Dear Friends and Patients: 
First of all, our staff and I want to say a THANK YOU for all of your referrals this past year. Our heartfelt wishes go out to you and your families and we hope you had a healthy and joyous holiday season. This issue of our Newsletter is a little delayed as there was a lot of late-breaking news I wanted to include. Many of you have been enjoying our quarterly newsletters which we also publish on www.prevent-doc.com. We appreciate the positive feedback we have been receiving. In this newsletter I am going to discuss some of the issues that have been raised about taking very high doses of supplements. 

Are Too Many Vitamins Harmful? Do Vitamins Affect Aging?


An editorial in a December 2013 an Annals of Internal Medicine journal declared vitamins are useless. Over the past decade an increasing number of articles have appeared in well-known medical journals cautioning people not to take certain vitamins such as vitamins A and E or other antioxidants, except to treat a diagnosed vitamin deficiency. “The literature is providing growing evidence that these supplements – in particular, at high doses – do not necessarily have the beneficial effects they have thought to,” stated Demetrius Albanes, a senior investigator at the Nutritional Epidemiology Branch of the National Cancer Institute. Some articles were alarming, indicating there might be an increased risk of heart disease or cancer by taking vitamins. Part of the problem in evaluating these negative articles is it is unknown whether synthetic vitamins and inorganic minerals were used as opposed to natural vitamins and naturally chelated minerals. The vitamin E studied in this science review, for example, was synthetic, isolated vitamin E which already has a long history of being toxic for human consumption. These researchers never looked at full-spectrum vitamin E, including the tocopherols, nor did they bother to study a food concentrate form of vitamin E. 

Just a few weeks after the Annals of Internal Medicine article came out, a study sponsored by the Department of Veterans Affairs was published in the JAMA (Journal of the American Medical Association) where over 600 elderly veterans were given high doses of vitamin E and this vitamin delayed the decline in daily living skills, such as making meals, getting dressed and holding a conversation. This is the first time any treatment has been shown to slow the course of dementia in mild-to-moderate Alzheimer’s disease. 

Because multiple other studies presented at medical conferences I have attended showed a benefit of taking vitamins in terms of reduction in cancer and cardiovascular risk, I initially ignored the negative journal articles. Most of the studies quoted, but not all, were what are called meta-analyses. A meta-analysis refers to methods focused on contrasting and combining results from different studies, in the hope of identifying patterns among study results, sources of disagreement among those results, or other interesting relationships that may come to light in the context of multiple studies. This is a retrospective type of study and is not the same thing as a prospective study where one group of patients would be given a drug or vitamin, and a similar group would receive a placebo, and the outcomes determined at the conclusion of the study. 

As we gain more and more medical knowledge the evidence is now suggesting aging is a far more complex process than exposure to free radicals and that there might be validity to a downside from taking too many antioxidants. 

Is The Free Radical Theory of Aging A Myth?


Rebeca Gerscham and her colleagues first introduced the notion that free radicals are toxic agents in Science in 1954. Roughly sixty years ago a physician and researcher by the name of Denham Harman hypothesized free radicals might be the cause of the aging process. He knew ionizing radiation, pollution and even normal metabolism by breathing oxygen sparked the production of free radicals. Because both cellular damage and free radical levels increased with age, Harman thought free radicals caused the damage and antioxidants probably slowed it. 

Dr. Harman tested his hypothesis by feeding mice antioxidants, and showed they lived longer. In 1969 researchers at Duke University discovered SOD (superoxide dismutase), an antioxidant enzyme produced inside the body. They hypothesized that SOD evolved to counter the effects of free radical accumulation. Over time, scientists had difficulty replicating some of Harman’s experimental results on a consistent basis. 

Conflicting Studies


By the 1990s genetic advances allowed researchers to test the effects of antioxidants by directly manipulating genomes to change the amount of antioxidant enzymes an animal was capable of producing. Arlan Richardson, director of the Barshop Institute for Longevity and Aging Studies at the University of Texas Health Science Center genetically engineered 18 different strains of mice. Some of the mice produced more than average antioxidants and some produced less than average. The life span curves between the two groups showed no significant difference, indicating the amount of oxidative damage the mice endured had no bearing on how long they lived. Researchers at the University of Washington have demonstrated that mice live longer when they are genetically engineered to produce high levels of an antioxidant known as catalase. So the results in the Washington study are completely the opposite of the Texas study. Of course, what applies to mice may not apply to humans. 

