by Glenn S. Rothfeld MD

1. Increase raw and lightly cooked foods, while decreasing processed foods.
2. Eat only when in a relaxed and conscious state.
3. Use digestive enzymes.
4. Take a probiotic supplement.

In my twenty-five years of practice, I’ve become more and more aware of the role that digestion plays in our physiology. I’m trained in both Western and Chinese medicine, and both systems emphasize the importance of the gastrointestinal functions. In Chinese Medicine the nutritive or digestive qi, or energy, is a prime source of our life force, along with breath and genetic material.

In Western medicine we have increasing evidence that digestive problems are connected with problems of other body systems. In nutritional literature, most auto-immune diseases are statistically associated with low production of digestive juices. Metabolic illnesses like diabetes and hyperparathyroidism have digestive components. The gastrointestinal illnesses including hiatal hernia, gastritis, inflammatory bowel disease and, particularly, the functional problems known as Irritable bowel syndrome are widespread in our society, and make up perhaps the most frequent complaints to present to a primary care practice. Finally, the use of antacids and of H2-blockers such as Tagamet and Zantac speak to the almost-universal effects of modern medicine and modern life on the digestive tract.

Looking at how the digestive system can affect so many illnesses and so many symptoms, we are reminded that the intestines make up the largest surface area of the body, and a surface that is a barrier between us and the outside world. In fact, if the walls of the intestines were laid out flat, they would cover a football field! Such a large organ has several special functions. The intestines are lined with immune proteins, particularly secretory IgA, and the lower bowel is covered with bacteria that protect against foreign substances entering the body. The stomach is bathed in a hydrochloric acid solution to sterilize anything that comes through it, and the mouth, stomach, small intestines and pancreas all secrete digestive enzymes to help break down foods into individual building blocks. The intestinal walls are made to allow the absorption of these food molecules, and various nutrients, some absorbed passively and some requiring active transport into the body.

What interferes with these functions? The answer, in a word, is LIFE. Many studies have shown that stress suppresses secretory IgA, making our digestive tracts more susceptible to invasion by harmful bacteria, fungi and parasites. The reliance on medications to neutralize the hydrochloric acid in our systems takes away this important barrier to foreign invasion, as well as limiting the important role that hydrochloric acid can play in digestion. Antibiotics and common foods such as colas, coffee and fried foods can alter and diminish the helpful bacteria in the colon. And lowered amounts and potency of our digestive enzymes leads to undigested foods.

Poor digestion in particular causes many problems directly and indirectly, and may be the key that links digestion to many systemic illnesses. First of all, when a food is not completely broken down in the intestines, it may not be absorbed well. Instead, it stays in the intestines to the colon, where it feeds bacteria, not always the helpful kind. Bacterial digestion of food particles frequently causes gas, bloating, and the production of harmful toxins in the colon. Second, bits of protein in particular can cause problems if not fully digested. Looking very much like foreign viruses and other invaders, they can stimulate the immune system, leading to so-called food sensitivities or allergies. Bannerman’s textbook, Food Allergies, describes much of this in detail. There is also good evidence that bits of protein can absorb intact into the blood stream, where they look and act much like the messenger hormones put out by the neurologic and endocrine systems. This is probably why some foods such as wheat, can cause mental and behavioral symptoms if not well digested. Finally, many of the nutrients that are contained in foods are not absorbed when the foods that contain them are not digested, leading to multiple small nutritional deficiencies.

Which brings us to a discussion of enzymes. The body produces digestive enzymes, enzymes which make biochemical processes happen, and enzymes that control inflammation and reactivity. Dr. Edward Howell, an enzyme researcher, first articulated the Law of Enzyme Conservation, since proven in several venues. Simply stated, this says that the body produces a set number of enzymes, and if there is an increased need for digestive enzymes, there will be a decrease in production elsewhere. Now, Nature gave us all the enzymes we want, contained in raw fruits and vegetables. These are activated in the process of eating raw foods, and they are inactivated upon cooking or otherwise altering foods. If we eat a diet strong in raw foods, there is less need of the body to produce its own enzymes. However, most of us do not eat a diet of raw foods, if any. Furthermore, we eat complex, processed foods with very little resemblance to “live” foods. And if that’s not sufficient, we eat them at business meetings, or shovel them in while watching TV, or gobble them with one hand while we drive toward our next appointment with the other. No wonder there is an epidemic of poor digestion, underabsorption of nutrients, and deficient digestive enzyme function!

