The Power of Prevention

Continuing on from last week’s topic a little bit I’m going to hop up on my soap box for a brief moment and talk about something that is really important to me. We all know the worn out phrase, “An ounce of prevention is worth a pound of cure” and probably all roll our eyes when someone says it. But I really want you to sit and think about what it means. It is not just something that our mothers say to us when we are being foolish and could hurt ourselves.

It means that the cure is more work than avoiding the condition, disease, or injury.

It means that prevention is far stronger than the cure.

It means that willpower is better than pain.

Prevention is what we call lifestyle therapy, which primarily means diet and exercise. At this point almost everyone is rolling their eyes again. Sure, you’ve heard it over and over that, “You should eat better and exercise more.” But the simple truth is that these two things can decrease out risk of chronic illness (and even some minor injuries) drastically.

Women who exercise regularly (even just walking) decrease their risk of developing breast cancer (1).

Adults who eat plenty of dietary Omega-3 fats daily decrease their risk of developing Alzheimer’s disease (sorry, no percentage available on this one) (2,3).

People who have fibre from cereal grains and fruits in their diet a reduced risk of developing colon cancer (4).

Regular exercise has been shown to reduce our risk of heart disease at any age (5,6,7).

These are just some of the statistics out there and there is so much more that research has shown us. However, we as a society have gotten ourselves into a rut and it is difficult to get out of it because that rut provides us with easy and cheap fast food and lots of activities and distractions that keep us too busy for exercise.

This path also lends itself to our collective fallacy of, “I don’t feel sick, therefore I am healthy.” We have to stop thinking this and remember that Health is NOT the absence of pain. Health is the optimal functioning of our bodies so that we may perform at our best at all times. Now, I’m not saying that we should all be Olympians. Optimal functioning means that we can meet the basic needs for survival and have plenty of energy and ability left over to rise to any challenge that is presented to us.

Most alternative medicines are based heavily in preventative care. Seeing a naturopath, massage therapist, or chiropractor on a regular basis can help to increase our ability to meet the challenges we face and decrease our risks of certain conditions and diseases even further.

So what is your plan for making your future the brightest it can be? I challenge you to go out and walk for 20 minutes, three days this week and take a look at your meals and make one thing on your plate healthier. Take that first step and see the difference it makes. Changing our habits and lifestyle is an uphill battle but it is far easier than dealing with the consequences of not doing it.

Thanks for reading,
Dr. Ben

References
1. Wu Y, Zhang D, and Kang S. Physical activity and risk of breast cancer: a meta-analysis of prospective studies. Breast Cancer Research and Treatment 2013;137(3):869-882

2. Dacks PA, Shineman DW, and Fillit HM. Current evidence for the clinical use of long-chain polyunsaturated n-3 fatty acids to prevent age-related cognitive decline and Alzheimer’s disease. The Journal of Nutrition, Health, and Aging 2013;17(3):240-251

3. Gillette-Guyonnet S, Secher M, and Vellas B. Nutrition and neurodegeneration: epidemiological evidence challenges for future research. British Journal of Clinical Pharmacology 2013;75(3):738-755

4. Murphy N, Norat T, Ferrari P, Jenab M, Bueno-de-Mesquita B, Skeie G, Dahm CC, Overvad K, Olsen A, Tjønneland A, Clavel-Chapelon F, Boutron-Ruault MC, Racine A, Kaaks R, Teucher B, Boeing H, Bergmann MM, Trichopoulou A, Trichopoulos D, Lagiou P, Palli D, Pala V, Panico S, Tumino R, Vineis P, Siersema P, van Duijnhoven F, Peeters PH, Hjartaker A, Engeset D, González CA, Sánchez MJ, Dorronsoro M, Navarro C, Ardanaz E, Quirós JR, Sonestedt E, Ericson U, Nilsson L, Palmqvist R, Khaw KT, Wareham N, Key TJ, Crowe FL, Fedirko V, Wark PA, Chuang SC, and Riboli E. Dietary fibre intake and risks of cancers of the colon and rectum in the European prospective investigation into cancer and nutrition (EPIC). PLoS One 2012;7(6):e39361

5.Lamina S, Okoye CG, and Hanif SM. Randomised controlled trial: effects of aerobic exercise training programme on indices of adiposity and metabolic markers in hypertension. The Journal of the Pakistan Medical Association. 2013;63(6):680-687

6. Fakhry F, Rouwet EV, den Hoed PT, Hunink MG, and Spronk S. Long-term clinical effectiveness of supervised exercise therapy versus endovascular revascularization for intermittent claudication from a randomized clinical trial. The British Journal of Surgery. 2013;100(9):1164-1171

7. Back DT, Casey DP, Martin JS, Emerson BD, and Braith RW. Exercise training improves endothelial function in young prehypertensives. Experimental Biology and Medicine. 2013;238(4):433-441

Health For Your Career

This week I went to see the Mirvish production of Les Miserables (it was absolutely wonderful and I highly recommend it to anyone who enjoys musical theatre) and it got me thinking about health, as many things do being the health nerd that I am. The performing arts can be absolutely brutal on your body, just like sports, and to have a prosperous career you need to maintain a very healthy lifestyle to meet the challenges that face you.

