All posts by Andrew Eberding

Probiotics: Good for More than Our Guts

Most people are aware of the digestive benefits of probiotics, but research now suggests that probiotics may also stimulate the immune system during times of stress, improve our mood, and decrease the amount of time that flu symptoms are experienced. Probiotics are live microorganisms (or ‘good bugs’) that, when administered in adequate amounts, offer health benefits to the host. More and more health care practitioners are beginning to recommend probiotics; they are often touted as a staple supplement due to their ability to balance the microbiome (the population of trillions of bacteria within our bodies).

One of the best ways to positively influence declining immune health that is due to stress is with the use of probiotics. Stress has a significant influence on the amount of ‘good bugs’ there are in our system relative to the number of ‘bad bugs’. In chronically stressed individuals, bad bacteria (like Enterobacteria and E. coli) tend to increase in number, while good bacteria like Bifidobacteria and Lactobacilli decrease. Probiotics can help restore the Bifidobacteria and Lactobacilli populations, thus having a positive effect on the immune cells within the gut and the immune system as a whole.

Another way probiotics positively influence our health is through their impact on our mood. There is now evidence that shows gut health to be inextricably linked to brain health. This is called the gut-brain axis and it encompasses bidirectional communication between the gut microbiome and the brain. Altered microbiota, for example, has been linked to depression, anxiety, and autism spectrum disorder. The good news is that when probiotics are introduced to the system they are able to modulate the severity of these mood disorders. Probiotics have also been shown to increase brain activity and improve mood even in healthy individuals.

Trials have also been conducted that assess the effectiveness and safety of probiotics when used to prevent and modulate acute upper respiratory tract infections. At this time, the research is very positive – the use of probiotics for respiratory infections shows beneficial results. Probiotics not only reduce the incidence of an acute infection, but also the duration and severity of an acute upper respiratory tract infection.

As more research becomes available, the consensus is that the gut microbiome appears to have an influence on nearly all systems and levels of the human body. Supplementing with probiotics is a one way to replenish, rebuild, and maintain the gut microbiota. Talk to your naturopathic physician about the specific strains and dosing that would work for your needs.

References:

Ahanchian H, Jafari SA. Chapter 42 – Probiotics and Prebiotics for Prevention of Viral Respiratory Tract Infections. 2016.

Manuel PM, et al. Oral probiotics supplementation can stimulate the immune system in a stress process. Journal of Nutrition and Intermediary Metabolism. 8:29-40. 2017.

Quick M. Cochrane Commentary: Probiotics For Prevention of Acute Upper Respiratory Infection. EXPLORE: The Journal of Science and Healing. 11(5):418-420. 2015

Zhou L, Foster JA. Psychobiotics and the gut-brain axis: in the pursuit of happiness. Neuropsychiatric Disease and Treatment. 11:715-723. 2015.

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Prolotherapy for Shoulder Pain

A patient of mine has a blog and posted some content related to treatments that we have been doing together.  I thought that I would post it up here for anyone else who might be interested.

I have been told that the rotator cuff is a very strong subset of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that stabilize and initiate movement of the upper arm at the shoulder. However, after years of competitive volleyball the rotator cuff muscles in my right arm no longer feel strong or stable. Also, there is quite a bit of dull, achy pain that varies in intensity depending on my daily activities.

The pain in my shoulder began gradually and has been getting progressively worse. For years now, I have moderate to severe shoulder pain with overhead motion and while I am sleeping. In other words, my shoulder pain has really been affecting my day-to-day life.

What are the options?

I see a Naturopathic Physician as my primary health care provider.  I decided to ask about the possible solutions for my shoulder pain. Unfortunately, there has been a long-standing debate in the medical community with regard to the optimal treatment for rotator cuff pain and dysfunction. I was given an array of options from acupuncture to physical therapy and from nutrition to lifestyle counselling. However, the modality I was most interested in was an injection therapy called ‘prolotherapy’.

What is prolotherapy and how does it relate to shoulder pain?