My strategy for combating this in my patients is several fold. First, I encourage an increase in raw and lightly cooked foods, and a concurrent decrease in processed foods, fried foods and “quasi-foods” such as colas, coffee, and carbo-laden snacks. Second, I try to emphasize the importance of eating in a relaxed state, and some concentration and awareness of what we’re eating. The digestive tract is too important to make it compete with everything else to do its job!

Third, I use digestive enzymes with just about everyone. Usually, this is the first thing I give when a patient comes in, that’s how critical they are to most people’s healing. I prefer plant-based enzymes to the pancreatic enzymes that are on the market. Plant-based enzymes are made from aspergillus, and have a much broader activity than animal-source or synthetic enzymes. That is, they are made up of a number of enzymes (proteases, peptidases, isomaltases, etc), each able to break a different bond. It’s analogous to using wild yeast, versus the stuff you get in the packets. The end result is a more completely digested food, not just the cleaving into small particles that you get with pancreatin. Furthermore, plant-based enzymes are more stable in acid environments, and thus can pass actively through the stomach, whereas pancreatin cannot.

My fourth suggestion takes us back to the intestinal bacteria which lines the colon and has so many important functions. You know, there are actually more bacteria in our colons than there are cells in our bodies, and damage to this bacterial cover can be due to antibiotics (given to us or to the animals that we eat), stress, alcohol, or other dietary indiscretions. Toxic bacterial overgrowth is implicated in problems such as auto-immune diseases and various cancers. And, as I said before, good bacteria are important in immune system function, in digestion and in absorption of nutrients.

To replenish the good intestinal bacteria, I give a bowel flora product This product contains DDS-1, a strain of lactobacillus acidophyllus which has been studied a lot for its positive effects on the digestive tract. It also contains other strains of bacteria, including bifidus, bulgaricus, and enterococcus faecium, all known to strengthen and build a healthy colon. This and other intestinal flora products usually also contain fructooligopolysaccharides, (FOS), a food used to nourish the healthy bacteria of the intestines.

So, in conclusion, let me say that we are not about to go back to the Garden of Eden, where Nature provided us with fresh enzyme-rich and nutrient-rich foods in an environment conducive to digesting it. But we can try to be conscious of what we eat and how we eat it. We can add plant-based enzymes to our regular diet, to help protect our body’s own enzyme activity and to prevent the ravages of poor digestion. And we can repair any damage to the bacterial layer of our intestines by taking intestinal flora supplements. It’s a good head start on any program toward better health.

To implement a program based on Dr. Rothfeld€™s recommendations, you may order the following supplements:

Similase(digestive enzyme) take 1-2 with meals
PB-8 (intestinal flora) 2 twice daily after meals
Other supplements that may be helpful for digestive problems are:
RF Plus (an herbal formula used to help the symptoms of irritable bowel syndrome) 2 after each meal
NeutraGas (an herbal formula used to help the symptoms of intestinal gas) 2 after each meal
 

[Please notify your doctor that you are planning on taking these supplements. This program is not a substitute for regular medical care, and does not purport to treat specific medical illnesses.]

By Glenn S. Rothfeld, MD 

The question of estrogen replacement therapy (ERT) is hotly debated among women nearing menopause, their physicians, and the press. Many complex issues make this debate a lively one, but osteoporosis is perhaps the most complex and important one. And for good reason. Osteoporosis affects over 20 million Americans, and is expected to cost over $30 billion dollars annually by the end of the decade. These costs include fractures that currently number 1.5 million per year. The elderly, who account for most of these fractures, frequently require extensive rehabilitation, surgery, long-term care, and treatment of secondary problems like infection. Between 12 and 20% of elderly who fracture their hip die soon after.

