DoctorShawn, Author at Dr Shawn

31/Oct/2017

Clinical Endocannabinoid Deficiency

Clinical endocannabinoid deficiency, (CED), was first introduced by Dr. Ethan Russo M.D. a neurologist, psychopharmacology researcher and former advisor to GW pharmaceuticals. The theory of CED is based on the concept that many neurological conditions are associated with neurotransmitter deficiencies, for example, a deficiency in dopamine with Parkinson’s disease. Subsequently, an endocannabinoid deficiency might be present in some disorders sharing predictable clinical features.

All humans possess an underlining endocannabinoid system governed by two primary compounds; Anandamide (AEA) and 2-Arachidonoylglycerol (2-AG). These are compounds naturally made in our body that interact with the same receptors marijuana and associated cannabinoids act upon. It is known through various studies that when endocannabinoid tone is decrease there is a lower pain threshold, disrupted digestion, mood and sleep disturbances. A deficiency of endocannabinoids can be caused by genetics, injury or disease.

Migraine

There is evidence for CED in several treatment resistant syndromes, most notably in Migraine, Fibromyalgia and Irritable Bowel Syndrome. All three present with: heightened pain sensitivity, mood disruption, and comorbidities. One study in chronic migraine sufferers discovered a statistically significant difference in endocannabinoid concentration within the cerebral spinal fluid of chronic migraine sufferers vs. non-migraine sufferers. With migraine there is a strong association between endocannabinoids and blood vessel dilation, a key component of the propagation of migraine. Furthermore activation of the CB1 cannabinoid receptor decreases pain fiber activity in the sensory nerves of the face and head.

It is worth noting that Cannabis was a mainstay treatment of migraine for a century between 1843 and 1943. A study from 2016 looked at the effects of medical marijuana on migraine headache frequency in adults. Headaches diminished from 10.4 to 4.6 attacks per month and overall 85.1% had decreased migraine frequency.

Fibromyalgia

Much like Migraine, Fibromyalgia is associated with hyperalgesia. In an uncontrolled trial of nine patients Tetrahydrocannabinol (THC) was administered in doses of 2.5-15mg a day for 3 months. Unfortunately 5 patients left the study early due to secondary THC side effects but those completing had marked reductions in subjective pain visual analog scales (VAS) 8.1 at start to 2.8 after 3 months. A survey of 1300 respondents called the National Pain Report from 2014 demonstrated that marijuana was the most effective treatment for Fibromyalgia compared to Duloxetine, Pregabalin and Milnacipran.

Cannabis most efficacious in Fibromyalgia

Irritable Bowel Syndrome

Another syndrome suspected of CED is Irritable Bowel Syndrome (IBS). The role of the endocannabinoid system in the gut is to regulate propulsion, secretion and inflammation. Cannabis was one of the first medications used for secretory diarrhea associated with cholera. A study done in 2007 demonstrated that endocannabinoids AEA and 2-AG influences the contractile force in the muscle fibers of the gastrointestinal tract. Studies also have demonstrated that there are increased levels of immunoreactive nerve fibers (TRPV1) causing pain and hypersensitivity in IBS. Cannabidiol (CBD) seems to increase AEA, which in turn reduces the activity of TRPV1. In 2007 a randomized control trial of 52 normal patients were given a single dose of 7.5mg THC. The outcome on the gastrointestinal tract was increased colonic compliance, inhibited postprandial tone, and a trend toward relaxation of fasting colonic tone.

There are a number of other conditions demonstrating evidence for CED, including motion sickness, Multiple Sclerosis, Huntington’s disease, Parkinson’s disease and Post Traumatic Stress Disorder (PTSD).

Conclusion

There is good evidence for disruption of the endocannabinoid system in Migraine, Fibromyalgia, IBS and many other neurological and psychiatric syndromes. Besides a wealth of anecdotal benefit, there exists some clinical evidence to support cannabinoids as a safe and effective treatment in these conditions. We also need to come to terms with the fact that effective medications are lacking in these conditions. An obvious shortcoming of past studies is the use of single cannabinoids for treatment such as THC. I am certain that future studies incorporating a more complete cannabinoid profile, including CBD, as a treatment approach will have far better outcomes and far fewer side effects. Lifestyle choices also play an important role in endocannabinoid function, specifically low-impact aerobic exercise. Multimodal approaches including diet, lifestyle and cannabinoid therapy will ultimately be the best approach in CED syndromes.

At my clinic I have repeatedly seen the benefits of cannabinoid therapy in these syndromes. After an initial assessment, if indicated, patients are referred to a medical cannabis clinic for registration under a licensed producer under the Access to Cannabis for Medical Purposes Regulations (ACMPR).

DoctorShawn

12/Sep/2017

Intermittent fasting is a different way of thinking about eating.

I’m suggesting that the majority of people have been eating too much and too often. I’m suggesting that breakfast is not the most important meal of the day. By following a few simple guidelines my readers can loose weight, feel great and be healthier than ever before. The guidelines are:

“6 to 8 and feel great”
“Eat what you need”
“Respect your food, respect yourself”

6 to 8 and feel great

Everyday eat within a 6 to 8 hour time frame. If you eat breakfast at 7:00am then your last meal of the day should not be later than 3:00pm. If you eat lunch at 12:00pm then your next and last meal should be no later than 8:00pm. In the first scenario you are basically skipping dinner and in the second scenario you are skipping breakfast. Water, tea, and even coffee are allowed outside of the 6-8 hour allotted time frame as long as there is no added calories, i.e. sugar, milk and or cream. There is also no snacking outside of your 6-8 hour window.

Now let me tell you why and how intermittent fasting works. Immediately after eating, a hormone in your body called insulin rises. Insulin tells your body to burn carbohydrates (sugar) for energy and to store whatever hasn’t been used in your liver and fat cells. This process continues for approximately 4 hours after eating. After 4 hours insulin drops and your body begins to dip into stored sugar and fat reserves for energy; or in other words that’s when you start burning fat.

It’s common practice for most people to eat 3 times a day with snacks in between, this means that we almost never dip into our fat stores. Therefore you would have to do some intensive daily exercise or eat incredibly small portions to loose weight. By following the 6-8 rule; you can almost be certain that you will be burning fat for approximately 10-12 hours per day. The only thing keeping you from shedding excess pounds is by being excessive with portion size and calorie intake, which brings us to the next guideline “eat what you need”.