Oxidation and the Formation of Free Radicals


What is oxidation? Oxidation is defined as the addition of oxygen to an atom or molecule. It is defined more technically as the loss of electrons from an atom or molecule. Reduction is the addition or gain in electrons. “Redox” refers to reduction/oxidation agents or reactions and changes in oxidative states (usually with electron transfer). There cannot be an oxidation reaction without a simultaneous reduction reaction. The term “reactive oxygen species (ROS)” is defined by the U.S. Library of Medicine as “Molecules or ions formed by the incomplete one-electron reduction of oxygen.” These reactive oxygen species were thought to cause oxidative damage to nucleic acids, proteins and lipids. 

Within mitrochondria a stream of electronically modified oxygen derivatives are continuously being formed and may not be as harmful as previously thought. In fact, after donating an electron, an antioxidant becomes a free radical, by definition, and some are capable of initiating chain reactions. Many vitamins and supplements classified as antioxidants are actually redox agents, meaning they act as antioxidants in some instances and pro-oxidants in others. Vitamin E and Vitamin C fit this category. So what we are finding is that antioxidants don’t “destroy” free radicals, they simple are involved in electron exchange. 

Are Free Radicals Helpful or Harmful?


Assuming free radicals accumulate as we age but do not necessarily cause aging itself, some researchers have speculated that free radicals, in some cases, might be produced in response to cellular damage as a way to turn up the expression of genes that help repair the body’s tissues. A 2010 study out of the University of California showed some free radicals turn on a gene called HIF-1 that is itself responsible for activating a number of genes involved in cellular repair, including a gene that helps repair mutated DNA. This study was done in worms. 

In January 2013, researchers at the University of Manchester (Colorado State) found that oxygen free radicals aid rather than harm cell regeneration in tadpoles. Hydrogen peroxide is not only harmless to cells, but is actually the catalyst that makes it possible for tadpoles’ tails to completely regenerate in less than a week. This regeneration process was inhibited by antioxidants. 

Exercise can increase oxygen consumption up to 15-20 fold over resting levels, which, in turn, generates vastly more free radicals. Exercise has been proven very beneficial to one’s overall health and longevity. Basically, a bout of exercise gives us a “dose” of free radicals. 

High dose intravenous vitamin C works as a pro-oxidant and causes the generation of hydrogen peroxide by white blood cells. Dr. Levine at NIH (National Institutes of Health) determined in his research with vitamin C that this was the mechanism intravenous high dose vitamin C killed certain types of human cancer cells – through the production of hydrogen peroxide. This finding was published in recent medical journals. Going back to the 1960s and 1970s, a group at Baylor University Medical Center found that intra-arterial and intravenous administration of hydrogen peroxide would aid in killing cancer and pathogens, and aid in the regression of atherosclerotic plaque. Humans do not produce vitamin C, but many animals can. According to H.M. Howes, M.D., Ph.D, animals that produce 1 molecule of vitamin C also produce 1 molecule of hydrogen peroxide. 
Summary 

So as counter-intuitive as it may seen, there is growing evidence that taking antioxidants in excessive amounts may have a negative effect by countering the positive effects of pro-oxidants and free radical stress. What constitutes an “excessive amount” remains to be seen. In my opinion, what may be excessive for one person may be therapeutic for another. I do not subscribe to a “one size fits all” concept for medication dosing or supplement dosing. 

We know large amounts of oxidative damage have indisputably been shown to cause cancer and organ damage, and plenty of evidence indicates that oxidative damage plays a role in some chronic conditions e.g. heart disease. We also know B vitamins and antioxidants are prescribed by ophthalmologists to treat certain types of macular degeneration. But what current evidence now shows is that free radicals may be beneficial in some contexts and dangerous in others. In my opinion, aging is a complex, multifactoral process that doesn’t have a single cause or a single cure. Taking mega-doses of antioxidants on a daily basis may not be wise and we need to remember a diet high in vegetables and fruits is not the same thing as taking a pill. Having said that, a significant number of Americans have poor dietary habits (e.g. a donut and coffee for breakfast) and taking a daily multivitamin is just insurance. At the Center we target nutritional therapies to correct deficiencies, using traditional labs, Spectracell intracellular nutritional testing, and hair analysis of minerals to help us determine deficiency states. 

