Holistic Health News
Dr. Cathy Rosenbaum

Tai Chi Easy Class Introduction

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Tai Chi Easy™ Class Introduction – Next Session Starts August 30, 2022 at MTCC in Milford, OH. Visit www.miamitwp.gov. to register.

Tai Chi Easy™, a type of meditation, involves a series of movements accompanied by deep breathing, performed in a slow, repetitive manner.  Each one-hour session consists of gentle physical exercise and mental focus (6). Some squatting and turning moves will be incorporated into your routine. You will need the physical ability to stand unassisted for at least 20 minutes. Tai Chi Easy™, a combination of Tai Chi and Qigong, builds strength without much exertion and recovery time.

In general, Tai Chi (pronounced tie-chee) emphasizes balance, harmony, and stress reduction (1-5, 8, 11, 12). Qigong (pronounced chee-gong) is the practice of harnessing your life energy (Qi). Both Tai Chi and Qigong are ancient Chinese exercises that promote optimal health and vitality.

Four Parts to Our Tai Chi Easy™ Classes in Milford,  OH:
• Deep Breathing Practices – designed to trigger relaxation responses, increase oxygen flow, and provide energy
• Mindful Tai Chi Easy Movements – five gentle exercises (see below) that relax, flex, and stretch your body to help improve balance and coordination, increasing blood and lymph flow (7)
• Self-Applied Massage – emphasis is placed on reflex points on hands, ears, feet, neck and scalp; intended to relax your whole body (9) for progressive muscle relaxation
• Standing Meditation – focused, intentional centering of your mind on the present to calm your emotions and with Spirit (10)

Five Mindful Movements Per Set (Your Choice of Moving or Sitting):
• Harmonizing Yin and Yang (Parting the Wild Horse’s Mane)
• Brush Knee, Send Chi
• Cutting Through to Clarity (Repel the Monkey)
• Cloud Hands
• Gathering Energy from the Earth and Heavens

Clothing and Footwear:
Comfortable loose (casual wear) clothing, comfortable flat sole shoes (e.g., Moccasins or sneakers).

Pre-Work:
None. Please come ready to have some fun.  Contact Miami Township Civic Center Milford OH at 513.248.3727 to register for a six-week Tai Chi Easy session taught by Dr. Cathy Rosenbaum, Practice Leader.

“When you cultivate balance and harmony within yourself, or in the world – that is Tai Chi. When you work and play with the essence and energy of life, nature and the universe for healing, clarity and inner peace – that is Qigong.” – Founder, Roger Jahnke, DOM

Question: “In Tai Chi, can you let your body become (e.g., concentrate your Chi until it becomes) supple as a newborn child’s?  Emilie Conrad-Da’oud’s comment:  There is no self-consciousness in the newborn child.  Later on, the mind wanders into self-images, starts to think, Should I do this/ Is this movement right? and loses the immediacy of the moment.  As self-consciousness develops, the muscles become less supple, less like the world.  But the young child is pure fluidity.  It isn’t aware of any separation, so all its movements are spontaneous and alive and whole and perfect.  If an adult body becomes truly supple, though, there’s a quality to its movement that the child’s doesn’t have, a texture of experience, an added dimension of time.  When we watch a seventy-year-old hand move, we feel, “Yes, that hand has lived,”  All the bodies it has touched, all the weights it has lifted, all the heads it had cradled, are present in its movement. It is resonant with experience; the fingers curve with a sense of having been there.  Whereas in a child’s hand, there’s a sense of just arriving. The child’s movement is pristine and innocent and delightful, but a truly supple adult movement is awesome, because all of life is included in it.”