This is where things got interesting. Prolotherapy (or ‘prolo’ as the injection is commonly known) is a complementary therapy for chronic musculoskeletal (MSK) conditions including the tendinopathy in my right shoulder. It includes injecting a  dextrose solution (which works as a mild irritant) into tender connective tissue attachments, as well as the surrounding joint spaces. The idea is that chronic MSK pain and dysfunction often result from degeneration of the structures. With prolotherapy, however, this degeneration is addressed at the tissue level. Prolotherapy injections are associated with localized inflammation, which leads to an induction of tissue growth factors helping the body heal more efficiently.

What does the science say?

In several studies, overuse injuries have responded well to prolotherapy; but I was most interested in those relating to shoulder pain. In 2016 prolotherapy was put up against control injections (normal saline) in painful rotator cuff tendinopathies. The idea was to ascertain the therapeutic efficacy of dextrose prolotherapy on pain levels and degenerative changes in rotator cuff tendinopathies. In this randomized double blind control trial, those that suffered from moderate to severe shoulder pain and received the prolotherapy injections (in combination with physical therapy) reported significant long term pain improvement and satisfaction when compared to those that received the saline injections (also in combination with physical therapy). Another study relating to rotator cuff pathologies published in early 2017 painted a similar picture.

An added bonus to this complementary injection therapy is that it is a very safe option, with no adverse events reported in the literature.

At this point, after years of pain, I have a viable treatment plan that will leave me with less pain and more stability in my right shoulder.

To recap, at its core, prolotherapy involves injecting a small amount of dextrose solution into tender ligamentous and tendinous attachments in a peppering fashion. As well, a practitioner will likely choose to inject into adjacent joint spaces. Typically treatment with prolotherapy encompasses at least three injection sessions with the time between injections ranging from two to six weeks.

References:

Bertrand et al. Dextrose Prolotherapy Versus Control Injections in Painful Rotator Cuff Tendinopathy. Archives of Physical Medicine and Rehabilitation. 97(1):17-25. 2016.

Jensen KT et al. Response of knee ligaments to prolotherapy in a rat injury model. American Journal of Sports Medicine. 36(7):1347-1357. 2008.

Seven MM et al. Effectiveness of prolotherapy in the treatment of chronic rotator cuff lesions. Orthopaedics & Traumatology: Surgery & Research. 103(3):427-433. 2017.

I do appreciate when others are commenting about my work and how it can benefit everyone.  If this write up intrigues you, then come by for a free 15 minute consult.

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Your Knees Needing Treatment?

Knees seem to be one of the first joints to go.  Once the knees start to fail, many other health factors worsen because you lose your ability to move. People gain weight, lose stamina and mobility decreases.  Knees, however, are treatable. I help people everyday, seeing improvements and recovery in almost all of my patients. This is even the case when knee replacement surgery has been suggested as the only course of treatment.

Male Runner in the Countryside at Sunrise

There are many different knee conditions, including Osteoarthritis, Chondromalacia Patella syndrome, Collateral ligament injuries, Joint instability, Osgood-Schlatter syndrome and Patellar Tendonosis (Runner’s knee).  All of these conditions have been improved using prolotherapy.  Let us consider Chondromalacia Patella syndrome. There is a small, but strong study showing the beneficial results of treatment with prolotherapy. If you are interested, you can read the details in the medical article.  Let me break down what is in the article.

The authors treated 61 patients (69 knees) in both men and women.  After prolotherapy, 97% of patients had little to no pain with activity; a vast improvement, considering that 33% had severe pain after activity before treatment. Stiffness was also improved. Before treatment, 11 of the knees had extreme stiffness; zero were reported to be so following treatment. In fact, 95% of the knees had little to no stiffness following treatment. The treatment improved range of motion, as well as, walking and exercise ability.  Medication for pain was no longer needed for treatment in 95% of the individuals.

When my patients arrive at my door they have often had cortisone injections to take the pain away. This is not a good idea as the injection in the long term results in a destabilization of the joint and a worse situation down the road when compared to people who never receive these treatments. If you are considering this, please come and discuss prolotherapy as a curative option over the simple pain reduction that cortisone injections offer.

If you are ready to get back in the game then please make an appointment at one of my clinic sites. I offer free introductory consults so you can understand what is involved before you commit to treatment.