But this rule does not only apply to performers and athletes. We all need to lead a healthy lifestyle to maintain our career if you think about it. Diet, posture, and activity all play a central role in the deterioration or upkeep of our body. If we sit at a desk all day, hunch by our computer, and get very little activity our body will feel the stress just as quickly as someone who operates a jackhammer all day. This means that our bodies will accumulate damage (“microinjuries”) over time and certain activities will no longer be easy or comfortable for us. This accumulation will limit our ability to do our jobs and could lead to serious disability and potentially losing all ability to work.

Pain, limited range of motion, weakness, numbness, and other downstream effects of these microinjuries all impact our ability to work. So what are we to do about it? Are these effects just an unavoidable by-product of working?

Why not look at it the same way these performers and athletes do? I need my body (and my mind) to do my job so let’s look after my body (and mind) the best that I can so that I can continue doing my job. We hear about so many major league athletes turning to alternative medicine for preventative and injury care but there are just as many performers out there who do the same.

Through prevention we can avoid nasty complications later down the road and keep our ability to work as strong as ever. This will pretty much guarantee a good career (aside from non-health/ability related issues, of course) in whatever field you choose. On top of this, early intervention is key to limiting the impact injuries have on our future ability to work. The longer we put off finding appropriate care the greater the impact an injury will have on our body.

So if you are looking for a long career take good care of your body because it’s the only one you’ve got. Get a little exercise every day, maintain a healthy diet, and make sure you treat your body right with good posture, deep breathing, and a calm, stress-free attitude. Think of yourself as a performer on our own little stage and the lifestyle will follow.

Thanks for reading,
Dr. Ben

The True Meaning of Multidisciplinary

When navigating the world of healthcare you have probably run into something called a “Multidisciplinary Clinic”. This means that there are multiple different professions working under one roof. The first thing that comes to most peoples’ minds is, “Well, that’s convenient!” but in the end it really isn’t that much better than having all of these professionals working in different locations. Within most multidisciplinary clinics there is just as much miscommunication as there is when they are separate.

The problem lies in the definition of “Multidisciplinary”. When these clinics started popping up they were supposed to be organized efforts to bring together teams of professionals to work together rather than just work next to each other. A truly multidisciplinary clinic will encourage and foster communication and collaboration which benefits the patient much more than one doctor working alone. This has been lost in the healthcare community but is being brought back through multiple different efforts from different groups (one of which, I am proud to say, is the Ontario Chiropractic Association).

The theory behind Multidisciplinary clinics is that doctors working in collaboration with easy communication and access will be able to provide better quality care to the patients. Through this there will be decreased wait times, increased patient and professional satisfaction, and improved prognosis for the patient’s condition. There is a very small body of research that supports these theories at the moment but more is being conducted all the time.

The other aspect of Multidisciplinary team care is knowledge of other professionals’ skill sets. Outside of the specialties within their own professions most healthcare practitioners do not know what other professionals are capable of. Multidisciplinary clinics allow practitioners to get comfortable with other professionals and know where others may be able to treat a patient better than they can themselves. This allows multidisciplinary teams to cover holes in patient care that might otherwise go undiscovered.

It is really important to check out any clinic you go to that promotes itself as multidisciplinary to ensure they embrace the true meaning of the term rather than just working in the same location. If not then you are not getting any extra benefit from it beyond only having to remember one address.

Thanks for reading,
Dr. Ben

Shoes and Our Feet

A while ago I wrote a post about our Feet and Chiropractic Care and today I would like to expand on that a bit. Today we are going to be looking at footwear and their impact on our feet. There are many different types of shoes out there but we will be looking at a few of the more common ones that people wear on a regular basis. For a reminder of proper foot biomechanics take a look back at the original post on feet

The biggest criminal in the shoe world is the high heel. I touched on this briefly last time but let’s go into more detail now. High heeled shoes take the foot, which is designed to spread the weight of the body evenly between the forefoot (toes and arch) and the hindfoot (heel and ankle), and angles it so that all that weight is now on the balls of your feet. The higher the heel, the greater the amount of weight bearing down on this one area. This puts a lot of pressure on the tissues between the bones of your toes. Add to this the restrictive nature of high heeled shoes (trying to maintain some stability) and you have a bad mixture which can lead to a condition called “Morton’s Neuroma”. Morton’s Neuroma is the build-up of scar tissue around the nerves that run between the bones of our forefoot and into our toes. This scar tissue takes up more space than we have available and so squeezes the soft tissues of the nerve and can cause significant amount of pain. The most commonly suggested solution to this problem is surgery where they cut the nerve to kill it and we lose all feeling to that part of the foot and toes. Not the most desirable of situations. Chiropractic and Acupuncture treatments can have a good effect on this condition but are much more effective if caught early.

