90 percent of all my female patients were protein deficient. The percentage was much lower for males, but especially significant in chronic back problems. Just examine the following list of clinical possibilities:

Hemoglobin and almost all of the factors involved in blood clotting are proteins. The photoreceptors in the eye responsible for vision are proteins. The neurotransmitters dopamine (alertness chemical) and serotonin (calming chemical) are proteins.

Protein defi ciency accounts for a large amount of infant mortality among malnourished children because specifi c antibodies against infection cannot be formed. Antibodies exhibit exactly the same chemical and physical properties of the plasma gamma globulins which are responsible for the body’s natural immunity to invasive agents. (See Table 2)

As extensive as the list in Table 1 is, it does not include fatigue and the often-heard complaint of being sick and tired of being sick and tired. This is so commonplace that it is usually ignored or even joked about by doctors and patients alike. When serious diagnostic investigations are made, the test results are usually normal and the patient is informed that nothing is wrong. Obviously the patient should be relieved that nothing serious is involved. But, without resolution of the vague symptomatology, their frustration lingers and they seek other means of treatment. Often many of these also fail but at a high price, since the expense must be covered out-of-pocket.

The medical profession is fi nding out that the old “try this and if it doesn’t work, we will do something else” routine has worn thin. By 1994, patient visits to so-called alternative health care providers were beginning to outnumber visits to medical providers. The economic “pinch” has gradually become stronger and now is driving the medical revolution toward alternative methods.

A cursory examination of the symptoms listed in Table 1 indicates that the allopathic approach in these conditions fails because they do not have anything to measure and, therefore, treatment with prescription drugs becomes hit-or-miss on a symptomatic basis. Obviously, it has been mostly miss. Once objective evidence of a disorder can be established, medicine’s track record improves. But, without objective evidence of pathological signifi cance, a vaccine or drug cannot be developed for the “sick and tired of being sick and tired“ syndrome. This should be good news to all who practice without the benefi t of pharmaceuticals. It means the patient is not diseased, and you will be able to help.

The answer for this common malady may lie within the body’s inability to handle stress (be it mechanical, nutritional, or emotional). Fortunately, the body handles all stress in a very predictable manner. Hans Selye was known for his landmark research that identifi ed the effects of stress on the human body. He found that stress, regardless of its source (chemical, mechanical, or emotional), always elicited a specifi c response. He called this process the General Adaptation Syndrome, and it consisted of the following stages:

• Alarm reaction to any stress;

• Resistance to or compensation for that stress;

• Exhaustion, if the stress is too strong or is maintained too long;

• The stages of disease, degeneration and, fi nally, death followed.

Symptoms do not occur until the body can no longer compensate for the stress being applied to it. And there can be no pathological fi ndings until the body reaches the stage of disease.

So the question is, what is lacking in a body in which symptoms are being manifested but is not yet evidencing alterations on objective tests such as blood, urine, X-ray, or MRI?

One obvious answer is that the body is not being supplied with adequate nutrients to nourish the organs responsible for the symptomatic pattern. Each organ and organ system is responsible for doing its part in maintaining, within narrow limits, the body temperature, pH, volume of extracellular fl uid, and the concentration of dissolved substances within that fl uid. This continuing process is called homeostasis. Seldom is homeostasis taken into consideration when deciding on a therapeutic course of action. Yet, if you can defi ne the price the body is paying to maintain homeostasis, you will know exactly how to solve the problem of “sick and tired of being sick and tired”!

As we turn our attention now to solving the riddle of being sick and tired, we can be sure of one thing: the body will maintain homeostasis or die. It maintains it all the time, everytime, and it does it with protein.

Despite all the claims made for the many combinations of vitamins, minerals, amino acids, and herbal extracts, the simple truth is that protein is the primary nutrient needed to maintain normal body functions. I didn’t say the others are not important. I said that, without protein, the others are totally irrelevant. To understand this seemingly outrageous statement, it is necessary to look at how the body uses protein to maintain the extracellular fl uid.

If detecting subclinical protein defi ciencies were easy, there would be no need for this article, because a big part of your formal education would have centered on correcting this insidious problem. I say “insidious” because blood tests for plasma proteins are usually normal outside of advanced disease states. Since homeostasis must be maintained ALL THE TIME and AT ALL COST, the body will catabolize its own tissues to maintain normal plasma protein levels in the blood. Consequently, the blood levels only drop when the body is exhausted. This results in protein defi ciency states going undetected until serious tissue damage has resulted. This brings us back to our basic premise: If protein defi ciency is undetectable in its early stages, then the only sign we have to go on is the symptom of an organ or organs being unable to meet the demands placed on it/them to maintain homeostasis.

Tissue catabolism for the purpose of maintaining homeostasis results in the sensation of fatigue and, if the condition continues uncorrected, the patient eventually becomes sick and tired of being sick and tired. Fortunately for us all, there are tissues the body will not tear down to use as protein sources, such as the heart and brain. Unfortunately, protein defi ciency can, and usually does, continue for long periods of time before a diagnosis of a specifi c disease process can be made.

While plasma proteins serve a host of important functions, it is important to remember that they are not used by the cells as metabolic fuel. Accordingly, they must be viewed quite differently from most other constituents of plasma such as glucose and cholesterol, which use the proteins as a vehicle for transport but are used by the cells.

Functions of Plasma Proteins

The functions of the plasma proteins (which remain in the blood and are not used by the cells), are as follows:

• The concentration of plasma proteins determines the colloidal osmotic pressure of the blood. In other words, it maintains fl uid balance between the blood, tissue fl uid, and the cells. Defi ciency results in the symptom of cold hands and feet.

• Plasma proteins act as buffers to help maintain acid-base balance. The body must always maintain acid-base balance, but stress in either direction will result in indigestion. Indigestion results from either the inability to spare adequate acidity to produce suffi cient stomach acid or the inability to spare adequate alkalinity to activate the pancreatic enzymes. This relationship has been discussed in many of my previous articles over the past fi fteen years.

• Plasma proteins bind and transport many critical compounds, such as lipids, hormones, vitamins, and minerals. Many nutritional problems can be laid at the doorstep of inadequate plasma proteins. Inability to perform these functions can result not only in nutritional defi ciencies, but endocrine dysfunctions as well.

• Plasma proteins bind and detoxify potentially dangerous drugs and other toxic substances. Therefore, a body catabolizing itself to maintain adequate plasma protein levels can and does result in the symptoms of toxicity. One of these, obviously, is fever; but before an elevated temperature becomes necessary come the sensations of being sick and tired!