 

Hauser RA, Sprague IS. Outcomes of Prolotherapy in Chondromalacia Patella Patients: Improvements in Pain Level and Function. Clinical Medicine Insights Arthritis and Musculoskeletal Disorders. 2014;7:13-20. doi:10.4137/CMAMD.S13098.

 

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Osteoarthritis, Blood Sugar and Revisiting Vitamins

I have been spending time reviewing individual nutrients recently.  Sometimes relearning feels far more important than the first time I learned; it feels familiar and the importance of the details can really be driven home.  Let me explain myself.

Today, I am reviewing about niacinamide.  This is a well know B vitamin.  Now we all need it, but if you are a person who is dealing with osteoarthritis (OA), metabolic syndrome or diabetes then this is of higher relevance to you.

SUP older man - ABlajanIn medicine, we seem to have a fondness for new evidence; but sometimes we seem to forget what we once knew and this is the case here.  Dr William Kaufman published a book in 1949, (almost 70 years ago) where he painstaking detailed how he relieved OA pain in many of his patients (about 90% of them).  He did not understand at the time how this was working, just that it was working and the world should know about it.

Now in more recent times, we are making a connection between OA and imbalanced blood sugar levels in conditions like diabetes and metabolic syndrome. Up to 80% of people with OA have been shown to have challenges controlling blood sugar. This is where we seem to see the link.

Niacinamide is a factor that supports the energy production in cells.  When the cells have enough niacinamide they function at a higher level.  One cell type that specifically benefits is the stem cells that are precursors to pancreatic eyelet cells where insulin is produced.  Just to close the loop for you, insulin is the signal that reduces blood sugar.

This one nutrient taken at around 3 g through the day after 3-4 weeks can improve or resolve OA pain and help control diabetes as long as you continue to take the vitamin. We knew this all along and nobody told you until now.

 

Kaufman W. The Common Form of Joint Dysfunction: Its Incidence and Treatment.Brattleboro, VT: EL Hildreth and Company, 1949.

Qi Zhuo et al. Metabolic syndrome meets osteoarthritis Nature Reviews Rheumatology 8, 729-737, 2012.

 

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Keeping Yourself Healthy

There are many activities that people recommend. If you are healthy and you would like to stay that way there are a handful of daily activities and nutrients you can make part of your daily routine to ensure on-going high levels of well-being. Go through this list daily and you will be moving toward wellness.https://unsplash.com/@somechrisguy

 

Breathe fully
Breathing with the full volume of your lungs is normal, but most people in western society shallow breathe. The act of breathing deeply has a calming affect by transferring energy away from the sympathetic (fight or flight) nervous system to the parasympathetic nervous system. If you have never learned breathing techniques then you might consider finding someone to coach you through this: a qigong master, a yogi, etc.

Quality Sleep
It is not possible to heal or retain health without deep restful sleep. Sleep disruptions including noise, light, temperature, stress, alcohol, posture (inadequate mattress or pillow support), family relationships (parenting, co-sleeping, primary care giving), medications, poor air quality, pain, food reactions (heartburn, caffeine, etc), shift work, emotional turmoil, and the list goes on. Your pre-bedtime ritual can make a difference too. Looking into a screen (TV, phone, tablet or computer ) prior to turning in gives your primitive brain the idea that you are staring at the sun, and therefore, it is not time to sleep. Your body registers light even if you wear an eye mask. Your bedroom should be free of all light sources, including clocks; if you get up in the night, opt to leave the light off if possible. Just make sure the pathway to the toilet is clear before climbing into bed.

Outdoors
Time spent outdoors helps in several ways. The fresh air invigorates your mind and stimulates your nervous system. Exposure to summer sun promotes Vitamin D production. The bright light, especially in the morning, helps to regulate the circadian rhythm thereby improving sleep.

Promote Digestive Health
We only function well if we are absorbing our food adequately. If you are uncomfortable after eating (bloating, gas, heartburn, cramping) then you are likely not getting the most of the foods that you are eating. If you are not having a well-formed bowel movement 1-3 times daily you are not removing toxins well from your body.