Eat what you need

This guideline basically translates to portion control. One advantage about using the 6-8 methodology is that you will start becoming more in tune with your body and more aware of hunger and satiety. It is a great feeling to eat when you are actually hungry rather than out of habit. When we experience hunger, food is digested better. Hunger causes your gastrointestinal tract to prepare for food, including ample amounts of stomach acid aiding in the proper breakdown and absorption of nutrients.

Pay close attention to the point at which you no longer feel hunger and you are adequately satiated. Do not overeat. Eat to a point that you feel satisfied but not heavy and bloated. You may notice that portion sizes become smaller. Now, because we are eating only two meals per day, it is also important that when we eat, we eat nutritious food and a variety of foods. Which brings us to the next guideline.

Respect your food; respect yourself

This guideline is about what kind of food you eat and how you eat it. As mentioned in the previous section, since we are essentially eating only twice per day, we want to be putting high quality foods into our body. Fresh, local and organic foods are what you want to focus on. The great thing about this diet is that it there are no restrictions on foods, it’s more about quality. Try to have meals that have a good quality protein, and complex carbohydrates such as veggies and whole-grains.

While making healthy choices is very important, it is also just as important not to stress over your food. Do your best to cook healthy while acknowledging that sometimes you will find yourself eating out, ordering fast food, and having desserts. Don’t beat yourself up about the choices you make, love whatever it is your eating, own it and do your best to eat healthy most of the time. Love your food and love yourself.

Final Thoughts

The guidelines I have purposed, although expressed in an original way, are not new concepts. Eating within a 6-8 hour window is also known as intermittent fasting; a lifestyle and medical intervention that shown to have a multitude of health benefits including lowering blood pressure, staving off cardiovascular disease and improving longevity. Presenting these ideas in away that is easy to incorporate into a daily routine can help to improve the lives of many people. I encourage you to try it out, give it a few weeks and let me know how you feel.

Fitness trainer Mike O’Donnell (2 meal mike) does a great job of further explaining intermittent fasting and how to easily incorporate it into your daily routine. I encourage you to visit his site http://www.theiflife.com

DoctorShawn

23/Aug/2017

Relax an let go

We need to learn how to relax. Many great spiritual teachings and teachers have at some point arrived at a similar insight. At its essence it’s the importance of relaxation and letting go. A Chinese proverb states “Tension is who you think you should be, relaxation is who you are”. We spend an awful lot of time in a state of tension and many believe this to be a productive state, describing it as “good stress”. In reality, tension of the body and mind is a great inhibitor of creative thought and positive emotions.

Recently I underwent a quest of sorts with a good friend of mine in the wilderness of northern Ontario. We were both very lucky to have walked away from that experience with several insights. The most important lesson was that ones true self and ones ability to act with creativity, love and insight is most possible when the mind is able to let go and the body is able to relax.

Health

It is a fact that stress can negatively impact health if left unchecked. Stress affects the body, mood and behavior; it can cause headache, fatigue, insomnia, anxiety, depression and overeating. A Japanese study from 2002 examined 73,000 Japanese men and women, age 40-79, for two years. Men and women who reported a high level of perceived mental stress had between a 1.5 and 2 fold increase in the risk of stroke and congestive heart disease. [1]

In Kompier and Coopers 1999 publication, “Preventing Stress, increasing productivity: European case studies in the workplace”, the impact of stress related illness in the UK is estimated at an economic cost of 2.5-10 percent of the gross national product, with an estimated 30 million days lost due to stress related illness every year.[2] One can easily see that stress is an impeder rather than a supporter of productivity. Kompier and Coopers publication outlines a very technical analysis of strategies for preventing stress in the workplace; however, as a healthcare practitioner I see and understand the need for a simplified strategy that one can implement anywhere and at anytime.

Training

Thus I return to the idea expressed at the beginning of this article, namely to relax and let go. I can predict that many of you reading this are probably muttering to yourself “easier said than done” or something along that line, and you would be absolutely correct; it is! Experience has taught me that in order for the mantra “relax and let go” to stick it helps to have experienced a prolonged state of mental and physical stillness, awareness, or expanded consciousness. By sampling an elevated state of being one is able to better understand the benefit of a stilled mind and better equipped to return to awareness. Unfortunately it is one of those things that as Morpheus told Neo “you must see… for yourself”.

Many of you that have practiced meditation, living in the moment or even a transcendental occurrence through a near death experience or psychedelics may have a sense of what I am talking about. For the rest, step one is to capture a moment of stillness in order to sew the seed of relaxed awareness. For this I can suggest a few things:

Go into nature (nature emits a certain vibration that facilitates meditation, or at least filters out the hustle and bustle of modern mechanistic living).
Practice meditation (for centuries this has been the primary tool used to quiet and focus the mind and body)
Practice a paradigm shift (try to gain a new perspective on yourself and life by pondering a night sky, life itself and trying to live within the moment).
Respectfully and responsibly participate in a traditional healing ceremony (A sweat lodge or a ceremony incorporating herbal medicine, often psychedelics, is a centuries old practice traditionally lead through ritual. Psychedelics are traditionally used to promote expansion of consciousness and are gaining favor in modern medicine as possible treatment for PTSD and depression.) http://www.mwikwedong.com/?page_id=131 http://www.rollingstone.com/culture/features/how-doctors-treat-mental-illness-with-psychedelic-drugs-w470673

In order to train a muscle to act in a certain way you must implement repetition, a process known as muscle memory. It is the same with the mind, in order to train the mind to relax and let go you must repeatedly remind yourself to do this. I want to clarify that it is possible to practice this without prior experience in achieving states of expanded consciousness, it is just more difficult to maintain because you may lack the frame of reference as to what to return to and why to return to it. The persistent reminding of yourself to relax and let go may be facilitated with a strategy such as setting an alert on a phone, calendar or clock every 30 or 60 minutes. Ultimately you will find a method that works best for you.

