Posted By Richard Jaffe, Esq.,
Thursday, March 23, 2017
Many CAM and integrative doctors recommend and/or sell all kinds of nutritional and herbal products to their patients. There is a supplement manufacturer sub-industry which only sells to physicians and other health care professionals, for resale to patients. And most of the top tier, high profile docs have their own private label supplement brands. That’s a fact. But is it legal and ethical to do so?
Legal is a matter of state law. But for better, (but mostly) for worse, ethical is largely determined by those noble, public-spirited and never ethically-challenged folks at the AMA (American Medical Association for those living under a rock). They’re not completely controlled by Pharma; just ask them and they will tell you. And they’re not trying to stop cheaper non-patentable interventions like nutritional supplements and herbs, all at Pharma’s behest. Their thought leaders do not receive tens, hundreds of thousands, or millions of dollars from Pharma for research, public relations and advocacy. Just ask them and they will tell you.
And their “ethical guidelines” reflect an open-minded attitude serving the best interests of the patients. Ok, you get the point.
So is it AMA “ethical” for physicians to sell nutritional and herbal products? Technically yes, but practically, not so much:
Here’s the latest iteration of the AMA “ethical” rule on the sale of health related products. (Sorry, it’s longish)
9.6.4 Sale of Health-Related Products The sale of health-related products by physicians can offer convenience for patients, but can also pose ethical challenges. “Health-related products” are any products other than prescription items that, according to the manufacturer or distributor, benefit health. “Selling” refers to dispensing items from the physician’s office or website in exchange for money or endorsing a product that the patient may order or purchase elsewhere that results in remuneration for the physician. Physician sale of health-related products raises ethical concerns about financial conflict of interest, risks placing undue pressure on the patient, threatens to erode patient trust, undermine the primary obligation of physicians to serve the interests of their patients before their own, and demean the profession of medicine. Physicians who choose to sell health-related products from their offices or through their office website or other online venues have ethical obligations to:
(a) Offer only products whose claims of benefit are based on peer-reviewed literature or other sources of scientific review of efficacy that are unbiased, sound, systematic, and reliable. Physicians should not offer products whose claims to benefit lack scientific validity.
(b) Address conflict of interest and possible exploitation of patients by: (i) fully disclosing the nature of their financial interest in the sale of the product(s), either in person or through written notification, and informing patients of the availability of the product or other equivalent products elsewhere; (ii) limiting sales to products that serve immediate and pressing needs of their patients (e.g., to avoid requiring a patient on crutches to travel to a local pharmacy to purchase the product). Distributing products free of charge or at cost makes products readily available and helps to eliminate the elements of personal gain and financial conflict of interest that may interfere, or appear to interfere with the physician’s independent medical judgment.
(c) Provide information about the risks, benefits, and limits of scientific knowledge regarding the products in language that is understandable to patients.
(d) Avoid exclusive distributorship arrangements that make the products available only through physician offices. Physicians should encourage manufacturers to make products widely accessible to patients.
So what does this gobbledygook mean? Well, it means that you CAM docs have a problem.
First, virtually no supplements or herbal remedies have the kind of scientific support set out in subparagraph (a). There are only a few supplements for which the FDA have approved health claims, like folic acid for pregnant mothers, and such. I also suspect that the peer-reviewed literature the rule refers to means mainstream journals to the AMA. My guess is that this AMA subsection could be used to render “unethical” the recommendation of the products routinely recommended and sold by physicians.
But there are bigger problems.
Subsection (b) seems to suggest you have to either give away the products, or sell them at cost in order to avoid the conflict of interest or appearance of the conflict. Moreover, you’re only supposed to give away or sell at cost enough product to meet the patient’s immediate needs, or until they can get the product from a less conflict-ridden source.
This is idiotic. By the logic of this provision, if you go to a surgeon for a surgical consult, it would be unethical for the surgeon to actually perform the surgery rather than just recommend it, because he has a financial interest in performing the operation.
But not to worry, under the rule, the surgeon can lessen the conflict by either 1. Operating for free, or 2. Charging his actual cost, rather than the high fees the surgeon normally charges. To further lessen the conflict, he should only do a temporary surgery, just fix the problem enough to allow the patient to go to another surgeon who has no financial conflict of interest arising from the first surgeon’s surgery recommendation. The same would apply to an interventional cardiologist recommending a stent, angiogram/angioplasty or to any other physician who both makes recommendations and provides a procedure or therapy to effectuate or implement the recommendation.
To generalize, there is the same conflict of interest for any professional who both consults and does something. By the logic of the AMA rule, a lawyer cannot both recommend suing and actually suing (unless he sues for free or at cost). Nor could a lawyer prepare a trust, or do anything the lawyer recommends, because implementing the recommendation means that the lawyer makes extra money for the doing, which under the logic of the AMA rule irreparably taints the lawyer’s judgement (unless the service is done for free or at cost, and is only a temporary fix until a conflict-free professional is retained).
The AMA world view embodied in this rule reminds me of the commercial for a personal identity protection company. You know these commercials: There’s a patient with his mouth open in a dentist’s chair, and a guy with a white coat looking in the patient’s mouth who says “you have one of the worst cavities I’ve ever seen.” The patient says. “OK doc, fix it.” And the guy in the white coat says “Oh, I’m not a dentist; I don’t fix teeth, I’m just a dental monitor.”
In the AMA la-la ethical world, the guy tells the patient “Yes I am a dentist and I’d like to fix your tooth, but I have a conflict because I’m going to make extra money doing what I said should be done. So, we’re done here and you have to see another dentist who will actually fix your cavity”
Is this really how we want physicians who have a service or product to act? Have them become health care monitors, and have another class who are health care problem fixers?
Let’s not leave AMA ethical la la land yet: At the new dentist’s office, the dentist looks over the films, examines the patient, and concurs with the recommendation, thereby creating a chargeable evaluation and management fee. Doesn’t the new dentist also have a conflict? He’s got his examination fee, and he’ll get extra money for fixing the cavity. This can get ridiculous!
Let’s face it, we rely on professional to give their opinions and implement a solution within the professional’s expertise. This happens zillions of times a day, all over the world. To single out physicians who use and sell the kind of products used by millions of people is just nuts.
This rule obviously hasn’t been used to stop surgeons, cardiologists or dentists from doing the thing they were trained to do. But what about a CAM physician who uses herbals or nutraceuticals as primary therapy? Can they do that, or are they caught in the same AMA ethical net?
But before we get to that, here is another question:
Does this AMA ethical rule matter?
Short answer: yes
Alittle longer answer: it matters because some state medical board laws have specifically incorporated the AMA ethical rules into their standards of professional conduct, such that a violation of an AMA ethical rule is a violation of the state’s medical board law. Even in the absence of express incorporation, states can and do go after physicians for ethical violations of all sorts (just ask docs like Burzynski about that).
Why is any of this relevant or important to CAM docs?
There’s a new case against a doc (it’s my case, and not in California or Texas where I maintain offices, but I don’t want to give the details just yet) which raises the very issue of whether it is unethical and a state board law violation to use and sell herbal and nutritional interventions as primary therapy. What makes the case more interesting is that the therapy is only available from physicians, and only physicians who have gone through the company’s training about how to use the products. (Many of you CAM docs probably know the product line I’m referring to.)
How can the AMA possibly view this kind of thing as the “sale of health a related product?” Well maybe it doesn’t, but initially at least, the state medical board seems to think it is the sale of a “health related product” and is going after the doctor for do so.
Here’s where it gets interesting with the AMA ethical rules: The second opinion after the sale of health related products is the following ethical precept:
9.6.6 Prescribing & Dispensing Drugs & Devices In keeping with physicians’ ethical responsibility to hold the patient’s interests as paramount, in their role as prescribers and dispensers of drugs and devices, physicians should:
(a) Prescribe drugs, devices, and other treatments based solely on medical considerations, patient need, and reasonable expectations of effectiveness for the particular patient.
(b) Dispense drugs in their office practices only if such dispensing primarily benefits the patient. (c) Avoid direct or indirect influence of financial interests on prescribing decisions by: (i) declining any kind of payment or compensation from a drug company or device manufacturer for prescribing its products, including offers of indemnification; (ii) respecting the patient’s freedom to choose where to fill prescriptions. In general, physicians should not refer patients to a pharmacy the physician owns or operates. AMA Principles of Medical Ethics: II,III,IV,V.
Does this section apply to a doctor prescribing and selling a product used as primary therapy if the product is only available from the health care provider and only from one who is trained by the manufacturer? It seems to.
Although the heading only refers to “drugs” and “devices”, the actual rule specifically mentions “drugs, devices, and other treatments.”
A prescription is just a written order issued by a healthcare provider containing the provider’s recommendation for a product, such as a drug, device, or other treatment, or in some cases a recommendation of behavior (like bedrest). So a written order by a physician to take an herb or nutritional supplement in order to cure or mitigate a disease is a prescription and such products are prescribed. (And in case you are concerned, the fact that a physician prescribes an herb or supplement for the treatment of a disease doesn’t turn the product into a drug, because it’s the manufacturer’s intent that governs not the prescribing practices of healthcare providers, under FDA law.)
Admittedly, the language in (b) mentions a pharmacy, but not all prescribed things are found in pharmacies. Take the aforementioned bedrest for example. And we’re stipulating that the prescribed products can only be obtained through the doctor, and is not available directly to the consumer.
So does this AMA rule 9.6.6 sanction a physician prescribing an herbal remedy or supplement for the treatment or mitigation of the disease or medical condition?
I looked at the literature and haven’t seen any cases on this yet. I think it does, and the case I’m working on will provide what may be the first legal ruling on the issue.
As a backup, it seems to me that even if both AMA ethical rules could apply, I don’t see how a medical board can sanction a physician for a violation of an ethical rule where the physician’s actions are ethical under another ethical rule, or arguably so. It seems to me that a board must first make this determination, publish it and put the licensees on notice, which my research indicates has not yet been done in this state at least.
So although I think I am right, as of right now, there doesn’t appear to be a definitive answer to the question as to whether a CAM physician can prescribe and sell an herbal remedy or nutritional supplement or supplement regime as primary therapy for the treatment or mitigation of a disease, at least in a state which has specifically incorporated the AMA ethical rules.
But give me six months or so and I’ll give you the answer; hopefully the one you’re looking for.
In the meantime, and to make that happen, any academics out there with some ethics background care to opine and help make it happen? I’ll be waiting to hear from you.
Posted By Richard Jaffe, Esq.,
Wednesday, March 15, 2017
Updated: Thursday, March 23, 2017
CAM or integrative medicine doctors have had their problems with the state medical boards. And CAM organizations have had their run-ins with governmental agencies. However, the groups have always survived in large part because they have had a steady income from membership dues and from their annual conferences, where their members learn the latest and greatest from their thought leaders. But the CAM organizations’ income stream is now in jeopardy, and thus so is their existence, based on what looks to be well-planned, systematic effort to put CAM groups out of business, and stop the dissemination information about CAM therapies.
AND THAT MY FRIENDS IS A VERY BIG DEAL.