At the other end of the foot we have the ankle being held in a toe-pointed (Dorsiflexion) position which is not good for it. The pressure that runs down the bones of our shin (Tibia and Fibula) should be transferred through the middle of the ankle joint but instead if pushing down on the back side of the bones. This puts pressure into the closest joints can causes tension in the ankle and hindfoot joints which can cause pain and discomfort. As well, this maintained dorsiflexion put the Garstrocnemius in a shortened position when, as I’ve talked about before, muscles like to reset their default length to the one they spend the most time in. That means that prolonged use of high heels will make it more difficult to bring the ankle through its natural full range of motion and thus make it hard to perform proper biomechanics of walking when not in high heels. Regular stretching and Chiropractic care can help clear up these tension and tight muscle problems.

Flip flop sandals are the next big culprit. They are on almost everyone’s feet during the summer but they are not very good for us. The problem is that we have to work to keep them on while moving around. This means that we grip them with our toes so that they don’t go flying off or twist under our feet. In doing this we eliminate a key part of the gait cycle (the pattern of our walking stride) called “Toeing Off” when we are pushing off with our back foot and our toes are relaxed and extended. This applies to both thong and Berkinstock style sandals. Sandals that strap to our feet around the ankle and will stay on without us actively keeping them there are fine. The gripping action of our toes causes tension along the bottom of the foot and can lead to discomfort and foot problems down the road. Massage, Acupuncture, Physiotherapy, and Chiropractic are all great choices in dealing with this kind of tension.

The next type of shoe I would like to discuss is ballet slippers. These little flimsy slip-on shoes are an interesting conundrum. The provide no support what-so-ever, which is not a bad thing for our feet but the majority of people do not have the muscle strength and endurance to support a barefoot because of the way we have treated our feet in the past. On the other hand we need to challenge our feet to support themselves but in this case the necessity of the shoe trumps our foot’s need. In order to stay on the slipper needs to be snug on the foot from toes to heel, which does not allow for full range of motion of the toes as they splay out and extend back as we are toeing off. So in the end I would say these shoes are not great but are definitely better then high heels by a wide margin.

Men’s dress shoes are much like women’s high heels in their rigidity compared to other shoes out there. They are stiff and do not provide much ability to accommodate the movement of the arch and toes during our gait cycle. A well worn in pair will be more flexible but to get to this point we have to put up with a lot of discomfort and dysfunction in our feet.

At the other end of the spectrum we have athletic shoes. These puppies are designed to be perfect for the foot. They cushion the foot but also allow it to move when it needs to. The only problem with these types of shoes is that they are only designed for one activity. So when doing anything else they are not necessarily what we need. Depending on the sport they can be too restrictive in the ankle or hold the forefoot too tight for everyday life. The only exception that I would say if good for most things is a real running shoe. They are designed for our gait in a wide variety of speeds.

So is all footwear bad? Can we every find something that won’t hurt us? Well, of course we can. The ideal shoe is one that is relatively flat so that the ankle is aligned and weight is spread even throughout to foot. It needs to provide some support as our feet are not used to working by themselves but not too much so that our feet will have to work a little and we can keep them strong. This shoe should also allow for full ankle range of motion and have a flexible enough sole to allow for our toes to extend during toeing off. Make sure to really explore all the aspects of a pair of shoes when buying them so that you don’t regret it later. Of course we can’t limit ourselves completely in our lives. If you have a pair of shoe that you absolutely love you can still wear them but I highly suggest only doing so sparingly. Also, no matter what shoes you wear, we should all spend a portion of the day barefoot so that our feet can move the way they were designed to. Make sure your feet and healthy and happy and the difference in your life will be amazing.

Next week we will take a look at some exercises for the feet which will help to keep us strong and mobile.

Thanks for reading.
Dr. Ben

Thoracic Outlet Syndrome: Posture’s Problem Child

Welcome back to my blog! This is the first post to DrBenRoffey.com so I would like to take a moment and say Thank You for coming by and I hope that you can learn something from what I do here. If you have any questions about what we discuss here or about any aspects of health or healthcare my door is always open. E-mail me at drroffey@gmail.com and I’ll get back to you as quickly as I can.

And now back to our regularly scheduled blogging.

One of the more common conditions that walks into a chiropractor’s office but you don’t hear much about is called “Thoracic Outlet Syndrome” (TOS). This is a condition which is not terribly serious but the symptoms can be very scary and if left long enough can cause become fairly debilitating.