• As the body’s means of transporting nutrients and waste products, the plasma proteins can be at the root of many blood test deviations.

The Most Prominent Chiropractic Finding

The appearance of Pottenger’s saucer (the so-called anterior dorsal complex) invariably heralds a digestive problem and adrenal stress. Adrenal exhaustion and plasma proteins go hand in hand and result in the syndrome of being sick and tired of being sick and tired. Understanding protein digestion and assimilation will increase your clinical confi dence because homeostasis is a constant on which you can depend.

Howard F. Loomis, Jr., DC, President of Enzyme Formulations ®, Inc., has an extensive background in enzymes and enzyme supplementation. As president for fi fteen years of 21st Century Nutrition® (now the Loomis Institute ® of Enzyme Nutrition), he has forged a remarkable career as an educator, having conducted over 400 seminars to date, in the United States and internationally, on the diagnosis and treatment of food enzyme defi ciency syndromes. Dr. Loomis welcomes your comments or questions through the Loomis InstituteTM at 6421 Enterprise Lane, Madison, WI 53719 or by phone at 1-800-662-2630.

Syndrome X and C-reactive Protein

Syndrome X is most easily viewed as a Pre-Diabetic State,as it is characterized by hyperinsulinemia and hyperglycemia. Syndrome X can initially exist without symptoms and, as it progresses, symptoms such as fatigue can develop, which are considered a “normal” part of aging, rather than the outcome of a pathological state.

Metabolic features of syndrome X:1

1. Increased production of pro-infl ammatory mediators: C-reactive protein (CRP), nuclear factor kappa-B (NF-kB), tumor necrosis factor (TNF), and free radicals

2. Increased platelet aggregation—platelet hyperaggregability

3. Reduced degradation of fi brin

4. Tonic vasoconstriction; reduced vasomotor regulation

5. Promotes a pro-thombotic state

6. Promotes greater infarct size

7. Leads to heart disease and stroke

As outlined above, there are numerous pro-infl ammatory factors involved in syndrome X. Perhaps the most well studied is C-reactive protein. CRP was discovered seventy years ago when scientists were studying the human infl ammatory response. It was initially characterized as an acute-phase mediator that was released during infection and trauma. However, we now know that CRP can be released chronically as part of an ongoing subclinical pro-infl ammatory state. Consider the diverse functions of CRP in the pathogenesis of heart disease.

Patients need to understand that dietary changes are the most important component for reducing the expression of syndrome X. In addition, supplements to help reduce the pro-inflammatory state include a multivitamin, magnessium, fish oil, vitamin D, and botanicals such as ginger, tumeric, and garlic.

Pro-inflammatory aspects of CRP:2

1. Localizes in atherosclerotic intima, but not normal intima

2. Induces the production of adhesion molecules

3. Reduces endothelial derived relaxing factor, which is also known as endothelial-nitic oxide

4. Induces the production of plasmin inhibitors which lead to increased fi brin deposition

5. Triggers the oxidation of LDL-cholesterol

6. Mediates the uptake of LDL by macrophages

7. Blunts normal endothelial vasoreactivity

8. Recruits circulating monocytes into the arterial wall, and their subsequent activition

9. Stimulates complement activiation

When I was in chiropractic college, as part of our training, we did blood tests on our patients, and CRP and ESR were part of the panel. Back in those days (1986) the CRP we tested for was never elevated unless there was overt trauma or infection or, perhaps, rheumatoid arthritis. Otherwise CRP was never elevated.

In recent years, a new high sensitivity CRP (hsCRP) has been developed, which can be used as a screening test for patients.3 Ridker indicates that many physicians screen for hsCRP, because it is associated with a markedly increased risk of myocardial infarction, stroke, peripheral arterial disease, and sudden cardiac death, even among apparently healthy individuals with low levels of LDL-cholesterol.2

What about musculoskeletal conditions? Most medical and chiropractic physicians have been taught that osteoarthritis (OA) is a non-infl ammatory condition caused by mechanical wear and tear. Recent research would suggest otherwise, and is consistent with most clinical presentations of osteoarthritis; that is, several joints hurt, but one may be most pronounced and perhaps associated with previous injury. We tend to forget that other joints also hurt, which takes our mind away from viewing OA, more correctly, as a systemic condition.4

In this regard, research suggests that increasing levels of CRP can predict the emergence and severity of osteoarthritis.5,6

If you decide to measure hsCRP in your offi ce, the typical interpretation is as follows: less then 1mg/L is low risk for heart disease prediction/expression; between 1-3 mg/L refl ects moderate risk; and between 3-10 mg/L suggests high risk. Greater than 10 suggests an acute phase response and, thus, a re-test in 3 weeks.3 In terms of diet, it appears that the following are associated with elevated CRP: syndrome X, low fi ber diet, low magnesium intake, low omega-3 intake, trans-fat intake, low micronutrient intake, and reduced sleep.7-15

The key to understanding elevated CRP is that it is a marker for dietary imbalances that create a pro-infl ammatory state. Syndrome X is a signifi cant metabolic driver of elevated CRP and numerous other pro-infl ammatory mediators. The dietary approach to syndrome X focuses on foods with a low glycemic index and low glycemic load, which means vegetables, lean animal products, fruits, and nuts.

Patients need to understand that dietary changes are the most important component for reducing the expression of syndrome X. In addition, supplements to help reduce the pro-infl ammatory state include a multivitamin, magnesium, fi sh oil, vitamin D, and botanicals such as ginger, turmeric, and garlic.

Dr. Seaman is the Clinical Chiropractic Consultant for Anabolic Laboratories, one of the fi rst supplement manufacturers to service the chiropractic profession. He is on the postgraduate faculties of several chiropractic colleges, providing nutrition seminars that focus on the needs of the chiropractic patient. He is also a faculty member at Palmer College of Chiropractic Florida, where he teaches nutrition and subluxation theories. He can be reached by e-mail at [email protected].

References

Dandona P, Aljada A, Chaudhuri A, Mohanty P, Garg R. Metabolic Syndrome – A Comprehensive Perspective Based on Interactions Between Obesity, Diabetes, and Inflammation. Circulation 2005; 111:1448-54
Ridker PM. Rosuvastatin in the primary prevention of cardiovascular disease among patients with low levels of low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: rationale and design of the JUPITER trial. Circulation. 2003; 108: 2292–2297
Ridker PM. C-reactive protein. A simple test to help predict risk of heart attack and stroke. Circulation. 2003:108:381-e85
Aspden RM, Scheven BA, Hutchison JD. Osteoarthritis as a systemic disorder including stromal cell differentation and lipid metabolism. Lancet. 2001:357:1118-20.