References
1. Harner et al. Tai Chi: Moving for better balance- development of a community-based falls prevention program. J Physical Activity Health 2008; 5:445-455
2. Huston. Health benefits of tai chi: what is the evidence? Can Fam Physician 2016 Nov: 62 (11): 881-890.
3. Zou et al. Tai chi for health benefits in patients with multiple sclerosis: a systematic review. PLoS One 2017 Feb 9:12(2) e0170212
4. Sawynok. Benefits of tai chi for fibromyalgia. Pain Manag 2018 Jul 1:8(4): 247-250.
5. Murley et al. Influence of tai chi on self-efficacy, quality of life, and fatigue among patients with cancer receiving chemotherapy: a pilot study brief. J Holist Nur 2019 Dec; 37(4): 354-363.
6. Jor’dan et al. Long-term tai chi training is associated with better dual-task postural control and cognition in aging adults. Adv Mind Body Med 2018 Summer;32(3):4-11
7. Klein et al. Qigong and tai chi as therapeutic exercise: survey of systematic reviews and meta-analyses addressing physical health conditions. Altern Ther Health Med 2019 Sept;25(5):48-53.
8. Conboy et al. Tai chi for heart attack survivors: qualitative insights. BMJ Support Palliat Care 2019 Apr 4.
9. Powerpak CEU for Pharmacists and Pharmacy Technicians 2019. Augmenting pain therapy with self-massage.
10. Chen et al. Meditative therapies for reducing anxiety: a systematic review and meta-analysis of randomized controlled trials. Depression and Anxiety 2012: 29:545-562.
11. Fouquerel. Convergence of the Nobel fields of telomere biology and DNA repair. Photochem Photobil 2017; 93:229-237.
12. Carlson. Protocol for the MATCH study (mindfulness and tai chi for cancer health): a preference-based multi-site randomized comparative effectiveness trial (CET) of mindfulness -based cancer recovery 9MBCR) vs tai chi/qigong (TCG) for cancer survivors. Contemp Clin Trials 2017; 59:64-76.
13. Curry et al. Case series of multiple health benefits in those undertaking extended Qigong practice as a complementary self-care practice in an outpatient pain clinic. OBM Integrative Complement Med Pain Management June 28, 2019.

Acupuncture: The Needle in the Haystack of Health

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Acupuncture: The Needle in the Haystack by Dr. Cathy Rosenbaum, Rx integrative Solutions
 

The first Chinese Medicine text was written around 3000 B.C. when medicine, philosophy, and religion were closely aligned.  Chinese Medicine draws from Ayurvedic principles even though the latter system of practices is rooted in the Hindu religion. Chinese Medicine, one of the oldest in recorded medical history, was based on local Taoism and later, Buddhism suggesting the body interacts with, and is inseparable from, its environment.  Taoists talked about Yin/Yang as two complementary forces in the paths of life.  Wu Xing, or the Five Elements, describes metal, wood, water, fire, and earth, the last three of which were taken from Ayurveda.

Chinese Medicine was practiced until 1911 until the revolution when it was frowned upon as unscientific and replaced by Allopathic Medicine as the country began its journey toward a democracy.  There was a ban on Chinese Medicine until the 1950’s when Integrative Medicine and Allopathic Medicine came together.  Chinese Medicine practitioners became barefoot doctors in rural areas of the country and allopathic physicians were encouraged by the government to get trained in Chinese Medicine.  I visited a barefoot doctor clinic in Chengdu, China in 2002 during my travels to study herbal research and global healthcare solutions.  Ultimately a new term, Traditional Chinese Medicine (TCM), was born, based more on scientific research, and replacing the term Chinese Medicine based more on anecdotal remedies handed down from generation to generation.  Today, TCM is common throughout China.

In the USA, French physicians were performing acupuncture as early as the 1700’s, but it was not until the 1960’s that TCM as we know it today came alive in our country.  Nevada was the first state to license non-physicians as acupuncturists in 1973. Both Yin/Yang and the Five Elements are diagnosed by radial pulse and tongue observations and are expressed to some degree in every person and in the universe, requiring us to work in harmony with nature and not against it.  Qi is the life force that runs through Yin/Yang and the Five Elements.  These principles were taught from childhood through adulthood, including keeping a healthy whole body which is thought to give a person a ticket to heaven.  Evidence of healing comes from expression of compassion, kindness, service, and love.  These characteristics in turn enhance the flow of Qi, or life energy, through invisible meridians throughout the body.

TCM practice starts with observing a wrist pulse, the tongue, the overall smell of the patient, the skin, and body build to assess balance or any imbalance of Yin/Yang in the patient.  The TCM practitioner looks at the patient, watches how she moves, speaks, watches some of her emotional characteristics (e.g., talks a little or a lot, is calm or fidgety).  That may be the extent of the history taking.  An allopathic physician who also practices TCM will, in addition, take a health/medical history for the patient. When imbalance occurs, several interventions may be recommended to rebalance Yin/Yang in the patient as well as the patient with her universe.  Interventions can include massage, meditation, herbs, nutritional recommendations, exercise, and acupuncture.  Once diagnostics are complete and a health goal is established, acupuncture along with other modalities (i.e., herbs and/or massage) may be combined to help achieve the goal.  Acupuncture can be used to balance energy composed of universal opposing forces, also known as Yin and Yang, for good health.