Here is what’s going on
For months, at least two CAM groups have been under review/ investigation by the primary private CME accrediting company, the ACCME (Accreditation Counsel for Continuing Medical Education). Recently, the ACCME has determined that a significant portion of the groups’ prior year’s CME courses does not meet various ACCME standards. ACCME is demanding that everyone involved in these courses be informed that:
“they were presented invalid information….”
and that the groups:
“instruct them [everyone] to avoid making any clinical decisions for testing and/or treatment based on what was presented, and
direct the registrants to accurate and valid sources of information for the problems or systems presented.”
I should point out that this “incorrect” information came from some of the most accomplished, respected and published thought leaders/teachers in the CAM community. These folks have been giving CME courses without incident for decades.
Further, in terms of future CME courses at their conferences, ACCME has informed these groups – and this is the key to understand what this is all about – that:
“recommendations involving clinical medicine must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients and all patient care recommendations must conform to evidence emanating from guidelines and data that meet generally accepted standards of experimental design, data collection, and analysis.”
In short, ACCME is trying to require these groups to only teach mainstream medicine! This is crazy and a huge deal!
Furthermore, the effect on the members of these organizations who attended the conferences last year and who used these courses to satisfy their state CME requirements is unclear.
I am not familiar with ACCME’s inner workings or guidelines, but it doesn’t seem out of the question that ACCME could contact state boards about these groups’ “noncompliance” and the retroactive withdrawal of CME credits. That could cause the state boards to retroactively hold the doctors non-CME compliant. I’m not saying that this will happen, but only that it’s a possibility. But I am saying that if the idea is to delegitimize CAM and cause problems for its practitioners, notifying the state boards would certainly advance that goal.
A specialty interest group also gets the same treatment
Beyond these two professional groups, a disease based group has recently been informed that its CME status for future conferences has been rescinded by its CME intermediary. The intermediary denies that it received any pressure or orders from ACCME.
Three CAM groups which have previously received ACCME course certification without any undue problems who in the last few months have had their prior CME course approval rescinded and/or their future CME approval withdrawn or placed in serious doubt.
Is this all a coincidence? Not a chance in hell.
My guess is that more of the same has or is going to happen to other CAM groups.
What to do?
At this stage, these groups need information about what’s behind this campaign to deny CME credit and delegitimize CAM teachings.
We need to get the word out to the CAM community.
Someone out there has to know something or know someone who knows something about how this came about, and who or what group is behind it. (My guess is that ACCME is the vehicle not the originator.)
I think there is a smoking gun out there, and if we find it, we can probably reverse ACCME’s decision quickly, so my suggestion is that all the CAM groups and interested parties get the word out to search for the smoking gun.
But let’s dig in to this and see if there is anything else that can be done. A logical place to start is:
What exactly is the ACCME and what does it do?
I don’t have any special info on ACCME, but here is what it says about itself:
“CME ACCREDITATION OF, BY, AND FOR THE PROFESSION OF MEDICINE.
The ACCME was founded in 1981 in order to create a national accreditation system. It is the successor to the Liaison Committee on Continuing Medical Education and the American Medical Association’s Committee on Accreditation of Continuing Medical Education. The ACCME’s purpose is to oversee a voluntary, self-regulatory process for the accreditation of institutions that provide continuing medical education (CME) and develop rigorous standards to ensure that CME activities across the country are independent, free from commercial bias, based on valid content, and effective in meeting physicians’ learning and practice needs. The ACCME accreditation process is of, by, and for the profession of medicine.
The ACCME’s founding and current member organizations are the American Board of Medical Specialties, the American Hospital Association, the American Medical Association, the Association of American Medical Colleges, the Association for Hospital Medical Education, the Council of Medical Specialty Societies, and the Federation of State Medical Boards of the United States.
Throughout its history, the ACCME has been dedicated to maintaining a relevant and responsive accreditation system that supports CME as a strategic asset to US health care quality and safety initiatives.”
Very noble and reassuring, isn’t it?
Basically, it’s a bunch of health care trade associations, organizations in charge of medical education and specialization credentialing. (Ironically, the medical specialty societies are the reason it’s illegal for practitioners to advertise their CAM board certifications.) And last but not least is CAM’s long-time adversary, the Federation of State Medical Boards. So maybe not so reassuring.
Did you know that the ACCME is accountable to the Public? Yea, just ask them and they will tell you so.
Here is what it says about that:
“Accountability to the Public
The ACCME is accountable to the public for setting and maintaining accreditation requirements that are designed to ensure that CME accredited within the ACCME system is based on valid content, is free from commercial influence or bias, and contributes to the quality and safety of health care. As the US health care system continues to evolve, the ACCME will respond by making changes to its requirements or processes that are necessary to assure that CME serves the best interests of the public.
I’m still not clear exactly how it is accountable to the public, and nothing in its web site gives any further elucidation.
I do have a couple ideas of how it might actually be made accountable to the public.
Some basic facts
It’s obviously a matter of individual state law what type of courses a state medical board will accept as acceptable CME. The ACCME might be the primary CME credentialer, but it is not the only one. For example, here is the Texas law regarding CME accreditation: It’s Board Rule 166.2 and it requires:
(1) At least 24 credits every 24 months are to be from formal courses that are:
(A) designated for AMA/PRA Category 1 credit by a CME sponsor accredited by the Accreditation Council for Continuing Medical Education or a state medical society recognized by the Committee for Review and Recognition of the Accreditation Council for Continuing Medical Education;
(B) approved for prescribed credit by the American Academy of Family Physicians;
(C) designated for AOA Category 1-A credit required for osteopathic physicians by an accredited CME sponsor approved by the American Osteopathic Association;
(D) approved by the Texas Medical Association based on standards established by the AMA for its Physician’s Recognition Award; or
(E) approved by the board for medical ethics and/or professional responsibility courses only.”
Other states have similar types of CME rules. The bottom line is that ACCME is a very important source of state approved CME accreditation, especially for everyone other than the major national and state medical trade groups. But there’s another way of looking at it. Without a state accepting its accreditation, ACCME doesn’t have much of a purpose or job.
What About CAM laws?
Texas, California and some other states recognize the rights of patients to receive CAM therapies. Texas, for example, provides that:
“The purpose of this chapter [Texas Board Rule Chapter 200] is to recognize that physicians should be allowed a reasonable and responsible degree of latitude in the kinds of therapies they offer their patients. The Board also recognizes that patients have a right to seek complementary and alternative therapies.” (Board Rule 200.1)
What are CAM therapies in Texas?
“(1) Complementary and Alternative Medicine–Those health care methods of diagnosis, treatment, or interventions that are not acknowledged to be conventional but that may be offered by some licensed physicians in addition to, or as an alternative to, conventional medicine, and that provide a reasonable potential for therapeutic gain in a patient’s medical condition and that are not reasonably outweighed by the risk of such methods.”
Convention medicine is defined as “Those health care methods of diagnosis, treatment, or interventions that are offered by most licensed physicians as generally accepted methods of routine practice, based upon medical training, experience and review of the peer reviewed scientific literature.”
(California has a similar definition of CAM at B&C code 2234.1)
So, Texas gives practitioners the right to provide non-conventional, not generally accepted therapies to patients, and patients have the right to receive these CAM or non-conventional therapies.
But even though Texas docs can provide CAM or non-standard therapies to Texas patients, ACCME now takes the position that Texas physicians can’t obtain CME credit for learning about these Texas sanctioned treatments. How can the ACCME be acting consistent with Texas law by its insistence that CAM medical groups can only teach:
“recommendations involving clinical medicine must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients and all patient care recommendations must conform to evidence emanating from guidelines and data that meet generally accepted standards of experimental design, data collection, and analysis.”
My view is that ACCME’s position is inconsistent, if not in violation of the Texas CAM Rule (and the California CAM statute) and probably every other state that has a CAM law.
So, what to do?
Complain to ACCME? Won’t hurt, but it won’t help. It’s doing what it’s doing intentionally, and some external pressure has to be brought forth.
Complain to the boards? Maybe, but it would take a lot of complaints.
In all the big CAM states like Texas and California, I know there are legislators who are pro CAM. My suggestion would be to identify who they are (not hard in Texas). I think the boards in a few of these states need to hear from some legislators about how ACCME is undercutting board rules (in Texas) or the CAM statutes (like in California).
These legislators should copy ACCME on their concerns expressed to the boards. If one of them is on a legislative health committee, even better. Better still would be for a couple states to start an investigation on ACCME’s motives. Maybe even an invitation to appear at a specially called hearing. Legislators can hold hearings for all kinds of reasons. So can federal legislators. I think with all the politically connected CAM docs out there, mulitipled by their politically connected patients, well I think there’s a heap of trouble that could be stirred up for ACCME.
It doesn’t have to happen in every state, or even many states, just a couple of the big ones. The story is going to get out, and questions are going to be raised. The widespread dissemination of ACCME’s action might even turn-up that smoking gun I mentioned earlier. And once the nefarious motive and scope of the conspiracy publicly surfaces, I think ACCME will be forced to rescind its actions. So, we need to shine some light on these jokers.
This could all happen pretty quickly if there’s a big enough outreach to the CAM community.
Posted By Ronald Hoffman, MD & Dana Cohen, MD,
Tuesday, February 21, 2017
If you or a loved one is a diabetic over 50 who has suffered a heart attack, there's an opportunity to obtain a potentially lifesaving therapy AT NO CHARGE. Dr. Dana Cohen describes the TACT2 trial, a multi-million dollar government-sponsored study to evaluate the effectiveness of chelation therapy. What is chelation? What is its history? How did the first TACT study demonstrate its effectiveness? Why was it greeted with skepticism by the medical establishment? Why have only integrative doctors been eager to embrace chelation? CLICK HERE
PART II: Dr. Hoffman continues his conversation with Dr. Dana Cohen about the TACT2 trial to evaluate the effectiveness of chelation therapy. CLICK HERE
Posted By Carol L. Hunter PhD, PMHCNS, CNP,
Tuesday, February 21, 2017
Serving Size: 4 to 5
1 c yellow mung dal
1 c basmati white or jasmine rice
1 inch piece of fresh ginger, peeled and chopped fine
2 Tbs shredded, unsweetened coconut
1 small handful fresh cilantro leaves
½ c water
3 Tbs ghee
1 and ½ inch of cinnamon bark
5 cardamon pods
5 cloves, whole
10 black peppercorns, whole
3 bay leaves
¼ tsp turmeric
¾ tsp sea salt
6 c water
1 slice of lime
Directions for kitchari
1.Wash the mung dal and rice until water is clear. Soaking the dal for a few hours helps with digestibility.
2.In a blender, put the ginger, coconut, cilantro and ½ cup water and blend until liquefied.
3.Heat a large saucepan on medium heat and add the ghee, cinnamon, cloves, cardamom, peppercorns and bay leaves. Stir for a moment until fragrant.
4.Add the blended items to the spices, then the turmeric and salt. Stir until lightly browned.
5.Stir in the mung dal and rice and mix very well.
6.Pour in the 6 cups of water, cover and bring to a boil. Let boil for 5 minutes, then turn down the heat to very low and cook lightly covered until the dal and the rice are soft, about 25 to 30 minutes. Decorate with a few sprigs of cilantro and a lime slice or two.