5. Pearle AD, Warren RF, Rodeo SA. Basic science of articular cartilage and osteoarthritis. Clin Sports Med. 2005; 24:1-12

Sharif M et al. Elevated serum C-reactive protein levels in osteoarthritis. Brit J Rheumatol 1997; 36:140-49
Ajani UA, Ford ES, Mokdad AH. Dietary fiber and C-reactive protein: findings from national health and nutrition examination survey data. J Nutr. 2004; 134:1181-5.
Lopez-Garcia E, Schulze MB, Manson JE et al. Consumption of (n-3) fatty acids is related to plasma biomarkers of inflammation and endothelial activation in women. J Nutr. 2004; 134:1806-11
Ma Y, Griffith JA, Chasan-Taber L et al. Association between dietary fiber and serum C-reactive protein. Am J Clin Nutr 2006;83:760–66.
King DE Mainous AG, Geesey ME, Woolson RF. Dietary magnesium and C-reactive protein levels. J AM Coll Nutr. 2005; 24L3):166-71.
Church TS, Earnest CP, Wood KA, Kampert JB. Reduction of C-reactive protein levels through use of a multivitamin. Am J Med. 2003;115:702–707.
Lopez-Garcia E, Schulze MB, Meigs JB et al. Consumption of trans fatty acids is related to biomarkers of inflammation and endothelial dysfunction. J Nutr. 2005; 135(3):562-66.
Pfutzner A, Forst T. High-sensitivity C-reactive protein as cardiovascular risk marker in patients with diabetes mellitus. Diabetes Technol Ther. 2006; 8(1):28-36.
Dandona P, Aljada A, Chaudhuri A, Mohanty P, Garg R. Metabolic Syndrome – A Comprehensive Perspective Based on Interactions Between Obesity, Diabetes, and Inflammation. Circulation. 2005; 111:1448-54.
Meier-Ewert HK, Ridker PM, Rifai N et al. Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol. 2004; 43(4):678-83.

Excuse me, can we talk about poop?

Not necessarily the Best Topic for a Cocktail Party, I agree. However, for over 40 million Americans who have been diagnosed with irritable bowel syndrome (IBS), bowel movements are an important topic. Some experts report that irritable bowel syndrome affects approximately 10–20 percent of the general population. Irritable bowel syndrome is characterized by a group of symptoms in which abdominal pain or discomfort is associated with a change in bowel pattern, such as loose or more frequent bowel movements or diarrhea, and/or hard or less frequent bowel movements or constipation. Gender plays a clear role, as more than 80 percent of IBS patients are women between twenty and fifty-five years old. The financial burden of IBS is high. In the United States, IBS results in an estimated $8 billion in direct medical costs and $25 billion in indirect costs annually.

The criteria for diagnosing IBS is based on the newly modified Rome criteria (Rome II criteria) as the presence for at least twelve weeks (not necessarily consecutive) in the preceding twelve months of abdominal discomfort or pain that cannot be explained by a structural or biochemical abnormality and that has at least two of following three features: (1) pain is relieved with defecation, and its onset is associated with (2) a change in the frequency of bowel movements (diarrhea or constipation) or (3) with a change in the form of the stool (loose, watery, or pellet-like).

Some people with the disorder have constipation (IBS-C). Some have diarrhea (IBS-D). And some alternate back and forth between constipation and diarrhea (IBS-A). IBS symptoms result from what appears to be a disturbance in the interaction between the gut or intestines, the brain, and the autonomic nervous system that alters regulation of bowel motility (motor function) or sensory function.

Research has shown that the cause of IBS is related to neuroendocrine immune system dysfunction (brain and stomach hormones). This connection is largely mediated by the neurotransmitter serotonin. The brain and gut are connected through the neuroreceptors 5-hydroxytriptamine-3 (5-HT3) and 5-hydroxytriptamine- 4 (5-HT4). These serotonin receptors regulate the perception of intestinal pain and the GI motility (contractions that move food through the intestinal tract). Therefore, serotonin controls how fast or how slow food moves through the intestinal tract. In fact, there are more serotonin receptors in the intestinal tract than there are in the brain. Ninety percent of serotonin receptors are in the intestinal tract.

Research suggests that IBS patients have extra sensitive pain receptors in the gastrointestinal tract, which may be related to low levels of serotonin. Decreased levels of serotonin may help explain why people with IBS are likely to be anxious or depressed. Studies show that 54-94 percent of IBS patients meet the diagnostic criteria for depression, anxiety, or panic disorder.

Restoring optimal levels of serotonin has been the focus of traditional drug therapy.

Zelnorm, a 5-HT4 receptor agonist, which was once hailed as “the drug” for IBS-C (IBS with frequent constipation), has recently been pulled from the market for its association with heart attacks and stroke. The percentage of patients taking Zelnorm that had serious and life-threatening side effects was ten times higher than the percentage of patients taking a placebo.

Even before this drug was recalled due to cardiovascular risks, many experts warned that this drug was dangerous for its other potential side effects, including severe liver impairment, severe kidney impairment, bowel obstruction, diarrhea, constipation, abdominal pain, headaches, abdominal adhesions, gallbladder disease, and back pain.

Lotrinex (Alosetron), a 5-HT3 agonist, is prescribed for IBS-D. Within eight months of being on the market, reports of ischemic colitis (a life endangering situation in which the blood supply to the intestines is blocked) began to grow each day. Lotrinex was responsible for at least four deaths, probably many more. Many who took the drug reported severe abdominal pain from constipation. The drug was taken off the market. It is now back and available with strict prescribing guidelines. An editorial in The British Medical Journal suggests that as many as 2 million Americans will be eligible for the drug under the new guidelines. According to previous reported side effects, this would result in 2,000 cases of severe constipation, almost 6,000 cases of ischemic colitis, 11,000 surgical interventions, and at least 324 deaths.

Antispasmodics (Levsin, Levsinex, Bentyl, Donnatal, etc.) are routinely prescribed for the treatment of IBS symptoms.

Potential side effects include bloating; blurred vision; clumsiness; constipation; decreased sweating; dizziness; drowsiness; dry mouth; excessive daytime drowsiness (“hangover effect”); feeling of a whirling motion; headache; light-headedness; nausea; nervousness; rash; hives; diffi culty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; agitation; confusion; diarrhea; diffi culty focusing eyes; disorientation; exaggerated feeling of well-being; excitement; fainting; fast or irregular heartbeat; hallucinations; loss of coordination; loss of taste; memory loss; muscle pain; pounding in the chest; severe or persistent trouble sleeping; trouble urinating; unusual weakness; very slow breathing; vision changes; and vomiting.