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New High Blood Pressure Guidelines Released – A Paradigm Change


In an article entitled “2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults, Paul A. James, et al.” published in the Journal of the American Medical Association in December 2013, the new guidelines released by the Eighth Joint National Committee for managing high blood pressure were presented. What most of the headlines in the newspapers and Internet emphasized was the panel declared adults older than age 60 should aim for a blood pressure level less than 150/90 mmHg., and not the previously recommended 140/90 threshold. For people aged 30-59 a blood pressure less than 140/90 mmHg was recommended. These conclusions were determined after looking at data from randomized controlled trials. However, if one reads the entire findings of the committee carefully, there are a number of important conclusions I will go into. 

The committee members identified “threshold blood pressure” – that is levels at which treatment can begin, rather than defining at which blood pressure level hypertension begins. The committee members concluded their guidelines by adding “However, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.” 

So what does this mean? For one thing, many people who had drug treatment started because of mild elevations in systolic blood pressure are now in an “over-treatment” category and patients who had high-normal values and were being treated for so-called “pre-hypertension,” a condition never officially sanctioned for treatment, are also being over-treated. 

In patients with kidney disease and/or diabetes, the authors similarly stated we lack evidence for the right targets and so they settled on a goal of less than 140/90. This is a change for some people whose physicians may have been using a target of less than 130 systolic for these patients. The authors noted that the 130 systolic recommendation does not have evidence to base it on. 

A second issue that came out of the panel report was there is insufficient medical evidence to support a systolic pressure threshold for placing people younger than 60 on anti-hypertensive drugs. This lack of medical evidence did not stop the authors from expressing an opinion to stay with the current threshold of 140 mmHg. for systolic in this age group, even though it is based on opinion and not evidence. The panel did indicate the diastolic blood pressure (bottom number) should be less than 90 for people age 30 and older, and there is scientific evidence to support this recommendation. 

Another important conclusion is that drug therapy, while lowering blood pressure, does not necessarily mean you have reduced someone’s risk for a heart attack or stroke, even though we know hypertension is a risk factor for these events. This conclusion was based on findings from several studies where patients with mildly elevated blood pressures that were lowered failed to reduce risk – this was a surprising finding. Please note there is no question that drug treatment of very high blood pressure levels is beneficial. 

From my standpoint, the good news from this panel was the authors were led to be more conservative in their recommendations for drug treatment and they also emphasized the importance of a healthy diet, weight control and exercise. At the Center, we have found in some hypertensive patients the addition of magnesium supplements, potassium gluconate, and/or an herbal product called Natural Blood Pressure relief will lower blood pressure. We have also found stress reduction is very important, as is making sure a person’s home blood pressure machine is calibrated in an accurate manner. 


Patient Success Story – Elderly Patient with Fibromyalgia Relieved with IV Magnesium Therapy


Mr. R is a male patient in his 80s with multiple medical issues. He had been experiencing pains in the muscles of the extremities and hips and has a diagnosis of fibromyalgia. He also suffers from chemical sensitivities. He was unable to be placed on most pain medications, including drugs such as Motrin and Aleve, due to a history of a bleeding ulcer and also coronary artery disease. The term fibromyalgia describes a set of symptoms — including chronic widespread pain, increased sensitivity to pressure, sleep disturbance, brain fog, and fatigue — that is believed to affect 1 to 5 percent of individuals in Western countries, more frequently women. While a diagnosis of fibromyalgia has been recognized by the National Institutes of Health and the American College of Rheumatology, its biologic basis has remained unknown. In the past, many physicians felt fibromyalgia didn’t really exist and that it was a psychological disorder. This was because lab tests looking at inflammatory and autoimmune markers, and even muscle biopsies were normal in fibromyalgia patients. 

Current research is now shedding new light for some fibromyalgia patients. A study from the journal Pain, published in June 2013, reports that almost half of a small group of fibromyalgia patients they tested were found to have damage to nerve fibers in their skin and other evidence of a disease called small-fiber polyneuropathy (SFPN). Small-fiber polyneuropathy is a type of peripheral neuropathy (nerve pain) that occurs from damage to the small unmyelinated peripheral nerve fibers. Although it is characterized by severe pain attacks that typically begin in the hands and/or feet, some people initially experience a more generalized, whole-body pain. 