The take away message from this discussion is that we can all be more productive, better listeners, more creative, more loving and more aware when we relax and let go. The “relax and let go method” is simple and can be practiced anywhere, you just simply have to remind yourself to relax and let go. It helps when you have a frame of reference as to what a truly relaxed state of mind and body is; however, it’s not necessary and with enough practice you will get there. There is no trying with this method, it is in essence the complete opposite of trying, one just has to remember, over and over, to relax and let go, relax and let go. https://doctorshawn.ca/about-me/

[1] https://doi.org/10.1161/01.CIR.0000028145.58654.41

Circulation. 2002;106:1229-1236

Originally published August 12, 2002

[2] https://books.google.ca/books?id=OFsSz45OxewC&lpg=PR11&ots=S64R_GVnY2&dq=stress%20and%20productivity%20in%20the%20workplace&lr&pg=PP1#v=onepage&q=stress%20and%20productivity%20in%20the%20workplace&f=false

DoctorShawn

25/Oct/2016

THC and CBD the ABC’s of Medical Marijuana

The perspective of a Naturopathic Doctor

As a practicing Naturopathic Doctor, I have understandably been occupying a front row seat in what has become one of today’s hot topic health issues; the use of medical marijuana. I have seen a trend recently in my patients; they’re dropping the conventional pain medications and experimenting with the unquestionably still taboo, cannabis. Two things seem to be driving this phenomenon: traditional pain medications aren’t doing the trick anymore and there is a curiosity about this promising although misunderstood plant.

Professionally, I too have been very curious about the medical applications of marijuana. For years patients would confide in me and share their experiences with using different preparations of cannabis. One of the usual preparations is “hemp oil”, which can contain a significant amount of a cannabinoid called CBD. Hemp oil may have been dismissed as folk remedy; however, with the recent surge in medical marijuana use prompting an educated examination of a potential effective therapy. I can now appreciate that hemp oil is a way to reap the benefits of cannabis without getting intoxicated.

There are thousands of articles on the web that explain in depth what the different components of marijuana are and how they differ in pharmacology and therapeutic applications. The point of this article is not to give a thesis but rather present a concise easy to grasp understanding of what those components do in the body and why cannabis in one form or another should be considered as a first choice medicine.

Before presenting the different types and components of marijuana, I would like to give this article some context and legitimacy by introducing myself, and my medical background. I am a Naturopathic Doctor and have been in private practice for just over 7 years in Toronto Canada. Over the past 4 years my practice has focused on the treatment of pain, debilitating neurological conditions and cancer. This really sets the stage as the first few regulated cannabis medications in Canada, namely Nabilone and Sativex, were approved for neuropathic pain, spasticity and nausea associated with cancer treatment and multiple sclerosis; both of which I see more consistently than the average naturopathic doctor. Naturally I started having patients that had experience with these medications or who were experimenting with unregulated forms of cannabis.

A watershed moment in my practice occurred when I began treating a 10-year-old girl that had suffered a stroke. I thought she would benefit from cannabis but at the same time was hesitant about subjecting her to the hallucinogenic properties of THC. Fortuitously around that very same time I viewed a CNN Sanjay Gupta report about a low THC / high CBD strain of marijuana called “charlottes web”. Treatment with this strain had been helping a young girl with a rare debilitating condition associated with frequent seizures. My young patient didn’t have seizures but had chronic high muscle tone as is also seen during seizures. The report also mentioned how CBD is not hallucinogenic. I was certainly intrigued as to the potential efficacy of this treatment and devoted both time and resources in understanding medical cannabis and CBD. As a result of this study and promising results, I now recommend CBD regularly in my practice. Now let’s take a step back and understand what CBD is and what does it do.

Although there are thousands of potentially therapeutic compounds in cannabis, research has really focused on two: THC and CBD. Depending on the sex and strain of the cannabis some will be higher or lower in one compound than the other.

THC is what gets you high. It acts on cannabinoid receptors in the body and brain with the result of inducing the perception altering experience that marijuana is known for. Along with the “high”, research has pointed out that there are definite pain lowering and mood enhancing properties of THC. However; there are some concerns with THC as it may impact learning in the developing brain, may trigger a psychotic episode in individuals predisposed to schizophrenia and impacts the users ability to carry out daily living tasks such as operating machinery and driving.

CBD, on the other hand, is a non-psychoactive component of cannabis that can comprise up to 40% of the active cannabinoids in marijuana. Although large doses of CBD in my experience can induce an intense feeling of relaxation there are no perception altering effects from even the highest doses of CBD. Research into this curious compound has pointed out that rather than binding to cannabinoid receptors in the body, as does THC, CBD for the most part blocks activity at these receptors and exerts most of its effect at a receptor called 5-HT1a. The 5-HT1a-receptor is linked to serotonin activity.

The overall effect of CBD in the complicated milieu of the human body is that it is anti-inflammatory, mood enhancing, offers protection for the nervous system, promotes relaxation, anti-spasmodic and negates some of the unwanted side-effects of THC consumption. CBD has even been shown to prolong the beneficial effects of THC by increasing the body’s amount of cannabinoid receptors. Furthermore, there has yet to be any evidence for negative side effects or toxicity even at very high doses of CBD per day. CBD research is currently exploring promising therapeutic effect in epilepsy, dementia, migraine and cancer. So all in all it’s a pretty impressive compound.

Now you may be wondering; “how do I get CBD?” – do I need a prescription and is it legal? Technically in Canada any derivative of Marijuana including THC and CBD is classified as a schedule 2-drug and can only be legally obtained with a prescription from a medical doctor. Personally I find it frustrating that Naturopathic Doctors, who receive 4 years of training in botanical medicine, are restricted from prescribing marijuana (a botanical last time I checked) whereas the responsibility falls on medical doctors who typically have no training in prescribing botanical preparations. Fortunately hemp, which is part of the cannabis family, is high in CBD, low in THC and in some cases legal (The legality of the extraction depends on factors such as THC levels and what part of the plant is used).

There are now many companies which specialize in CBD preparations derived from hemp and do not require a prescription from a medical doctor. Unfortunately the CBD on the market continues to be a bit pricey per milligram ($1/10mg) since a therapeutic dose often starts at around 40mg all the way up to 200mg per day. Hopefully in the future we will start to see some higher potency, cheaper preparations of CBD.

As a Naturopathic Doctor, I offer the following personal and professional perspective to both botanical medicines as a whole and specifically CBD. Medicines derived from whole botanicals are a complex collection of thousands of compounds. Often we really only have an understanding of a few of those compounds and that is what disorients many practitioners, especially medical doctors. However, I believe we should appreciate the complexity of botanical medicines precisely because our own physiology is just as complex. Pharmaceutical preparations are very specific in their composition and action in the body. Our bodies are not built that way and that is why we often see side effects with pharmaceutical preparations.