First of all let’s look at what this condition is and what causes it. The Thoracic Outlet is the triangle shaped space between your collar bone, shoulder blade, and the base of your neck. Through this space all of the arteries, veins, and lymphatic ducts travel to and from the chest cavity (Thorax) and out into the arm. These structures are also joined by the nerves from the neck that travel to the muscles and skin of the arm. That is a lot of stuff going through a fairly small area. Thoracic Outlet Syndrome occurs when any or all of the nerves, arteries, or veins become compressed which causes pain, numbness, and or tingling, in the hand and arm

The compression of these structures can happen in several different ways but most are due to poor posture, specifically hunching of the upper back (Thoracic spine), rolling forwards of the shoulders, and the head pushing forward in front of the shoulders. Any or all of these postural positions will stress and strain the muscles around our skeleton and cause them to tense up to hold the weight we are not placing upon them. As the angles of these muscles change and their tension increases dramatically they will push against the nerves at the base of the neck and the arteries and veins exiting and entering the top of the rib cage (the Thoracic Outlet) thus causing Thoracic Outlet Syndrome.

The pain and numbness or tingling associated with TOS can be continuous or episodic in nature depending on the amount of pressure on the structures and they usually have a specific area that they stays within. Most commonly the symptoms are experienced in the hands but over time they may spread into the forearms and even up into the shoulders. People with TOS may also notice a decrease in sensation in the areas affects. If left for a long period of time without treatment muscle weakness can occur in the hand affected.

The exact areas of numbness and tingling and change in skin sensation will be different depending on if it is the nerves, arteries, or veins involved but in general the hand and forearm are the most common areas to experience these symptoms. These symptoms can be mimicked by other conditions such as Carpal Tunnel Syndrome, Herniated Intervertebral Discs in the neck (Cervical Spine), and even active trigger points in the rotator cuff muscles that can refer pain down into the hand and fingers. Make sure you see a doctor to determine the true cause of your pain.

When you go to a doctor they should ask a series of questions and perform a number of tests on you to help determine the nature and source of the problem. Thoracic Outlet Syndrome reacts very well to complementary treatments and therapies including chiropractic, acupuncture, massage, and physiotherapy all have excellent results.

Posture is an extremely important thing in our lives and if we maintain a good posture we can avoid conditions like TOS. So I hate to say it but our mothers were right, “Sit up straight and stop slouching.”

Thanks for reading,
Dr. Ben

Surviving the Holidays: Stress

(Originally posted on bcotoronto.com on Dec 6th, 2012)

Welcome back to part two of the Surviving the Holidays series at BCO. This week we will be discussing the stress of the holidays and ways to avoid it or survive it. Numerous times in the past I have posted articles on Facebook and Pinterest about the impact of stress on the body so I’m not going to talk about it today. We may cover it some time in the future. Needless to say, stress is a useful tool for coping with difficult situations but is unnecessary and potentially harmful over long periods.

So what causes you stress? Family interactions, mall crowds, travel, screaming kids off from school, work deadlines? Whatever it is all the same techniques can be used to manage it. Let’s take a look now.

Deep Breathing
Deep breathing from your tummy can be performed anywhere, in any situation (except underwater I guess, but that’s an acceptable time to be stressed). Sit or stand up as straight as you can and breathe from your belly. Your shoulders should not move much while breathing like this. This type of breathing provides the greatest amount of oxygen to the blood and engages the diaphragm. This diaphragm movement stimulates the Parasympthetic Nervous System which we have talked about before (the Rest and Digest side of the Autonomic Nervous System). With the PNS stimulated this decreases stress signals and increase the calming and relaxing effects of the nervous system. The greater amount of oxygen also helps to relax the body as it brings oxygen to tight muscles and the brain, which slows the heart rate and lowers blood pressure.

Acupuncture
Acupuncture has been used for centuries to treat any number of conditions including stress. Recently, research has shown the mechanism of this action of acupuncture’s effect on the physiology of stress. But it is rather impractical to go to a crowded mall or deal with rambunctious kids with needles sticking out of you. So see your acupuncturist during any time you can find in your busy schedule. For those of you who don’t have the time here are some points you can stimulate at home or on the go to help bring down your stress this holiday season. All you need to do is press into your skin with your nail with pulsed pressure. You need to press hard enough to leave a mark. This will be a little uncomfortable but the results are remarkable. You can walk around stimulating these points for as long as you want but to have a good effect it should be between 5-10 minutes at a time.

Conception Vessel 17 is a point in the midline of your sternum (boney centre of your chest) level with your nipples. This is generally 2 finger widths above the bottom edge of your sternum.

Conception Vessel 17

Conception Vessel 17

Shenmen is a point on the cartilage of your ears at the tip of the “Triangular Fossa” (see the picture below). If you place a finger on the lobe of your ear and move upwards along the back edge you will feel a point where the cartilage splits into two ridges, the “Helix” and the “Anti-Helix”. Follow the inner ridge (the Anti-Helix) until it splits again. These two ridges will surround the “Triangular Fossa”. This split is where the point is.