Nutritional information: per 1 cup of mung dal
14 grams protein
15.5 grams of fiber
Directions for making ghee:
1.Melt 8 sticks of unsalted butter in a large heavy pot over low to medium heat for about 30 minutes. Use the very best quality butter you can find from grass fed, no antibiotic cows. The butter will separate into 3 layers: white foam on top (water content), clarified butter in the middle and mild solids on the bottom.
2.Strain butter through a fine sieve or cheese cloth into a mason jar.
3.If you still see white milk solids, you can strain it a second time. It should be a clear yellow color and is known in India as liquid gold.
Bon appetite! This will be the easiest cleanse you have tried!
Recipe compliments of Ayurvedic Cooking for Self-Healing by Usha Lad and Dr. Vasant Lad, The Ayurvedic Press, Albuquerque, NM, 2nd edition.
Posted By Carol L. Hunter PhD, PMHCNS, CNP,
Tuesday, February 21, 2017
As spring peeks around the corner at us, our thoughts go to the rejuvenation of mind and body that this time of year seems to inspire in us. Perhaps it’s the vision of how we will appear in a bathing suit, knowing that we could still shed a few pounds. Perhaps it’s that attempt to put a better dent in that rising cholesterol level. Perhaps it’s the first touch of the warmth of the sun upon our skin, leaving the chill of winter far behind. Whatever the source of our inspiration, it drives up our motivation and prepares us to take action.
Detox cleanses are becoming more and more common in our world and more groups are joining in: the athletes, the overweight, those with chronic illnesses and of course the walking well but worried! I, for one, freely admit, I have had a love/hate relationship with green juices. When I visit my daughters, I am invariably handed a very tall glass of green “juice.” It all began with smoothies, so firm and so smooth, that I barely could tip the contents out of the glass. Between the almond milk and the banana, it was too thick for my taste. Making them was fun to watch; however, and I was amazed at how you could throw large pieces of kale and other greens in the mixer and how smooth it came out. I only lasted a few months on those. Next in line were the green juices that are made in a juicer that removes all the pulp. While the nutrients of fresh vegetables were beneficial, there was no fiber in this drink. I didn’t really like the taste either. Actually I did better with the “red” juices, the ones made with beets, apples, celery and lots of ginger. If I tried to have one of these for breakfast and was too rushed to eat anything else, I’d be starving in a matter of hours, not a good strategy in the middle of a workday.
Fortunately, for those of us who prefer to eat solid than liquid food, there is the mighty mono food diet. Kitchari is used as an Ayurvedic detox food that also is believed to foster spiritual growth in its native India. Kitchari is the Sanskrit word for mixture and is used to describe any dish that is made with beans and rice. Originally it was used to feed the sick, the elderly and babies due to its high digestibility. The purpose of the diet is similar to the goal of juicing with some added benefits. First of all, the food has substance, so it is high on satiety, which is the feeling of fullness and satisfaction we get after eating a meal. The higher the satiety the higher the leptin levels which stave off hunger for longer periods of time and prevent overeating. This makes it a perfect weight loss food. If you have any gastrointestinal issues, it is an excellent diet for healing and repair of inflammation. Mono diet means you eat the exact same food for a period of time, up to about a week. Mung dal or moong dahl is the mono food of choice due to its high level of digestibility. Mung beans are hulled, split and soaked until ready to prepare. In combination with a grain such as rice, quinoa or teff, the meal becomes a complete protein, low in fat and high in B vitamins and minerals. White rice is recommended because brown rice has its outer shell and is harder to digest. The downside is that the shelled mung beans and white rice have a low fiber content so a caveat is to supplement some form of fiber like psyllium while on this cleanse to prevent constipation. Its estimated glycemic load is only 59 on the scale of 0-100, which means it has the ability to keep your blood glucose level at a steady level longer, able to prevent frequent hunger spikes. If you will be eating it for days at a time, you can make it more interesting by changing the vegetables from one dish to the next. One day add carrots and kale, the next add zucchini and swiss chard, the next butternut squash and cilantro. Another variation is to cook the mung dal and the rice separately instead of together. The true beauty of this dish is that it does not precipitate the “starvation response” that is characteristic of so many diets in which the body feels deprived and goes into the emergency mode of decreased metabolism in order to hold onto its calories. Conversely, kitchari allows the nervous system to relax, feeling it is being properly nourished and satisfied. The result is that fat is metabolized and toxins washed away leading to, in the minds of many, the perfect cleanse. In addition, it is cheap! One 32 ounce bag of both rice and mung dal can feed two people 3 meals a day for a whole week! Try it out and you will be glad you did.
A word about ghee or clarified butter: I have included the recipe for making ghee as it is the most important fat in Ayurvedic dishes. Not only does it have a high smoking point similar to coconut which makes it useful for cooking but it does not need to be refrigerated. Kept in the dark in an airtight container, it can be kept two to three months or up to a year unopened in a refrigerator. There are accounts of 100 year old ghee! It has been used in Ayurveda for thousands of years and is found in the original Sanskrit texts. A sampling of benefits include: it is safe for the lactose and casein intolerant due to the removed milk solids and impurities; It is rich in vitamin A, E, K2 and CLA (from grass fed cows;) it is a source of medium chain fatty acids that are an excellent energy source and that allow the body to burn other fats; it is rich in butyric acid which increases killer T cells in the gut that foster the immune response and help to keep the intestinal mucosa healthy. In a 2010 study by Shamara et al in the journal, AYU, the researchers concluded that data in the literature does not support a harmful effect on lipids by the moderate consumption of ghee in the general population.
Excessive toxic metal exposure from the air, food, water, dental amalgams, and other sources is becoming a recognized and established underlying cause of both acute and chronic disease. With ongoing medical research validating the link between chronic diseases like heart disease and environmental exposure to toxic metals, it is more important than ever for doctors and patients to be well-informed about the detrimental effects of toxic metals and the potential treatments for heavy metal toxicity, including IV chelation therapy.
What is chelation?
The Greek word “chele” means claw. Chelation is the binding of metals (like lead) or minerals (like calcium) to a protein “chelator” in a pincer-like fashion, forming a ring-like structure. Chelation is an important treatment protocol for the removal of toxic metals such as lead and mercury from the body’s bloodstream and tissues. Natural chelation, although weak, regularly occurs from eating certain foods such as onions and garlic. A stronger chelation effect can be induced when certain supplements, such as some amino acids, are taken orally. The strongest chelation effect is achieved with intravenous chelation.
What is chelation used for?
Intravenous chelation therapy is used and accepted within conventional medicine as an FDA-approved treatment for the removal of toxic minerals such as lead from the body in cases of severe poisoning. However, it is also used in a less conventional way: the repeated administration of intravenous chelating agents is used to reduce blood vessel inflammation caused by specific toxic metals and to reduce the body’s total load of those metals, especially lead. It has been shown that the risk of dying from cardiovascular events begins when a person’s blood level of lead is still well within the established normal reference range.
IV chelation therapy often utilizes the chelating agent disodium ethylene diamine tetraacetic acid (EDTA) and is sometimes referred to as EDTA chelation. EDTA chelation is being used in the treatment of all forms of atherosclerotic cardiovascular disease, especially heart disease and peripheral artery disease. Although there is less published research in these areas, chelation therapy is also being used to treat macular degeneration; osteoporosis; mild to moderate Alzheimer’s disease associated with heavy metal toxicity; autoimmune diseases, especially scleroderma; and fibromyalgia or chronic fatigue syndrome with high levels of toxic metals detected with a challenge test.
Does chelation really work?
The most recent study to examine the effects of EDTA chelation therapy showed compelling value for preventing cardiovascular events, especially in people with diabetes who had a history of heart attack. The controversial Trial to Assess Chelation Therapy, or TACT, found an amazing 40% reduction in total mortality, 40% reduction in recurrent heart attacks, and about a 50% reduction in overall mortality in patients with diabetes who had previously suffered from a heart attack. TACT was a large, randomized, placebo-controlled study published in JAMA that randomized patients to a series of IV chelation using EDTA or placebo.
What kinds of doctors offer IV chelation therapy?
Doctors must be well-trained in chelation therapy in order to utilize the correct tests and treatments. Testing for toxic metal exposure is not straightforward since blood tests typically identify only those with severe and acute toxicity but fail to identify those with toxic metals stored in the tissues due to chronic exposure. Applying the appropriate chelating agent to properly treat toxic metal accumulation is also not a straightforward endeavor. Different chelating agents bind with different affinity to different metals. Some chelating agents may be taken orally, while others are administered intravenously.
Chelation therapy is not taught in conventional medical school but rather through various professional medical organizations. The most recognized leader in educating and certifying healthcare professionals, including MDs and NDs, in chelation therapy is the American College for the Advancement of Medicine (ACAM). ACAM’s chelation therapy training teaches doctors how to diagnose and treat patients with heavy metal toxicity as well as how to use diet and nutrients to optimize toxic metal chelation strategies and protocols.
 ACAM website. Detoxification / IV Chelation. Downloaded Jan 7, 2014.
Posted By Administration,
Monday, February 20, 2017
Sleepless nights can be triggered by countless factors, but by controlling confronting the issue head on, practitioners are able to gain a better understanding of what causes them. By Nicholas Saraceno
As the old saying goes, time flies when you’re having fun (or sleeping for that matter). Unfortunately for some, this is not always the case. According to the American Sleep Association (ASA), 50 to 70 million adults in the United States have some sort of sleep disorder. These disorders can range from dyssomnia’s to parasomnias.
Often times, this inability to rest results in sleepless nights. Although there are a plethora of causes linked to difficulty sleeping, integrative practitioners are able to pinpoint the most popular ones, while finding potential solutions.
Causes & Common Conditions
As previously mentioned, the causes that influence the lack of sleep are numerous, but doctors and experts alike have been able to narrow these down to ones backed by science, such as brain function, which could be the root of the problem.
“There are cycles of sleep: rapid eye movement (REM) and non-rapid eye movement (non-REM),” said Jeremy A. Holt, associate director of Ajinomoto North America’s health services section in New Jersey. “REM is typically 25 percent of the sleep period. Non-REM is divided into four stages. Stage One is the period between being awake and falling asleep. Stage Two is the onset of sleep and becoming disengaged from your surroundings. Stages Three and Four are the deepest and most restorative sleep, where muscles are relaxed, blood pressure drops and breathing becomes slower.
“A restless sleeper will wake up while transitioning between these stages. Once the body wakes, it doesn’t return to the state it awoke from – it must go back to stage one. Continually waking during the night and not reaching Stages Three and Four is what causes poor sleep quality.”
However, lack of sleep can also stem from gender-related issues that interfere with the REM process.
Gina Besteman, RPH, is the director of compounding and dispensing at the Women’s International Pharmacy in Wisconsin, a compounding pharmacy that provides high-quality bioidentical hormone therapies.
“One of the more common symptoms of peri-menopause and menopause that patients complain of is difficulty sleeping. There is a significant amount of research showing how hormones affect sleep,” she noted. “Progesterone affects GABA receptors which are responsible for non-REM sleep, the deepest of the sleep stages. Progesterone also affects breathing. Its’s been shown to be a respiratory stimulant and has been used to treat mild obstructive sleep apnea. Estrogen’s role in sleep appears to be more complicated than that of progesterone. Estrogen is involved in breaking down norepinephrine, serotonin and acetylcholine in the body. Estrogen has been shown to decrease the amount of time it takes to fall asleep, decrease the number of awakenings after sleep occurs and increase total sleep time. Low estrogen levels may lead to hot flashes which can also affect sleep.”