Certainly I do not claim that there are no side effects with botanical medicines, but it is a fact that there are far fewer. Pharmaceutical medicines have a definite time and place in specific treatment but we should not be frightened to use botanical medicines because it is their complexity that often make them safer for prolonged use proving for a more balanced therapeutic effect.

During my relatively short period of recommending CBD, I have seen the benefits in: Pain, Sleep, Focus and Rigidity. I work with a great deal of patients who have suffered from neurological injuries (Spinal cord injury, brain injury, stroke) and neurological disease (Multiple Sclerosis, Transverse Myelitis, Chronic Regional Pain Syndrome, Migraine, Fibromyalgia). I have witnessed more than half of these clients taper down or completely come off of several pain medications including addictive opioid medications and manage their symptoms more effectively with a combination of THC and CBD.

I have a number of patients who after several years of insomnia return to a normal sleep pattern with a therapeutic program that includes CBD. Many of my clients with high tone and muscle rigidity experience a relaxation response within minutes of taking CBD. In fact patients will often take a dose of CBD during a treatment session and will see the effects immediately. I have several patients tell me that since starting CBD their thinking has been clearer. I even have one patient who has told me that her vision is clearer, which makes sense in the context of inflammation of the optic nerve often experienced in multiple sclerosis.

As a Naturopathic Doctor it is my job to be on top of the latest research and treatment-options within the realm of nutraceuticals, complimentary therapies and herbal medicines. CBD is an exciting new treatment option with an excellent safety profile, promising results and that fits in well with my patient population. I am proud to an advocate for medical marijuana and have made a commitment to continue to update my patients and peers as to my clinical experience with CBD.

DoctorShawn

02/Mar/2016

There are few fruits more enticing than the jewel-like arils (seed casings) of pomegranate. Adding to the allure of pomegranate are its incredibly versatile culinary applications and its amazingly powerful medicinal properties.

The fruit we know as Pomegranate comes from the deciduous shrub Punica Granatrum. The Pomegranate is native to Iran, The Himalayas and Northern India. An ancient fruit mentioned as early as Iron-Age Greek Mythology; pomegranate is now cultivated in many warm and dry climates around the world. In the northern hemisphere the fruit is typically in season from September to February. There are many culinary uses for pomegranate. The sweet and sour juice has long been a popular drink in Persian and Indian cuisine and has recently become familiar to consumers in Canada and the United States. The cocktail mixer, Grenadine, is a syrup made from sweetened and thickened pomegranate juice. Pomegranate can also be used to create delicious sauces. For instance, in the traditional Iranian recipe, Fesenjan, a thick sauce is made from pomegranate juice and ground walnuts. Pomegranate arils are also great to eat on their own. After opening up the pomegranate, try separating the arils from the pulp in a bowl of water. The pulp will float while the arils sink to the bottom of the bowl.

Pomegranate is an important traditional remedy in many ancient systems of medicine. In Ayurvedic medicine the rind of the fruit is used against diarrhea, dysentery and intestinal parasites. It is now known that the rind contains ellagitannins that are anti-parasitic, anti-inflammatory and astringent (helping to stop diarrhea). The medicinal applications of pomegranate that ancient medical systems have known about for centuries through empirical evidence is now being validated through scientific investigation.

Recently a multitude of studies has surfaced outlining pomegranates therapeutic application in areas such as: cancer therapy, cosmetics, rheumatology and cardiology. The following is a summary of some of the most recent research on pomegranates application in these medical topics.

In 2009 the journal “Nutrition and Cancer” published a review on cancer chemoprevention by pomegranate. In the review the authors outline recent research showing that pomegranate polyphenol extracts selectively inhibit the growth of breast, colon and lung cancer cells in culture. The review also demonstrated that in pre-clinical animal studies, oral consumption of pomegranate extract inhibited the growth of lung, skin, colon and prostate tumors. As far as human trials go, an initial phase 2 clinical trial of pomegranate juice consumption in patients with prostate cancer reported significant prolongation of prostate specific antigen (PSA) doubling time. This means that the pathological growth and disruption of normal functioning prostate tissue was likely decreased. PSA doubling time can be a useful tool in the screening and monitoring of prostate pathology in men, but has to be interpreted in the correct context and by a trained health care professional.

An excellent article was recently published on the topic of PSA in the November 2010 issue of Naturopathic Doctors News and Review (ndnr). Research would suggest that pomegranate has potential application in the field of natural cosmetics. A study in the “International Journal of Dermatology” demonstrated that a polyphenol extract of the rind fruit and seed of pomegranate protected skin cells against UV-B radiation induced skin damage and increased the synthesis of collagen. Collagen is a connective tissue closely related to cartilage; the shock absorbing cushion found in joints. Interestingly, a recent study in the journal of “Arthritis Research and Therapy”demonstrated that pomegranate extract has the ability to inhibit chemical messengers involved in the breakdown of cartilage, as well as decreasing inflammation often seen in osteoarthritic joints.

Since ancient times, Pomegranate has been known as a tonic for the cardiovascular system. I often prescribe a glass of pomegranate juice per day as adjunctive treatment for high blood pressure. The rich red color of pomegranate juice suggests that it is high in polyphenol rich antioxidants. There is great concern in patients at risk for cardiovascular disease for the development of atheroscelrotic plaques. In summary, atheroscleortic plaques develop when lipoprotein (fat transporting protein) becomes oxidized by free radicals and are subsequently attacked by the immune system. The combination of oxidized lipoproteins and immune cells create pimple-like outgrowths in the artery wall, blocking blood flow. LDL-cholesterol (often referred to as bad cholesterol) is not bad in of itself, it is the action of free radical damage on LDL-cholesterol that makes for trouble. Antioxidant-like molecules produced by the body such as PON1 and PON2 protect against atherosclerotic development. A study in the England journal “Biofactors” demonstrated that the polyphenols in pomegranate juice increase the production of PON1 and PON2 therefore helping to decrease the risk of forming atherosclerotic plaques. These studies suggest that molecules called polyphenols found in pomegranate juice, rind and seed have multiple benefits on health. It is our luck that pomegranate arils and juice are delicious and can be easily incorporated into the diet. Unfortunately it is impossible to know exactly how rich the polyphenol content is in the pomegranate or pomegranate juice you buy. However, a good rule of thumb to ensure that you get a good dose of polyphenols is to pick fresh, brightly colored, organic if possible; pomegranates. When buying juice, make sure that it is 100% pure pomegranate juice. A great website on how to pick and prepare pomegranate is www.pomegranatefruit.org

DoctorShawn

21/Nov/2015

In this months edition we shift gears slightly to focus on a “super-food” most commonly found in the form of a dietary supplement; Spirulina.

