Is Surgery Necessary for ACL Tears? The Answer Will Surprise You

I personally had my right knee scoped when I was 18 for a torn medial meniscus.  I now have arthritis on the inside part of my knee, which I keep solidly pain free with soft tissue work and exercise.

Knowing what I know now, I never would’ve had that surgery done.  While this particular article looks at 121 young active adults with ACL tears (a more complex injury than a meniscal tear), it again raises questions about the dogma that exists on the need for surgery for many knee conditions.  Basically, delaying surgery and trying non-surgical management first (which, in this office would include aggressive soft tissue techniques like Graston as well as whole body vibration to stabilize the joint) seems to be the better option.

Here’s the specifics:

• 62 were put in rehab and had early ACL reconstruction, with 59 assigned to rehab plus optional delayed ACL reconstruction
• Of the 59 who initially did not have surgery, 23 (39%) underwent delayed ACL reconstruction.
• Based on the Knee Injury and Osteoarthritis Outcome Score (KOOS, which asks about pain, symptoms, function in sports and recreation, and knee-related quality of life), there was NO difference in any of the treatment approaches.

In other words, just because you have an ACL tear does NOT mean that you have to have surgery.  It makes complete sense to go into rehab after an injury like this with the expectation that you will not need surgery, but keeping an open mind about the topic if you do not respond to the rehab itself.

 

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I’ll Just Exercise it Off…Critical Reason Why This is a BAD Idea

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I hear it all the time.  “I’ll just exercise it off.”  Or, someone will say something like “he’s an athlete, he’ll burn it off.”  All of this over the “comes-with-a-hand-truck” sized drink at Starbucks.

If only it were that simple.  If only all you had to do was exercise more to burn off any excess calories you took in, regardless of the quality of those calories, obesity and diabetes would be a rare thing.  But have you ever looked down on the “calories burned” indicator on the elliptical or treadmill you’re using?  Disappointing, isn’t it?  All that work and you’re lucky if you’ve burnt off enough calories to account for even half of a small Starbucks mocha.

What about those crazy high activity runner?  Let’s say you are a marathon runner in training and you just finished a 1/2 marathon.  That’s approximately 1200 calories burned.  While that sounds like a lot, it’s not even enough to burn off the calories in a Big Mac Value Meal.

So why even bother with exercise?

Because, quite frankly, it’s the right thing to do.  The benefits of exercise cuts across every organ and every disease state.  But it has little to do with the calories that you burn during exercise.  One benefit of consistent exercise is that it does increase the amount of lean body mass that you are carrying around.  Muscle, unlike fat, burns off quite a bit of calories.  This is reflected in your basal metabolic rate (BMR)–the more muscle mass you have, the more calories you burn at rest.

Imagine if you could boost your BMR by a mere 100 calories per day?  Do the math…that’s 3,000 per month and 36,000 more calories burned per year.  It adds up.

Despite all of this, the benefits of exercise do not stand on their own.  Diet, stress management and environmental exposure consciousness needs to be a part of the equation as well.  So, if you are the type of person who hits the gym every day, bikes to work 35 miles each way uphill, swims 750 laps before most of our alarm clocks are buzzing or runs more miles in a week than many of us drive…BUT, eats, quite frankly, like crap (and you know who you are…) just thinking you’re going to “burn it off,” than this particular article is for you.

It in, researchers looked at the communication between skeletal muscle and the beta cells of the pancreas (the cells that produce insulin) in samples of human skeletal muscles that had been subjected to exercise or were left at rest.  These samples were then mixed with beta cells to see if inflammation played a role in protecting or damaging these insulin-producing cells.  Here’s what they found:

• When inflammation (IL-1β plus IFN-γ) was present, there was an increase in the death of beta cells and a weaker insulin response (not good).
• Without inflammation, the myokine IL-6 (a chemical released by the muscle during exercise that generally does good things), blocks the death of the beta cells of the pancreas (good thing).
• However, when inflammation is present, IL-6 from exercise WORSENS beta cell death (very much NOT good).

