Muscle-Wasting In the Aging Adult

Sarcopenia is the loss of muscle tissue in the aging adult affecting mass, strength, and function.  This tissue loss may have a greater impact in an individual than even bone loss.  It appears after the age of 40 and accelerates after about 75.  It may be expected to be seen in the inactive adult, but it is also seen in life-long physically active people.  So while remaining active is essential to avoiding sarcopenia, there are other contributing factors such as decreased hormone levels, lack of protein, oxidative stress and disease.   Another factor is nutritional; namely creatine deficiency.

The fast-twitch muscle fiber recritied during high-intensity, low-endurance movements such as weight lifting and sprinting are mostly affected by creatine deficiency.  There is plenty of research found to support that creatine in supplemental form can improve some of the physiological changes in aging.

After exercise, free radical production increases, a potentially negative effect if the body can’t manage them.  Creatine may help modulate inflammation due to some anti-inflammatory properties by reducing cell damage caused by exercise.

One of the most profound ways creatine affects individuals is improving the cell’s ability to raising ATP status in the mitochondria thus resulting in improved energy.  In vegetarians and non-vegetarians alike, creatine has been shown to improve brain function in healthy adults.  It may work better when combined with other nutrients such as chromium and alpha lipoic acid.

Usual dosages range from 2-3 grams in the healthy adult and those with muscle loss or brain injury may benefit from 5-10 grams per day.  A good source is often found in whey products.

Yeast Infections-Vaginal Symptoms, Preventative Steps

Vaginal yeast infections are caused by a fungus called candida albicans and affect some women more than others.  You recognize the symptoms of yeast by itching and burning in the vagina and around the vulva which is the skin that surrounds your vagina.  You will note a white vaginal discharge that may look like cottage cheese and experience pain during intercourse.  Sometimes the vulva swells.  While the infection can be very uncomfortable, the symptoms usually aren’t very serious.  Health information regarding  candidia offers practical self-help preventative steps to limit or avoid developing an infection.

Candidia is a natural organism found in the vaginal area. Usually the acidic balance of the vagina keep yeast from over producing, but that balance can be altered by menstruation, pregnancy, diabetes, antibiotics, birth control pills as well as the moist environment.

You will want to talk to your doctor to make sure a yeast infection is the cause of your yeast infection.  A prescription may be required.

Here are some simple suggestions to help you avoid and control yeast infections:

1.  Wear cotton underpants.  Avoid nylon underwear since it retains moisture and  heat which encourages the growth of harmful bacteria.

2.  Don’t share washcoths, towels, or bathing suits with others.

3.  After bowel movements, wipe front to back to avoid anal-vaginal contamination.

4.  Avoid chemicals in your personal hygiene regimen (e.g., harsh soaps, perfumes, commercial douches, tampons, sprays, perfumed toilet paper, etc.).

5.  Avoid sugar, sweets and refined foods in your diet.

6.  Include ample amounts of vitamins A, B, C, and E in your diet.

7.  Get an adequate amount of sleep.

8.  Don’t douche except for curative reasons; avoid commercial douches.

9.  Avoid wet or damp towels.

10.  After bathing, pat genital area dry and keep it dry.

11.  Avoid pants that are tight in the crotch.

12.  If using antibiotics, eats lots of yogurt.

13. Take showers instead of baths.  Soaps can more easily get into the vagina with baths.  Soap or bubble baths are “basic”– the vagina is normally an acidic environment.

14.  Make sure your sexual partner is clean or use a condom.

15.  Make sure you have proper lubrication for intercourse.   Poor lubrication can cause irritation and inflammation, which can lead to the growth of bacteria.

16.  Be aware of and avoid vaginal irritants such as tampons, unclean diaphragms,  aggressive intercourse,  and examining instruments.

17.  Avoid emotional stress.

18.  Avoid leaving tampons in too long, trapping normal discharge. Change  tampons at least twice a day.

19. Wipe from front to back after using the toilet. This may help prevent the bacteria that normally live in your rectum from getting into your vagina.

20. Also avoid using colored or perfumed toilet paper. These items seem to affect the balance of acidity in the vagina and can lead to yeast infections.

Sulfation-Another Liver Function

Sulfate is a major pathway in the body that is essential for many biological processes.  For example, sulfate is needed to start the cascade of digestive enzymes from the pancreas.  Without protease, lipase and amylase, food is not digested efficiently. Biochemical sulfation is a phase II enzyme reaction in the liver effective in rendering manmade (xenobiotic) pharmacological drugs and toxic substances less active.  Sometimes the pathway of phase I is imbalanced with phase II and can actually cause these same substances to be more active.  Sulfation is the derivative of the target  amino acid tyrosine.   