Laugh and Play
These activities improve mood. A strong social network that allows you the opportunity to experience happiness drives away long-standing undesirable moods (depression, anxiety, irritability) from your life.

https://unsplash.com/@aidanjjmeyer

Sufficient Water
Water is really the elixir of life. Unlike the myth it won’t grant you eternal life, but without it you are decidedly reducing your quality of life. Water is the solvent that our bodies run on. You lose it constantly through your breath, sweat and urine production. This corner of BC has high quality tap water and you should not be afraid to drink it. In many cases, it is better than bottled water which may have extra contaminants from the plastic bottle it comes in. If you are a regular consumer of coffee and/or alcohol then you should at minimum increase your water consumption to compensate for the added requirements these habits contribute.

Regular Movement
Your body was made to move constantly. If you are like many of the worker bees in our society, you will find yourself seated for large sections of your day. Look for opportunities to add more movement. This is part of the detoxification process. It pumps the cellular waste from the extremities and prevents them from damaging your tissues. Lack of movement leads to breakdown of muscle tissue. When you lose muscle, your posture suffers and you will develop health issues as a result.

Complete Diet
A healthy diet consists primarily of whole foods (not packaged or processed). If you prepare them yourself in your home then you have the most important part of a healthy diet in order. The rest is about balance of nutrients and moderating excesses.

At the end of each day if you have taken care of these areas of your life you can expect to be moving your health in a positive direction.  These things underlie all others components of healthy living. If you feel you could use help with any or all of these items or other health challenges please arrange an appointment with me and we will work through your challenges together.

 

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Happy? – Avoid S.A.D.

gloomyYou have probably noticed that the days are shortening rapidly. This decrease in daylight can lead to something that you might have heard of called Seasonal Affective Disorder, otherwise known as SAD.  The long dark winters in our great northern country can be associated with particular feelings like fatigue, low moods, increased irritability, decreased sex drive, indifference to life and overeating. Then, almost magically, when spring comes, all of these negative feelings fall away.

This occurs so commonly that it is recognized within the medical field with a well-defined diagnostic set of parameters.  For some, the feelings are so strong that they can be admitted to hospital.  Most people, fortunately, experience it to a much lower extent.  It is best to take a proactive approach and do what you can to minimize these feeling before they become overwhelming.  The time to do that is now.  Here are some things that I recommend to ward off SAD.

Get Some Light

If you know that winter brings an great sense of gloom, you should be strongly considering light therapy.  Not everyone needs this degree of commitment, but for those who do suffer every winter, light therapy can make a world of difference. The following factors are important considerations:

  • Lux Level: try to get 10,000 lux (equivalent of full daylight).
  • Spectrum: Full-spectrum (visible wavelength) light is also crucial
  • Size and proximity: small lamps may have 10,000 lux light but may not work at a comfortable distance.
  • UV Output: UV light is important to generate Vitamin D excessive amounts are damaging in several ways. Balance is the key. Know what you are getting.

Eat a Supportive Diet

Comfort foods (simple carbohydrates, salt and processed fats) are detrimental and are not beneficial any time of year, but are the worst possible choice in the dead of winter.  Instead choose to eat soups and stews with plenty of protein and vegetables. Beans, legumes, nuts, healthy lean protein and hearty fruits should also be regular fare.

Promote the Release of Endorphins

Endorphins are the feel good chemicals that your body produces.  There are many ways to promote production:

  • Vigorous exercise: If you can do something that gets your heart pumping and quickens your breath. Simple walking may help, but if you can push a little harder the results will be much greater.
  • Laugh: Along with laughing comes positivity, so spend time with your joyful friends, watch a comedian or join a laughter therapy group.
  • Strengthen your social network, support others and be supported. Share caring interactions.
  • Experience sexual pleasure: the sensation of having an orgasm is primarily due to endorphins

Plan a Vacationhttps://unsplash.com/@frankiefoto

If you can financially and realistically afford a getaway to a tropical region then strongly consider taking one. This provides two different benefits.  Firstly, this gives you a boost of mid-winter sunlight. Secondly, it gives you something to look forward to in dark days of winter.  I find most people do best taking this trip between mid-January and mid-February.  After the holiday season has past, but spring is not too far away once you return.