Spirulina is a cyanobacteria; meaning that it’s a bacterium which derives its energy through photosynthesis. Cyanobacteria are also commonly known as blue-green algae. Spirulina is commonly made from two strains of cyanobacteria: Arthrospira platensis and Arthrospira maxima. Although now cultivated around the world, spirulina is found naturally growing in only three lakes: Lake Chenghai (China), Lake Chad (Africa) and Lake Texcoco (Mexico).

Spirulina is available at most health food stores in the form of powder, flake or tablet. Much like Quinoa, Spirulina is a complete protein source, containing all essential amino acids. It is also a source of essential fatty acids and is one of the only vegan friendly reservoirs of the omega-3 fatty acids EPA and DHA. Spirullina’s blue-green pigment is an indicator that it is rich in vitamins and other beneficial anti-oxidants. These antioxidants include, but are not limited to: beta-carotene, zeaxanthin, and chlorophyll. The unique blend of antioxidants found in spirulina make it a fascinating health promoting supplement, which has demonstrated benefit in the treatment of HIV, brain health, heavy metal chelation, cardiovascular disease and allergies.

The Journal of Nutritional Science and Vitaminolgy published a paper that investigated the effect of supplementing rats prone to the development of cognitive disease , similar to Alzheimer’s disease, with spirulina. Alzheimer’s disease is characterized by the deposition of amyloid beta-protein, which is thought to “gum up” the functioning of neurons in the brain. The rats studied were bred to be prone to the deposition of amyloid beta-protein. One group of rats received daily supplementation of 50mg/kg spirulina, another group received 200mg/kg spirulina and the third group did not receive spirulina. Analysis of the rat brains (poor rats) demonstrated a reduction in amyloid beta-protein in both spirulina treated groups. There were also lower levels of oxidative damage in the brains of spirulina treated rats. Therefore spirulina may be a beneficial supplement for the prevention of Alzheimer’s disease in genetically prone individuals.

Back in 1998 a paper was published that investigated the effect of spirulina extract on the growth of HIV in human white blood cells. It was found that extract concentrations ranging between 0.3-1.2 micrograms/ml reduced the growth of HIV by 50%. The authors concluded that spirulina may be a potential agent used for the treatment of retroviruses like HIV.

Aside from a runny nose, itchy eyes and sneezing, seasonal allergies are characterized by a relative increase in white blood cells known as TH2 cells. One of the ways TH2 cells increase and cause allergy is by a messenger molecule in the blood called interleukin 4 (IL4). In 2005 the Journal of medicinal food published a study that looked at the blood of individuals with allergic rhinitis before and after supplementing with spirulina. The study was a placebo controlled randomized crossover trial where individuals either received 1g, 2g spirulina or placebo daily for 12 weeks. The blood samples at 12 weeks found that 2g spirulina per day reduced IL4 levels by 32%.

Environmental medicine is an exciting emerging field of medicine that looks at how toxins in our environment effect our health, and more importantly how to protect ourselves from the harmful effects of environmental toxins. There are few natural substances that have demonstrated an ability to promote the excretion of some of these harmful toxins, spirulina is one of them. A study published in 2006 looked at the effect of a spirulina and zinc supplement on individuals in Bangladesh chronically exposed to the toxic metal arsenic. These individuals were given 250mg spirulina extract and 2mg zinc twice daily for 16 weeks. There was a increase in urinary excretion of arsenic (detoxification) at 4 weeks which continued for an additional 2 weeks in individuals taking the spirulina zinc combo. At 16 weeks the spirulina plus zinc combo removed 47.1% arsenic from scalp hair (one of the ways to test for arsenic exposure is through hair analysis), whereas results from placebo were not statistically significant. Other studies have shown that spirulina may also chelate (remove) iron, which can be useful for individuals with toxic amounts of iron in the body but may be counter productive for individuals taking an iron supplement.

It seems that a large part of the health benefits seen through the use of spirulina are due to its unique blend of antioxidants. A laboratory study discovered that cells exposed to harmful chemicals had 4-5 times less apoptosis (cell death) when treated with an aqueous extract of spirulina. Another study demonstrated that a diet supplemented with 0.1% spirulina protects against inflammation and oxidative damage in brain neuronal cells. This same studied showed that spirulina increased the proliferation of neural stem cells which have the ability to replace damaged cells. Spirulina is therefore a promising natural supplement for the field of neural and cognitive health.

A study published in the november 2007 edition of the journal: Lipids in Health and Disease, investigated the effect of spirulina supplementation on cholesterol and blood pressure. Thirty six men and women had blood cholesterol levels and blood pressure measured before the study. They were supplied with 4.5g/day spirulina for 6 weeks. There were no other changes to diet and exercise. After 6 weeks total cholesterol levels decreased by approximately 20 mg/dl, tracylglycerides decreased by approximately 60 mg/dl and HDL (good cholesterol) increased by approximately 10 mg/dl. Systolic and diastolic blood pressure also decreased in participants by approximately 10 mmHg. With all the health promoting benefits of spirulina, it is important to consider a few things before taking this medication. As with every supplement, allergy can occur so be careful to monitor and possible allergic symptoms when taking spirulina for the first time. Spirulina contains the amino acid phenylalanine, which can be harmful for individuals who cannot metabolize this amino acid known as phenylketonuria. Since spirulina is a water born blue-green algae it is important that it is not sourced from a contaminated water source. I would recommend going with a reputable supplement company. Spirulina is a very promising natural dietary supplement whose beneficial effects can be seen in almost every organ system in the body. These effects are likely due to its unique blend of antioxidants. Use this supplement with necessary caution and remember that in nature there exist both beneficial bacteria and harmful bacteria, a naturopathic doctor can help to explain the difference and point you in the right direction toward optimal health.