Many people will state they are allergic to sulfate when they mean they had a reaction to a sulfa medication, a phamaceutical drug classification for sulfonamides.  Sulfonamides are antibacterial medications that prevent the growth of the bacteria by disrupting the metabolism.   

Sulfate is needed for formation of proteins in joints.  Low levels of sulfate are found in plasma and synovial fluid in patients with rheumatoid arthritis. 

Sulfate is essential in forming the mucin proteins which line the gut walls.  These have two main functions–they stop the gut contents from sticking and they block transport of toxins from the gut to the bloodstream.  Low plasma sulfate is found in patients with irritable bowel syndrome.  Irritable bowel syndrome is identified with symptoms that may include constipation, diarrhea, alternating bowel habit, abdominal bloating and pain, and flatulence.  

Sulfate is necessary for formation of brain tissue.  Before birth, the functional units of the brain, neurons, are laid down on a scaffolding network of sulfated carbohydrate chains.  Reduced sulfation can leand to faulty neuronal connections and later dysfunction. 

Sulfate is not easily absorbed across the gut wall.  Recent research has shown that it can be absorbed across the skin.  It is also formed in the body by oxidation of the amino acids cysteine and methionine.  This pathway is often suboptimal and many people benefit from sulfate supplementation.   

A comprehensive detoxification test that demonstrates the liver’s health regarding detoxification is available to help identify the efficiency of the process of phase I and phase II detoxification.  The advantages of properly identifying the balance of the detoxification system are you can support it nutritionally and identify areas of concern such as amino acid deficiency, heavy metal burden, and also pesticide toxicity.    One should not indescriminately add tyrosine supplementation into their regimen as it can produce unintended consequences since it is also a target amino acid for the cascade of neurotransmitters called catecholamines.

Today’s Quote:  ” If you ask me anything I don’t know, I’m not going to answer.”  Yogi Berra

Obesity-Inflammation Related; Common Thread with Diseases Part 3

For the past couple of weeks we have published articles on obesity and Michael Glade’s belief that inflammation, as the result of poor diet, environmental factors, and others is the primary cause of obesity.  People who are high is visceral fat have a high risk of developing metabolic syndrome, prediabetes, and diabetes. 

University of California, San Diego School of Medicine researchers “discovered that inflammation provoked by immune cells called macrophages leads to insulin resistance and Type 2 diabetes. Macrophages, found in white blood cells in the bone marrow, are key players in the immune response. When these immune cells get into tissues, such as adipose (fat) or liver tissue, they release cytokines, which are chemical messenger molecules used by immune and nerve cells to communicate. These cytokines cause the neighboring liver, muscle or fat cells to become insulin resistant, which in turn can lead to Type 2 diabetes. The hope is to block or disarm the macrophage inflammatory pathway to interrupt the cascade that leads to insulin resistance and diabetes. A small molecule compound to block JNK1 could prove a potent insulin-sensitizing, anti-diabetic agent. The research also proved that obesity without inflammation does not result in insulin resistance. Olefsky, researcher, explained that when an animal or a human being becomes obese, they develop steatosis, or increased fat in the liver. The steatosis leads to liver inflammation and hepatic insulin resistance.” ScienceDaily (Nov. 7, 2007)”  See this article in it’s entirety at http://www.sciencedaily.com/releases/2007/11/071106133106.htm

Of interest, the National Center for Complementary & Alternative Medicine (NCCAM)  has the following clinical trial posted on its website.  I was disappointed to see the study fell short of criteria which might further substantiate Dr. Glade’s position or lead to a broader study.  Six weeks is hardly enough time for a fair assessment of any meaningful conclusion regarding long term effects of inflammation.  I also found it interesting that fish oils were not included nor excluded since they are recognized to influence inflammation and immune system markers. The low number of participants does not represent the population adequately, either. Hopefully, this is just an initial step in a broader study that will change the way we approach the subject of inflammation and metabolic syndrome and diabetes II. 