Shenmen

Shenmen

Liver 3 is a point on the foot so it would be a little difficult to work on while walking around but you can always sit down and rest while working on it. Liver 3 is located between the bones that make up the 1st and 2nd (Big and index) toes. Place your finger on the web between these toes and move it up towards your ankle. You should feel a long tubular bone on either side of your finger. At the point these bones end is a small ridge. This is the location you want.

Liver 3

Liver 3

Stomach 36 (the point used in the research I mentioned before) is another difficult one to use while moving around. This point is just below the knee cap. Feel the ridge at the front of your shin and place the tips of all four fingers (not your thumb) along the outer edge of it with the top finger also touching your knee cap. One finger’s width away from the ridge where your bottom finger lies is where the point is.

Stomach 36

Stomach 36

Chiropractic
Chiropractic care can decrease the levels of stress hormones in your body and help regulate the nervous system to bring the parasympathetic and sympathetic nervous systems back into balance. You can’t really take chiropractic with you on the holidays but coming in when you can really makes a big difference. I shouldn’t have to say this but just in case, let me remind you; DO NOT adjust your own neck or back.

Yoga/Tai Chi/Meditation
I guess you could sit down in the middle of a mall and start meditating or strike a Tai Chi position but you might have a difficult time not getting jostled. The health benefits of these types of self-centering and meditation are many and the list is growing everyday but the one thing they are used for most often in North America is stress relief. I highly suggest taking some time to do any of these quiet, calming techniques.

With these tricks you can beat the holiday stress and have a happy and healthy season. So don’t let the stress of the season get you down. Pick yourself up and dust yourself off naturally.

Thanks for reading and good luck.
Dr. Ben

Dealing With Seasonal Affective Disorder

(Originally posted on bcotoronto.com on Nov 1st, 2012)

Seasonal Affective Disorder

Well, it’s November 1st and Halloween is over, the sun is rising late and setting early. There’s very little sunshine and when the sun is up, there are generally lots of clouds. So we can go days without seeing or feeling the sun. This is the season when we all feel a little slower and grumpier. We are thrown of our natural rhythms and start to hunker down for the winter.

This is the time of year for Seasonal Affective Disorder (SAD).

As animals, our bodies naturally slow down in the winter even if we do not hibernate. With the colder weather and less light we try to conserve energy because our bodies remember a time when these signals meant a scarcity of food. Modern conveniences have not bread this out of our systems. But it is important to differentiate between the natural decrease in energy and motivation during the colder months and the diagnosis of SAD, which describes a series of seasonally-based episodes of depression with multiple associated symptoms like sleep difficulties, apathy, and many others.

SAD can occur during spring and summer but is much more common during the autumn and winter months. It is also more common in regions that have less light during this time of year like Finland. This is why one of the more common theories is that it is associated with lower levels of light exposure.

This has lead to years of UV lamps being used as the primary therapy for SAD. When compared to antidepressants it shows earlier responses to treatment and less risk of side effects, but no significant difference between outcomes1. There are many difference types of light therapy ranging from Fluorescent light boxes to ambient bright light and even some new research looking into transcranial (across the brain) light through the ear canal, which seems to be a possibility2. Most sources in the literature and around the web say that 15-60 minutes a day of using a UV lamp is sufficient to treat SAD which is similar to the recommended time of uninterrupted sunlight for appropriate vitamin D production.

Vitamin D deficiency has been linked to depression in general (correlation, not causation yet) and supplementation has been used clinically to treat depression but very little research has been completed studying its efficiency. What little here is has been varied in quality and in their outcomes3,4. As far as I can find, only one study has explored vitamin D supplementation in SAD and they found no difference between the treatment and non-treatment groups5. Their study only looked at a population of women 70 years old and above, so it is not really applicable to the population at large.

So, with so much doubt about Vitamin D, why do I bring it up? Well, because Vitamin D deficiency is incredibly widespread around the globe. The general rule of thumb is that if you live in an area that does not enjoy a tropical climate then you are most likely Vitamin D deficient. So we should all by supplementing with D daily and eating foods high in this nutrient. But, back on topic, many physicians and patients claim to have success with Vitamin D supplementation as a treatment for SAD, so why not give it a try?

Other therapies for SAD include antidepressants, negative air ionizers, and supplementation with melatonin to try to aid in sleep and maintenance of circadian rhythms. Antidepressants have a similar success rate to light therapy and ionizers have slightly less. I was unable to find any solid evidence on the success of melatonin treatment though.

Acupuncture and chiropractic treatments have also been used with patients with SAD with mixed results. Naturopathy has also had mixed success with treating mood disorders of different kinds.

Seasonal Affective Disorder is still not a well understood condition yet and most treatments are still being adjusted to maximize their effectiveness. But this does not mean it hurts any less when it hits. So my recommendation is try different treatments and find something that works for you. Maybe it’s just getting to bed earlier during the cold months and maybe it’s a combination of light therapy and antidepressants. There are plenty of options out there, most people just don’t know where to look. I also suggest that everyone should take Vitamin D year round but we’ll talk about that more later.