If Necessary Supplement

Certain nutrients, especially if they are lacking in your diet, can be useful to include in your regimen.  Consider adding Vitamin D, Vitamin B complex, Polyphenols, Omega 3 oils, L-Theanine and Tryptophan.  There are herbals that can also be supportive like Licorice root, Rhodiola, and Ashwaganda.

Don’t wait until you get down before you do something to support yourself, especially if you have a history of low moods in the winter.   Take care of yourself because you deserve it!

 

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Come Out of the Dark on Vitamin D

Of all the vitamins, the greatest amount of discussion tends to be around Vitamin D. It is hotly debated because the research is unclear; experts strongly disagree with one another on adequate/dangerous levels in the blood and on dosing to achieve those blood levels.

What is Vitamin D?
Vitamin D is different from other vitamins, because it can actually be made by the body. Once it is made, the body then uses it more like a hormone than as a metabolic support molecule (like other vitamins). It also differs because it is not acquired from food, rather it is created by inactive Vitamin D being exposed to effective sunlight. The reaction takes place on the skin and the activated Vitamin D is then reabsorbed and circulated throughout the body.
Vitamin D is commonly known to support bone health as an overt shortage leads to rickets (ineffective mineralization of the bones). But it is needed for healthy cardiovascular function, immune health, brain and nervous system function, cancer prevention, muscle health, etc. Recently there has been evidence showing that Vitamin D is protective against Alzheimers, depression, hypertension, and autoimmune diseases like Crohns, rheumatoid arthritis, type 1 diabetes and multiple sclerosis.
Specifically Vitamin D regulates calcium in the blood bones and digestive tract, as well as insuring proper intercellular communication.

Where Does Vitamin D Come From?
As mentioned above there is very little Vitamin D in food so it must be obtained from the sun or via supplementation. The sun is not so much the source of the Vitamin D as it is a key component in the production of the vitamin. Human skin is capable of creating large amount of Vitamin D when exposed to ultraviolet B radiation (UVB) from the sun. However, it is now considered a healthy practice to protect yourself from all UVB light using sunscreens resulting in large numbers of people being significantly low in Vitamin D. Factors that affect Vitamin D production:
1. Your complexion: A fair-skinned person can get up to 25000IU in a 15 min exposure. You don’t need to tan or burn your skin in order get Vitamin D. Darker skinned individuals take substantially longer to achieve similar levels.
2. Where you live and the time of year: The farther north you live, the smaller your annual window for getting adequate UVB from the sun. In southern BC, you get insufficient UVB from the end of August until April to have any effect on your Vitamin D levels.
3. The amount of bare skin exposed: The more skin exposed the greater the effectiveness of the exposure.
Vitamin D supplements are really your only other choice. This is a major issue for health within our society.https://unsplash.com/@sam

Healthy Dosing Levels
There are many different groups that have different recommendations of daily levels of supplementation.
1. Food and Nutrition Board: Adults 600-800 IU – forms the basis for recommendations of both the Canadian and American governments; however they tend to be significantly behind on updating their numbers
2. Endocrine Society: Adults 1500-2000 IU – recognized society of doctors of endocrinology
3. Vitamin D Council: Adults 5000 IU – an advocacy group dedicated to Vitamin D awareness and health promotion

So who do you rely on? It seems that when the specialist cannot agree you have to come to your own decisions. I tend to feel that 4000 IU for 3 months followed by testing of blood levels is a good compromise given that most people are low. Other doctors test first and treat accordingly but I find everyone tests low on initial baseline testing. Blood levels should be greater than 30 ng/ml, but optimal levels are 70-80 ng/ml.

Other interesting insights:
There was some research comparing the Vitamin D levels of two groups: surfers in Hawaii and hunter gatherers in Africa. All logic should lead to the simple conclusion that the African group would have lower Vitamin D levels due to their darker complexion. It turned out that the Hawaiians had 30 ng/ml and the Africans had 50 ng/ml. Why? One argument was the surfers were protected with sunscreen, but that turned out to be false as they denied ever applying it. There is the possibility genetics were affecting the numbers. But there is a greater possibility Vitamin D was being washed off the surfers before they had the chance to reabsorb it. Eighty year old research actually supports this line of thinking. Given that reality, the effects of modern hygiene may be inadvertently negatively affecting the majority of us. We, as a rule, wash ourselves often; cleaning off both the filth and, apparently, some positive chemicals, like Vitamin D, from our skin.