Maybe this seems a little complex, but the take home message is that, in the presence of inflammation, the normally protective compounds released by the muscles during exercise actually damage the beta cells of the pancreas–a situation that absolutely will set you up for diabetes given enough time.

This means that exercising in the context of an otherwise unhealthy lifestyle may not allow you to just “burn off the calories.”  Rather, this lifestyle may actually prove toxic to the incredibly important beta cells of the pancreas that are constantly fighting to keep blood sugar under control and stave off diabetes.

Think about that the next time your half marathon takes you to that fast food restaurant.

 

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Can Artificial Lighting Raise Blood Pressure?

As a way of background, asymmetric dimethylarginine (ADMA) is nitric oxide’s (NO) arch enemy.  NO is a small molecule that helps blood vessels relax, leading to a lower blood pressure.

Just in case you think you’ve never heard of something like this concept before, Viagra works by affecting NO levels.  So, higher levels of ADMA will lead to higher blood pressure.

It is very well accepted that prediabetes increases ADMA levels, which is why most cases of high blood pressure are actually prediabetes in disguise.  What I was not aware of is that oxidative stress also leads to an increase in ADMA levels (the same mechanism as insulin resistance–by inhibiting the enzyme that breaks down ADMA).

This particular study finds that melatonin, on the other hand, actually blocks this process, leading to normal levels of ADMA.  This means that normal sleep patterns and exposure to as little artificial light as possible at night, can help normalize ADMA levels and hence blood pressure.

 

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Is YOUR Stress Programming Your Kids for Depression?

There is absolutely no doubt that stress is a major factor in the declining health of our country.  From the standpoint of treating patients in my office, helping patients manage their own stress is one of the most difficult tasks I undertake.  Sadly, only on rare occasions are patients successful.

I know that my own life is virtually stress free (despite its challenges) but I am unfortunately all to often unable to help guide patients to the same state of mind.  Maybe if patients truly understood how devastating stress is the outcomes would be better.

This particular article points to previously unforeseen consequences.  Basically, early on (preschool up until 3rd grade), children who were at high risk of dysphoric disorder had a slower than expected cortisol response to stress.  At some point in the next few years, these same high risk kids OVER react to these same stressful situations.

There is something that happens very early on to our children that may predispose them to depression.  Alterations in healthy stress responses begin as early as preschool.  Research has even suggested that life in the womb can predispose children to altered stress responses.

Is YOUR stress affecting your children more than you think?

 

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Does Being Overweight Really Increase My Risk of Diabetes?

The answer is yes, but what is striking about this study is just how much it puts you at risk.

In this particular study, researchers looked across multiple studies to determine the risks associated with being overweight or obese and diabetes.  Here’s what they found:

• Those who were overweight had a 728% higher risk of developing diabetes.
• Those who were obese had a staggering increase of 828%.

Personally, I really wish we would get rid of the diagnosis of diabetes.  A scoring system to tell if you are physiologically handling your blood sugar better or worse.

Somewhere along the line, we gave a magic value to a blood marker and that has become the only thing to worry about.  It’s like using the same marker for cigarette smokers and lung cancer.  Do those smokers who have not yet been diagnosed with lung cancer think everything is ok?

Of course not.

So why do people who are overweight and have not (yet) been diagnosed with diabetes think everything is ok?  The prediabetic state is arguably one of the most damaging states for our bodies to be in.  But we continue to ignore this condition, with drastic ramifications on all aspects of health.

 

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Devastating Arthritis in Children Starts at the Pediatrician

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Arthritis in the typical 50 or 60 year old is not a surprise, but when it strikes our children it’s something to be heavily concerned about.