Perimenopause refers to the menopausal transition, normally occurring in a women’s 40’s, sometimes mid-30’s (mayoclinic.org). Dr. Besteman also cited that if there is a disruption in cortisol, the stress hormone produced by the adrenal glands and melatonin, the hormone responsible for sleep and wakefulness manufactured by the brain’s pineal gland, these could be contributors to the issue.
As a result, different sleep conditions affect different societal demographics. According to Svetlana Kogan, MD, an integrative doctor in New York, NY and author of Diet Slave No More!, individuals affected by difficulty sleeping can be broken up into three categories.
“Young people have over stimulated nervous systems due to cell phones, video games, computers, TV and other electronic gadgets,” she said. “Older people (ages 35-60) are having difficulty sleeping due to all of the above, plus the stress of having to balance family, children and work. Much older people (over 60) have physiologic issues during sleep that cause them to wake up many times during the night (urinary incontinence or frequency, sleep apnea, insomnia, pain syndromes). Overall, people who live in big cities sleep much less than the rest of the country. This could be due to overstimulation of the nervous system, work stress and lack of time spent outdoors (that is, less oxygen to the brain).”
Solutions to Better Sleep
After hearing of patients’ difficulty sleeping, the next question is: what exactly can practitioners recommend to their patients to help combat these issues?
A great starting point would be in the mineral magnesium, which notably has a calming effect to it.
“Magnesium is an essential electrolyte and is known as the anti-stress mineral, and is a natural sleep aid,” mentioned Carolyn Dean, MD, ND, advisory board member of the Nutritional Magnesium Association. “Numerous Studies have shown its effectiveness in reducing stress levels as well as helping with deeper more restful sleep. This mineral has been depleted from our soils and foods due to modern farming methods and food processing. More than 75 percent of Americans do not get their recommended daily allowance of this mineral, which is a co-factor in 700-800 enzyme reactions in the body.
“A magnesium deficiency can magnify stress because of serotonin, the feel-good brain chemical that is boosted artificially by some medications, depends on magnesium for its production and function. Not all forms of magnesium are easily absorbed by the body. Magnesium citrate powder is a highly absorbable form that can be mixed with hot or cold water and sipped at work or at home throughout the day.”
As another option, Boiron USA, a Pennsylvania-based manufacturer of homeopathic medicine, offers Quietude, dissolvable tablets that help target lack of sleep, without the effects that come with it. Christopher Merville, DPharm, director of education and pharmacy development at the company, explained how exactly the medication is effective.
“Quietude temporary relieves sleeplessness, restless sleep and occasional awakening without grogginess or risk of dependency,” he said. “The biggest advantage of this sleep aid is that it doesn’t knock you out. It may sound funny for a sleep medicine to be non-drowsy and non-doping, but this means you won’t have that groggy hangover effect the next day like you are still in a fog, which is typical with sleep aids that mask the problem by sedating you. Instead, Quietude helps and overactive mind calm down. It’s perfect for when your head hits the pillow but you keep going over that to-do list or replaying the day’s events. If you’ve had a particularly exciting day- whether it’s from good or bad news- prepare for bed by taking Quietude once in the early evening and then again at bedtime.”
A common trend among those struggling with sleeplessness is the fact that the body, especially the brain, is operating at full capacity even during the late evening hours, when it should be resting. Glycine, and amino acid found in Ajinomoto’s Glysom, is able to affect he body accordingly.
“Glycine is a naturally occurring amino acid that induces sleep by setting the body’s internal clock and reducing the core body temperature,” said Holt. “It signals the body to relax and prepare for a better sleep cycle, improving the body’s sleep architecture. Taking Glysom together with melatonin provides a combo effect- the melatonin helps you fall asleep, the Glysom keeps you asleep.”
State of the Market
Being that difficulty sleeping is an ongoing issue, there are positive strides being made in the market, precisely in terms of both traditional and natural medications respectively. In fact, a major contributor to traditional medicine’s success is the severity of the conditions that it treats.
“Insomnia is recognized as the fourth most prominent health issue just behind stress,” said Dr. Dean. “The projections for sleep aids for 2018 are approximately $732 million with a 27 percent category growth rate. The recognized drawbacks are side effects and addictive nature of these medications.”
Moreover, as Dr. Kogan stated, “the sales are unprecedentedly high- especially those of generic sleep meds, as they are cheaper.”
On the other hand, natural sleep medication has continuously garnered attention, partly due to individuals that are popular in the public eye. “Awareness of the importance of sleep an getting proper sleep is growing, and with high profile celebrity deaths (Michael Jackson, Prince) related to sleep issues, consumers are searching for and demanding natural alternative to otherwise harmful side-effect ridden medications,” added Dr. Dean.
As a result, being that pros and cons lie in both forms of medication, practitioners must fairly provide both options to their patients.
There are endless questions surrounding sleep, such as what in fact is the best solution to a good night’s sleep and how one gets to that point. Progress has been made in this regard, and to further enhance this progress, practitioners are thinking out of the box with their interest in research.
“I am interest in researching auto-hypnosis and sleep- specifically how teaching patient’s self-hypnosis techniques can help them fall asleep easier,” noted Dr. Kogan.
In fact, she is quite fond of this delivery method, as it takes more of a holistic approach to medicine. “Self-hypnosis (which I admire) is the least popular method because it’s an acquired skill that needs to be rehearsed many times over, until it becomes a lifestyle,” she mentioned. “Teaching patients self-hypnosis is my favorite modality, because it empowers patients to tap into their own inner resources, instead of depending on pills.”
Although the medical world may not have received all the answers is has been looking for thus far, one ideas is for sure: good sleep is king.
“There is a much greater understanding of the overall physiological and emotional role sleep plays on a body’s health,” said Holt. “Polysomnographic studies have proven that there is no substitute for good sleep. If a body is deficient in vitamin C, a supplement will help adjust that. The same cannot be said of sleep deficiency. Lack of sleep affects the whole body, including metabolism. That’s why good sleep is so important for weight loss.”
Posted By Administration,
Tuesday, February 7, 2017
The Airway Centric® Model prevents Airway-Centered Disorders, Sleep-Disordered Breathing to maintain mental and physical health. Learn how to recognize and correct Airway-Centered Disorders, Sleep-Disordered Breathing. Gasp is about our airway, breathing and sleep. Problems can start at birth. Many premature babies are mouth breathers. A poorly structured and functioning airway leads to mouth breathing, snoring and sleep apnea; it can interfere with restorative sleep and ultimately damage the part of the brain called the prefrontal cortex, which controls executive function skills, attentiveness, anxiety and depression. Learn how to restore an ideal airway with early intervention, and where to go for help. Learn how once the airway is established with breastfeeding, allergy treatment, and other methods, neurocognitive and neurobehavioral problems are greatly improved—often without any medication. Anxiety and depression are alleviated, and the behavior and performance of children are remarkably transformed.
Today there is a health movement toward “Wellness.” Wellness is about diet and nutrition, exercise, and mental attitude. The new paradigm is called “Functional Medicine.” It addresses the causes of chronic disease with an individualized approach and emphasizes early intervention. It restores the balance amongst functional systems and the networks that connect them. The missing link is airway, breathing, and sleep. If we don’t breathe well when we sleep, 1/3 of our life is affected. Gasp describes the impact of a narrowed airway from cradle to grave. Every day, we encounter fatigued patients with chronic headaches and neck pain. They have difficulty concentrating; they suffer with GI problems from acid reflux to irritable bowel syndrome. They range from thin women to men who have put on a few pounds. And you do not have to be obese to have an airway problem. Many of our younger patients with ADHD and airway issues have little body fat. Time after time we see that once the airway is opened during the day and maintained during sleep, the transformation is quick and dramatic. Breathing is life.
Posted By Administration,
Tuesday, February 7, 2017
In her new book The Cancer Revolution, Leigh Erin Connealy,MD shares her groundbreaking integrative approach to both treating and preventing cancer.
“Fortunately, you can learn about many cutting-edge cancer therapies by reading this book,” says Dr. Joseph Mercola in The Cancer Revolution foreword. “Dr. Connealy carefully and clearly details the wide array of comprehensive strategies that you can consider for treating cancer. There really are an astounding number of choices and she does a magnificent job of compiling them conveniently in one place. It would take you many weeks, and more likely months or years, to collect the options that she concisely reviews here…Not only does she outline the natural options for treating cancer, but she provides resources that you can use to identify a natural clinician that resonates with your philosophy and budget.”
Dr. Connealy’s latest book offers practical strategies that have helped thousands of patients:
Let food be your medicine.
Remove toxins to repair and restore your body.
Harness the healing power of supplements.
Reduce stress and reclaim your life.
Strengthen your immune system with sleep.
With a 7-day detox and a 14-day healing program — including recipes based on anti-cancer foods, as well as inspiring stories from patients successfully treated at her Cancer Center for Healing — Dr. Connealy provides healing strategies for patients and those at risk.
“Dr. Connealy understands the role of nutrition, epigenetics, and integrative approaches in healing cancer and even preventing cancer,” says author and documentarian Ty Bollinger. “Cancer is not a death sentence. There is always hope, and this book will empower you with knowledge that just might save your life or the life of a loved one.”
The Cancer Revolution reveals its’ secrets in this three-part book:
A New Way to Prevent, Treat, and Beat Cancer
Cancer: What It Is, What Causes It, and How to Fight It
How to Detect Cancer Before It Wreaks Havoc
Groundbreaking Cancer Treatments
The Six Revolutionary Cancer Strategies
Let Food Be Your Medicine
Remove Toxins to Boost Your Health
Harness the Power of Supplements
Get Moving to Get Well
Reduce Stress and Reclaim Your Life
Strengthen Your Immune System with Sleep
The Cancer Revolution Plan for Health and Wellness
Putting Together Your Support System
Creating an Anticancer Living Environment
The 14-Day Anticancer Wellness Plan
The 7-Day Juicing Detoxification Program
Living a Cancer-Free Life
The Recipes: Dishes for Repairing and Restoring Your Body
“The Cancer Revolution enables everyone to understand and take responsibility for their health and their role in the prevention of disease. It is truly an outstanding guide of how to create health and maintain wellness — from a personal and professional standpoint,” notes Paul Fisher of Biotics Research.
Posted By Carol L. Hunter PhD, PMHCNS, CNP,
Wednesday, February 1, 2017
Everyone has their favorite scent: lavender, rose, balsam and many others, but for me it is definitely coconut. Maybe this particular scent conjures up the tropical vision of swaying palm trees and turquoise waters and immediately, I am feeling more relaxed. Whether the scent is coming from some type of beauty product or from something yummy cooking in the oven, coconut based products and edibles are abundant today. Aside from its soothing qualities, its health benefits are rapidly being documented in research studies, so let’s take a look at some of those first. I was curious about what was being studied in regard to coconut oil.