I hope that this has given you are few more options to help you through these cold, dreary months and as always, thanks for reading.
Dr. Ben

Reference List
1. Lam RW, Levitt AJ, Levitan RD, Enns MW, Morehouse R, Michalak EE, and Tam EM. The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. The American journal of psychiatry. 2006 May;163(5):805-12.
http://www.ncbi.nlm.nih.gov/pubmed/16648320

2. Timonen M, Nissilä J, Liettu A, Jokelainen J, Jurvelin H, Aunio A, Räsänen P, and Takala T. Can transcranial brain-targeted bright light treatment via ear canals be effective in relieving symptoms in seasonal affective disorder? A pilot study. Medical hypotheses. 2012 Apr;78(4):511-5.
http://www.ncbi.nlm.nih.gov/pubmed/22296809

3. Parker G and Brotchie H. ‘D’ for depression: any role for vitamin D? ‘Food for Thought’ II. Acta psychiatrica Scandinavica. 2011 Oct;124(4):243-9.
http://www.ncbi.nlm.nih.gov/pubmed/21480836

4. Howland RH. Vitamin D and depression. Journal of psychosocial nursing and mental health services. 2011 Feb;49(2):15-8.
http://www.ncbi.nlm.nih.gov/pubmed/21261225

What Is Acupuncture: The Research

(Originally posted on bcotoronto.com on Oct 18th, 2012)

Acupuncture ResearchLast week we discussed the history of acupuncture and the place it has found in the current healthcare community. This week we will be exploring the world of acupuncture research, what works, what doesn’t, and what’s out there now.

First off, let’s talk about the scientific process of research to set up the background we need. There are many different ways to design a study but the golden standard is called a Randomized Clinical Trial. This means that there are two groups (randomly assigned from the volunteer subjects) who either receive the treatment being tested or a placebo or a different treatment type. This way all the subjects think they have received the treatment and the desired outcomes are measured to compare the treatment against the placebo or the other treatment. Sometimes a third group is added where the subjects do not receive any type of treatment to determine the effect of the placebo as well.

Randomized Clinical Trials are considered the highest form of scientific evidence. On the other end of the spectrum is Anecdotal evidence, or “Case Studies”. This evidence is still important because it drives the direction high quality evidence takes but by itself it is not enough to show a connection between a treatment or therapy and a specific outcome.

So now let’s get down to how acupuncture fits into this system. Over the past half century or so a large body of evidence has been created with regards to acupuncture. The problem is that the results have been fairly conflicting in nature. A little more than half have said that acupuncture is no better than placebo and the rest have said it is more effective. So which is it, and why is there such a dichotomy here? Well, one of the main problems is the issue of the placebo treatment. There have been a couple of different approaches to this problem.

The first is to place the needles in points outside of the meridian pathways (the pathways of energy used in acupuncture) but as any acupuncturist worth their salt will tell you, these are still considered acupuncture points called, “Ah Shi” points (You can imagine what we called them in school). This is part of acupuncture where you place the needles where the pain is or surround the area with needles. The second technique is to use blunted needles against the skin so that the subjects think they have received the regular sharp needle but in reality have just had the pressure on their skin. Well, this is just silly because this is a technique unto itself called Acupressure. So you are not providing a sham treatment, you are in fact, providing a different but related therapy. Another way is to not use any sham treatment at all which critics say does not truly test the technique. The last technique is to complete the study using animal subjects as they are generally considered unable to experience a placebo effect. But this is commonly viewed as lower quality evidence because it is on a species different from us.

So as you can tell, it is difficult to design research studies to properly test acupuncture within the scientific method and provide the highest quality level of evidence. But this difficulty and struggle are no reason to throw the baby out with the bathwater. Just because it does not fit within this system of evidence does not mean that acupuncture is worthless or that it does not work. Within the last 5-6 years there has been an outpouring of research that has shown, through controlled trials measuring small physiological and chemical changes rather than larger subjective ones, the amazing power of acupuncture.

In 2012, a study out of Japan, despite using the blunted needle “placebo” control group, showed a significant clinical improvement in patients with Chronic Obstructive Pulmonary Disease (COPD) after a 12 week course of acupuncture treatments1. Also in 2012 a study out of Georgetown University was published which demonstrated the protein associated with elevated stress in humans decreased in rats when treated with electroacupuncture at a single acupuncture point2. It is very exciting to see this kind of, in the author’s own words, “molecular proof of benefit”.

Along the same lines, the results of a yet unpublished study were presented at a conference early in 2012 which showed decreased levels of genetic expression of the gene Atrogin-1 which is responsible for protein degradation in muscles3. This means that the fibres within muscles that make them work will not be broken down as quickly. These results absolutely blow my mind and are incredible proof of the power of acupuncture. You can’t get much more of a physiological effect than altering genetic expression. This study was also performed in rodents but this gene and its regulation is common between most mammals.