In general, arthritis that strikes our kids is going to fall into the auto-immune type where the immune system has turned in on itself, attacking the joints of your children when the immune system should otherwise know better.  The most common version of this is juvenile rheumatoid arthritis or juvenile idiopathic arthritis, but it doesn’t really matter what you call it–your child will experience pain that children should not experience.

Even worse, this early joint destruction is going to create a major issue years down the line, setting up children for more pain and disability as they age.  It is likely that these children will also have a later increased risk of heart disease.  All in all, not a good picture.

At this heart of all of this is a whacked out immune system.  You see, we have two main branches of the immune system–the cell-mediated Type 1 (I refer to this arm as the “attack dogs” – they attack anything that tries to invade your body) and humoral mediated Type 2 (I refer to these as the “guard dogs” – they try to keep everything from getting into the body in the first place.

Balance is key here.  You want your immune system to attack things that it should (like a bacteria or virus) and NOT attack things it shouldn’t be attacking (joints, thyroid, adrenal, DNA, connective tissue, etc…).  We ALL have some degree of immunity.  Our immune systems aren’t perfect–there are mistakes that occur, but a healthy functioning immune system keeps this autoimmune attack under control.

This proper balance is set up very early in life.  And if we don’t get it right in the first few years of life, the will be a near-lifetime battle to keep the immune system in check.

And there are some very, very, critically important things that happen (or don’t) to our little ones that will screw up immune balance for a lifetime.  Way up at the top of the list is antibiotic use.

Antibiotic use.  Not even overuse.  Just USE.

Yes–that seemingly benign treatment that pediatricians STILL hand out like candy absolutely decimates immune balance from the get-go.  I have said it before and I will say it again (and again and again):

There is nothing more devastating to the long term immune, gastrointestinal and neurological health of your child than exposing him or her to antibiotics in the first few years of life.  The first 2 years is likely the most critical, but exposure at any time during childhood can have an effect.

And all of this would not be so bad if antibiotics were used appropriately.  That means as narrow-spectrum as possible (sniper rifle instead of cannon) and only used when absolutely necessary.  As in life-threatening.  Despite decades now of an attempt by researchers and guidelines to get doctors to stop the overuse of antibiotics.  Despite marketing efforts geared towards getting the message to patients.  Despite all of this, doctors can’t seem to resist writing prescriptions for conditions like ear infections, upper respiratory infections and pharyngitis (including Strep throat).

And all along, the battle cry is “antibiotic resistance.”  Sad that the destruction of the microbiome is only now, almost a century later, being viewed as a consequence of antibiotic use.

All of this brings us to this particular article.  In it, researchers looked at the association of antibiotic use in children with juvenile arthritis.  Here’s what they found:

• ANY antibiotic exposure was led to a scary 210% increased risk of a child developing juvenile idiopathic arthritis.
• This risk went up with more courses of antibiotics, jumping to an increased risk of 300% with over 5 antibiotic courses.
• The risk was strongest when those kids developed arthritis within one year of taking antibiotics.
• It was NOT the infection itself (the risk did not change based on the number or type of infections).
• To drive the idea that it was NOT the infection itself, those children who had antibiotic-treated upper respiratory tract infections were more strongly at risk for arthritis than untreated upper respiratory tract infections.

This is serious.  This is not about antibiotic resistance of thinking that antibiotics are needed for that sore throat.  This is about a near-permanent disruption of the delicate balance of the immune system in a child.

And this study does not stand alone.  Strong links with other autoimmune conditions like Crohn’s disease and ulcerative colitis are also known.  Overall, it is very, very clear that antibiotics are in no way benign.  Rather, they begin the process of the destruction of proper immune balance.  Even a single course is enough to tip the scales.  And don’t think for a minute that following up with probiotics will wipe out the bad effects of the antibiotics.  I firmly believe that it takes years of dedication to rebuild the microbiome after a single course of antibiotics.

That’s some serious stuff.

 

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Pre-eclampsia, Gestational Diabetes and Lifestyle Choices

BETTER PREGNANCY OUTCOMES THROUGH LIFESTYLE?