In a cursory perusal of PubMed abstracts, a number used rats as the subjects. In a study by Rahim et al (2017), virgin coconut oil (VCO) was associated with increased antioxidative, cholinergic activities along with reduced oxidative stress that produced enhanced memory in the groups treated with the VCO. Another study by Alves et al (2016) showed that intravenous doses of lauric acid, the most abundant medium chain fatty acid in VCO, reduced blood pressure and oxidative stress in hypertensive rats. In another study on lauric acid, Lekshmi et al (2016) found that animals fed lauric acid had lowered cholesterol levels. In a different type study by Famurewa et al (2017) VCO attenuated the toxic effects of the anticancer drug methotrexate on the liver by reducing oxidative stress in rats.
In the studies on humans, research focused on the antibacterial efficacy of VCO, particularly on the effect of Streptococcus mutans in the mouth (Peedkayil et al, 2016). An ayurvedic practice for oral hygiene is to swish VCO in the mouth for 20 minutes in the morning. Other studies examined effects on cardiovascular risk factors. Cardoso et al, 2015, found that a diet rich in VCO increased HDL cholesterol, the “good cholesterol ,” and decreased waist circumference and body mass in coronary artery disease patients. Another study by Vijayakumar et al, 2016 showed that the use of coconut oil as a cooking oil for two years did not alter the lipid profile of patients with stable coronary heart disease receiving standard medical care.
I did not find any studies on diabetes and VCO but there was one on Alzheimer’s disease that discovered that subjects who received 40mg/day of VCO had an improvement in their cognitive status as measured on their test scores, particularly in women and those without diabetes type II. (Hu et al 2015). There was an additional study looking at the antioxidant, anti-inflammatory and anti-arthritic effects of an ayurvedic formula, kerabala, which is partially comprised of VCO. There was a beneficial effect on inflammation, tissue damage and the pain associated with arthritis.(Ratheesh et al, 2016).
There is certainly more positive data than not but VCO should still be used in moderation. Botanically the coconut fruit is a drupe, not a true nut. A drupe is a fruit that has an outer fleshy part surrounded by a pit of hardened endocarp with a seed inside. Allergic reactions to coconuts are very rare and it is thought that those with tree nut allergies are safe eating coconuts. Although it does not contain any cholesterol, it is a saturated fat, although approximately 75% is in medium chain fatty acids that produce ketones that can serve as an energy source for the brain. The best VCO is the pure natural oil, which is hardened at room temperature and has a higher heating point than olive oil, making it preferable for frying and baking.
In honor of Valentine’s Day, there are several ways that VCO can add to your enjoyment. The first is with a sweet treat that will be featured with its recipe. The other is with a hot VCO massage that can be shared with your sweetheart. It is also beneficial to give yourself a weekly VCO massage to keep your skin and hair supple and moist. Heat up about 8 to 10 tablespoons of VCO in a small saucepan( half that for one person) until it melts. The best way to use it is to pour it into a glass container that has a pump on top. For couples, spread out a large towel on a bed and begin at the head. If you are standing, spread out a towel on the floor because the oil will spatter and collect on everything around it. Slowly massage the oil through the hair and scalp and face. Proceed downwards all the way to the feet but avoid the bottom of the feet if you will shower afterwards. Vigorous rubbing is good for the extremities where often the skin tends to be dryer and rougher. Use long strokes on the limbs and a circular motion on the joints. One of my daughters, who attends the Ayurvedic Institute, likes to put a small heater in the bathroom and break out into a sweat during the self massage. When finished, you can then shower but only use soap on the areas that need it, avoiding most of the body. The oil running off the body makes for slippery footing so be very careful and either have something you can grab onto or a mat to prevent a fall. After drying off, your skin will be silky smooth. The VCO also helps to prevent razor burn if you are shaving and you can apply some extra to shaven areas after the shower as well. You will be glowing which makes for a nice Valentine’s present. Enjoy!
Posted By Walter J. Crinnion ND,
Wednesday, January 18, 2017
Do you ever look around, possibly at the political process in our country, and ask yourself “is everyone brain-dead”? Contrary to what one would think when looking at the advances in technology our overall IQ is dropping as the decades go by, not going up! Those alive during the Victorian era actually had higher overall IQ than we do.[i]While that may explain a lot, one still has to ask what the cause could be.
During the last few decades our environmental burden has continued to increase. During the same time new illnesses that are clearly associated with environmental overload, like chemical sensitivity, have appeared. Other illness that are strongly associated with environmental overload, such as ADHD, allergies, asthma, autoimmunity, autism, T2DM, obesity and Parkinsonism have begun to increase dramatically.
The main body systems affected by environmental burden include the immune, neurological, endocrine and cardiovascular systems. Multiple toxicants that we are all commonly exposed to during daily living have been associated with damage to all of these systems.
Cognitive decline has been linked to both prenatal exposure and exposure in daily life. The major prenatal exposure that have been directly associated with neuroinflammation and loss of cognition are:
In utero exposure to organophosphate pesticides, primarily through diet, has been associated with slower motor speed and worse motor coordination, visuospatial performance and visual memory when the children reached the age of 6-8. [This translated to a developmental delay equivalent to 1.5 - 2 years.[ii] Maternal use of personal care products, especially fragrances and nail polish have higher levels of plasticizers in their blood and urine. Those moms have kids with lower IQs by the age of 7![iii] Moms eating high mercury fish when they are pregnant, and who then have high blood methyl mercury (levels fairly common for frequent fish eaters - nothing that far out of normal) are FOUR TIMES more likely to have a child with an IQ less than 80! Study The sad thing is that many women consume more fish during pregnancy to make a smarter child (because fish oil does that).[iv]
The major “post-natal” or daily life exposures that reduce our cognitive power along with increasing neuroinflammation are primarily:
1.Vehicular exhaust (urban air pollution)
A group of Spanish researchers led by Lillian Calderón-Garcidueñas have done a number of studies in the metropolitan area of Mexico City regarding cognition and air pollution. They have found that children exposed to higher levels of vehicular exhaust (especially PM2.5) have more problems with memory and attentiveness.[v] Children in Mexico City with no other risk factors for cognitive deficits except living in polluted areas exhibited clear cognitive deficiencies and neuroinflammation.[vi][vii] The same relationship between vehicular exhaust and cognitive function has been found in men whose average age is 71.[viii] Those men with the highest level of traffic exposure had a mental decline that equaled 1.9 years of aging. Women between the ages of 70 – 81 with higher long-term exposure to PM2.5 and PM 2.5-10 exhibited a cognitive decline equivalent to 2 years of aging.[ix]
With indoor and outdoor exposures to vehicular exhaust being the greatest factor in neuroinflammation and cognitive decline, the second greatest factor is lead. Even though the blood lead level is lower in the United States than it has been in decades, lead remains in the environment and is still associated with cognitive decline in children and adults.
It has been shown repeatedly that children’s blood lead levels (BLL) below the current CDC level of <5 ug/dl are still capable of reducing children’s IQ levels.[x][xi][xii] Italian adolescents with BLL’s above 1.71 ug/dl lose 1 IQ point for each 0.19 ug/dl increase in BLL , with each doubling of the BLL equated to a 2.4 pt. reduction in IQ.[xiii] Not surprisingly lead-associated decline of cognitive function in children has been shown to persist into adulthood[xiv], giving the current state of municipal water lead contamination the potential for grave consequences amongst future adults in those areas.
Cumulative lead burden in adults, assessed via bone lead fluoroscopic assessment, has been associated with decreased cognition[xv] while BLLs have been shown no association.[xvi] Increasing levels of tibial lead were inversely related to impaired language, processing speed, eye-hand coordination, executive functioning, verbal memory, verbal learning and visual memory.[xvii] As the tibial lead concentration rose, hand-eye coordination diminished. Women in the Nurses’ Health Study also showed increased cognitive decline with increasing tibial lead levels.[xviii] Every 1-standard deviation jump in tibial lead was associated with a functional decline equivalent to 0.33 years of aging. Computerized neurobehavioral testing, easily done in a clinical setting, show clear cognitive declines associated with bone lead burden[xix], but shows no correlation with BLLs.[xx] Since bone lead measurement is unavailable to clinicians a lead mobilization test should be done in order to gain information on total body lead burden.
[i] Woodley MA, te Nijenhuis J, Murphy R, Were the Victorians cleverer than us? The decline in general intelligence estimated from a meta-analysis of the slowing of simple reaction time. Intelligence 2013;41(4):843-850.
[ii]Harari R, Julvez J, Murata K, Barr D, Bellinger DC, Debes F, Grandjean P.Neurobehavioral deficits and increased blood pressure in school-age childrenprenatally exposed to pesticides. Environ Health Perspect. 2010 Jun;118(6):890-6.PubMed PMID: 20185383.
[iii]Factor-Litvak P, Insel B, Calafat AM, Liu X, Perera F, Rauh VA, Whyatt RM.Persistent Associations between Maternal Prenatal Exposure to Phthalates on ChildIQ at Age 7 Years. PLoS One. 2014 Dec 10;9(12):e114003. PubMed PMID: 25493564.
[iv]Jacobson JL, Muckle G, Ayotte P, Dewailly É, Jacobson SW. Relation of PrenatalMethylmercury Exposure from Environmental Sources to Childhood IQ. Environ HealthPerspect. 2015 Aug;123(8):827-33. PubMed PMID:25757069.
[v]Basagaña X, Esnaola M, Rivas I, Amato F, Alvarez-Pedrerol M, Forns J,López-Vicente M, Pujol J, Nieuwenhuijsen M, Querol X, Sunyer J.Neurodevelopmental Deceleration by Urban Fine Particles from Different EmissionSources: A Longitudinal Observational Study. Environ Health Perspect. 2016Oct;124(10):1630-1636. PubMed PMID: 27128166.
[vi]Calderón-Garcidueñas L, Mora-Tiscareño A, Ontiveros E, Gómez-Garza G,
Barragán-Mejía G, Broadway J, Chapman S, Valencia-Salazar G, Jewells V, MaronpotRR, Henríquez-Roldán C, Pérez-Guillé B, Torres-Jardón R, Herrit L, Brooks D,Osnaya-Brizuela N, Monroy ME, González-Maciel A, Reynoso-Robles R,Villarreal-Calderon R, Solt AC, Engle RW. Air pollution, cognitive deficits andbrain abnormalities: a pilot study with children and dogs. Brain Cogn. 2008Nov;68(2):117-27. PubMed PMID: 18550243.
[vii]Calderón-Garcidueñas L, Villarreal-Calderon R, Valencia-Salazar G,Henríquez-Roldán C, Gutiérrez-Castrellón P, Torres-Jardón R, Osnaya-Brizuela N,Romero L, Torres-Jardón R, Solt A, Reed W. Systemic inflammation, endothelialdysfunction, and activation in clinically healthy children exposed to airpollutants. Inhal Toxicol. 2008 Mar;20(5):499-506. PubMed PMID: 18368620.
[viii]Power MC, Weisskopf MG, Alexeeff SE, Coull BA, Spiro A 3rd, Schwartz J.Traffic-related air pollution and cognitive function in a cohort of older men.Environ Health Perspect. 2011 May;119(5):682-7. PubMedPMID: 21172758.
[ix]Weuve J, Puett RC, Schwartz J, Yanosky JD, Laden F, Grodstein F. Exposure toparticulate air pollution and cognitive decline in older women. Arch Intern Med.2012 Feb 13;172(3):219-27. doi: 10.1001/archinternmed.2011.683. PubMed PMID:22332151.