Why in the world would someone prescribe this crap? (Pun intended.) It is absurd to suggest that individuals with IBS have a drug defi ciency. IBS is not a disease; it is a symptom of a compromised gastrointestinal system. Using potentially dangerous drugs to reduce symptoms, while ignoring natural and often more effective approaches, is typical of what is wrong with “cookbook” (symptom-focused) medicine.

Reversing IBS with nutritional therapy

I fi nd that IBS usually disappears rather quickly once my patients correct their poor eating habits (increase fi ber, reduce simple sugars, caffeine and junk foods), uncover any hidden allergies when present, including gluten intolerance (Celiac disease), boost optimal stress coping chemicals (serotonin, magnesium, B-vitamins, etc.), restore bowel ecology (probiotics), and take digestive enzymes with their meals.

5HTP

To boost serotonin levels, I recommend patients take the amino acid responsible for making serotonin, known as 5- hydroxytryptophan (5HTP). Patients should take 300-400mg a day with food.

Digestive enzymes

Most digestion and absorption takes place in the small intestine and is regulated by pancreatic enzymes (digestive) and bile. The pancreas aids in digestion by releasing proteolytic enzymes, which help break down proteins into amino acids. Natural digestive enzymes are found in raw fruits and vegetables. Processed foods are usually devoid of digestive enzymes. Over consumption of these processed foods can lead to digestive enzyme defi ciencies. This may then lead to malabsorption and/or intestinal permeability syndrome (bloating, gas, indigestion, diarrhea, constipation, and intestinal infl ammation). To ensure proper digestion and absorption, I recommend taking pancreatic enzymes with each meal.

Magnesium

I always recommend people take a good optimal daily allowance multivitamin/mineral formula. Patients with IBS have depleted their stress coping chemicals and this not only leads to IBS but also prevents them from beating IBS. It is a vicious cycle that can only be broken by taking adequate amounts of essential vitamins and minerals. The mineral magnesium, which is involved in over 300 bodily processes, is particularly important for reversing the symptoms of IBS-C. Magnesium helps relax the smooth muscle of the colon (natural laxative) allowing normal bowel movements. While a diet high in nutritious fiber is important, magnesium is even more important. A magnesium defi ciency not only causes constipation but can also lead to heart disease, mitral valve prolapse (MVP), depression, anxiety, chronic muscle pain, headaches, migraines, fatigue, and many other unwanted health conditions. Those with IBS-C may need up to 1,000mg of magnesium each day. While those with IBS-D, may need less than 500mg. I recommend patients begin with 500mg of magnesium a day.

Probiotics

The human intestines are inhabited by billions of benefi cial bacteria. These bacteria, which are mostly located in the colon, aid in digestion by fermenting substances that were not digested in the small intestine and by breaking down any remaining nutrients.

A healthy intestinal tract contains some 2-3 lb. of bacteria and other microorganisms, such as yeast, that normally don’t cause any health problems.

However, when the intestinal tract is repetitively exposed to toxic substances (antibiotics, steroids, NSAID’s, etc.), these microorganisms begin to proliferate and create an imbalance in the bowel flora. Harmful organisms, like yeast and some normally dormant bacteria, begin to overtake the good bacteria. This is known as intestinal dysbiosis.

IBS and small-intestinal bacterial overgrowth may share similar symptoms. One study showed that 78 percent of IBS participants had small-intestinal bacterial overgrowth. To aid in digestion and prevent intestinal dysbiosis, patients with IBS should take probiotics (Lactobacillus and Biidobacterium) on a daily basis.

This approach isn’t guaranteed to solve every case of IBS. However, in the majority of my patients, symptoms improve to such a point that, within a few weeks, we can focus on more important topics, like, “Who is going to win American Idol?”

Rodger Murphree, D.C., has been in private practice since 1990. He is the founder and past clinic director for a large integrated medical practice located on the campus of Brookwood Hospital in Birmingham, Alabama. He is the author of Treating and Beating Fibromyalgia and Chronic Fatigue Syndrome, Heart Disease What Your Doctor Won’t Tell You, and Treating and Beating Anxiety and Depression with Orthomolecular Medicine. He can be reached at www.treatingandbeating.com or [email protected] or 1-205-879-2383.

References

1.Bodemar G, Ragnarsson G. [Irritable bowel syndrome. Survey of definitions, differential diagnosis and pathogenesis]. Lakartidningen. 2001 Feb 14;98(7):666–71.2.FDA Announces Discontinued Marketing of GI Drug, Zelnorm, for Safety Reasons,” published on 3/30/07 via the U.S. Food and Drug Administration Web site (www.fda.gov). Accessed 3/30/07.3.“FDA Public Health Advisory, Tegaserod maleate (marketed as Zelnorm)” published on 3/30/07 via the U.S. Food and Drug Administration Web site (www.fda.gov). Accessed 4/3/07.4.“Novartis Stops Zelnorm Marketing, Sales on Heart Risk,” by Eva von Schaper. Published 4/2/07 via Bloomberg.com (www.bloomberg.com). Accessed 4/2/07.5.Sandler RS. Epidemiology of irritable bowel syndrome in the United States. Gastroenterology. 1990;99:409-415.6.Thompson WG, Longstreth G, Drossman DA. Functional bowel disorders and Functional abdominal pain. In: Drossman DA, Corazziari E, Talley N, Thompson WG, Whitehead W, eds. Rome II: The Functional Gastrointestinal Disorders. 2nd ed. McLean, VA: Degnon Associates, 2000:351-375. 7.Goldberg PA, “Modification ofvisceral sensitivity and pain in irritable bowel syndrome by 5-HT3 antagonism (ondansetron).” Digestion Nov-Dec 1996:57(6):478-83.8.Saggioro A. Probiotics in the treatment of irritable bowel syndrome. J Clin Gastroenterol. 2004 Jul;38(6 Suppl):S104–S106.9. Monthly Prescribing Reference. Prescribing Reference Inc. New York, NY. October 2006.

News BYTE Dietary supplement to the next level

Lifepak® nano is a nutritional anti-aging program formulated to nourish and protect cells, tissues, and organs in the body with the specific purpose of guarding against the ravages of aging. Lifepak® nano offers the highest bioavailability with a first-ever nanotechnology process and advanced levels of key anti-aging nutrients in a comprehensive formula available exclusively through Pharmanex.* Taking this product will increase your anti-oxidant score or they will refund your money.