Acupuncture, one of the key components of TCM, which has been practiced for thousands of years, starts with the belief that life energy (Qi) flows through meridians or tracks around the entire body.  Chinese Qi is analogous to prana, mana, maya, and orgone in Ayurvedic systems, and Ki in the Japanese healing system.  Meridian based therapies were first recorded in the book the Yellow Emperor’s Inner Classic written in 2698 B.C.  According to TCM beliefs, there are 12 main meridians and two secondary meridians.  Meridians are called 1) lung, 2) large intestine, 3) stomach, 4) spleen, 5) heart, 6) small intestine, 7) bladder, 8) kidney, 9) pericardium, 10) triple Warmer, 11) gallbladder, 12) liver, 13) conception vessel or Ren, 14) Governor Vessel.  Meridians touch the skin’s surface at over 2,000 acupuncture points.  From a Western allopathic perspective, there is no physical proof that meridians exist per se as there are for nerves in the nervous system.  According to the Five Element theory, each meridian, or Yin/Yang combination of two meridians, is associated with one of the elements.  Lung (arm-yin) and large intestine (arm-yang) correspond with metal; stomach (leg-yang) and spleen (leg-yin) correspond with earth; heart (arm-yin) and small intestine (arm-yang) correspond with fire; bladder (leg-yang) and kidney (leg-yin) correspond with water; pericardium (arm-yin) and triple Warmer (arm-yang) correspond with fire, and gallbladder 9leg-yang) and liver (leg-yin) correspond with wood.

Acupuncture is a procedure involving the placement of sterile needles into the skin by an experienced practitioner to stimulate specific anatomic points in the body for therapeutic purposes.  Sometimes electrodes are attached to any one of the six needle types during a session and used in combination with a variety of electroacupuncture techniques.  Very small microampere electrical impulses will flow through the acupuncture points.  In 1996, the FDA approved the use of acupuncture needles for licensed acupuncture practitioners and requires needles to be sterile, nontoxic, and labeled for and disposed of after single use to protect consumers.  Needles vary in length, diameter, and head shape, and their insertion and manipulation in the skin is rarely painful and feel more like a bee sting.  Needle punctures may draw as small amount of blood from the skin.

In 1997, a National Institute of Health panel issued a position statement that acupuncture is effective for post operative nausea and vomiting, chemotherapy related nausea and vomiting, and pregnancy related nausea.  The World Health Organization recognizes TCM and acupuncture as interventions for gynecological disorders (PMS), gastrointestinal disorders (peptic ulcer, indigestion), urogenital disorders (stress incontinence), respiratory disorders (emphysema), musculoskeletal and nervous system disorders osteoarthritis pain, headaches, back pain), and emotional disorders (anxiety, depression), among others.

Based on a 2007 National Health Interview Survey, an estimated 3.1 million Americans responded that they had tried acupuncture in the past year for pain or musculoskeletal complaints (i.e., back pain, joint pain, neck pain, severe headaches, migraines) (Diener).  According to the American College of Physicians and the American Pain Society, for patients who do not improve with self-care options, clinicians should consider the addition of non-pharmacologic therapy with proven benefits for chronic low back pain (Chou), exercise therapy, acupuncture, massage therapy, yoga, or progressive relaxation (weak recommendation, moderate-quality evidence) (Chou).  According to the NIH Consensus Conference, “both animal and human laboratory and clinical experience suggest that the majority of subjects respond to acupuncture, with a minority not responding.”

When evaluating acupuncture efficacy research for pain management it is important to consider the placebo effect (Linde).  If a person experiencing acupuncture believes it will help with pain and expect positive results, she/he will typically report pain relief at some level (Walling).  Acupuncture is thought to activate the brain’s opioid system (receptors).

Are there risks or side effects to acupuncture?

The National Institutes of Health has concluded acupuncturists have a very good safety record when they use sterile needles and follow proper needle insertion practice.  Yet, for some, changes in appetite, sleep, bowel or urination patterns, or emotional state may be triggered after experiencing acupuncture.  It is also common to have a sensation of deep relaxation or even mild disorientation immediately following the treatment. These effects should wear off within 24-48 hours (Leung).  Rare risks of acupuncture include bruising/bleeding at the needle insertion sites, fainting, muscle spasms, and nerve damage. A few people have reported more serious reactions, such as dizziness, sweatiness, or nausea (Peuker).  Acupuncture is contraindicated to needle the abdomen and lumbosacral areas of pregnant women.

Types of Acupuncture

Traditional acupuncture involves puncturing the skin at Qi points along the meridians to regulate the flow of Qi and balance Yin/Yang and Five Element forces.  Very fine needles are inserts with a quick thrust and then twisted gently.  Patients will report a little jolt of energy when the needle is inserted properly.  Needles are left in place for 30 -45 minutes then removed.