DoctorShawn

03/Nov/2015

Like a fine wine, Pu-erh is a variety of tea that is often better with age. Pu-erh is a post-fermentation tea, typically produced in the Yunnan province of China. The tea derives its name from Pu-er county in Yunnan, where trading of this fermented tea took place during imperial China. Pu-erh tea begins it’s life much like green tea but undergoes the process of pressing (compacting the tea into round or brick-like shapes) and then fermentation. Raw Pu-erh has not been artificially fermented and therefore must be aged for several years allowing bacteria and fungi to slowly act of the tea leaf breaking down and transmuting many of the compounds and enzymes in the tea. Ripened Pu-erh is a relatively recent invention where the tea leaf undergoes special processing to mimic aged Raw Pu-erh. Moisture, heat and rotation are some of the conditions employed on the tea in order to accelerate the process of fermentation. A good Pu-erh requires the right amount of aging and the right strains of bacteria and fungi for fermentation. The taste is distinctively earthy with many subtleties.

Much like wine, Pu-erh tea ranges in its quality and vintage. Pu-erh can range from 3-months to 100 years old. Most enthusiasts will agree that the very young or the very old Pu-erh is the best, the middle years are sometimes referred to as “awkward”. Usually a raw Pu-erh will start to develop it’s mature taste after 5 years of aging. Buying Pu-erh can be difficult for the westerner as most authentic Pu-erh (must come from Yunnan to be considered authentic Pu-erh) has little to no english on the package. The best way to ensure that you are getting the quality you’re interested in is to develop a relationship with a tea distributer or manufacturer who is knowledgeable on the subject. There is a Pu-erh out there for every palate and every pocketbook.

Pu-erh tea has been a favourite of monks and is a common ingredient of many health promoting elixirs in China. The fermentation process endows this tea with slightly different compounds than green or black tea and therefore deserves its own scientific investigation. When tea undergoes fermentation, such as is the case with Pu-erh, some health promoting compounds are lost (such as catechin antioxidants); however, others are gained. Recent research has revealed that the concentration of gallic acid (an anti-microbial), a compound called theabrownin, various polysaccharides and enzymes are increased in fermented tea.

Scientific studies performed in the last decade have demonstrated Pu-erh tea to have antimicrobial, fat busting and cholesterol reducing properties. The Journal of Agricultural Food Chemistry published a study demonstrating that a Pu-erh tea extract (PTE) had an antiviral effect on hepatitis B virus (HBV). The PTE had the ability to suppress the replication of virus DNA, while also exerting antioxidant effects inside cells affected by the virus. The researchers could not pinpoint the exact components that made PTE effective but conclude that it is likely due to a combination of compounds working together. The importance of this study is enhanced due to a small amount of substances currently available to treat HBV.

The journal Nutrition Research published a research paper in June of 2011 investigating the weight reducing effects of Pu-erh tea extract. 36 pre-obese Japanese adults were followed in a 12-week double blinded placebo controlled comparison study. The subjects ingested a barley tea with or without PTE (333mg) before each of three daily meals. The group taking PTE had a reduction in weight and body mass index (BMI) compared to the placebo group. The reductions in weight and body mass were only evident after 8-weeks on the PTE. Computed tomography demonstrated the the PTE group had a significant reduction in visceral fat after 12 weeks. There were no adverse reactions in the PTE treated group. The authors speculate that the weight reducing properties of PTE may be due to the high gallic acid content since prior research has demonstrated gallic acid to have anti-obese effects in animals.

Theabrownin (TB) is another compound found exclusively in Pu-erh tea that has recently been shown to have cholesterol and fat lowering properties. A study in 2010 demonstrated that increases in triglycerides, total cholesterol, LDL cholesterol and decreases in HDL cholesterol (also known as good cholesterol) were prevented in rats who were fed a high fat diet and supplemented with TB versus rats fed a high fat diet with no supplemental TB. The content of cholesterol and bile-acids found in the feces of the rats with supplemental TB was significantly higher than that of those rats with no supplemental TB. This suggests that TB could promote the transformation and excretion of dietary cholesterol. Therefore, TB and Pu-erh tea may be a promising supplement in the treatment of high cholesterol.

For centuries, Pu-erh tea has been touted as a great digestive aid. A scientific study in 2010 investigated the molecular composition of polysaccharides isolated from Pu-erh tea. Due to the fermentation process the content of water soluble polysaccharides was increased as well as the content of digestive enzymes including: cellulase, pectinase, and glucoamylase. In theory these enzymes may aid with the the digestion of certain foods when taken with a meal, thus reducing gas and bloating.

While all tea (Chamellia Sinensis) has health promoting qualities, different ways of preparing tea, endow it with slightly different properties. Recent research suggests that the fermentation process that Pu-erh tea undergoes gives this tea a slightly higher complement of gallic acid, polysaccharides and hydrolase enzymes. These compounds have been demonstrated to be useful in weight reduction, intestinal gas reduction and as an antimicrobial. There are no reported adverse effects with drinking this tea aside from those associated with caffeine intake. If you choose to age Pu-erh yourself, many experts recommend a clay pot (to allow the tea to breathe) and to store in a cool dry place away from other odours (as tea will take on odour it is exposed to). If in a compacted form, the tea can be broken up with a knife “called activating the tea” if stored for short term but should be kept in compacted form if storing for over 5 years. The consumption and collection of Pu-erh can quickly become a healthy hobby.

DoctorShawn

13/Oct/2015

Title: Reduction in symptoms associated with Fibromyalgia at six weeks using Intravenous Vitamins and Minerals (Myers Cocktail).

Running Header: Myers Cocktail for Fibromyalgia

Author: Dr. Shawn Meirovici N.D.

Physio-Logic 96 Scarsedale Road, Toronto, Ontario, M3B 2R7

Disclaimer: Patient consent was obtained

Key words: Intravenous, Vitamins, Minerals, Fibromyalgia

Abstract: Fibromyalgia is a musculoskeletal disorder characterized by widespread pain commonly with one or more coexisting symptoms. Treatment often includes both non-pharmacological and pharmacological therapy. Pharmacological therapy includes the use of antidepressants and GABA derivatives with varying success rates and often with unpleasant side effects. Micronutrient infusion is a newer approach with the majority of use in the field of alternative medicine. To date one placebo controlled pilot study has examined its use in fibromyalgia patients noting statistically significant effects on pain and fatigue. The following is a case study using a similar “cocktail” as the one used in the placebo controlled trial, for 4 treatments using the modified visual analogue scale of the fibromyalgia impact questionnaire (mVASFIQ) as an endpoint measure. Significant reduction in all parameters of the mVASFIQ was noted at 6 weeks, suggesting that micronutrient infusion should be further investigated as a treatment approach for fibromyalgia.