 Recruiting -verified and sponsored  by (NCCAM), May 2008
ClinicalTrials.gov Identifier: NCT00334919 due to be completed in November 2008. ClinicalTrials.gov processed this record on December 19, 2008
RCT of the Naturopathic Anti-Inflammatory Diet
Conditions: Diabetes Mellitus, Type 2;   Prediabetes
Intervention: Behavioral: Diet (Anti-Inflammatory or standard diabetic diet)
Funded By:  NIH
Start Date:  May 2006  Current Status – Phase II
The purpose of the study is to determine which diet is better, the naturopathic Anti-inflammatory Diet or the standard diet based on current ADA (American Diabetes Association) guidelines?
 The primary outcome measures of cytokines for 13 weeks, and secondary outcome measures:
            *Glucose: 113 weeks
            *Weight:13 weeks
            *Lipids: 13 weeks

Estimated Enrollment was 36 .  Details include being on the ADA diet for 5 weeks, then randomized to either ADA or AI for 6 weeks.  Other restrictions apply related to the diet as well as looking at blood markers that show how the immune system responds to the different diets. The expectation is the AI will result in less inflammation and a better response by the immune system than the ADA diet as well as looking at the effects of lipids and glucose. Levels of blood lipids and glucose will be considered to evaluate any effects.  Of course, appropriate inclusion criteria related to diabetes is listed and the following exclusion criteria.

 *Current major debilitating mental or physical illness that would interfere  with participation (as determined by the participant’s medical history)
*Taking diabetic medication other than sulfonylurea
*Taking Gymnema silvestra (a naturopathic diabetes treatment)
*Taking medications that have anti-inflammatory affects (lipid lowering agents,   NSAIDS, COX 2 inhibitors, aspirin, HRT, oral contraceptives, testosterone, seizure medications)
*Taking weight loss medications
*Severe renal, hepatic, or heart disease
*Triglycerides >500 mg/dL
*Bulimia
*Pregnancy or lactation
*Current excessive use of alcohol
Current/recent chronic use of recreational drugs
Smoker
More than 4 hours/week of aerobic exercise
Have gained or lost more than 15 pounds during previous 6 months
Planning on moving out of the area in the next 4 months
Is a participant in another medical research study
Is following a weight loss diet
Is unwilling to accept random assignment of the experimental diets
Food preferences and/or allergies that will interfere with consumption of experimental medications
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Obesity-Inflammation Related-Common Thread with Diseases-Part 2

 We continue from last week’s Part 1 with Michael Glade and his insights into obesity as it relates to the inflammation process.  A quick overview is two types of fat are present in the body: subcutaneous and visceral. Subcutaneous fat is the type found just underneath the skin, which may cause dimpling and cellulite. Visceral fat, on the other hand, is located in the abdomen and surrounding vital organs. It can infiltrate the liver and other organs, streak through your muscles and even strangle your heart; and turns out you can have it even if you appear to be thin.  It is the latter, visceral, fat that is linked to many other diseases, everything from bad cholesterol and hypertension to diabetes, heart disease and stroke. Dr. Glade believes at the core of the problem is the issue of inflammation.  Please refer to that article as we will continue here where we left off.

Break down of fatty acids in an abnormal fashion causes an inflammatory load which does unhealthy things to body tissue. If you expose cartilage, cancer, arthritic tissue to a specific signal of inflammation called alpha, they will always respond as if they are under attack.  Chronically exposed poor dietary input can cause or predispose a downward spiral in the body upset.  For example, the problem may be a missing array of essential fatty acids.  Over nutrition seems to be a problem and not sufficient oils or anti-inflammatory products.  If the body can stabilize with eating right, exercise, not smoking or drinking, then the body becomes more stable. 

With a wound you would expect a short term inflammation situation which is a good thing.  The brain is just like other tissue.  We need to replace at least at the same pace as old stuff carrying off. The human brain also experiences changes related to inflammatory factors.  The brain wants to heal with growth of new neurons, a normal response of learning that deals with activity where they grow and dispose of old stuff. 

 Conventional approaches to control of body fat includes weight loss and exercise.  MRI can identify the infiltration of visceral fat around and in specific tissue, but Michael Glade suggests the use of a laboratory test called C Reactive Protein (CRP) to get some inkling that inflammation is present.  There may be a balance between CRP and the oil EPA (Eicosapentaenoic Acid).  Normal  ranges are tested with a group of norms which may be difficult to identify.  What is normal within a group since the control group could represent those in the elevated portion of the population?  We just don’t know. (A test we may use is a genetic test which identifies inflammation from a hereditary factor, particularly when trying to decide if the influence may be environmental rather than hereditary.)

 One of the markers for longevity is control of abdominal fat which is identified as the visceral load.  An inflammation marker is a practical approach of getting the belly fat down.  The dual nature of obesity is that if there is an imbalance in the body, then there is going to be an unintended consequence.  The goal needs to be met to control and modify abdominal fat load. 

A few of the suggestions he gives are as follows:

*Our food supplies have become disconnected from nature.

*Learned failure is when you change lifestyle and then over-exercise. If the patient losses 10 pounds but hurts and is fatigued from over exercising,  they will have an excuse to not stay the course.