In 2010, a study utilizing a novel approach to determining the effects of acupuncture was presented at a conference. Functional Magnetic Resonance Imaging (fMRI) was used on patient experiencing a pain stimulus both with and without acupuncture treatment. The fMRI provided images of the brain activity during these two conditions and demonstrated a change metabolic change in the areas of the brain that process pain4.

I wasn’t completely honest before when I said that the Randomized Clinical Trial was the highest level of evidence. It is the highest for a long period of time until you have a large body of research and then there can be one level above them. This is called a Systematic Review or a Meta-analysis. A systematic review is when all the research pertaining to a specific topic is brought together and the conclusions are compared and a general consensus is reached. A Meta-analysis is a little different. The empirical data from the results of all of the collected clinical trials is taken and combined. Then statistical analysis will produce the overall impression of the combined data. This provides an excellent view of what the trends in the literature suggest for a specific topic.

One such meta-analysis was published in the Archives of Internal Medicine in 2010 explored the research published about acupuncture as a treatment for chronic pain. It looked at 29 randomized control trials with a cumulative 17,922 subjects all together. The authors found that, despite the previous general consensus about acupuncture, it was superior to both the control (no treatment) and the sham treatment groups5.

There is a long way to go to uncover the full effects of acupuncture and I’m sure there will be a lot of resistance along the way from people who are afraid because they do not trust or understand acupuncture which will only make the wait longer. But there is definitely enough evidence to show there is something to this treatment that should not be ignored.

What do you think of all of this? Could acupuncture be something you might try next time you are in pain?

Thanks for reading,
Dr. Ben

Reference List
1. JAMA and Archives Journals (2012, May 14). Acupuncture appears linked with improvement in patients with chronic obstructive pulmonary disease. ScienceDaily. Retrieved September 10, 2012, from http://www.sciencedaily.com­/releases/2012/05/120514122751.htm
(http://archinte.jamanetwork.com/article.aspx?articleid=1151703)

2. Georgetown University Medical Center (2012, January 10). Acupuncture reduces protein linked to stress in first of its kind animal study.ScienceDaily. Retrieved August 15, 2012, from http://www.sciencedaily.com­/releases/2011/12/111219150915.htm
(http://ebm.rsmjournals.com/content/237/1/18)

3. Federation of American Societies for Experimental Biology (FASEB) (2012, April 23). Acupuncture can improve skeletal muscle atrophy. ScienceDaily. Retrieved April 29, 2012, from http://www.sciencedaily.com­/releases/2012/04/120423162247.htm

4. Radiological Society of North America (2010, November 30). Acupuncture changes brain’s perception and processing of pain, researchers find. ScienceDaily. Retrieved October 10, 2012, from http://www.sciencedaily.com­/releases/2010/11/101130100357.htm

5. JAMA and Archives Journals (2012, September 10). Acupuncture may be better than no acupuncture, sham acupuncture for chronic pain. ScienceDaily. Retrieved October 2, 2012, from http://www.sciencedaily.com­/releases/2012/09/120910161548.htm
(http://archinte.jamanetwork.com/article.aspx?articleid=1357513)

What Is Acupuncture: A History

(Originally posted on bcotoronto.com on Oct 11th, 2012)

Acupuncture HistoryDespite coming into an alternative health care clinic a lot of people will give me a funny look when I mention acupuncture. Many people either don’t know much about acupuncture or only know what main stream media has said about it, which isn’t much and is a little biased. So, let’s explore where acupuncture comes from and the different inputs it has had over the years. Next week, we will discuss the difficulty of performing controlled research in acupuncture and what the current body of literature says about this ancient treatment.

Acupuncture can be traced back over 2000 years with the ancient text, “Nei Ching Su Wen” or the “Yellow Emperor’s Classic of Internal Medicine” or the “Yellow Emperors Inner Canon” (~200 BCE). Some scholars even claim that acupuncture dates back to between 4000 and 5000 years ago. It originated in Eastern Asia, most historians agree it was most likely China, but it spread throughout the region along trade routes and made it all the way to Southern Europe, most notably France (more on that later). In Chinese history, acupuncture is portrayed as a fairly ubiquitous form of life. There were professional acupuncturists but every mother and wife was expected to know some acupuncture for day-to-day use within the family. This was passed down from mother to daughter in a tradition similar to that seen around the world.

This became even more prominent when acupuncture fell out of style at the end of the Song Dynasty and began to be associated with the lower classes. In the 1820’s the Emperor banned the teaching of acupuncture from the Imperial Academy of Medicine. The Chinese Communist Party treated acupuncture much the same way until Chairman Mao Zedong reversed this attitude when he came to power and reintroduced acupuncture to the Chinese medical system.