Auricular acupuncture involves applying needles to the outer ear.  Each ear is believed to have over 100 acupuncture points.  For perspective, the major meridians are thought to overlap the ear on either side.  Medical acupuncturists may use this type of acupuncture for treating nicotine and alcohol dependence.

Korean acupuncture developed in 1971 by Tae Woo Yoo involves hand meridians Qi points.  Needles or self-adhesive acupressure pellets may be used to achieve balance.  Korean hand acupuncturists believe the entire meridian map is represented on the hand.

Medical acupuncture is the application of needles to meridian points to reduce symptoms by affecting sensory input to the nervous system through the release of neuropeptides like endorphins.  It does not include TCM, its underlying philosophy, or diagnostic techniques.  As defined by the American Board of Medical Acupuncture it is the “medical discipline having a central core of knowledge embracing the integration of acupuncture from various traditions into contemporary biomedical practice.”  This practice entails the practitioner memorizing needling protocols for symptoms and/or diseases and ignores Taoist and medical hypotheses of TCM.  Medical acupuncture was created for doctors of medicine, chiropractors, and osteopathic physicians who may or may not believe in the existence of Qi or meridians in the body.

Most U.S.A states require certification or training to perform acupuncture excluding North Dakota and South Dakota.  Check with your state laws for more information by visiting http://www.acupuncture.com/statelaws/statelaw.htm.

Most states license acupuncturists (LAc) through a national certification exam.  Look for acupuncturists in your state who are recognized by the National Certification Commission on Acupuncture and Oriental Medicine www.nccaom.org or the Accreditation Commission for Acupuncture and Oriental Medicine www.acaom.org.  There are over 150 schools of acupuncture training in the U.S.A.  For more information visit the American Association of Acupuncture and Oriental Medicine www.aaaomonline.org , and the Council of Colleges of Acupuncture and Oriental Medicine www.ccaom.org .  To follow acupuncture research, visit  www.clinicaltrials.gov or The Society for Acupuncture Research www.acupunctureresearch.org .

Questions to ask the acupuncturist before treatment begins:

  • Is this acupuncturist licensed?
  • Where is acupuncture practiced?  Acute care, ambulatory care, long term care, private office practice, spas.
  • Does acupuncture hurt?  Most people feel a little pinch when the needle is inserted.  Inserted needles are then flicked by hand or electrically eliciting a minor response.
  • Are the needles sterile?
  • What is acupuncture used for?  How many people with my condition have you successfully treated?
  • Is acupuncture covered by insurance?  Rarely, yes.  Check with them first.
  • Will acupuncture interfere with my medications or reduce the need for medications?
  • How often should I see my acupuncturist?

References

Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK, Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel.  Diagnosis and treatment of low back pain; a joint clinical practice guideline from the American College of Physicians and the American Pain Society.  Ann Intern Med 2007;147:478-491.

Diener HC, Kronfeld, K, Boewing G, Lungenhausen M, Maier C, Molsberger A, Tegenthoff M, Trampisch HJ, Zenz M, Meinert R [GERAC Migraine Study Group].  Efficacy of acupuncture for the prophylaxis of migraine: a multicentre randomized controlled clinical trial.  Lancet Neurol 2006;5:310-316.

Johnston MF, Hays RD, Hui KK.  Evidence-based effects size estimation: an illustration using the case of acupuncture for cancer-related fatigue.  BMC Complementary and Alternative Medicine 2009;9:1-26  doi:10.1186/1472-6882-9-1.

Leung PC, Zhang L, Cheng K.  Acupuncture: complications are preventable not adverse events.  Chin J Integr Med 2009;15:229-232.

Linde K, Witt CM, Streng A, Weidenhammer W, Wagenpfeil S, Brinkhaus B, Willich S, Melchart D.  The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain.  Pain 2007;128:264-271. doi: 10.1016/j.pain.2006.12.006

Manheimer E, Ezzo J, Hadhazy V, Berman B.  Published reports of acupuncture trials showed important limitations.  J Clin Epidemiology 2006;59:107-113.  doi: 10.1016/j.jclinepi.2005.06.003

Peuker ET, White A, Ernst E, Pera F, Filler TJ.  Traumatic complications of acupuncture. Therapists need to know human anatomy.  Arch Fam Med 1999;8:553-558.