*When failure of weight loss occurred due to calorie restriction becoming very aggressive with omega 3 fats using  3-5 tablespoons of flax or fish oil would give good results.  The body wouldn’t change weight but it would reshape.

*Efficiently operating digestive tract is important.

*Activity needs to be increased.  Failures often are because activity isn’t high enough.

*Cause is heightened inflammation- imbalance can be tipped either way and neither may be the most beneficial.

*Anti-inflammatory medications often are mild poisons that push the body back into less inflammation-Dr. Glade questions if this is a good thing.

*Structural fats do very important replacement of fatty acid membranes.

* Use omega oils generally for inflammatory condition.  These are not generally stored or used in the body as caloric intake as the fundamental function of fatty acids in many ways is to restore balance.  They don’t suppress or stimulate inflammation.  Balancing inflammation is what they do and are essentially not drug like, they don’t turn off signals.  

*Suggested Ratio EPA:DHA  EPA 3,000 mg of product  4,000 mg DHA to renormalize triglycerides in the system.  This information is recognized by the drug industry.

Other products:

*Diet: avoid process starches and fatty acid meat and increase fruit and veggies.

* Development of brain is dependent upon DHA and is not found in most any place other than fish. 

* Berries, diversifying your response system is appealing.Recommended are 10 servings of fruit and vegetables per day. Salads are encouraged before meals.

* Starchy vegetables are off the menu. 

*Manganese, selenium, and other trace minerals can only come from our soil.  We are at a point of having to resort to food supplements.  Even if the soil is fortified, the soil is exhausted.  Consequently, trace mineral supplements are absolutely essential.

    – Selenium 100 mcg-anti cancer effective-balance with iodine

     – Chromium 1,000 mcg for sugar regulation of the body

*Boron 2 mg- places a role in digestion -good for inflammation in digestive tract and central nervous system

*Carnatine and acetyl-carnatine- heart and skeletal-less free-radical production

*Co-Q10 increases efficiency of fat burning and make systems more efficient-less free radical production resulting in feeling and moving better. 

Calcium-drop dairy because it causes inflammation-calcium supplement, vitamin D- Take optimum dose over 5-6 times per day for absorption.

Dr. Glade notes slim people fidget 2-3 hours more times per day and are always moving.

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Obesity-Inflammation Related; Common Thread with Diseases Part 1

Obesity is thought to be a disease of inflammation, according to Michael Glade, Ph.D. 

I became acquainted with his work through a DVD given to me by NeuroScience.  We have use NeuroScience protocols with great success; a company that focuses on “Target Amino Acids” as a means to address healing of the adrenal gland and balance neurotransmitters for the treatment of many symptoms including anxiety, sleep maintenance and insomnia, depression, and memory loss.

Dr. Glade is a Certified Nutritional Specialist (CNS) with degrees from the Massachusetts Institute of Technology (MIT) and Cornell University and teaching and research experience at Rutgers University, the University of Maryland, Northwestern University and at the Nutrition Institute of the University of Bridgeport. [1] 

Dr. Glade contends that when a patient has obesity for 5 years or more, the cellular mechanism is disrupted and regulation is thrown off through nutritional and other influences.  Cancer, arthritis, allergy, digestive literature look for a common thread which is traditionally separate in peoples minds as separate diseases, but it is looking more and more that they are individual symptoms manifested in an individual similarly condition.  It starts with people who eat improperly and once the  condition of unregulated inflammation develops, then under that umbrella,  one could end up with all the listed above common disease.

Insulin resistance falls under this umbrella where something goes arye in the metabolism of glucose within muscle cells.  People don’t get better, they get worse.  It doesn’t cure or arrest with the use of any existing medications. Control of diabetes II and insulin is not cured or suppressed by any existing treatment medications.  The premise is that people who have insulin resistance will slowly but surely deteriorate.  Dr. Glade believes there is something missing in that model.  We are treating a blood level of insulin but not the disease. He suggests that something, possibly environmental is the missing piece.

Research suggest abdominal fat in the visceral organ (around organs inside) appears to be genetically different from much of the than other fat in the body.  It is the most insulin responsive part of the body. In insulin resistance patients, the insulin is not responsive on the muscle whereas the belly fat stores is over reactive and sucks the insulin up.  The degree of hypersensitive reflects as the more inflamed they become.  The more inflamed they are the more tendencies they have to over-store abdominal fat.