[x] Canfield RL, Henderson CR Jr, Cory-Slechta DA, Cox C, Jusko TA, Lanphear BP. Intellectual impairment in children with blood lead concentrations below 10 microg per deciliter. N Engl J Med. 2003;348(16):1517-26. PubMed PMID:12700371.
[xi] Jusko TA, Henderson CR, Lanphear BP, Cory-Slechta DA, Parsons PJ, Canfield RL. Blood lead concentrations < 10 microg/dL and child intelligence at 6 years of age. Environ Health Perspect. 2008;116(2):243-8. PubMed PMID: 18288325.
[xii] Lanphear BP, Hornung R, Khoury J, Yolton K, Baghurst P, Bellinger DC, Canfield RL, Dietrich KN, Bornschein R, Greene T, Rothenberg SJ, Needleman HL, Schnaas L, Wasserman G, Graziano J, Roberts R. Low-level environmental lead exposure and children's intellectual function: an international pooled analysis. Environ Health Perspect. 2005 Jul;113(7):894-9. PubMed PMID: 16002379.
[xiii] Lucchini RG, Zoni S, Guazzetti S, Bontempi E, Micheletti S, Broberg K, Parrinello G, Smith DR. Inverse association of intellectual function with very low blood lead but not with manganese exposure in Italian adolescents. Environ Res. 2012 Oct;118:65-71. PubMed PMID: 22925625.
[xiv] Mazumdar M, Bellinger DC, Gregas M, Abanilla K, Bacic J, Needleman HL. Low-level environmental lead exposure in childhood and adult intellectual function: a follow-up study. Environ Health. 2011 Mar 30;10:24. PubMed PMID: 21450073.
[xv] Shih RA, Glass TA, Bandeen-Roche K, Carlson MC, Bolla KI, Todd AC, Schwartz BS. Environmental lead exposure and cognitive function in community-dwelling older adults. Neurology. 2006;67(9):1556-62. PubMed PMID: 16971698.
[xvi] van Wijngaarden E, Winters PC, Cory-Slechta DA. Blood lead levels in relation to cognitive function in older U.S. adults. Neurotoxicology. 2011;32(1):110-5. PubMed PMID: 21093481.
[xvii] Bandeen-Roche K, Glass TA, Bolla KI, Todd AC, Schwartz BS. Cumulative lead dose and cognitive function in older adults. Epidemiology. 2009;20(6):831-9. PubMed PMID: 19752734.
[xviii] Power MC, Korrick S, Tchetgen Tchetgen EJ, Nie LH, Grodstein F, Hu H, Weuve J, Schwartz J, Weisskopf MG. Lead exposure and rate of change in cognitive function in older women. Environ Res. 2014;129:69-75.PubMed PMID: 24529005.
[xix] Dorsey CD, Lee BK, Bolla KI, Weaver VM, Lee SS, Lee GS, Todd AC, Shi W,Schwartz BS. Comparison of patella lead with blood lead and tibia lead and their associations with neurobehavioral test scores. J Occup Environ Med. 2006;48(5):489-96. PubMed PMID: 16688005.
[xx] Krieg EF Jr, Chrislip DW, Crespo CJ, Brightwell WS, Ehrenberg RL, Otto DA. The relationship between blood lead levels and neurobehavioral test performance in NHANES III and related occupational studies. Public Health Rep. 2005;120(3):240-51. PubMed PMID: 16134563.
The Drug Enforcement Agency (DEA) is moving against cannabidiol (CBD), a supplement used to control pain and inflammation. The circumstances are extremely suspicious.
Late last year, the DEA published a final rule that classifies marijuana and hemp extracts, including CBD, as Schedule 1 controlled substances—a category that includes heroin, LSD, mescaline, and MDMA. Note that none of the CBD extracts contains significant amounts of the psychoactive chemical in marijuana—only the non-psychoactive painkilling chemicals.
There are thousands of published scientific studies on CBD and its beneficial health effects on pain, inflammation, seizures, rheumatoid arthritis, and other inflammatory conditions. CBD is available as a dietary supplement.
Posted By Alliance for Natural Health,
Tuesday, January 17, 2017
Updated: Wednesday, March 29, 2017
Governments and much of the press seem to be covering up that Flint is just the tip of the iceberg. State-based Action Alert!
We reported last month that in Flint, Michigan, tap water in residents’ homes contained astonishing levels of lead, as high as 104 parts per billion (ppb), when the Environmental Protection Agency’s limit for lead in drinking water is 15 ppb. We also noted that research has linked lead exposure to violent and criminal behavior.
A new report from Reuters shows that lead exposure is not an isolated problem in a few communities. In the investigation, Reuters found about 3,000 areas with lead poisoning rates at least doublethose in Flint at the peak of that city’s crisis.
A recent article in Scientific American upends the conventional wisdom about what caused the recent spike in mumps in the US. In 2016 there were about 4,000 cases across the US; in 2010, there were about 2,000.
If you followed the mainstream press and a number of opportunistic politicians, the answer was clear: unvaccinated kids were the cause. Parents who didn’t vaccinate their kids according to the government’s schedule were vilified and derided in the opinion columns of newspapers and magazines, and state politicians like Sen. Richard Pan of California used the hysteria to enact legislation (SB 277) that eliminated parents’ right to decide whether and how to vaccinate their children.
In the waning days of 2016, the US Food and Drug Administration (FDA) ignored the expressed will of Congress. The agency completed a “guidance” document that prohibits traditional compounding pharmacies from stocking doctors’ offices with custom drugs.
In December 2015, Congress included a provision in an end-of-the-year spending bill ordering the FDA to issue a guidance document clarifying how physicians and compounding pharmacists could continue the “office use” of drugs. These are custom drugs that a doctor keeps on hand for immediate treatment use. Congress could not have been clearer: the agency was not to forbid office use. The FDA has now answered—by ignoring it.
Posted By Carol L. Hunter PhD, PMHCNS, CNP,
Wednesday, December 28, 2016
As we know well, good nutrition is incredibly important to a growing child, but it also has to be tasty and appealing. In keeping with that goal, homemade granola is a wonderful food for children. Not only can they have it with milk for breakfast, but it makes for a nutritious portable snack anytime and anyplace. It is a perfect finger food for those independent two year olds, who would rather “do it themselves!” I do hope the little ones in your lives will enjoy this healthy recipe! Enjoy.
½ cup pumpkin seeds
½ cup sunflower seeds
½ cup of any other nuts: cashews, almonds, walnuts
1 tablespoon white sesame seeds
1/8 teaspoon cinnamon
3 to 4 shakes of cardamom
Light sprinkle of nutmeg
Light sprinkle of ground ginger
2 cups of rolled oats
¼ cup of Earth Balance organic vegan buttery spread
½ cup of real maple syrup
Preheat oven to 350 degrees
Place the seeds, nuts and spices in a dry frying pan to roast. Stir the mixture and shake the pan frequently until the mixture releases a fragrant aroma, about 7 minutes or until the mixture has turned a golden brown.
Liquify the Earth balance separately and pour over the mixture and work it in well with a spatula. Add the maple syrup and work that in until the mixture is starting to stick together.
Spread the mixture out on a non stick baking sheet and bake for about 10 minutes. Be careful not to burn on the bottom. After cooling, break the granola into bite sized chunks and store in a mason jar. Enjoy!
WARNING: This granola should only be given to children with molars who can chew well. If not, it could be a choking hazard.
Posted By Carol L. Hunter PhD, PMHCNS, CNP,
Wednesday, December 28, 2016
Recently, I had a visit with my step daughter and her beautiful family. Her two boys, ages 5 and 3, are exceedingly comfortable in their own little skins. When I kissed the 3 year old goodbye on his cheek, he responded by pointing to his lips and saying, “kiss on lips, not cheeks!” Not only did I get a laugh out of it but it struck a deep chord within me and I realized I had a goal to achieve in 2017.
It’s a bit odd to want to teach someone in your life to hug and kiss. I’m talking about a two and a half year old boy and he happens to be my grandson. We’ll call him Blaine. You pretty much can’t get near Blaine without him struggling to bolt away. He does like to interact with others and there are no signs of autism spectrum disorder. Unfortunately, the signs more closely point to RAD ( reactive attachment disorder) and there’s a very good reason for that. You see, like so many children of substance dependent parents, he has lost his mommy. He’s starting to make memories and one overriding reality right now is that his mommy is gone. He didn’t get to see his mommy at Christmas time but kept asking his grandpa over and over again, “where is mommy?” There are few things in life more heartbreaking than a child who has lost a parent, in one way or another, and I have been deeply affected by it.
He started off his life as a preemie, weighing in at 3 pounds, 3 ounces. Because of his frailty, his mother never had that skin to skin contact right after birth or the opportunity to start him nursing. He was in NICU for several weeks, more due to his age and weight than any serious medical problem. During that time his mother and father visited him and held him but it was hard with all the monitor wires. When he came home, he was on oxygen for several more weeks. I remember months later hearing his mother say that she had never really bonded to him. That failure to feel a strong attachment to one’s child is a very foreign, difficult experience for me to relate to, although I know it happens.
Time went on and mommy was now a full time employee while his father pursued his art at home in his art studio, a separate building. There was a monitor installed in the nursery but I never liked the fact that here was a baby essentially left alone in a house. It got worse. Somehow his mother found out that sometimes daddy was too busy to stop and feed the baby solid food. Instead, he’d run inside to prop up a bottle. I don’t think I ever saw either one of them cuddling him in their laps for a bottle. Breast feeding had gone by the wayside shortly after his birth. As you can imagine, his weight gain was very slow. His mother liked her job, more than her parenting duties, so she never set things straight at home and covertly complied with this horrific neglect. Despite this nutritional compromise, his development seemed to be coming along on schedule. His motor skills were good, he seemed interested in people and everything going on around him and his grammy was able to engage him and coax him into a smile and then a laugh.
When he began to walk, I really started to worry about his safety. Now he was mainly secluded in his play yard while mommy worked and daddy dabbled in his art projects. Sometimes daddy would bring the play yard into the studio with its toxic vapors. Other times the play yard would be dragged outside and he’d be left with the dogs for company. And as the substance abuse progressed, the household became more and more chaotic. There were arguments late at night and the police were called for domestic “disputes.” Dishes were piled high in the sink and you literally had to step over mounds of clothing, toys and other household items to walk across the floor. The police made a referral to CYFD and I was greatly relieved. His mommy was mandated into outpatient substance abuse treatment but over the ensuing weeks, it was clear she was not serious in her attempts to become sober. Daddy was also doing his fair share of using illicit substances but seemed to be able to wiggle his way around the system.