Primary Benefits
• Nourishes and protects cells, tissues, and organs in the body with the specific purpose of guarding against the ravages of aging each day of your lifespan*
• Superior bioavailability with CR-6 LipoNutrients™ enhances uptake from the gut into the bloodstream and body for maximum anti-aging benefits*
• Advanced anti-aging formula helps protect the body with key nutrients, such as NanoCoQ10™ and nano carotenoids*
• Helps maintain normal inflammatory responses in the body*
• Feeds and helps protect the brain with DHA and EPA (two CR-6 LipoNutrient™ softgels contain the same amount of EPA and DHA as two MarineOmega softgels)*
• Offers superior DNA protection against damaging free radical attacks by providing the body with important antioxidants and phytonutrients such as alpha-lipoic acid and catechins*
• Protects cell health with an antioxidant defense network*
• Helps protect cardiovascular health with a comprehensive blend of omega-3 fatty acids and other nutrients
• Provides comprehensive bone nutrition support*
• Promotes healthy immune function*
• Supports normal blood sugar metabolism*
• Corrects nutritional deficiencies*
• SCS certified

For more information go to www.aolscanner.com or call 1-800-337-7715.

The Chiropractic Connection: The Structural Manifestations of Elevated Homocysteine Levels

Cardiovascular disease is the number one cause of death in the United States. The pharmaceutical industry spends an enormous amount of money on advertising prescription drugs that will lower “bad” LDL cholesterol to lower the risk of heart attack or stroke. In fact, according to a report aired on 60 Minutes,1 much more money is spent on advertising than on researching solutions.

One of the factors involved in cardiovascular disease is an amino acid called homocysteine. The correlation between cardiovascular disease and elevated homocysteine levels was first suggested in 1969 and confirmed in 1976. Yet, little definitive information has confirmed homocysteine as a primary contributing factor. Those studies that have been done concern the role of vitamins B6, B12, folate and betaine in protein metabolism in the liver.

What Is Homocysteine?
Homocysteine is a transitional sulfur-containing amino acid that is formed in the liver by the breakdown of methionine, which should be quickly transformed into other compounds. If this transformation does not happen and elevated levels of homocysteine are found in the blood, this indicates that a metabolic enzyme reaction was inadequate to meet demand.

The first step in this process is that protein must be adequately digested, beginning in the stomach with the conversion of pepsinogen to pepsin by hydrochloric acid, and continued in the duodenum by the pancreatic enzymes. After absorption, the resulting mixture of peptides and amino acids is carried to the liver.

Metabolic Enzyme Pathways in the Liver
Methionine is the major sulfur-containing amino acid and plays a role in cysteine, carnitine and taurine synthesis, as well as lecithin production and the synthesis of phosphatidylcholine and other phospholipids. This conversion is performed in three metabolic enzyme stages culminating with the production of homocysteine which now must be converted to S-adenosylmethionine (SAM).

The conversion of homocysteine to SAM involves three separate metabolic enzymes that each contain either vitamin B6, B12, folate or betaine as their prosthetic group or cofactors.

I am not suggesting that you begin using over-the-counter SAM (commonly marketed as SAM-e), vitamins B6, B12, and folate, or betaine supplements. I am suggesting that you direct your efforts at restoring normal function and recognize the early warning signs of failure of the above enzyme pathways.

One of the most common problems chiropractors face in day-to-day practice involves protein digestion and its metabolism in the liver, yet the pharmaceutical approach is to begin by supplementing enzyme cofactors for the liver and ignoring the need for the much larger protein portion of the enzyme. Worse yet, antacids are used to block gastric digestion.

Homocysteine and LDL Cholesterol
Pharmaceutical interest in homocysteine stems from the fact that it can cause cholesterol to change to oxidized low-density lipoprotein (“bad” LDL cholesterol), which is associated with atherosclerosis. In addition, high homocysteine levels may increase the potential for blood clots, intensifying the risk of stroke. While no studies have shown that lowering homocysteine levels helps reduce strokes, heart attacks, and other cardiovascular events, homocysteine levels have been shown to be elevated in those at risk for heart disease.

Dietary Recommendations for Lowering
Homocysteine Levels
Most people with a high homocysteine level don’t get adequate amounts of betaine, vitamins B6, B12, and folic acid in their diet. It is well known that diets high in meat and dairy products are deficient in these compounds, usually because of processing. Thus, marginal deficiencies can result in the accumulation of homocysteine.

Eating more fruits and vegetables (especially leafy green vegetables) can help lower your homocysteine level by increasing how much folate you get in your diet. Good sources of folate include many breakfast cereals, lentils, asparagus, spinach and most beans.

If you or your patients do not have enough vitamin B6 in your diet, add good dietary sources, like fortified breakfast cereals, potatoes, bananas, garbanzo beans and chicken. Dairy products, organ meats (such as liver), beef, and some types of fish are good sources of vitamin B12.

Dietary sources of betaine include beets, broccoli, and spinach. Interestingly, many wines contain betaine, particularly less expensive wines that use beet sugar to increase the alcohol content. Some experts suggest that this may be part of the “French paradox,” in which wine drinkers from France tend to have low rates of heart disease despite diets high in fat and cholesterol.

Dietary Supplement Approach for Lowering
Homocysteine Levels
If adjusting your diet is not enough to lower your homocysteine levels, you may need to improve protein digestion with digestive enzyme supplementation and improve liver function by using betaine, vitamin B6 and vitamin B12 supplements.

Elevated levels of homocysteine have been linked to increased fractures in elderly persons. Recall that vitamin B12 absorption is severely reduced in elderly patients. Homocysteine does not appear to have any effect on bone density. Instead, it appears that homocysteine affects collagen by interfering with the cross-linking between collagen fibers and the tissues they reinforce.

Can vitamin supplements counter the effects of homocysteine on collagen? Possibly. Recent data show that the use of folate fortification of foods has reduced the average level of homocysteine in the U.S. population.2,3

Studies with rats have suggested that betaine may help protect against fatty deposits in the liver, which can occur from chronic alcohol use, protein malnutrition, obesity, poorly controlled diabetes, and other causes.4 A few studies have also been conducted on people. But, those who received a betaine combination supplement had improved liver function, reduced fat in the liver, and diminished abdominal pain.5

Studies reported in 2006 have shown that giving folic acid to reduce homocysteine levels does not give any benefit, and suggested that, if given with B12, it might increase some cardiovascular risks.6,7

The American Heart Association does not currently recommend population-wide homocysteine screening and suggests that obtaining appropriate amounts of betaine, as well as folic acid and vitamins B6 and B12, be met through diet alone. Individuals at high risk for developing heart disease, however, may be screened for blood levels of homocysteine. They do recommend that, IF ELEVATED LEVELS ARE DETECTED, a healthcare practitioner should suggest nutritional supplements in addition to dietary changes.