The research is very heavily in support of the idea that healthy pregnancies begin long before a couple becomes pregnant.  Mom’s AND dad’s weight and health status dictate not only the health of the developing baby but the likelihood of getting pregnant in the first place. In fact, polycystic ovary syndrome (PCOS) is the most common cause of infertility in women and it is, without a doubt, a product of a prediabetic lifestyle.

This particular study looks at the levels of oxidative stress in a woman’s body are higher in both gestational diabetes and pre-eclampsia.  This means that managing oxidative stress via exercise, a higher phytonutrient diet and  lower caloric intake beginning long before the decision to get pregnant can help improve the outcomes of pregnancy.

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Dentists Rejoice! Brushing and Flossing for your Heart

DO YOU BRUSH AND FLOSS TWICE PER DAY FOR YOUR HEART?

This is yet another study in the continuing saga relating good oral health to overall health.  In this particular study, those with poor oral hygiene had a 70% greater risk of having heart disease.  That’s something to pay attention to.

Now, I’m sure this goes both ways, that having good overall health will also be good for your oral health.  Oral health means regular cleanings, brushing regularly, flossing , regular use of xylitol based products (gum and mints are the easiest) AND (the one most don’t do..) tongue scraping.

Yes–tongue scraping.  There are all kinds of pits and grooves in the back of your tongue that hold and harbor all kinds of gunk (that’s the technical term).  Even after you brush your teeth and tongue, the amount of crud that comes off on a tongue scraper will weaken the strongest stomach.  And without scraping, this crud from your tongue, gums and teeth continues to drive inflammation in the body, creating all kinds of potential problems for long term health.  Breath Rx carries an awesome tongue scraper on Amazon that will last for years.

 

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Whooping Cough Vaccination; Mother Nature Always Wins

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Now that it’s back to school time, the subject of vaccination is on everyone’s mind. Especially since California decided to remove your rights as a parent to make decisions for your child.

If the vaccination topic was cut and dry, it wouldn’t be a big deal.  Mandate teeth brushing and flossing?  Ok.  Mandate more broccoli?  Great.

But what if the government decided to mandate that everyone needs to have chemotherapy once a month.  This way we can beat cancer before it ever starts, right?  Wrong–it would be a completely asinine idea and lives would be destroyed.  Are there a few lucky souls who would benefit from chemotherapy?  It’s probable, but hardly outweighed by the damage done and cost.

I’m not saying that vaccination is as devastating to the human body as chemotherapy is, but where do we draw the line between benefits and harm?  And here’s the problem with vaccination–it’s not a single intervention we are talking about here.  Rather, it is at least 12 separate disease vaccinations given over the course of some 30+ episodes by the time your child is in first grade.  These numbers can go up depending upon how many diseases we think we can prevent with vaccination.

Even worse, these vaccines are truly loaded with chemicals that are INJECTED into the bloodstream (while you may hear all types of crazy accusations on this point, you can check out the CDC’s website that includes when these ingredients were updated by the manufacturer).

None of this gets into the argument about the effectiveness of each individual vaccination or whether or not it’s even a good idea to try to outsmart Mother Nature by wiping out communicable diseases.

In other words, mandating something that is so rife with controversy is NEVER a good idea, especially when each side of the debate thinks they have all the answers and use fear and emotions to achieve goals rather than facts.

(Just in case you were wondering…yes, this rant is leading somewhere)

The idea that when you suppress one type of infection or one form of an infection another comes in to take its place is called antigenic shift.  We have seen this happen with many vaccines–HPV (Gardasil) and pneumoccocal (Prevnar) are just two solid examples.  In other words, a vaccination is designed to protect against only a small sample of a certain family of infectious agents.  With time, the types of infection that the vaccine protects against does indeed go down in the population.  But, unfortunately, other related “cousins” of these infectious agents begin to rear their ugly heads, all too often leading to strong, more deadly infections that are harder to kill.