Insulin control in the pancreas is disturbed when the body is carrying a high amount of an inflammatory formed, abnormal cytokine molecules produced by the body so one part of the body can communicate with another part. Overreactions throughout the body because of  lifestyle, environment, diet, result in tissue not normally responsive, but will then activate due to an overexposure of inflammation.  This will force the organ to over-respond.  This condition is not well monitored or regulated in the body.  The blood has an almost unlimited capacity to carry these inflammatory molecules in the body.  This response is what needs to be brought under control and can only be accomplished by improved lifestyle, environmental factors, detoxification, and a healthy diet.

Part 2 will address what can be done about this dynamic problem.

[1]Dr. Michael Glade emphasizes  specific dietary plans and supplement protocols, especially in programs targeted at brain function, weight reduction, smoking cessation, and life extension for the terminally ill.  Dr. Glade lectures extensively across the US and Europe. Dr. Glade is a noted researcher who is deeply appreciated in the nutritional and scientific communities for providing a significant body of peer-reviewed substantiation for multiple health claims that have been approved by the FDA.

Insurance – “Medical Necessity” Requirement Part 2

Services:  What does the requirement of  meeting “Medical Necessity” mean? 

What it does not mean is what your doctor thinks is beneficial or necessary.  No, the insurance company decides if recommendations meet community standards which are encompassed in the field of traditional medicine or medical literature reviewed by peers only.

If you see the doctor for a condition or illness that does not include a primary diagnoses, the service cannot be billed at a level that meets coding requirements and will be denied.

Conditions such as yeast infections, depression, anxiety, psychiatric codes, heavy metal burden, multiple chemical sensitivity, erectile dysfunction and many others are not primary diagnoses codes.  Irritable Bowel Syndrome is a primary code (criteria must be met for this as with diarrhea and constipation.)  Gas and bloat are not primary.

Some patients arrive at the doctors office with a short list, wanting only a specific condition addressed.  When this happens, it may automatically set the course for denial by the insurance company.  The insurance company wants to see primary diagnoses codes which are define by a coding standard.  Requirement for correct billing is an appropriate ICD-9 code or billing code and a primary CPT code.  

Uncovered codes are patient responsibility if waiver is signed.  Before you leave the clinic with a laboratory test, we will provide you with the cost of the test and the extent of what we believe your insurance will pay.  That amount will be collected at the time of service.   We cannot guarantee your benefit amount because your insurance will not guarantee the information received when we call and verify benefits.  They state and our business agreement states that you solely are responsible for bill regardless of your insurance coverage.

Sample Profiles (list not complete for covered and uncovered tests):

Pesticide Panels:   You must provide a payment for the total billed to the laboratory.  We can then bill your insurance company, later refunding you if coverage is accomplished. 

Amino Acid Assays, Nutritional Based Assays-most insurance companies do not pay these items, however, through an agreement with the laboratory, we can accomplish quality assays for amino acid serum, RBC mineral, organic acid and fatty acid profile for a very low cost.

Genetic Testing-.While this is not a covered expense at this time, there is talk that it may be in the future.  You should consider, if that benefit becomes available, the consequences your genetics may have on life insurance, for example.  

Comprehensive Detoxification Panel:  Portions of this tests are not covered by insurance, therefore, unbilled portions are paid to the patient.  We notify you what we believe your responsibility will be.

DMPS Chelation Therapy and Metals Challenge Test-Does not meet medical necessity and is therefore paid by the patient.  See next segment.

EDTA Chelation Therapy and Metals Challenge Test-We use this therapy for reducing specific heavy metal burden.  Because the conditions we treat are due to chronic exposure, only on rare occasions does insurance ever pay.  Payment is always due date of service.  Toxicity is defined by blood test only and is rarely seen in patients with acquired body burden.   The appropriate test in this case usually will not qualify you to meet medical necessity.  Payment in full is required by the patient.

Environmental Pollutants-We will not bill for this service as most of it is not covered by insurance, therefore, paid in full by the patient.

Food & Inhalant Testing-covered if qualified.  Qualifying a patient includes ages under four, autoimmune disease and chronic skin conditions such as eczema or psoriasis where the doctor believes skin testing may worsen the condition, chronic use of antihistamines without benefit and steroid use.

Hair Analysis-We will not bill for this service as  it is not covered by insurance, therefore, paid in full by the patient.

Vitamin Mineral IV’s-generally not covered and PPO insurances requires that you provide documentation after the service is performed to see if it meets medical necessity.  Therefore, we require payment upfront with a waiver.  In almost every case, insurance does not cover. 

Nutritional Consults by Certified Nutritionist-typically uncovered. 

Other tests such as the ION and TRIAD panel by Metametrix is payable in advance.  We will then bill your insurance company and refund any portions paid.  

Stool Testing:  Payable if criteria is met.

Center for Environmental Medicine

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