Pharmaceutical Approach for Lowering
Homocysteine Levels
Vitamin supplementation may be important pharmaceutically to lower elevated homocysteine levels in the blood. But, accumulation of homocysteine has also been shown in patients with low levels of thyroid hormone, kidney disease, psoriasis, hallucinations, psychoses, and use of some prescription medicines.

At this point, I could present a list of pharmaceutical attempts to lower homocysteine levels but, frankly, there isn’t a clear-cut known way to do that yet. What is known is well documented in the literature. For example, while a high level of blood serum homocysteine is considered to be a marker of potential cardiovascular disease, current research is attempting to determine if serum homocysteine is the problem or merely an indicator of extant problems.

It is more important to point out that all prescription drugs have side effects, because they interfere with or block normal enzyme systems in the body. Clearly, this is needed to save lives after damage has been done; but, if you could identify patients at risk before abnormal test results are identified, these problems could be prevented.

What is needed is an examination that will identify metabolic subluxations and viscerosomatic stress points in the body before elevated laboratory values are found. Only then can preventive measures be instituted that will remove the stress and restore normal function.

Chiropractic Approach for Recognizing Potential CV Disease
Poor protein digestion is the first step and poor liver metabolism of protein is the second step on the path to elevated homocysteine levels in the blood and cardiovascular degeneration. Both of these “metabolic subluxations” are seen in chiropractic offices everyday and are easy to recognize. Obviously, structural problems also begin with poor protein digestion, its metabolism in the liver, and maintenance of adequate calcium in the blood and tissues. The following is only a brief list of related problems:

Have you considered that a chiropractic examination can probably identify those patients at risk for elevated homocysteine levels and LDL cholesterol levels long before abnormal laboratory tests reveal the problem? The trick, of course, is early detection. For medicine, that means waiting for blood and urine tests to become positive before treatment can begin. Treatment then consists of recommendations of lifestyle changes and prescription drugs.

Metabolic Subluxations and Viscerosomatic Stress Points
For the chiropractor, “very early” detection of physiological stress means recognizing chronic or recurring subluxation patterns emanating from a visceral source and involving poor protein and calcium metabolism. This is easily accomplished by recognizing muscle contraction patterns involving the spinal innervation to the digestive organs in the mid-thoracic spine, beginning with frequent occurrence of a Pottenger’s Saucer. After that, particular interest should be muscle contractions related to:

• Cardiovascular dysfunction and recurring back pain in the shoulders and upper thoracic spinal area, as well as
• Liver and kidney dysfunction and recurring back pain in the dorso-lumbar spinal area

I believe that by broadening its vision and recognizing that metabolic subluxations produce viscero-somatic stress points, muscle contractions, and loss of range of motion, the chiropractic profession could ultimately serve as a true health care provider and leave sick care to medicine and the pharmaceutical industry.

Dr. Loomis can be reached by mail at 6421 Enterprise Lane, Madison, WI 53719, or by phone at 1-800-662-2630. Visit his website at http://www.loomisenzymes.com.

Adding a Successful Nutritional Component to Your Chiropractic Practice

I have studied many different patient management systems designed for chiropractors over the past twenty-five years. But practitioners who try to use chiropractic systems to manage the nutritional aspects of a patient’s case will find themselves falling short of true success. I had the same problem until I made the discovery that, while a chiropractic patient may benefit from nutritional support, these two aspects of the case need to be managed separately. If you know this and how to implement it, it takes all the stress off managing the nutritional aspect of a patient’s case and greatly increases compliance to the nutritional program.

Chiropractors in an insurance-based practice can’t normally charge for the nutritional part of a routine chiropractic visit, so they do a regular chiropractic visit and then spend extra time on nutrition. The patient is not used to paying cash so, quite often, the consultation fee is simply not collected. And then the patient may or may not buy the nutritional supplements. In other words, there is no system of nutritional patient management for actually getting the patient onto a nutritional program, which is essential to correcting the chronically recurring subluxation complex.

Enter…nutritional patient management. Why nutritional patient management? Billions of dollars are spent on health in the United States, yet we have the highest rate of infant mortality of all the so-called civilized or industrialized countries. And, even more significant, we rank number thirty-seven out of the top thirty-seven industrialized nations in overall health.

We have national malnutrition as a result of fast foods and foods that are non-perishable. These “foods” are inadequate to support life.

If malnutrition is at the core of the chronic health problem, the answer is not pharmaceutical medications, which suppress symptoms while the underlying pattern of disease develops.

One vital answer is adding a successful nutritional component to your practice.

There are three key ingredients of a successful nutritional cash practice.

The first one is effective nutritional products that you can count on—using a company with products that have a track record of proven workability and dependability.

Next, you need a workable system of zeroing in on the patient’s needs. We developed Nutrition Response Testing(sm) to give the doctor all the answers needed about the patient’s nutritional requirements in a relatively short visit. Using Nutrition Response Testing, we can provide a high quality, competently delivered service in a short enough period of time to fit within the economics of a cash practice. If you have a system that accomplishes this, you already have a head start.

The third key ingredient is an effective, standardized system of nutritional patient management, which will increase compliance and results. The system that you use for finding out what’s wrong with the patients and determining what they need for their program to get well is not what gets compliance and results. What’s needed is an effective standardized system of nutritional patient and practice management.

Such a system turns your patients and staff into zealots who build your practice for you.

There are specific rules for managing a nutritional practice. However, some rules are so important that I’ve elevated them to the status of maxims.

Maxim #1: Never start a treatment program or sell a supplement until you know what the patient needs and that the patient understands and has accepted your recommendations, and is committed to doing the program.

To do otherwise gives the patient the misunderstanding that the product is the program. The product is not the program. It is simply one of the tools that enables the patient to complete the program.

Maxim#2: Never sell more supplements than the patient needs to take him or her to the next scheduled visit. The purpose of the next visit is so that you can verify that the patient needs to continue those supplements. If the patient “has enough” for a longer period of time, he/she will tend to skip the appointment. There’s nothing worse than selling the patient a 360-tablet bottle because you think he needs it and, three days into it, he’s got a problem with it for whatever reason.

Maxim #3: A patient needs to be seen as often as it takes until he or she is in full compliance with the recommended program and is responding positively to it. My clinical experience indicates that, at the start, a patient needs to be seen for a nutritional program approximately once a week (regardless of his current chiropractic schedule).