Background: I have a special interest in the treatment of chronic pain. Operating out of a rehabilitation clinic in Toronto, Canada has allowed me the opportunity to work with neurological conditions and traumatic injuries of which chronic pain is often a prevalent symptom. Fibromyalgia is characterized by chronic widespread pain and often involves disruption of many body systems including the gastrointestinal tract. While pharmaceutical intervention is focused on regulating the body’s response to pain, many alternative therapies are focused on restoring function to debilitated body systems. One such treatment is the Myers Cocktail: a intravenous micronutrient therapy that delivers vitamins and minerals directly into the blood stream thereby bypassing the gastrointestinal tract. There is both a review and placebo controlled pilot study demonstrating intravenous micronutrient therapy as an effective treatment for symptom reduction in fibromyalgia. [1] [2]

Introduction: Fibromyalgia is characterized by chronic widespread pain, increased tenderness at specific sites known as “tender points,” un-refreshing sleep, fatigue and cognitive dysfunction not attributable to other disease states. While the etiology of fibromyalgia is not entirely clear, associations with trauma, adverse life events, impaired mood, anxiety, irritable bowel syndrome, cold intolerance, paresthesias and other medical conditions have been described. The pharmacologic treatment of fibromyalgia ranges from antidepressants to analgesics. Here we are commenting on a novel treatment involving the infusion of vitamins and minerals also known as a Myers Cocktail.

Case Presentation: J.M. is a 38-year old female who had been diagnosed with fibromyalgia in 2008. Her symptoms started approximately 10 years ago after enduring a series of traumatic life events. Symptoms included: chronic widespread pain, non-restorative sleep, muscle weakness, morning stiffness, subjective swelling, multiple chemical sensitivities, frequent severe headaches, vestibular dysfunction, TMJ, paresthesia, chronic fatigue, dysmenorrhea, anxiety and irritable bowel syndrome. J.M. had tried a number of GABA derivatives, antidepressants and analgesics with varying degrees of relief but with significant adverse reactions including aphasia, depression and dyspepsia. At initial presentation, J.M. was taking Wellbutrin 300mg XL daily and Tylenol with Codeine as needed. She felt that she was starting to develop a tolerance to Wellbutrin. She was not taking any dietary supplements and was not on any type of specialized diet or exercise program.

J.M. was prescribed an intravenous infusion Myers Cocktail (B-complex 1ml, Dexpanthenol 250mg, Pyridoxine 100mg, Hydroxocobalamin 1mg, Ascorbic Acid 2000mg, Calcium Chlroide 100mg, Magnesium Chloride 1000mg and Sterile Water 46ml) via 60cc syringe with a 24 Gauge butterfly needle at the right median cubital vein, delivered over 15 minutes once per week for 4 infusion sessions. This patient completed a modified visual analogue scale of the fibromyalgia impact questionnaire (mVASFIQ) at initial consult (Image 1) and again after her final infusion (Image 2). She was also prescribed magnesium malate 1.5 grams per day, 1000iu vitamin D per day and 1mg melatonin at night 30 minutes before sleep. However, J.M. was admittedly not taking these supplements consistently during the 4 weeks of intravenous treatment.

The mVASFIQ score at treatment initiation was: (Fatigue 9.5, Insomnia 9.5, Depression 4.5, Anxiety 6.5, Rigidity 8.5, Pain 8.5, Difficulty with work 8.5) at four weeks the mVASFIQ score was: (Fatigue 3, Insomnia 5, Depression 1, Anxiety 3, Rigidity 3, Pain 3, Difficulty with work 3). Besides mild nausea and flushing during the first treatment no adverse effects were reported.

Discussion: Micronutrient infusion delivers vitamins and minerals involved in stress response, muscle contraction and nerve signaling, while able to bypass the need for gastrointestinal absorption. This is an effective delivery method for chronic conditions, such as fibromyalgia, where there is often gastrointestinal disruption as well as the potential for micronutrient deficiencies. The results of this case study demonstrate that micronutrient infusion Myers Cocktail may be an effective treatment for fibromyalgia related symptoms as indicated by a decreased in symptoms score on mVASFIQ at 6 weeks post treatment. This joins the small collection of evidence for the validity of this treatment for fibromyalgia. More study into this treatment for fibromyalgia is warranted.

Confounding Factors: As was outlined in the treatment plan, J.M. received a few dietary supplements on initial consult; however, J.M. admitted to not taking these consistently throughout the 4 intravenous treatments. The patient received all 4 infusions by myself and was not blinded to the treatment. There was also no placebo control. Additionally, the patient may have been influenced by the doctor patient relationship or through placebo effect. However the significant improvement observed within a relatively short time helps to validate the results of this study.

[1] Intravenous Micronutrient Therapy (Myers’ Cocktail) for Fibromyalgia: A Placebo-Controlled Pilot Study, Ather et al., The Journal of Alternative and Complementary Medicine, Volume 15, Number 3, 2009, pp. 247-257

[2] Myers’ Cocktail, Dr. Alan Gaby M.D., Alternative Medicine Review, Volume 7, Number 5, 2002.

Image 1

mVASFIQ for J.M. on July 18^th 2015 (patient incorrectly marked X in box rather than a check through the appropriate line, therefore, results have +/- 0.5 confidence interval.

Image 2

mVASFIQ for J.M August 28^th 2015.

DoctorShawn

28/Sep/2015

Pumpkin is a gourd-like squash of the Cucurbitaceae family. The origin of the pumpkin is not definitively known although it is thought to have originated in North America. Pumpkin is a very versatile food; almost every part of the vegetable is edible (shell, seeds, pulp, leaves, flowers). Although the taste and uses of pumpkin as a food may be common knowledge, especially around this time of year, the medicinal properties of pumpkin can often be overlooked.

The color of pumpkin can be attributed to the pigmented carotenoids beta and alpha carotene, the latter of which generates vitamin A in our body. Pumpkin also contains lutein making it an excellent menu choice to maintain eye health. Pumpkin seeds are often roasted and make an excellent snack in the fall and wintertime. Pumpkin seeds have many health benefits, which include a good source of zinc, tryptophan, magnesium, manganese, phosphorous and phytosterols. These nutrients help to promote immune system, cardiovascular, and reproductive health.