Finally, mommy left the household, alone, leaving her baby boy behind. A male roommate moved in with daddy. Mommy’s interactions were spotty and irregular. There was no legal jurisdiction as both parents wanted to avoid it. There was a second call to CYFD by a friend because mommy was supposed to have supervised visitation and daddy was leaving him alone with mommy. Another point of neglect was his hair. Daddy had a long pony tail in keeping with the artist mentality and insisted that my grandson also have long hair. As you can well imagine, this became a nightmare, with his little hands constantly trying to brush stray hairs away from his eyes in order to see. Sticky, dirty fingers were getting sections of hair matted. It was more than I could deal with because I thought it was such a selfish act by his father and passive mother. At the risk of infuriating the parents, I plotted to get him a haircut. After all, I was the first person to take him to get his first haircut so why shouldn’t I be the second. I have included that adorable photo right after his first haircut! My goal was to make him more comfortable. The parents were going out of town and the plan was for his other grandmother to care for him for several days, then hand him off to me for several days. I had it all carefully planned but grandpa accidentally spilled the beans and all bets were off. The parents had a total meltdown from afar and refused to allow me to take him. That was almost a year ago and I have not had the opportunity to care for Blaine since. My poor grandbaby is now sporting a man bun, but it’s always a mess and the strays still prevent him from being comfortable.
So my New Year’s resolution is to teach my grandson how to hug, kiss and love himself and others. Unfortunately, I will need the power of the court to do so and his grandpa and I are planning to file a motion to begin grandparent visitation privileges. As I know so well, grandparents have privileges, not rights. No time in my life have I felt so powerless to help someone I love than I have in his short life time, but I am determined to change that and show that precious little boy that even though mommy is gone and daddy is limited, there are those who will put him first.
Posted By Alliance for Natural Health,
Friday, December 16, 2016
Updated: Wednesday, March 29, 2017
Here we go again. Any moment now, the FDA is likely to complete outrageous, unnecessary, and dangerous anti-supplement policies that will impose burdensome requirements designed to do one thing: make it harder for Americans to access lifesaving healthcare products. Based on our own commissioned study, these policies would likely eliminate tens of thousands of supplements from the market .
Don’t let the FDA pull supplements from the shelves.
An anonymous donor has recognized the importance of this threat to natural health and has generously offered to match every dollar we can raise before the end of the year. We have fought the FDA for over 20 years, but the threats continue to escalate —now is the time to give to ANH and double your impact as a member.
Please make your 100% tax-deductible gift before December 31!
Our members mean the world to us. Without your support over the years, very little would have stood between the FDA’s blatant power grab for control of your supplements. Thank you, profoundly, for standing up to defend our right to natural health!
Posted By Carol L. Hunter PhD, PMHCNS, CNP,
Monday, November 28, 2016
By Kalyn’s Kitchen
In addition to creating my own culinary delights, I like to peruse recipes. I found this one from Kalyn’s Kitchen that I thought to be the perfect antidote to the heaviness of holiday mealtime. This lovely and colorful recipe can be a standalone entrée or a side dish. Just follow the link and you will find the step by step recipe along with appetizing pictures. Bon Appetit!
Warm wishes for a joyous holiday season! See you in 2017.
Posted By Carol L. Hunter PhD, PMHCNS, CNP,
Monday, November 28, 2016
I never thought, or at least hoped, that I would ever spend a holiday alone. After all, I had a big family and having 16 at Christmas or Thanksgiving dinner was not that unusual. I loved all of it: the chaos and the noise; the food and table preparations; the distractions and the realization that I needed to stop socializing and start focusing on dinner; the varying ages around the table; the dogs and cats meandering around; the laughter and the familiar silliness I had with my daughters. I clearly remember one moment in time when all of this was going on and I stood still in the kitchen and thought to myself, “it won’t always be this way; I need to enjoy every minute of this.”
Years went by and life shifted both imperceptibly and radically, but shift it did. I was no longer married and had been traded in for a younger woman. I survived that shock and went on to forge a life for myself alone. Children moved away to distant parts of the globe. I moved several times for my career. I could feel the layers of my happiness peeling off, one by one. And then it happened. My one daughter that lived nearby was invited to her in laws in Philadelphia for the Christmas holidays. My granddaughter was only 4 months old and this would be the first of many flights for her in the coming years.
The first blush of realization was quickly swept from my conscious mind. “Of course you should go,” I declared, “I’ll be fine.” The reality started to sink in and I began to wonder, “what will I do alone?” I was feeling afraid, knowing that I would be entering uncharted waters. After a lot of thought, I came to the conclusion that I shouldn’t change a thing. I still put up the Christmas tree and planned on cooking my usual feast, albeit, quite reduced in size. My daughter and her family left a few days before Christmas so I had a few days to soak in my aloneness. I took the dogs out on the trail, practiced my violin, visited some friends and for the first time in a long time, took a nap. I built fires, watched movies, read books and magazines that I hadn’t had a chance to read and took a few bubble baths in candle light. While a part of me missed the commotion, a new part of me welcomed this opportunity to indulge in some soothing activities. I had the thought, “I’m going to get through this OK!”
On Christmas day, I talked to all four of my daughters and then sat down alone, with candles lit, and ate my delightful, but small dinner. As the lights from the tree mesmerized me, memories flashed by in my mind and eventually, I came back to that moment long ago, when I realized that moments of happiness can be fleeting. I could see myself standing in the kitchen amidst the revelry, understanding that full appreciation was in order. But instead of crying, I smiled and before I knew it, my beautiful baby granddaughter was back in my arms
Would I do anything differently today if I had that challenge again? There’d probably be a few motorcycle rides to places I have wanted to visit, like the wolf sanctuary and the hot springs. Maybe I’d get a massage with warmed coconut oil, have breakfast with old friends at our usual hangout and start a new painting. What I’ve realized is that what I do doesn’t matter as long as I nourish my soul and avoid the temptation of giving in to self pity. Being alone during the holidays has been stigmatized; it’s as if something surely must be wrong with you if you are alone. Don’t fall into that mind trap because it is myth, not reality. All of us at some point in our lives may find ourselves alone and we must adapt and even prosper from the experience in order to function at our mental and emotional best. We can also serve as an inspiration to others, as I hope I am doing in this holiday blog.
Posted By M. Nathaniel Mead, MSc - ACAM Guest Columnist,
Monday, November 28, 2016
Over the past few decades, we’ve seen a revolution in our thinking about cancer, how to overcome it, and, when the disease persists, how to control it over the long term. This revolution stems from the recognition that cancer can’t develop and progress without an adequate blood supply to deliver nutrients and metabolites to the tumor. This means that an expanding vascular network is needed to keep pace with the growing mass of cells.
The overall process, known as neovascularization, refers to various aspects of blood vessel growth. The best studied of these aspects is the generation of new blood vessels from pre-existing vessels, a multifaceted process known as angiogenesis.
As one of the so-called hallmarks of cancer, angiogenesis offers a promising angle on slowing tumor progression and preventing relapses after surgery and other treatments. In some cases, blocking this process could also enhance the effectiveness of mainstream chemotherapy and radiotherapy.
To understand why angiogenesis has garnered so much research attention, it’s helpful to consider cancer at its incipient phases of growth. Every cancer starts out as a microscopic nest of abnormal cells that’s devoid of any blood supply. This cluster grows to about one or two cubic millimeters in size, roughly the size of the tip of a ballpoint pen. At this point, oxygen and nutrient diffusion become limited, and the abnormal cells may either die or simply remain in a dormant state.
In order for the tumor’s diameter to increase further, neovascularization is required. This occurs with the help of growth factors (angiogenic signals) that may be produced in response to inflammation, such as from surgery or an infection. Also, the more oxygen-deprived a cluster of cancer cells is at the center of the mass, the more growth factors are produced in that area to stimulate capillary growth.
The sudden surge in vascular growth that takes place in response to angiogenic signals is referred to as the angiogenic switch, the point at which new blood vessels begin to form in and around the microscopic cluster of cells. The expanding network of capillaries enables the mass of mutated cells to grow into a detectable cancer. And only after the vascular network forms can the tumor’s growth rate begin to increase exponentially. Like a racecar that has been idling and then accelerates onto a super highway, angiogenesis enables tumor growth to literally take off.
Angiogenesis has been implicated not only in tumor growth, but also the deadly process of metastasis. Why would this be the case? Keep in mind that blood vessels not only provide the tumor with nutrients, but also give the cancer access to the entire bloodstream. This is an open invitation for the spreading of cancer, or metastasis, to take place. For these reasons, anything that interferes with angiogenesis could be a tremendous boon to cancer therapy.
Ever since Judah Folkman’s pioneering research on tumor angiogenesis in the early 1970s, anti-angiogenic therapy has been regarded as a promising cancer treatment, perhaps best used in tandem with surgery, radiation and chemotherapy. And yet, today’s clinically approved anti-angiogenic drugs are only effective for a minority of cancer patients and malignancies.
This fact has dampened much of the early optimism for using anti-angiogenesis as an effective cancer therapy. More recently, however, hopes for targeting tumor angiogenesis have been renewed with the realization that plant-derived substances and other natural medicines could offer a more comprehensive approach to the problem.
Overcoming the Challenges of Targeting Tumor Angiogenesis To understand how a natural medicine approach could prove effective, it’s helpful to look more closely at the reasons the drug-based approach has fallen short. The most serious limitation concerns the fact that tumor cells can mutate sufficiently to circumvent the effects of anti-angiogenic drugs. Thus, while many people show a good initial response, they later develop resistance to the drugs.
The resistance issue first reared its head with Avastin (generic name: bevacizumab), one of the most widely used of anti-angiogenesis drugs. Avastin specifically targets VEGF (vascular endothelial growth factor), which is thought to be of paramount importance for the control of tumor angiogenesis. Nevertheless, many tumors inevitably develop resistance to Avastin, resulting in a decline in the agent’s effectiveness over time. Multiple molecular pathways are known to support angiogenesis, and targeting multiple pathways at once may be needed to overcome the problem of treatment resistance.
Another major drawback is that some of these drugs are quite toxic. For example, common side effects of Avastin include generalized weakness, nausea, vomiting, poor appetite, constipation, pain (mostly abdominal pain), upper respiratory infection, and low white blood cell count, which can increase the risk of infection. Less commonly, patients taking Avastin may develop a perforation in the stomach or intestine. Cuts or surgical wounds can be slow to heal or may not fully heal, which is why surgery must be postponed for a few days whenever taking Avastin.
Given these drawbacks and limitations, integrative medicine practitioners have been exploring the use of natural, non-toxic agents that can be taken as supplements on a daily basis. It is hoped that this approach will be able to overcome the limitations of mainstream therapy. As we saw with the Avastin example, however, finding the most critical molecular targets could prove quite challenging as each tumor and its microenvironment consists of many different cell types, some of which are the host’s own immune cells. Moreover, tumors are genetically unstable populations of cells, and this instability results in a steady increase in the number of different angiogenic factors produced as the cancer evolves to an advanced stage.
For these reasons, the optimal anti-angiogenic supplement strategy should include a mixture of non-toxic natural compounds that, in turn, impact multiple mechanisms, including those involved in angiogenesis and much more. Below are three key principles for using natural medicines or supplements supplements (herbal, nutritional, nutraceutical) to block or control angiogenesis:
The supplements should be non-toxic or have a wide margin of safety, enabling daily use in order to have a more frequent or constant protective impact, thus targeting the more sustained angiogenesis that drives cancer’s growth and spread.
To reduce the chances of resistance, the supplements should be capable of modulating as many angiogenic pathways as possible, including, for example, endothelial cell migration, hypoxia, lymphangiogenesis, and tumor-promoting fibroblasts and inflammation.
