Vitamin D Now Found Useful in Certain Lymphomas

The standard message for patients with vitamin D deficiency is that everyone can take vitamin D unless they have a granulomatous condition (for example tuberculosis or sarcoidosis), or a lymphoma.

The exact details on the why and why not this vitamin D optimization of patients with these diseases is not discussed in detail in the medical literature.

Now a new study has come out that shows that vitamin D actually appears to HELP patients with two specific types of lymphoma.

In a significant paper published in the Journal of Clinical Oncology that was just published online, Matthew Drake, MD and his colleagues from the Mayo Clinic and 2 other schools  tested the theory that vitamin D levels might be predictive of "event free survival" (EFS), and "overall survival" (OS) in non-Hodgkin's lymphomas (NHL). An "event" would be getting so sick the patient would need intervention most likely in a hospital. Otherwise, these terms are self-explanatory.
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Vitamin D Related to Pre-Eclampsia

A new study shows a possible link between vitamin D deficiency and a pregnancy condition called preeclampsia.

Preeclampsia is a condition which usually occurs at the end of pregnancy that is characterized by high blood pressure as well as protein in urine. Without treatment it can become very serious and can affect the delivery of the baby.

Early onset preeclampsia is not very common. It occurs in only about 2 or 3% of pregnancies. Nevertheless it is responsible for about 15% of premature births yearly. The definition of "early onset" is when it occurs before the 34th week of pregnancy.
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Vitamin A, Children, and Lung Function

All of my pregnant patients take a prenatal vitamin based on what would be best for the developing fetus. I have even found a prenatal vitamin that I like so much that I put my own private  label on it.

Now a new study published in the New England Journal of Medicine has  been published showing the importance of vitamin A and its relationship to lung development in the womb.

In this study, that was led by Wiliam Checkley, M.D., over 1600 children in Nepal were evaluated. Some of the mothers were given vitamin A pills during pregnancy and others were given placebo. An additional set of women was given beta-carotene which is a derivative of vitamin A.
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Yet Another Essential Nutrient for Pregnancy

All pregnant women are given a prenatal vitamin by their obstetrician. The implication is that what is in the prenatal is all the extra vitamins that a pregnant mother needs for herself and her fetus.

Recently after an enormous amount of data in the medical literature many prescription prenatal vitamins have start to add an essential fatty acid capsule that is necessary for brain development of the fetus in the uterus.

Integrative medicine doctors have been prescribing this essential fatty acid known as DHA for over 20 years. The information has been in the medical literature but not that literature that is commonly read by obstetricians. More and more studies have shown that DHA during pregnancy and in the first four years of a child's life are necessary to optimize the child's neurological and brain development.

There are other nutrients that the medical literature shows that are essential for pregnancy, and one that has been overlooked by all of the prescription prenatal vitamins that I have seen, is called CHOLINE.

Choline is an essential nutrient and it is usually considered part of the vitamin B complex. It is found in the fat that makes up cell membranes and in certain neurotransmitters. Choline has been found to be essential for the normal functioning of all cells, liver metabolism and the transportation of nutrients throughout the body. Choline can be produced within the body but the amount the body makes is often not sufficient to meet the individuals needs. Therefore choline must be consumed in the diet. Recent research has shown that only 10% or less of older children, men, women, and pregnant women in America are getting sufficient levels of choline on a daily basis.

High amounts of choline is found in foods such as eggs, chicken liver, beef liver, beef steak, cod, broccoli, peanut butter, and milk. I am happy to see that because choline is especially high in egg yokes, the Egg Industry has created a website that talks about choline.

In a pregnant woman choline works with folic acid to help promote brain and memory development in growing fetuses and newborn infants.
Now a new study has been published that shows in mice that a diet low in choline and vitamin B2, during pregnancy influenced the development of the fetus' heart. Specifically the mice that were born to choline deficient mothers had more heart defects, which were specifically ventricular septal defects. The vitamin B2 deficient mothers gave birth to  late embryos and smaller embryos. In addition, vitamin B2 deficiency resulted in decreased thickness of the offsprings' left ventricle in the heart.

The conclusion of the authors of this article were: "Low dietary choline and riboflavin affect embryonic growth and cardiac development in mice. Adequate choline and riboflavin may also play a role in the prevention of these pregnancy complications in women."