Walling A.  Therapeutic modulation of the psychoneuroimmune system by medical acupuncture creates enhanced feelings of well-being.  J Am Ac Nurse Practitioners 2006:18:135-143.  doi: 10.1111/j.1745-7599.2006.00115.x

Is Functional Medicine Another Holistic Practice?

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The short answer is, ‘Absolutely. Yes!’  In the 1970’s Jeff Bland PhD FACN FACB CNS, former Professor of Chemistry at the University of Puget Sound in Washington state, started his work in Functional Medicine (FM).  Ten years later Dr. Bland began teaching practitioners how to implement preventive nutritional medicine in their professional practices.  FM, like many health practices, spotlights whole-food nutrition as a cornerstone of healing.

The Institute for Functional Medicine was launched in 1991, with Dr. Bland as the Co-Founder.  The organization offers a FM Certification Program for physicians and health care professionals holding at least a Masters’ degree and licensure in their fields.

In 2014, the Cleveland Clinic established The Center for Functional Medicine with the Functioning for Life™ 10-Week Program where patients can select from a disease-specific series of options to meet their individual functional health needs.  Please visit https://my.clevelandclinic.org/departments/functional-medicine for more information.

FM is a proactive, personalized care approach that incorporates three distinct paths into a patient’s health assessment/history, namely natural medicine, molecular medicine, and systems biology.  FM health practitioners are MDs, DOs, DCs, CNPs, and PharmDs, among others.  The University of Western States offers a degree in Human Nutrition and Functional Medicine (see https://www.uws.edu/human-nutrition-functional-medicine/ ).

FM practice attempts to address the underlying root cause of disease rather than just symptoms and symptom management.  FM is based on the principle that a diagnosis can be the result of more than one cause, or one cause (e.g., inflammation) may lead to multiple diagnoses over time.  The primary FM outcome goal is for a patient to modify as many lifestyle choices as necessary to address the root cause of their issues and to prevent illness as much as possible.

Typical laboratory blood tests ordered by FM practitioners to help assess patterns of imbalance may include, but are not limited to, the following biomarkers:

  • Nutrient deficiencies (e.g., blood or genetic test)
  • Immune and inflammation
  • Digestive
  • Oxidation
  • Neurotransmitters
  • Hormones
  • Toxicity (e.g., heavy metals)

 

The FM physician will assess your medical and surgical history, home/life environment, lifestyle choices, possibly your genetics, and how any/each may be influencing your symptoms.  An individual FM intervention/treatment plan will be built around your whole-person health needs.

By comparison to Integrative Health and Medicine (IHM), FM embraces much of the philosophy of IHM, while adding a biologic systems-oriented approach to proactive patient care.  Comprehensive IHM involves traditional medicine health care plus complementary, holistic, mind body spirit interventions that may include other IHM practitioners on the health team.

Your physician’s IHM care recommendations may include meditation/stress management, acupuncture, Yoga, massage, dietary supplements, nutrition education, exercise, and lifestyle changes to improve your health.  For more information about IHM, visit the American Board of Integrative Medicine @ https://www.abpsus.org/aboim/ or the Andrew Weil Center for Integrative Medicine in Tucson AZ @ https://integrativemedicine.arizona.edu/ .

For perspective, the American Academy of Family Physicians does not embrace FM principles in their entirety.  Regardless of your preference for FM or IHM, it is important to enlist a trained licensed physician as your gatekeeper to coordinate your health team.

Check with your insurance carrier to see if FM office visits and laboratory tests are covered by your insurance carrier.  Several FM practitioners are located within the Greater Cincinnati Northern Kentucky area from which to choose.  Holistic pharmacists are becoming more involved in FM practices in the areas of nutrition coaching and pharmacogenomics/nutrigenomic testing throughout the country.  For more information visit https://wwwifm.org/find-a-practitioner .  For more information on FM research, visit www.clinicaltrials.gov.

 

 

Lavender (Lavendula angustifolia) Tea for Relaxation

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Lavender is one of many beautiful and fragrant herbs that attracts butterflies and bumble bees, and will repel moths, mosquitos, and flies from the garden. Lavender flowers (buds) can be used as a tea for their relaxing and calming effect (Basch).

There may be as many as 160 active constituents in lavender including linalool (a terpene), linalyl acetate, B-caryophyllene, B-myrcene, alpha-ocimene, B-ocimene, and terpinen-4-ol. Calcium, iron, and vitamin A are also found in lavender.