This little tidbit you don’t hear about much.  Instead of promoting the problem, there is just a quiet push by medicine to get your children “updated” with the new vaccine.  Prevnar is the perfect example that you can read about more in a previous article by clicking here.

In this particular article, researchers looked at the effect of the pertussis / whooping cough vaccination on the growth of a related microbe, Bordetella parapertussis (as opposed to Bordetalla pertussis, which causes whooping cough).  You see, the current vaccinations (the “aP” part of the DTaP shot) does nothing to protect against the parapertussis bacteria, so researchers looked at the results of the current pertussis vaccination on parapetussis infection in rodents.

The results should raise some very strong concerns for parents in the state of California:

• The current vaccination does nothing to protect against B. parapertussis infection.
• While the vaccination helped clear B. pertussis infection, there was a FORTY-FOLD increase in B. parapertussis infections (as CFUs).
•  This increase was the result of a DECREASE in the immune response (lung inflammatory and neutrophil responses) against B. parapertussis.

Yes, this was “just” an animal study, but it raises the very real possibility that the use of the pertussis / whooping cough vaccination is wreaking havoc on our children’s immune ability to fight of similar competitive infections.

So, the next time your pediatrician pressures you to vaccinate your child (in this case, for whooping cough) and tries to guilt you or shame you in caving in, ask him or her how much he or she knows about antigenic shifts and the rise of competitive infections with the vaccination.  If you get a blank stare, it’s time to turn and run.

And hopefully, you’re not living in California.

 

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Does My Brain Really Have to go as I get Older?

It seems like just about every third person has Alzheimer’s these days, or at least has a parent that has been diagnosed.  Makes it seem pretty dismal for the future.

Research into medications to help curb the progression is on every research budget.  But every shining star in the research has fallen flat and many researchers are getting frustrated.

The reality is that the incidence of neurodegenerative disorders is increasing rapidly and this rapid increase is NOT due to genetics.  As a human species, our DNA has not changed appreciably in several hundred thousand years, leaving lifestyle as the likely answer.  And sure enough, unlike the research on treatment, the research supporting prevention continues to grow to the point that it is solidly accepted that this disease state can be prevented.

This particular review gives a short, simple list of some of the lifestyle factors that could be managed to greatly lower your risk.  Combine this with an anti-diabetic lifestyle and exercise, and you’re doing boatloads to protect your brain into the future.

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Shining the Light on Breast Cancer Statistics–Literally

 

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Most solid cancers have a long list of well-documented ways to prevent them. Treatment, however, remains shaky. Breast, prostate, colon and pancreatic cancers are all very preventable.

But the lifestyle choices known to prevent these deadly cancers are not always easy.  Luckily, many of them are easy to implement and live by.  More troubling, however, are the risk factors that you may not be aware of or that you can’t change.

Exposures in the womb are something that you can’t go back and change.  It is established that chemicals like diethylstilbestrol (DES) that was given to pregnant women in the 1960s increased the risk of breast cancer in the moms as well as the female children later in life.  Other estrogen-like environmental chemicals like BPA and phthalates have been linked to breast cancer and it is highly likely that exposure in the womb would increase breast cancer rates later in life as well.

Things that happened to you as a teenager can have a lifelong effect on breast cancer rates.  You age when you started menstruation, how much sun exposure you got and how much soy you ate as a teen are all influential factors.

But what about your own personal circadian rhythms?

“My what?”

I’m not talking about a blues band from Atlanta.  I’m talking about your body’s daily rhythm as it pertains to day and night.  We are NOT nocturnal creatures.  We’ll leave that to the bats.  We should be sleeping at night.

Despite this, sleeping disturbances are quite common in society.  Insomnia, sleep apnea, restless legs, late nights and problems falling asleep plague society.  Much of this is because we are so stressed that we can’t relax enough at night to settle into a restful night’s sleep.