Given the number of conditions with an association to low Vitamin D, our northern location, and culture of washing. For this vitamin, there is plenty of argument for supplementing or testing.

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Get Ready for the Viruses

As August turns to September, every year, without fail, there is an increase in the number of colds and flus that people endure. With the kids going back to school there seems to be a fresh group for each virus to infect.  Even if you do not have children, the people around you likely do and this, in turn, affects you.

BackpackThere are things that you can do to decrease the likelihood that you will contract one of these viruses. Even if you do contract one, your body will more quickly and readily fight it off.

Stay Hydrated

As summer turns to fall, we are less aware of the need to drink water. Just because you are no longer overheating doesn’t mean you don’t need to drink water. You still require one ounce of water for every two pounds of body weight.  When you are well hydrated your body can produce ample mucus your primary barrier to incoming microbes like viruses.  When your membranes dry out, not only are you less comfortable but you are poorly protected.

Watch your diet

Summertime provides us with many fresh fruits and vegetables.  Continue focusing on eating these and other whole foods to provide you with the best spectrum of nutrients to ward off viruses. Some of the most important foods are:

  • Garlic and onions: These related species have components that are both anti-viral and anti-bacterial.
  • Mushrooms: most edible mushrooms, except the common white button mushrooms (sorry), contribute immune health by increasing white blood cell production and activity.
  • Honey: Raw honey is both a food and a medicine. It contains small amounts of bee pollen which stimulates lymphocytes, the foot soldier of your immune system.
  • Citrus fruits and dark leafy greens: these have high levels of vitamin C, which is a plus for immune function.
  • Brazil Nuts, Oysters and Chia seeds: A strange combination of foods but these some of the best sources of selenium, a mineral that your immune system requires for optimal function
  • Spinach, Pumpkin Seeds and Lamb: These foods are high in zinc, a mineral that supports immune health.

Supplement Your Vitamins

The most potent nutrients to protect against infection are:

  • Vitamin C
  • Vitamin A
  • Vitamin E
  • Vitamin D
  • Selenium
  • Zinc 

Get Daily Exercise

The amount of exercise that you get on a daily basis greatly affects your ability to fight off viruses.  By exercising daily, you will improve your sleep, increase your metabolism and improve overall health. Even if you can’t exercise every day, try to get at least 150 minutes per week. 

Echinacea

By drinking Echinacea tea, you are promoting immune health by warding off and fighting microbes that you become exposed to during the course of the day.  You can take Echinacea throughout the winter months and in large doses (contradictory statements have been proven false). Some people with ragweed allergies should avoid this herb.

Astragalus

This Chinese herb can stimulate white blood cells to both prevent and fight infections. Astragalus works at protecting you over the long term; it takes 6-8 weeks before it reaches its full effect.  It can easily be added to any soup or stew that is simmering over a long period of time.

Probiotics

Mostly people think of probiotics as supporting digestive health but it has a broader scope than the local gastrointestinal effect.  Probiotics eliminate unhealthy bacteria and fungi from the digestive tract. This helps to alleviate the overall number of challenges that your immune system is managing at any given time. This, in turn, frees up a substantial amount of immune cells to protect you in other areas of the body.

Stress and Sleep

Quality sleep and reduced stress are two other very important factors for immune health.  Insomnia increases internal stress and stress depletes the energy in your body.  Reduced energy weakens immune function.

Bathroom SinkHand Washing

The biggest protection you can give yourself though is consistent hand-washing throughout your day.  Anti-bacterial soap is more harmful than it is helpful; these products build resistance in bacteria and truly are unnecessary.  It is best to thoroughly wash your hands for TWO minutes with a gentle soap.

Individualized Care

There are always dangers in generalizing care, for an approach that is best suited to your needs, please contact my clinic and book an appointment.

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