Diabetes

There have been several studies over the past decade investigating the effect of extracts of pumpkin on diabetes. One of the most recent studies found that mice who were fed a pumpkin paste concentrate maintained a lower blood sugar level than the control group. The authors were able to isolate two compounds from the pumpkin paste (trigonelline and nicotinic acid) which seem to have an ability to regulate enzymes involved in triglyceride accumulation and the progression of diabetes.

Another study, looked at a major complication of diabetes; kidney damage, and whether pumpkin can be used to prevent its progression. This 2010 study in the journal of Food Chemical Toxicology used a mixture of flax and pumpkin seed in the diets of rats with alloxan-induced diabetes. The flax and pumpkin seed mixture was able to quench free radicals and increase the level of antioxidants in the blood of the diabetic rats. Furthermore, on kidney biopsy, rats fed the seed mixture had less glomerular hypertrophy and tubular dilatation, meaning healthier kidneys.

Prostate

The application for pumpkin seed oil in prostate health has been a popular topic of scientific investigation. A recent double blind placebo controlled trial investigated the efficacy of supplementation of pumpkin seed oil and saw palmetto oil in middle-aged Korean men with benign prostatic hypertrophy (BPH). The trial was performed over 1 year on 47 patients with BPH. The patients received either potato starch (320 mg/day), or pumpkin seed oil (320 mg/day), or saw palmetto oil (320 mg/day) or a mixture of both pumpkin seed and saw palmetto oil (320 mg/day). The groups taking pumpkin seed and saw palmetto oils all saw a decrease in symptoms and an increase in quality of life after 3 months. Serum prostate specific antigen (a laboratory marker of prostate pathology) was reduced in the group taking a mixture of pumpkin and saw palmetto oil after 3 months. Urinary output (which is obstructed in many cases of BPH) improved in both the group taking pumpkin seed oil and the group taking saw palmetto oil at 6 and 12 months respectively. The study concluded by saying that pumpkin seed oil and saw palmetto oil supplementation is clinically safe and may be used as an effective complementary therapy for BPH.

When ripe, pumpkin can be boiled, baked, steamed or roasted. It can be eaten mashed or as a base for soups, purees and pies. I hope that you now see a whole world of possibilities for this incredible orange vegetable. Pumpkins are lonely after Halloween, so take one home and experiment in the kitchen.

Links

Pumpkin may be a good addition to the plate for Diabetes. Be sure to include exercise into any successful type 2 diabetes treatment protocol.

Check out this article on Exercise and Diabetes

DoctorShawn

10/Sep/2015

Apple is the fruit from the tree Malus Domestica, a member of the rose family (Rosaceae) which also includes Peaches. The apple tree originated in western asia and was brought to north america in the 17th century.

Thousands of years of cultivation has lead to many varieties of apples differing in texture and taste. I personally enjoy Russet for its sophistication of flavor and Honey Crisp for its crispy sweetness. The wide variety of apples make them a great fruit to enjoy on their own or to prepare into other foods. Apples are now in season, making it a great time to go to a local orchard and experience the taste of a freshly picked apple.

The proverb “an apple a day keeps the doctor away” dates back to 19th century Whales. There are many healthy compounds found in apples, such as: antioxidants, fiber, vitamins and minerals. Recent research has focused on investigating the health benefits of the polyphenols found in apple peel.

A study published in the Journal of Pharmacology in July of 2010 demonstrated that an apple peel polyphenol extract (APPE) protected colorectal cells against the cytotoxic effects associated with consumption of the anti-inflammatory drug indometacin. APPE was shown to have free-radical scavenging ability, preventing mitochondrial (the energy production center of the cell) oxidative damage induced by indometacin.

A study in the Journal of Agricultural Food Chemistry in June 2010 revealed that APPE may have a role to play in the treatment and prevention of H. pylori infection. The study concluded that doses of 150 and 300 mg/kg/day of APPE showed an inhibitory effect on H. Pylori attachment to the stomach lining. Furthermore, APPE also showed an anti-inflammatory effect on H. Pylori associated gastritis.

The same journal contained a study published in May 2010 demonstrating the liver protective effects of apple polyphenols. The study concluded that apple polyphenols had significant effect against acute liver damage induced in mice. The authors speculate that the effect may be due to the free radical scavenging, inhibition of fat oxidation and increased antioxidant activity of apple polyphenols.

In the same month, the same journal published a study demonstrating that apple juice containing apple polyphenols can actually inhibit the activity of toxins produced by staphylococcus. A toxin which effects the intestine known as “staphylococcal enterotoxin A” is a common culprit of gastroenteritis. The apple polyphenols studied here were shown to bind to the enterotoxin rendering it biologically inactive.

In Naturopathic medicine, as with all health care models, safety is never taken for granted; even when dealing with relatively natural substances. It is necessary to seek out, if possible, studies demonstrating the safety profile of a medicinal substance. The Journal of Oleo Science published a study this year evaluating the safety of excessive intake and efficacy of long-term intake of beverages containing apple polyphenols. Subjects were either given a normal dose (340g/day) of apple polyphenols for 12 weeks or three times the normal dose (1020g/day) of apple polyphenols for 4 weeks. There were no adverse reactions noted in either trial. The study also found that the consumption of the apple polyphenols led to a significant reduction in visceral fat area of subjects who were above normal range at baseline, with no change in visceral fat area in subjects in normal range at baseline.

As I have mentioned in previous articles, I especially like studies that evaluate consumption of the whole food over time. The European Journal of Cancer Prevention published a study in January of 2010 that evaluated the effect of regular consumption of apples on colorectal cancer risk in populations with low intake of fruits and vegetables (i.e. most north american populations). The study revealed that while there was more than a 30% reduction in cancer risk with just one apple a day, risk was reduced to around 50% with intake of more than one apple per day. The authors speculate that the beneficial effect may result from the rich content of flavonoid and other polyphenols, which can inhibit cancer onset and cell proliferation.

It seems the old proverb is true, so enjoy your apple, or better yet, more than one apple a day and remember to always have the peel too.

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Cannabinoid Balance (Clinical Endocannabinoid Deficiency)

Eat What You Need: Intermittent fasting made simple

Relax and Let Go; training for a clear mind

Why CBD is my new favourite medicine

Pomegranate for health

Spirulina, a truly super supplement!

Pu-erh tea for digestion and weight loss

Vitamin and Mineral Infusion for Fibromyalgia: Case Study

Pumpkin; more than just decoration!

Diabetes

Prostate

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An Apple A Day

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