So osteoporosis is not merely another nuisance of aging, but a severe and growing medical problem in the U.S. Unfortunately, much is not understood about this disease, and the present medical treatment is largely limited to TUMS, synthetic estrogens, and (in a growing number of women) strong drugs that prevent further damage to already diseased bones. To understand a natural approach to osteoporosis, we must appreciate how the many systems of the body work together to foster health.

Osteoporosis is defined as a loss of bone mass, and therefore, bone strength. This is very different from osteoarthritis, which is a wearing away of cartilage and bone at joints, and from diseases such as rickets and osteomalacia, which involve abnormal bone formation. Osteoporosis is not painful, in fact, it causes no symptoms until it is bad enough so that a fracture occurs, usually after many years of losing bone mass. Bone is constantly being broken down (reabsorbed) and formed again in a process called remodeling, which allows our bones to stay strong and to adapt to different situations. After age 40, bone is slowly lost in both sexes, and after menopause, women lose additional bone for about a decade. Thus the best strategy of preventing osteoporosis is to reach age 40-50 with as dense a bone as possible, so that the age-related loss will not be as serious.

Bone turnover is affected by diet, by nutrients, by many different bodyhormones, by physical activity, by stress and sleep, and by genetics. There clearly are environmental factors: women in Surinam in South America were found to have less osteoporosis than their North American counterparts despite having less calcium in their diet. Skeletons from 200 years ago show much less bone loss than today. Toxins that interfere with bone formation, fewer micronutrients in the diet, and modern-day stresses are all implicated.

A diet that supports bone health should be low in sugar and table salt, both of which promote loss of calcium in the urine. It should avoid soft drinks for the same reason, and because of calcium-wasting phosphates that are added to sodas. Non-starchy vegetables and fruits should be emphasized, and some protein as well. Grains, when eaten, should not be processed or refined. And as for dairy (the food most people and their doctors associate with calcium), it’s unclear. Dairy is certainly rich in calcium but that calcium is not as usable due to high phosphorus content in dairy, and other problems like lactose intolerance, allergy to milk protein and toxins in milk make it a mixed blessing.

The key nutrient of bone health is, of course, calcium, and calcium supplementation has been shown to benefit bones in a variety of ways, especially before and during menopause. All calcium is not the same, however, and the calcium in TUMS and similar products is calcium carbonate, one of the least absorbable sources. Calcium lactate, citrate, gluconate and aspartate are all well absorbed, and several studies have shown their increased availability over calcium carbonate. Of recent interest is some products containing something called microcrystalline hydroxyapatite concentrate (MCHC), which contains calcium in the form that it exists in bone, along with the other factors occurring in bone. This substance has shown superiority in several studies of bone density and fractures.

Contrary to popular ideas, the story of bone health doesn’t stop with calcium, however. Wherever calcium goes in the body, magnesium goes as well, and it comes as no surprise that over half the body’s magnesium is in the bones, and that magnesium deficiency leads to abnormal mineralization of bone. What causes magnesium deficiency? Just about any stress we are exposed to, including many medications, emotional stresses, prolonged illness or activity, and even loud noises! The best magnesium sources are the same as for calcium, and frequently these minerals are combined. The preferred ratio of calcium to magnesium is 1:1.5 or even 1:1, which usually means adding more magnesium.

Vitamin D is essential in calcium metabolism and, fortunately, we’ve been given a regular source of vitamin D, sunlight. Outdoor activity has many advantages, and vitamin D supplementation is one. Vitamin K, usually ignored except in bleeding situations, is essential in the forming of bone proteins, and prevents calcium loss in the urine. Boron, a trace mineral, also seems to have a regulating effect on calcium and bone metabolism, as well as the sex hormones estradiol and testosterone.

Which brings up the role of sex hormones in bone activity. Estrogen, contrary to popular understanding, does not treat osteoporosis. It prevents further breakdown of bone, and has been shown to prevent fractures after taking it for years post-menopausally. The body of evidence supporting estrogen usage in post-menopausal women is growing, and most physicians would agree that significant osteoporosis on bone density testing is a reason for hormone replacement, if otherwise appropriate. However, the timing and type of estrogen is still very much in question.