Magnesium can be used intravenously for a very rapid and powerful effect. Our experience has shown an acute migraine attack can often be broken by intravenous magnesium sulfate or chloride. It is also very helpful for settling down fibromyalgia pain, which has a muscle and nerve component. Unlike oral magnesium, where high doses cause bowel upset or diarrhea (e.g. Milk of Magnesia effect), IV magnesium bypasses the gut and is very well tolerated at higher than oral doses. It has an added benefit of also calming a person. Mr. R was given a series of two Magnesium Chloride IVs with complete relief of muscle pains by the end of each IV (0 out of 10 pain scale rating). His pre-treatment pain level was 4 out of 10.The pain relief lasted for several more days. 

There is a growing interest among traditional physicians in using magnesium for cardiovacular disease, diabetes and hypertension. For decades, intravenous magnesium sulfate has been used in the treatment of pregnant females with pre-eclampsia or eclampsia (characterized by elevated blood pressure and seizures). Among most integrative physicians, magnesium is used for pain management. This is not an FDA (Food and Drug Administration) approved or recognized therapy. The reason magnesium can help muscle pain is clear – it helps muscles “relax.” Why magnesium helps neurogenic pain (nerve pain conditions) is less clear. 
A major mechanism of pain is the excessive stimulation of a brain chemical called “NMDA” or N-methyl-D-aspartate. Magnesium seems to settle down NMDA without the toxicity of drugs. There are a number of drugs that block the NMDA receptor providing analgesia in nerve pain. These include dextromethorphan (a cough suppressant, but at higher doses than those needed to block cough), ketamine (an anesthetic), and amantadine (an anti-viral drug and Parkinson’s disease drug). A double-blinded randomized controlled study showing the value of sequential intravenous and oral magnesium therapy with chronic low back pain with a neuropathic component was published in the journal Anaesthesia, 2013;68:260-266. 

Patient Success Story – Allergies Treated with NAET Therapy


Dr. Nambudripad is a medical doctor, doctor of Oriental medicine, LMT, Ph.D, and acupuncture physician who has a large clinic in Los Angeles, California. Dr. Nambudripad pioneered a method of eliminating allergies in 85% of the people she treated through the use of acupuncture or acupressure, rather than using traditional allergy shots or sublingual immunotherapy treatments. Her definition of allergy is different than Western medicine. We think of someone having an allergic reaction when they develop hives, or swelling of the lips, or wheezing after being exposed to an allergen. Her definition of allergy is an “energy incompatibility” where the offending substance alters, in a negative way, the bio-energy field and/or acupuncture meridians of the person. With this definition a person can have atypical symptoms e.g., fatigue, brain fog, musculoskeletal pain, headaches, ADD-like symptoms, etc. which resolve after a successful treatment. Dr. Nambudripad calls her technique NAET (Nambudripad Allergy Elimination Technique). 

I was fortunate to find out about her and learn from her over a decade ago. I flew out to Los Angeles to meet her and to take one of her teaching courses. We offer this therapy to our patients. For the past 10 years using this therapy at the Center our experience has been very positive where most patients either reduce or completely eliminate allergy symptoms. Dr. Nambudripad has published a number of books on the subject, including her best-known publication Say Good-bye to Illness, where she goes into great detail on this subject. I would encourage anyone with allergies or even unexplained symptoms to read this book. We carry a few copies at the Center. 

Mrs. M is a 42 y.o. female patient who has allergies to foods and environmental factors. Her mother was also a patient who underwent NAET treatments with me successfully for treatment of her allergies. After screening Mrs. M for positive reactions to NAET allergen vials, she was found to be allergic to a number of foods, including sugar mix. Within a day of receiving a treatment to sugar mix, she had a sense of “calm” that she hadn’t felt in years. 

My oldest son Mike had a severe allergy to poultry since he was a toddler. If he ate one bite of chicken or turkey, or a spoon of chicken soup, he would break out in a rash and his throat and lips would swell up; he would also vomit. I always had to keep adrenaline around for emergencies. He was the first patient I treated with NAET therapy, and he has been eating poultry without any adverse reactions since his first treatment over 13 years ago.