Given the increasing preponderance of evidence that choline is essential during pregnancy I have been using a specific prenatal vitamin that is fortified with choline. I believe that choline is the next nutrient that will be found to be essential for all pregnancies. I can only guess how many years it will be until the prescription prenatal vitamins will contain this nutrient. But I am happy to be using one that does contain this nutrient for all my pregnant patients. I like it so much that I have begun to private label it under my name.

Does your prenatal or your family's prenatal's include choline or are you making and sure enough that you are eating enough of the choline containing foods to get enough for the fetus? Let me know if you think I should make my Prenatal vitamin available on my website for the public?

REFERENCE

Other resources and articles:

Egg Nutrition Center

Choline: Critical Role During Fetal Development and Dietary Requirements in Adults

USDA Database for the Choline Content
of Common Foods

 

I Will Be Teaching at UCLA

I have accepted an opportunity to teach medical students at the prestigious David Geffen School of Medicine at UCLA, starting this September.

After more than 30 years of practicing integrative medicine, I realize that it is time to share what I have learned and what I've been doing with young medical students and medical doctors, as well as the general public.

Through my blog I have been sharing my knowledge with the general public. However, I felt it was a necessity in my life to also be able to train young medical doctors.

Starting this September, I will be teaching a course to second-year medical students called "Doctoring". In this course I will be paired with a psychologist and we will be teaching young medical students how to interview patients, and get their history and how to help patients deal with difficult problems, from drug addiction to a cancer diagnosis. This course is not so much about the science of medicine at the art of meeting with the patient, and meeting their needs.

A recent study in  JAMA showed that if a patient comes to their doctor with more than two complaints, that the chance of the second complaint ever being addressed is 8%. This study was shocking to me as an integrative doctor, because I recognize that the body is an inter — connected web of organs and not just a narrow view of one organ system and one complaint. So knowing ALL the patients symptoms is important.

This course at UCLA is a required course and all medical students must take it. It goes on their permanent deans record that they use to get into a residency program.

I will be specifically teaching eight or nine students throughout the year. I expect it to be a very fun course. That is because UCLA uses what are called "standardized patients". When I heard this expression I asked what it meant?  A "standardized patient" is a professional actor who has been taught and trained to act out all parts of any given disease that the doctors are assigned for the day. The "patient"  will know the signs and symptoms of the disease and they will be able to intelligently answer the medical students questions while the psychologist and I look on and teach the students how to interact with them as a patient.

My partner in the course,who is a psychologist, has been doing this for a number of years and she told me that it is not only very valuable but also can be fun.

I look forward to telling you about the "cases" that we see, but  most importantly I  look forward to helping the students to learn that they must listen to the whole patient, with a compassionate ear.

It is wonderful that medical schools are starting to do this.

What has been your experience with interacting with physicians? Have you had to interact with physicians taking care of a loved one? How has your experience been? Let me know what you think?

 

Acupuncture Improves Heart Disease

Most people believe that acupuncture is just for pain control. In fact it is an active medical modality which I use to treat almost all medical problems.  Now a new study shows that acupuncture can help people with heart disease.

The recent study by Kristin AV and others, has recently been published in the medical journal Heart.

In this specific study they looked at congestive heart failure. This is a condition where the heart, due to illness is unable to pump sufficient blood to the rest of the body. It can vary from very mild, to the extreme that a person is unable to walk without oxygen. 4.8 million Americans have this condition. This includes 10% of people over the age of 70.

In this study the authors took 17 patients who were stable with congestive heart failure. All of them were already receiving an optimized medication program for  their heart failure when they entered the study.

The study is all the more impressive because they did use a control group. One group of patients got real acupuncture in the other group received "sham" acupuncture.

After the series of acupuncture treatments, the group that received the real acupuncture significantly increased their ability to walk with less symptoms,. In addition in this group, they found a significant improvement in their "recovery" in regards to their ability to breathe after the exercise.

Furthermore heart rate variability which is a sign of the health of the heart increased after the real acupuncture but actually decreased after the "sham" acupuncture

In addition the "general health" score and "body pain" score improved after the real acupuncture.

In a press statement the research group noted that heart failure is recognized to be much more complex than had previously been assumed. Specifically it involves an imbalance in the autonomic nervous system, as well as in various neurotransmitters.