We’re still learning about lavender’s pharmacology from animals. In a study by Harada et al, adult male mice were tested using a linalool scent delivered in a light/dark box. Some of the mice in the study had the sense of smell (active group) and others did not (control group). The mice in the active group that were exposed to the linalool scent over 30 minutes experienced anxiolysis. The control group did not. The positive effect in the active group was negated by flumazenil, a medication that reverses the effects of benzodiazepine anxiolytics like Valium, Ativan, and others. The authors concluded that the linalool effect was mediated by GABA transmission via benzodiazepine-responsive GABA receptors.

Lavender may also work by modulating T-type calcium channels in the body, providing yet another possible therapeutic effect that deserves more research in humans. Calcium channels play a role in neuron excitability, neuroprotection, sensory processes, sleep, and pain (Alaoui, Ayaz, Kopecky).

Lavender side effects may include sun sensitivity, headache, and allergic reaction, among others.

If you are consuming lavender tea, taking lavender dietary supplements, or using topical lavender essential oil in aromatherapy, please be sure to first discuss the appropriateness of this herb/essential oil with your health care provider or pharmacist to determine if it is safe and right for your health goals. This includes a thorough review by your trusted healthcare professional of any drug/lavender interactions and potential side effects.
For more information please visit https://www.drugs.com/mtm/lavender.html and https://www.gardenmandy.com/types-of-lavender-plants/.

Recipe for Lavender Tea

Add the 1 Tbsp fresh, or 1-2 tsp dried, lavender flower buds to a teacup (mug).
Bring 8 oz – 10 oz water to a boil.
Pour the hot water over the lavender flower buds, steep for 5 minutes. Place a small plate or lid over the top of the cup to keep the steam inside, further infusing the tea.
Remove the plate (lid) from the cup and add honey or agave, sweetening to taste.

Drying Out Fresh Lavender Flowers

If you want to dry out fresh lavender flower buds from your garden, harvest the lavender just before it fully blooms, and cut the flowering stalks right above the leaves. Bind the stalks with the buds into bundles and hang them upside-down in a dark, cool, and dry place for 2 and 4 weeks. Lightly brush the stalks and the lavender buds should fall off, to be stored and used later for tea.

References

1. Alaoui. Modulation of T-type Ca2+ channels by lavender and rosemary extracts. PLoS One. 2017 Oct 26;12(10): e0186864.
2. Ayaz. Neuroprotective and anti-aging potentials of essential oils from aromatic and medicinal plants. Front Aging Neurosci 2017; 9:168.
3. Harada. Linalool odor-induced anxiolytic effects in mice. Frontiers in Behav Neurosci 2018;12: Article 241.
4. Kopecky. T-type calcium channel blockers as neuroprotective agents. Pflugers Arch 2014; 466 (4): 757-765.
5. Basch. Lavender (Lavandula angustifolia Miller). J Her Pharmacother 2004;4: 63-78.

Probiotic Dietary Supplement Safety & Efficacy Is in Question

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Probiotic dietary supplements have become quite popular in recent years, touted for such conditions as general health (prevention), immune health (prevention), leaky gut, diabetes mellitus, and dysbiosis from antibiotic overuse, among others.

Probiotics are generally safe for a heathy person (Generally Recognized as Safe [GRAS] per the FDA classification).  However, some live  probiotic strains may negatively play on a weakened immune system in at-risk persons,  allowing unwanted organisms to enter the body and cause pneumonia, endocarditis, or sepsis.  Probiotic supplements are not for everyone!

Activia yogurt, Yakuit yogurt, Dannon Probiotic yogurt, kefir, kimchi, sauerkraut, tempeh, miso, and kombucha are examples of food sourced-probiotics. Culturelle and Align are popular probiotic dietary supplements. Florastor is a prescription medication.  Examples of probiotic strains include, but are not limited to, bacteria (e.g. Lactobacillus, Lactococcus, Leuconostoc, Pediococcus, Bifidobacterium, Bacillus) and yeast (e.g., Saccharomyces).

It’s important to choose the right probiotic product for your health needs with the help of your pharmacist, who can thoroughly evaluate the product  before recommending it to you.  Product criteria:

  • strain identification by genome sequencing
  • transmissible antibiotic resistant gene profile
  • toxicology in vitro and in vivo studies
  • clinical studies on efficacy (how well does the product work)
  • target population (healthy  vs sick)
  • product formulation and labeling (product purity, contaminants)

If probiotic manufacturers claim to treat/prevent disease, their probiotics should be studied and marketed as drugs, rather than as  supplements, upholding FDA regulation.  Probiotics are not drugs, not magic bullets, nor are they universally safe and effective.

The appropriate probiotic strain and formulation should be recommended by your healthcare professional based on your individual health needs.