After World War Two many areas of the world were devastated but none quite like Japan. The pictures of the devastation are quite famous now including the massive scarring on survivors at the outer edges of the blast radius. Acupuncture was used prominently in the treatment of these survivors to resolve scars and heal tissues. The success of this is not as well known but is just as well documented.

In France acupuncture picked up steam and got quite a foothold. In the 1950s French acupuncturists started to combine the traditional acupuncture style with newer technology. This was the birth of Electroacupuncture which uses low intensity electricity to stimulate the qi. This has become a prominent form of acupuncture in the Western world.

In 1972, President Nixon made his famous trip to China, opening up communication between the United States and most of Asia. As with most presidential trips, he was trailed by copious numbers of journalists and reporters. One reporter, James Reston of the New York Times, had the ill fate of coming down with appendicitis during the trip. He had to get an emergency appendectomy and, as was the practice in China, acupuncture was used to relieve the post-surgical pain. Mr. Reston was so amazed by the effectiveness of this treatment that he wrote a piece praising acupuncture when he returned to the States. This was the dramatic introduction of acupuncture’s power to North America.

In North America, acupuncture has had a difficult time finding its place. Because the basis of acupuncture is grounded in a completely different philosophy and world view than is common in Western culture, many people have a very difficult time accepting the practice and the claims its practitioners make. Currently, acupuncture is still not well understood but it is not waning in popularity. In fact, it is cropping up more and more in integrated care facilities for chronic pain, addiction centres, and even the United States military, which is using it for both pain control and treatment of PTSD in their troops. The National Institutes of Health (NIH) in the States, the National Health Service (NHS) in the UK, and the World Health Organization (WHO) have all endorsed acupuncture as a therapy for specific conditions but the list is still growing.

In Asia, it is still practiced alongside modern medicine in both the traditional form and as electroacupuncture. It is used as a treatment for many difference conditions as an alternative and in conjunction with medical interventions.

So that is a brief overview of the history of acupuncture and where it is today. I hope this gives you a broader view of this powerful therapy. Come back next week when we will explore the research behind this technique.

Thanks for reading,
Dr. Ben

Healing Injuries: Doctors

(Originally posted on bcotoronto.com on Aug 30th, 2012)

Healing Injuries - DoctorsWelcome to the third and final week of the Healing Injuries series I’ve been doing here at BCO. This week we’re going to talk about what different doctors can do for you when you have injured yourself.

MD’s
The first doctor that most people think of going to when they are in pain is a Medical Doctor but the truth is that unless you have broken something or completely torn a muscle they don’t know what to do with you unless they are a sports doc. The average GP will give pain killers and muscle relaxants for minor injuries and occasionally suggest ice and rest. These drugs will help decrease the symptoms of the injury but will do nothing to help heal it. In fact, many times pain killers will numb the pain so much that you think nothing of using that body part again and end up hurting yourself more. In some cases these drugs are appropriate but the majority of the time they are overkill.

When the skin has been broken or punctured during an injury then your MD may be the correct professional to visit. Initially, you should clean off the wound with soap and warm water or if the cut was particularly dirty or large with rubbing alcohol or peroxide and wrap it with a sterile bandage. If you start to experience signs of an infection; redness, heat, and swelling, then your MD is the person to see for the appropriate antibiotics.

DCs & PTs
On the other hand, Chiropractors (DC) and Physiotherapists (PT) are healthcare professionals who are trained to deal with issues of the musculoskeletal system, which almost all minor injuries are. Through the identification of the exact tissues injured, the appropriate approach can be determined and tissue specific care given. These techniques used by both DCs and PTs have been shown to decrease the necessary recovery time as well as increasing the function regained after an injury. Chiropractic care has also been shown to decrease the risk of injury in the first place as well as effectively manage pain in the case of injuries as well as general daily aches and pains.

Acupuncture
Acupuncturists may not be the first healthcare professional you think of when you injure yourself but those who have tried it before swear by it for almost all pains. Acupuncture is a very effective treatment for pain management as well as injury healing. Through the application of local needles tissues can be targeted for repair. Research has shown that muscle and ligament healing times decrease with the use of acupuncture.

ND
While the musckuloskeletal system is not a Naturopath’s (ND) primary focus their guidance can be extremely helpful with nutritionally aiding the body’s own resources to help repair and stimulate tissues. They can also do this through supplementation of the diet with vitamins and minerals as well as natural substances to help the body.

So all doctors have something to bring to the table, it all depends on your needs and wants at the time. I urge you, next time you injure yourself, consider what you have done and remember the best way to take care of it and who might be able to help you the most.

I hope that you have learned something about healing injuries over these last few weeks. If you missed any of the installments you can find the segments on Heat vs Cold and Immobilzation vs Stretching through the links. As always, if you have a question of comment, please leave a message below or e-mail me at drroffey@gmail.com.

Thanks for reading,
Dr. Ben