In a press release the authors were quoted as saying "This is precisely where acupuncture may intervene, by bringing these processes back into balance — it influences the autonomic sympathetic nervous system (excitation), boosts the parasympathetic nervous system (relaxation), and also has an anti-inflammatory affect,"

Furthermore, Dr.Arnt Kristen, one of the authors of the study stated "The blood level of a certain messenger, tumor necrosis factor alpha (TNF alpha) actually drops after the real acupuncture treatment. Since TNF alpha leads to a reduction of muscle mass and muscle strength among other things, this would explain the positive effect (of acupuncture) on skeletal muscle function"

I've been using acupuncture in my practice on a regular basis for the last 30 years. I've seen remarkable results in almost every medical condition with acupuncture over and over again. It is wonderful that these types of studies are now coming out that objectively show the benefits of acupuncture for much more than just pain control. This will encourage conventional doctors to begin to be open to the use of acupuncture in congestive heart failure.

Let me know — do you have loved ones who have congestive heart failure? Have they tried acupuncture as an adjunct to their medications? I look forward to hearing from you.

REFERENCE

 

Economic Burden and Premature Deaths in Canada Due to Vitamin D Deficiency

Studies by Garland and other medical researchers have shown the tremendous economic cost of vitamin D deficiency in America. For example, studies published in 2004 estimated that vitamin D deficiency costs the United States from $40-$56 billion annually. It is estimated that every year there are 60,000 premature deaths from cancer caused by insufficient vitamin D in the United States.

Now, for the first time, a study on the economic burden of vitamin D deficiency in Canada has been published. It is especially important for Canada to pay attention to their population's vitamin D levels because most of the Canadian population lives north of the 43rd parallel. Because of this, making vitamin D from sun UVB radiation is impossible for at least 4 to 5 months of the year. ("Vitamin D Winter")The Canadian diet provides about 200 IU of D from food every day, which is not enough to maintain normal blood levels. Therefore the people of Canada should all be taking supplementary Vitamin D for at least those winter months.

This article was written by William B. Grant and others. The authors carefully searched the medical literature for articles that showed the dose-response relationships for vitamin D and disease outcomes. For example they reviewed one study which I discussed in my book that showed increasing vitamin D levels could reduce the risk for death from cardiovascular disease by 25% or more. They looked at many other diseases including cancer, diabetes, influenza, falls and fractures, multiple sclerosis and even pregnancy outcomes.

They then obtained data from Health Canada, on mortality rates for 2005.

The authors then estimated the benefit in reducing disease based on increasing the average person's vitamin D level from 27 ng/ml to 42 ng/ml.
The results were astounding. It was estimated that the death rate in Canada would fall by 37,000 deaths per year, which represented over 16% of annual deaths and that the economic burden of disease could be reduced by 6.9% which is equal to over $14 billion per year.

Their conclusion was that they recommended that "Canadian health policy leaders consider measures to increase serum vitamin D levels for all Canadians". Of course I would certainly agree with this!

I would ask all of my readers who live in Canada or anyplace that far north to check their vitamin D levels at least once a year. My book has been translated into the Estonia language and I would remind my Estonia readers that the latitude of Estonia is 58 degrees. Even more north than Canada! And all of Scandinavia is north of Estonia ! They need vitamin D even more!

So if you have family or friends in these northern countries, call or email them to remind them to take their D at least during the winter.

Let me know what you think of all this information? Have you notified your friends even in the north of the United States about taking vitamin D?

REFERENCE

 

My Lecture at UCLA

I was one of 5 speakers to a pre-med class of students at UCLA who are taking a course entitled "Introduction to Integrative East-West Medicine". The students came from all over the world to study.
My friend Ka-kit Hui, M.D., F.A.C.P is the Chairman of the Course and invited me to share with the students my perspective on integrative medicine as a primary care doctor in private practice.

The other speakers included my friend Myles Spar MD, MPH who is the director of the Venice Integrative Medicine Clinic, at the Venice Family Clinic. Also Richard Pietras MD, Ph.D. who is the chairman of the Stile Program in Integrative Oncology at UCLA spoke. And Ping Ho, MA,MPH who is the director of the UCLArts and Healing Center spoke.

We each spoke to the students about our work and showed slides of our offices and projects.

After our talks we then all sat on a panel and answered questions from the students about integrative medicine from our perspective.

I had a really good time and enjoyed meeting my colleagues to see what they are doing. I look forward to more teaching opportunities in the near future.

Here is a nice picture of the five of us!

From left to right : Dr Pietras, Dr Hui, Ping Ho, Dr Soram, Dr Spar