For more information or to schedule an integrative health and wellness consultation with Dr. Cathy Rosenbaum,  holistic clinical pharmacist, Certified Health Coach, Certified Dementia Practitioner, and Tai Chi Easy Practice Leader in Blue Ash OH,  please visit www.rxintegrativesolutions.com.

–Dr. Cathy Rosenbaum

 

 

 

Kothari.  Probiotic supplements might not be universally-effective and safe: A review.  Biomed Pharmacother 2019;111:537-547.

Restless Leg Syndrome

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Restless Leg Syndrome

By Cathy Rosenbaum PharmD MBA RPh CHC
Founder & CEO, Rx Integrative Solutions

Introduction
Restless leg syndrome (RLS) was first described over 70 years ago. Symptoms can show up as achy or crawling sensations in the resting leg that oftentimes go away with leg movement. RLS can be caused by iron or folate deficiency, kidney problems, pregnancy, rheumatoid arthritis, fibromyalgia, thyroid issues, Parkinson’s disease, and depression, among others. A family history of RLS is common in individuals with idiopathic RLS. Individuals with RLS can have trouble getting a refreshing REM sleep. RLS is often misdiagnosed as a vascular problem in the veins, and that’s why it’s important to get an accurate diagnosis from your PCP first before treating the condition.

Factors that may make RLS symptoms worse include cold, heat, fatigue, and stress. RLS prescription medication treatments can include, but are not limited to, benzodiazepines, gabapentin, clonidine, propranolol, and narcotics, each of which have significant side effects. The use of opioids and benzodiazepines together (e.g., Valium, Ativan, Xanax, clonazepam) is not safe. For perspective, benzodiazepines as a medication class are best avoided in seniors due to drowsiness and increased risk of falls and dementia. Depending on the type of RLS diagnosed, non-prescription medication and/or non-invasive alternatives can be considered to treat symptoms.

Iron Deficiency
Interestingly, there might be less iron in the brain of an RLS individual compared to non-RLS individuals. People with iron deficiency RLS respond well to iron supplementation. Improvement is most often seen in those with the lowest initial serum ferritin levels.

Pregnancy
Pregnant women are more likely to develop RLS than non-pregnant women due to reduced folate levels in the former population. In most instances, symptoms are mild and resolve after delivery. Treatment involves folate supplementation, reassurance, and appropriate food intake.

Medication-Induced RLS
Different medications can either cause or worsen RLS symptoms. Antidepressants like Prozac, Paxil, and Zoloft are three such culprits. One study showed that use of non-opioid analgesics is associated with an increased risk of RLS in individuals on long-term antidepressant therapy (Leutgeb. Eur J Med Res 2002;7:368-379).

Vitamin D and Magnesium Deficiency
Published literature (J Sleep Breath 2016) indicates that low vitamin D levels and/or low magnesium levels may be associated with RLS. Magnesium supplementation makes it easier for leg muscles to relax. Treatment with vitamin D or magnesium dietary supplements with the advice and consent of your PCP or pharmacist are two options to consider if you are suffering from these types of RLS.

Holistic Therapies
For individuals with mild RLS symptoms, other holistic options include relaxation/stress management therapy, acupuncture, and abstaining from caffeine and caffeinated products, nicotine, and alcohol to help improve sleep, help reduce stress, and indirectly lessen symptoms.

Summary
If you are experiencing RLS-like symptoms and are concerned about what to do, the first step is to schedule an office visit with your PCP to get an accurate diagnosis. It is unwise and unsafe to self-diagnose and try various remedies without your PCP’s knowledge.

Finding Gluten-Free Nutrition, Dietary Supplements, and Medications

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Non-celiac gluten intolerance and celiac disease are becoming more common. Celiac disease is a chronic autoimmune disorder caused by a genetic intolerance to gluten. Non-celiac gluten intolerance is diagnosed in people who do not have celiac disease, but have intestinal or extra-intestinal symptoms related to ingestion of gluten-containing grains.

Both conditions are treated by avoiding gluten containing foods. Finding ‘gluten free’ nutrition is becoming easier to do, but eliminating gluten from one’s diet can be a complex and time-consuming process.

Gluten is the protein component of wheat (e.g., including spelt, kamut, semolina, and triticale), barley (e.g., including malt), and rye. When a person with celiac disease or non-celiac intolerance ingests gluten, specifically the antigenic gluten constituent called gliadin, it can cause intestinal inflammation, diarrhea, abdominal pain, bloating, weight loss, fatigue, and iron deficiency anemia. Food malabsorption and nutritional deficiencies result.