The supplements should be able to impact multiple cancer-promoting pathways other than the angiogenic pathways, such as cyclooxygenase-2 (COX-2), epidermal growth factor receptor, the nuclear factor kappa-B transcription factor, the protein kinases, and other pathways.
With these principles in mind, we can now identify biological response modifiers in the natural world that may play a valuable role in cancer control and prevention, as well as possibly serving as adjuncts to mainstream treatment. It turns out that a large group of natural compounds, also referred to as either nutraceuticals or pharmaconutrients, exhibits antiangiogenic effects as well as other types of anticancer activities. The remainder of this article provides a concise overview of ten of the most promising of these natural products.
Natural Products for Blocking Angiogenesis Most of the published clinical trials of anti-angiogenic cancer therapy have reported improved response rates and progression-free survival (lowering recurrence rates), but no increase in overall survival compared to standard chemotherapy alone. But what if the anti-angiogenic therapy was non-toxic and could be received on an ongoing basis? And what if multiple anti-angiogenic agents could be used concurrently and implemented in much earlier stages of the cancer, rather than waiting until the disease had become more advanced and aggressive?
Specific nutritional and botanical supplements are thought to play a role in the prevention and control of cancer by modulating angiogenesis. These natural products include the following: curcumin, resveratrol, green tea catechins, silybin, reishi mushroom, omega-3 fatty acids, scutellaria, ashwagandha, diindolylmethane, and convolvulus. A number of these substances are capable of inhibiting tumor angiogenesis by blocking VEGF and many other pathways at the same time. What follows is a brief survey of some of these effects.
1) Curcumin. The East Indian spice turmeric is a rich source of the polyphenol curcumin. This supplement has dozens of well-documented anti-cancer effects, mainly attributed to its impact on the immune response, antioxidant response, programmed cell death (apoptosis), cell cycle regulation and tumor progression. Curcumin inhibits angiogenesis in a huge variety of cancer cells, through the modulation of many cell-signalling pathways. For example, curcumin was shown to suppress VEGF secretion from tumors while also significantly improving the survival of mice with VEGF-expressing tumors, as reported in the 14 August 2014 issue of Oncotarget. Although this supplement has extremely poor bioavailability, this problem is readily solved by using either a phytosome or liposome form of curcumin. Alternatively, combining curcumin with biopiperine (from black pepper) boosts the supplement’s bioavailability by some 2000 percent.
2) Resveratrol. Found in grapes, berries, chocolate, and some nuts, resveratrol is a polyphenol known mainly for its antioxidant and anti-inflammatory properties, as well as its ability to promote cardiovascular health. Resveratrol has been shown to decrease glucose consumption in cancer cell lines while also inhibiting VEGF expression, as reported in the October 2013 issue of Human & Experimental Toxicology. Thus, part of the agent’s anti-cancer impact entails a coupling of anti-angiogenesis with a calorie-restricting pathway. In principle, the latter effect could be further exploited by following a low-calorie diet. The anti-angiogenic effects have been studied mostly in brain and mammary (breast) tumors. Because of resveratrol’s low bioavailability, it is best to use the supplement in either phytosome or liposome form.
3) Green tea catechins. Green tea consumption has been linked with lower rates of cancer and heart disease. A specific group of green tea polyphenols called catechins are though to account for most of the tea’s anti-cancer impact. The main compound of interest is EGCG, a major green tea catechin that blocks VEGF and other aspects of tumor angiogenesis. Research suggests that green tea extract may help prevent tumor recurrences, possibly due to inhibition of matrix metalloproteinases (MMP-2 and MMP-9) and epidermal growth factor receptor (EGFR)-related pathways. A study conducted at the University of Texas Health Science Center at Tyler (TX) indicates that EGCG inhibits pancreatic tumor growth, invasion, metastasis and angiogenesis, as reported in the January 2008 issue of Frontiers in Bioscience.
4) Silybin. Silybin, also known as Silibinin, is the primary active component of silymarin, a standardized extract of milk thistle seeds. In animal studies, silybin’s tumor-killing effects have been shown to be mediated through inhibition of both tumor cell proliferation and angiogenesis, as reported in the January 2013 issue of Nutrition and Cancer. Classified as a flavonolignan, silybin is also known to target various elements of the tumor microenvironment, thus rendering it more effective for preventing, retarding, or reversing the cancer process. When taken as a phytosome, Silybin shows a nearly five-fold increase in absorption compared to standard milk thistle extracts.
5) Scutellaria. Scutellaria baicalensis, commonly known as Chinese skullcap (and sometimes called wogonin), is a frequent component of Traditional Chinese Medicine protocols for cancer therapy. This herb has been shown to inhibit both angiogenesis and lymphangiogenesis, the formation of lymphatic vessels from pre-existing lymphatic vessels, an angiogenic process that also fuels tumor growth. The anti-tumor and anti-metastatic actions of scutellaria may be linked with inhibition of VEGF-induced lymphangiogenesis, as reported in the April 2012 issue of PloS One. Some research suggests that scutellaria may have efficacy against advanced-stage prostate cancer. Scutellaria contains the anti-inflammatory compounds baicalin and baicalein, which together may account for most of its anti-cancer impact.
6) Reishi. Reishi mushroom (scientific name: Ganoderma lucidum) has long been regarded as among the most valuable medicines in Traditional Chinese Medicine. Inhibition of angiogenesis is among the anti-tumor mechanisms of reishi, and laboratory studies have demonstrated effects against tumor growth, invasion, and metastasis. When used in tandem with conventional treatments, improvements in immunity and quality of life have been noted in advanced-stage cancer patients. The beta-glucan compounds in reishi mushroom are known to activate dendritic cells (DCs), which in turn induce the activation of T cells against cancer. Most of the anti-angiogenic and anti-tumor effects are attributed to the triterpenoid compounds in reishi, as reported in the August 2013 issue of Expert Opinion in Investigational Drugs.
7) Omega-3s. Omega-3 fatty acids are highly unsaturated fatty acids found in coldwater fish, algae, flaxseed and various nuts. The U.S. food supply is largely deficient in these essential fatty acids, and yet there is ample evidence that these nutrients are critical to the control of inflammation and a host of cancer-related processes. Much research has shown that omega-3s can inhibit the production of VEGF, platelet-derived growth factor (PDGF), and other key angiogenic mediators, as reported in the August 2009 European Journal of Cancer. The highest quality omega-3 products are processed under oxygen-free conditions and use molecular distillation to remove all impurities.
8) Diindolylmethane. Diindolylmethane, or DIM, is a metabolite of indole–3–carbinol (I3C), and both compounds exist naturally in cruciferous vegetables like kale and broccoli. Upon contact with gastric acid in the stomach, I3C is converted to a number of active compounds, mainly DIM. DIM has been shown to stimulate a number of anti-cancer processes and to increase the urinary excretion of toxic estrogen metabolites. In laboratory studies, DIM was shown to block tumor angiogenesis in animal models for both breast and prostate cancers. At least part of DIM’s anti-angiogenic effect may entail inhibition of the VEGF receptor, as reported in the 5 May 2015 issue of Chemico-Biological Interactions.
9) Ashwagandha. Ashwagandha (Withania somnifera) is a well-known adaptogenic herb that helps counteract the effects of stress and supports cardiovascular, immune, cognitive and joint comfort and functioning. Research has shown that ashwagandha inhibits inflammatory processes that support the growth and spread of malignant tumors. A large number of withanolides have been isolated from the roots and leaves of this herb. Amongst these compounds, Withaferin A, a potent VEGF inhibitor and one of the most bioactive constituents of Ashwagandha, has been shown to inhibit tumor cell growth, metastasis and angiogenesis. In one animal study, withaferin A exerted strong anti-angiogenic activity at doses that were 500-fold lower than those previously reported to block tumor growth, as reported in the February 2004 issue of Angiogenesis. Ashwagandha is widely used as a dietary supplement for reducing stress and bolstering resilience.
10) Convolvulus. Convolvulus arvensis (CA) is a species of bindweed in the morning glory family and is native to Europe and Asia. Chemical analyses of the extracts from this plant have shown a mixture of polysaccharides and proteins, including proteoglycans that have been shown to inhibit tumor growth and angiogenesis. In a mouse study of fibrosarcoma, high doses of CA inhibited tumor growth by 70%, and the tumor growth inhibition occurred at non-toxic doses. In other studies, significant anti-angiogenic activities were observed with CA, as reported in the December 2014 Journal of Complementary and Integrative Medicine.
CA is the sole active ingredient in a supplement known as C-Statin. In a small pilot clinical study, C-Statin was combined with another product called Imm-Kine, which contains a beta-1,3-glucan derived from baker’s yeast (Saccharomyces cerevisiae) and a bacterial cell wall extract from Lactobacillus fermentum. The combined effect of C-Statin and Imm-Kine on blood plasma VEGF concentrations was examined in 10 people with advanced-stage metastatic cancer. The study found a statistically significant reduction in VEGF concentrations over time among these patients.
Although this study was too small to provide meaningful data for an impact on survival, it is among the very few clinical studies to have examined the effects of natural products on tumor angiogenesis. Moreover, several well-documented case reports have indicated that the C-Statin/Imm-Kine combo may have had a favorable impact on survival in Stage IV cancers of the breast, ovaries, colon, and pancreas. Of course, well-designed clinical trials will be needed to put such observations to the test.
Supplementing the Anti-Cancer Lifestyle The anti-angiogenic supplements described in this article have been shown to help prevent tumor growth and spread. Evidence for their anti-angiogenic activities stems mainly from animal and cell culture studies. Nevertheless, these natural products are already in widespread use among humans because they display a wide margin of safety, are readily available as dietary supplements, and tend to be inexpensive when compared to pharmaceuticals.
Dr. Keith Block, medical director of the Block Center for Integrative Cancer Treatment in Skokie, Illinois, has proposed a multi-agent strategy for cancer management and long-term disease control, using an approach he refers to as multifocal angiostatic therapy (MAT). According to Block and his colleague Mark McCarty, the MAT strategy “seeks to impede cancer-induced angiogenesis by addressing multiple targets that regulate the angiogenic capacity of a cancer and/or the angiogenic responsiveness of endothelial cells, using measures that are preferentially, but not exclusively, nutraceutical.”
The MAT supplement regimen includes a number of supplements (including several addressed in this article), along with a low-fat, high-fiber vegan diet, exercise training, and, where feasible, the drug tetrathiomolybdate and a salicylate. Since angiogenesis is a process relatively restricted to the growing tumor, Dr. Block’s team believes the MAT regimen could provide an attractive, non-toxic approach to the prevention and control of malignant disease.
In conclusion, natural products for blocking tumor angiogenesis have the advantage of a wide margin of safety and relatively low cost, enabling daily supplementation and thus the potential for a more sustained impact on cancer prevention and management. Supplement strategies for curbing angiogenesis may ultimately prove to be more effective than pharmaceutical strategies, though controlled studies comparing these two vastly different paradigms for cancer control are unlikely in the near future.
M. Nathaniel Mead, MSc, is a nutritional oncology research consultant for several integrative medicine clinics in the Research Triangle of North Carolina. He can be reached at: firstname.lastname@example.org
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