I keep seeing patients once a week until they are in full compliance with the recommended program and responding positively to it. At that point, the “fine-tuning period” is over and I put them on a twelve-week Healing and Observation, where I see them every other week for six more visits over a three-month period and continue to monitor their progress. If they “fall off the wagon,” they go back to once a week until they are again in full compliance to the recommended program and responding positively to it.

Maxim #4: There is a correct way to handle each and every patient, starting with the initial visit and taking them all the way through to becoming life-long wellness patients who enthusiastically refer new patients for years to come.

We don’t have to advertise for new patients because we know the right way to handle each and every patient starting with the initial visit. And the system we use takes them all the way through to becoming life-long wellness patients who enthusiastically refer new patients for years to come.

Maxim #4 A and B are corollaries of Maxim 4. The more compliant the patients are and the better they are doing, the less often they need to be seen.

And the other corollary is: It often takes six to nine months of close monitoring to establish healthful new eating and life style patterns. We educate our patients and help them develop new healthful lifestyle habits while we support them with supplements.

Maxim #5: Not knowing or applying these rules (which are based on decades of clinical experience) results in less optimum gains in terms of patient benefits and the overall success of your practice.

The Initial Visit
The purpose of the initial visit is to establish rapport and to build trust. The secondary purpose is to determine patient need. And the last, but most important purpose of the initial visit, is to prepare the patient for the Report of Findings visit. I no longer examine the patient on the first visit, sell him some product and then hope that he comes back. When I stopped doing that, my practice became stress-free, my retention rate went up greatly and we became far more successful.

I don’t sell anyone nutrition on the first visit. Selling nutrition on the first visit would violate Maxim #1 by selling somebody a product before he or she fully agrees with and understands my recommendations and is committed to doing the program.

The purpose of the Report of Findings visit is to ensure that the patient knows what his/her role is going to be in obtaining maximum possible health restoration. Patients need to know what we expect of them before we’re willing to accept them. If the person has any questions or any objections, this is when they are handled.

This visit answers the key question: Is the patient ready to commit to doing the program and following recommendations? If they are, we start them. If they’re not, we handle them by giving them more time, more information or we thank them for coming. We don’t ever start a nutritional program on somebody who is not committed to doing the program and following our recommendations.

Once we’ve completed the Report of Findings visit, then we set the first therapeutic visit to get the patient started on the program.

Three Phases of Care
We’ve determined that there are three phases of care in a nutritional program.

The first phase of care is “Fine Tuning.” During the fine-tuning period, we ensure the program is correct and the patient is actually doing the program as we recommended. We continue the fine-tuning until the patient’s nutritional program is stabilized and he/she is complying with dietary recommendations and starting to experience results. All patients fill out seven-day diet records every week and we help them fix what needs attention, in a way that they can actually do. Once they’ve achieved that, we graduate them to their initial twelve-weeks’ Healing and Observation period.

Completing a twelve-week healing and observation period enables us to determine their rate of improvement so that longer-term recommendations can be made to enable each one to achieve a more optimal state of health. At the final visit of the healing and observation period, we review each aspect of the program and compare where they are now. If they’re fifty percent better, they do another twelve-week healing and observation period. If they’re twenty-five percent better, they do another healing and observation period with expectation of another one after that.

The Secret to Compliance
After twenty-five years of clinical experience, I finally realized that there is a secret to getting compliance to nutritional programs. It turns out that you—the practitioner—are the most critical ingredient of a successful nutritional cash practice. The fact is, you’ll never have a patient who is more compliant than you. The reason why most practitioners have trouble getting the patient to comply is found in their own compliance.

I have expanded these maxims and key points into a three-day workshop so that every practitioner interested in providing their patients with nutrition can easily do so. It’s an easily do-able program on how to build a highly successful, low stress nutritional practice.

Our “joyful obligation” as nutritional practitioners is to enable each patient—through education and guidance—to experience life in its fullest.

Dr. Freddie Ulan, developer of Nutritional Response Testing, has been training health practitioners in the techniques of Nutritional Response Testing for over a decade years and, as an adjunct, provides a monthly workshop on nutritional patient management called Secrets of a Successful Nutritional Cash Practice. For information on the Nutrition Patient Management Workshop or Nutrition Response Testing workshops and DVD’s, call 1-727-442-7101 or visit www.unsinc.info.

Understanding Eicosanoids and Diet

What is the Zone?
The concept of maintaining drugs within a therapeutic zone is well known to physicians. Below that therapeutic zone, the drug is ineffective, and above that therapeutic zone, the drug is toxic. The same concept can be applied to the hormones generated by the food you eat. There are two hormonal systems that are controlled by the diet. These are eicosanoids and insulin. Eicosanoids are controlled by the balance of the dietary intake of essential fatty acids, and insulin is controlled by the balance of protein to carbohydrate at every meal. Moreover, there is a great deal of interaction between these two hormone systems.

Maintaining these two hormone systems within appropriate zones that define a state of wellness is the goal of the Zone Anti Inflammatory diet. Such a hormonal Zone is not some mystical place, since it can be defined by specific blood tests. The benefits of maintaining the patient in the Zone is that silent inflammation will be decreased and blood flow increased, thus improving virtually every chronic disease condition. The blood tests that define the Zone for the treatment of chronic disease are ultimately the same tests that can be used to define wellness. The concept of evidence-based wellness™ is ideally suited for the physician, since it requires consistent blood monitoring of the patient to determine whether or not they are remaining well.

What are Eicosanoids?
Eicosanoids are hormones derived from long-chain essential fatty acids. They represent the first hormones developed by living organisms some five hundred million years ago. They are also the most powerful hormones, since they affect the synthesis of every other hormone in your body. In a sense, eicosanoids can be considered as “super-hormones” capable of great health benefits (“good” eicosanoids) or great harm (“bad” eicosanoids), depending on which eicosanoid a cell produces. Unlike typical hormones that are produced by a particular gland, every cell in your body is capable of producing eicosanoids. In essence, you have about sixty trillion eicosanoid glands, and the goal of the Zone diet is to maintain an appropriate balance of the molecular building blocks of both “good” and “bad” eicosanoids in each cell.

The terms “good” and “bad” eicosanoids are simply operational terms, terms that describe very powerful, but opposite physiological actions generated by different eicosanoids. Just keep in mind that the patient needs a balance of “good” and “bad” eicosanoids for optimal health. This is no different than talking about “good” and “bad” cholesterol. If a patient had no “bad” cholesterol, he/she would die. What patients need, though, is an appropriate balance between “good” and “bad” cholesterol to help reduce the risk of heart disease. You can think of eicosanoids in a similar fashion, but realize that they’re vastly more important than cholesterol in terms of their impact on your overall health as shown in Table 1.