Then there are the midnight-shift workers and airline personnel that are frequently changing time zones.  This group of people have problems with their circadian rhythms because of their work schedules.

There are documented health problems that midnight shift workers experience.  Weight gain and obesity are on the top of the list.  Higher rates of breast cancer have also been demonstrated.

Which brings us to this particular article.  In it, researchers take a much deeper look at the relationship between sleep disturbances, light exposure at night and breast cancer risk.  In this study, female mice at an increased risk of breast cancer (along the lines of a BRCA mutation) were evaluated to see what kind of effect swapping dark and light exposure had on tumor growth over a lifetime.  At the end of each week, the mice were exposed to a full 24-hour period of either light or dark.

The results were a little shocking:

• Switching up light and dark led to a decrease in the body’s ability to stop tumor growth, leading to an increased numbers of tumors that developed faster.
• In addition, there was an increase in body weight.
• These mice also slept much more, increasing sleep times by 50% (which led to a reduction in overall physical activity)

Based on this study, it is clear that messing up the normal day-night rhythms that we are all designed for creates problems.  There are a number of ways in which this might occur, such as:

1. Suppression of the brain-protective melatonin by light exposure at night
2. Stress from sleep disruption
3. Alterations in lifestyle due to sleep disturbances (smoking, unhealthy diet, altered timing of food)
4. Decreased vitamin D levels due to lack of sunlight exposure

Whatever the reason, the links continue to be proven.  If you are one of these people that gets exposed to light at night, here are some tips:

• For insomnia, stress is likely an issue.  Rather than relying on meds, find someone to help you with the underlying problem and fix it.
• Sleep apnea?  The long term answer is an anti-diabetic lifestyle.  In the short-term a CPAP machine is a must.
• Wearing a sleep mask can help block your nighttime exposure to light that can disrupt sleep.
• Specialized glasses to block blue light can be used in the evening to help combat sleep problems.

If you have a job that requires the midnight shift or lots of travel to different timezones, there may not be a lot you can do in this regard.  However, there is still a long list of lifestyle choices that go a long way to combat your sleep / wake cycle disturbances.  These choices become that much more important.

 

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Statins Versus Fast Food; Really an Even Battle?

JUST HOW OFF BASE IS MEDICINE?

Keep in mind that this particular article is an editorial.  The author is writing for the British Heart Foundation.  He believes that the use of a statin can zero out the negative health effects of a Quarter Pounder with cheese and a small milkshake.

Have we really come so far down the dark path of unhealth that we have to accept that patients can’t change and we need to rely on medications instead of lifestyle?  That is truly a sad state of affairs if doctors collectively do not have faith in their patients.

Maybe this is because they themselves are not exactly free of hypocrisy?

Regardless, the faulty reasoning here is that the beneficial effects of statins have been overblown while the negative effects of fast food have been under emphasized.  Or maybe this is just representative of the tightening relationship between medicine and big business as epitomized by the endorsement of Coca Cola by the American Association of Family Physicians…

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PSA Testing: Is Medicine’s Idea of Prevention Falling Apart?

IS MAINSTREAM MEDICINE’S IDEA OF “PREVENTION” FALLING APART?

While there is a clear distinction between early detection and prevention, mainstream medicine does not seem to recognize this.  Mammography, colonoscopy, PSA screening…these are all designed to catch disease in its early stage, but they are all catching the DISEASE (or at least the precursor to the disease like a polyp).

None of these actually address preventing the disease or condition in the first place.  Is it just me that seems disturbed by this?

Further confounding this issue is that we are beginning to find that mainstream medicine’s “prevention” is doing more harm than good.  Mammography’s effectiveness has come under fire (many lesions can resolve spontaneously, leading to high levels of overtreatment) and now PSA is under the same level of scrutiny.  The bottom line is that lifestyle changes NEED to be implemented instead of relying solely on early detection.

Read the article here

 

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