Over time, these conditions can cause liver disease, defective gallbladder emptying, and osteoporosis. Celiac disease may be a reversible cause of osteoporosis. Adherence to a gluten-free diet is one way to help suffers minimize overall symptoms and to maintain maximal bone mineral density.

For perspective, oats are considered a type of gluten grain, but do not have the antigen that other gluten grains above do. Thus, oats do not induce an immune reaction in the small intestine of people with celiac disease. However, many commercial oat products are contaminated with wheat, barley, or rye and it’s important to carefully read their labels. Look for products that are certified to contain less than 20 ppm of gluten (FDA’s ‘gluten free’ definition).

Consumption of as little as 10 mg-50 mg gluten daily can lead to a clinical relapse in people with these conditions. Celiac disease may increase the risk of developing some types of cancer (e.g., T cell lymphoma and intestinal adenocarcinoma) if gluten restrictions are not maintained or gluten intake is only partly restricted.

It is important to find out where gluten resides in foods. This means not only reading food labels on products you purchase for home but also on foods you consume from fast food establishments and restaurant dining. Soups, sausages, and ice cream may contain hidden amounts of gluten as fillers. Talk with your grocer and restaurant owners before you consume questionable food items.

Watch out for the gluten content in herbs, other dietary supplements, and medications.

Gluten-Free Foods
Consuming foods certified to be ‘gluten free’ will help keep the daily gluten total to under 50 mg and not cause symptoms for most people with celiac disease. Gluten-free grains include rice, millet, corn, quinoa, sorghum, and buckwheat. For more information, visit http://glutenfreecooking.about.com/od/gettingstarted/a/hiddengluten.htm
or http://www.glutenfreeliving.com/nutrition/ingredients.

Gluten-Free Herbs and Other Dietary Supplements
It would be impossible to find information about the gluten content in over 60,000 products on the worldwide market. One can contact dietary supplement manufacturers directly for more information on gluten content before taking any of these products, including vitamins.

Gluten-Free Medications
Over-the-counter and prescription medications may contain gluten in the list of inactive ingredients. For example, sweeteners used in medications may be hidden sources of gluten. Some manufacturers cannot guarantee their medications are gluten-free because the suppliers of raw materials can not do so, making it even more difficult for consumers to figure out what is safe to take and what is not.

A great resource for determining the overall ingredient content in medications, including whether or not gluten is present, can be found online at www.glutenfreedrugs.com .

Another online medication reference comes from the National Institutes of Health at www.dailymed.nlm.nih.gov. Go to the site, type in the generic name of the medication you want to review, then scroll down to the name of the manufacturer of that particular product, then click on ‘description.’ Scroll down to the inactive ingredients and look for gluten.

A third way to find more information about your medication’s gluten content is to call the medication manufacturer directly. Be sure to have the medication’s lot number available when you call.

Finally, click on https://www.ncbi.nlm.nih.gov/pubmed/?term=Gluten+content+of+the+top+200+medications+of+2009%3A+a+follow+up+to+the+influence+of+gluten+on+a+patient%E2%80%99s+medication+choices for “Gluten content of the top 200 medications: follow up to the influence of gluten on a patient’s medication choices” by AR King in Hosp Pharm 2013:48:736-43.

By Cathy Rosenbaum PharmD MBA RPh CHC

Grapefruit Interactions with Medication

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Certain prescription and/or OTC medications and dietary supplements may negatively interact with grapefruit juice, grapefruit, Seville oranges, pomelos, and tangelos due to chemicals in the fruits.

Fruit chemicals are thought to block enzymes in the body that metabolize medication in the small intestine, thereby causing the medication to hang around longer than expected. Interestingly, these fruits may also interfere with transporters in the body, causing medication to be less well absorbed into the bloodstream, and may reduce medication or supplement effects. Sound confusing? It’s complicated.

Product classes involved in unwanted interactions include, but are not limited to:

-Antihistamines (e.g., Allegra)
-Antianxiety
-Antihypertensives
-Cholesterol-lowering ‘statins’
-Corticosteroids for Crohn’s disease and ulcerative colitis
–Dietary supplements

Only some of the medications and supplements in each of the categories can be affected by the fruit/juices. Every person may react differently based on the amount of fruit they consume, the medication or supplement type/dose taken, and the individual’s natural ‘enzyme levels.’

Don’t worry, but do get educated about how and when to properly take your medications and supplements to be safe. Enjoy healthy nutrition. Talk with your pharmacist about what’s best for you!