In fact, you can see from the list above that the “bad” eicosanoids appear to have very few redeeming characteristics, since many chronic diseases can be viewed as an excess of “bad” eicosanoid production. Here are some examples of chronic diseases that result from an excess production of “bad” eicosanoids.

• Alzheimer’s
• Arthritis
• Cancer
• Depression
• Heart attack
• Hypertension
• Stroke

Why not just eliminate all the “bad” eicosanoids so that you would never get a heart attack or cancer? It’s not quite that easy. Let’s take the example of the heart attack. If you didn’t have enough “bad” eicosanoids, you would probably bleed to death, since you need some “bad” eicosanoids to form a clot that stops bleeding. Of course, if you are producing too many “bad” eicosanoids your platelets will clot at the wrong time to stop blood flow. The same is true of high blood pressure, cancer, pain, immune disorders, and neurological diseases. What the patient needs is an improved balance of “good” and “bad” eicosanoids, since most chronic diseases stem from an imbalance of eicosanoids, not a deficiency.

1982 Nobel Prize in Medicine
Although the role of eicosanoids in the human physiology is currently less well understood by most physicians, the importance of these hormones in chronic disease was recognized when the 1982 Nobel Prize in Medicine was awarded for the initial discoveries of how they control virtually every physiological function, and how the wonder drug of the 20th century, aspirin, works by altering eicosanoid levels. Eicosanoids include a broad number of subgroups, including the following:

• Hydroxylated essential fatty acids
• Leukotrienes
• Lipoxins
• Prostaglandins
• Thromboxanes

Understanding the relationships of these hormones to the development of chronic disease and their effects on gene expression is one of the prime research areas in the biotechnology industry.

The balancing of these hormones is the goal of the Zone Lifestyle program.

Optimal Health Matrix
Both insulin and eicosanoids are ultimately controlled by the diet. Although both hormonal systems are synergistic, their relative importance in the treatment of various chronic disease conditions is variable as shown in the Optimal Health Matrix.

As can be seen from this chart, apart from fat loss and type 2 diabetes, most of the health benefits of being in the Zone are derived from improved eicosanoid control. What is not quite as obvious is that the greater the eicosanoid influence on a chronic disease condition, the more the patient must supplement his/her diet with ultra refined EPA/DHA concentrates to demonstrate significant clinical benefits. That’s because high-dose fish oil primarily influences eicosanoid levels.

Of course, by controlling both insulin and eicosanoids, simultaneously, the patient will achieve the full range of health benefits of the Zone Lifestyle.

Dr. Barry Sears, leading authority on the dietary control of hormonal response, author of the New York Times #1 best seller, The Zone, is a former research scientist at the Boston University School of Medicine and the Massachusetts Institute of Technology. For more information about The Zone program call 1-800-404-8171 or visit www.drsearszonefast.com.

Omega-3 fat confusion AND the beginning of a krill oil kraze

Pharmaceutical grade fish oil…NOT

Misinformation abounds when it comes to fish oil, such as that created by marketers of “pharmaceutical grade” fish oil, a recent buzzword. Readers should be aware that there is no such thing as pharmaceutical grade fish oil. This is a term created by a nutritional supplement supplier. Nutrition companies are notorious for marketing very basic and common supplements as magical elixirs; fish oil may be the most obvious example.

There are likely to be at least a couple of thousand companies that sell fish oil, and many have a unique story. The fact is that only about five companies in the entire world manufacture fish oil supplements, which means that the 1000+ companies buy the same products from the same manufacturers. There may be slight differences among the products made by the five manufacturers; however, they are all very similar. I would suggest not falling for appealing marketing tales about product uniqueness, and stories about special resources in the northern Atlantic Ocean.

Another way to capture the attention of doctors, and their patients, is for a supplement company to advertise about unique fish oil purity and a mercury-free product. First, remember, all 1000+ supplement companies buy from the same five manufacturers. Second, there is no data to support the notion that fish oil supplements are a source of mercury toxicity. In fact, the opposite is true. A recent study looked at fish oil supplements sold by the following brands: CVS, Kirkland, Nordic Ultimate, Omega Brite, and Sundown. In short, either there were no detectable levels of mercury or it was at an insignificant level.1 To my knowledge, there are no reported cases of mercury toxicity from taking fish oil, which is likely one of the reasons the authors suggest that there is a greater chance of mercury toxicity from eating fish, compared to taking fish oil.1

Krill Oil Kraze

Many are aware of mercola.com, Dr. Joe Mercola’s website for health and wellness. He has regular email newsletter that goes out for free. This newsletter is a bit more commercial than it needs to be; however, each email typically contains an interesting research article. Recently, Mercola has been heavily promoting krill oil as the absolute best oil for humans to supplement with, far better than fish oil.2 He provides fourteen references to his advertisement—only two of which involve krill oil specifically.

The problem with advancing krill oil as the premier oil to supplement is that we have virtually no studies on animals or humans. Even the two papers mentioned by Mercola cite references that do not involve krill oil.

The most objective way to begin looking at whether the claims regarding krill oil use are supported by research is to search pubmed.gov., using krill oil as the search term. Do this for yourself and you will see that only eight papers appear, and many are absolutely useless from the perspective of human nutrition. For example, reference #4 is titled “Feed training of peacock bass.”

Only two human studies seem to have ever been published on krill oil, and both are published in a nutrition company’s journal that is indexed on medline. One study looked at krill oil versus fish oil in the treatment of hyperlipidemia,3 and the other evaluated clinical outcomes in patients with premenstrual syndrome and dysmenorrhea.4 Both studies indicate that krill oil is superior to traditional EPA/DHA fish oil supplements. More studies need to be published.

Summary

There are no magic nutritional bullets. We simply need to eat less high calorie, low nutrient foods, and focus on low calorie foods (fruits and vegetables) that are rich in nutrients. In addition, taking a multivitamin, magnesium [calcium], fish oil, coenzyme Q10, vitamin D, and an anti-inflammatory botanical seems prudent.

Dr. Seaman is the Clinical Chiropractic Consultant for Anabolic Laboratories, one of the first supplement manufacturers to service the chiropractic profession. He is on the postgraduate faculties of several chiropractic colleges, providing nutrition seminars that focus on the needs of the chiropractic patient. He is also a faculty member at Palmer College of Chiropractic Florida, where he teaches nutrition and subluxation theories. He can be reached by e-mail at [email protected].