Some physicians prefer to control menopausal symptoms naturally (herbs, diet, acupuncture have all been effective) and to wait until age 60-65 to begin estrogen, since the main risk of estrogen therapy, breast cancer, is related to the total amount of exposure to estrogen. Others begin hormones at the time of menopause, trying to eliminate the larger bone loss around menopause. The studies have mostly used Premarin or other conjugated estradiols, one type of estrogen that is made in the ovary. Physicians interested in natural therapy frequently use estriol or a combination of different estrogens. Estriol, another natural estrogen, seems to be cancer-preventive, but it’s not clear whether it has the same effect on bone as estradiol. Finally, there are choices between oral and “patch” forms of estrogens.

Phytoestrogens, or plant-source estrogens, raise interesting possibilities. Soybeans, for instance, contain a substance called daidzein (similar to a medication in Europe used to treat osteoporosis). This and another isoflavone (the name for the estrogen-like substances) called genistein have been shown to stop bone loss in animals, to slow down calcium loss in urine, and to relieve menopausal symptoms.

Other hormones besides estrogen seem critical to bone health. There is a wealth of information suggesting that progesterone is important, not just to balance estrogen, but to promote bone growth. For instance, marathon runners who have maintained estrogen levels develop osteoporosis from progesterone loss. Progesterone is a tissue-building hormone, and thus it seems to promote bone formation, not prevent its loss. Most women are given Pro-Vera or similar medications, which is not progesterone but a synthetic imitation called a progestin. Progesterone itself can be given in a special oral preparation. It also can be given in a skin cream which is then absorbed. However, it is very hard to regulate the dose with skin creams, since progesterone accumulates in the fat tissue and may be released in bursts. Also, although yams are used to produce progesterone (and the other steroid hormones like DHEA) in the laboratory, the body cannot convert the yam substance to hormones, and therefore yam creams must have a hormone added to them to be effective.

Other hormones that are important in bone health are DHEA and testosterone, which are male (androgen) hormones and therefore tissue-building. Both hormones have been shown to be lower in women with osteoporosis, and to improve bone density and calcium balance. These hormones should generally be measured at menopause, and can be supplemented if low. Contrary to estrogen and progesterone, testosterone production does not decrease after menopause. DHEA may decrease, but if it does, it is associated with higher chronic disease and stress levels.

Recent chemicals have been developed to more aggressively prevent bone loss. These drugs (Fosamax, Didronel) do not grow bone once it’s been lost, and they have not been used long enough to establish long-term safety records. However, they are useful in cases of severe osteoporosis.

Exercise plays a major role in maintaining bone health. There is clear evidence that weight-bearing exercise helps to reach and to maintain bone density, at whatever age it is begun. Since the best strategy for preventing osteoporosis begins well before menopause (many women lose half their vertebral bone before the estrogen levels go down), an exercise program should begin when younger. However, even someone already showing signs of bone loss will benefit from exercise. This may be careful weight training, walking, movement sports and dancing. Also, yoga and qigong are exercise systems well-suited to older people anxious to maintain strength and mobility.

Finally, one can’t say enough about the importance of stress management. As odd as it sounds that stress causes bone loss, some estimates of the effect of chronic stress on bones are as high as 50% of the total effect. This is because stress raises the adrenal hormone cortisol, which has a strong demineralizing effect on bones. Lack of restful sleep has also been shown to affect the formation of new bone the following day. Since an adrenal gland overproducing cortisol and other stress hormones will tend to underproduce estrogen, DHEA and other hormones essential to bone health, the effect is cumulative. . Recently, salivary assays have been developed to measure the stress hormones and sexual hormones over the course of a day and throughout a month€™s cycle.

Osteoporosis is certainly one of the ravages of age, but it doesn’t have to be. The prevention and treatment of this illness can demonstrate a good Integrative Medicine approach, combining the best of nutrition, lifestyle modification, stress management, herbal therapies, and the wise use of medication in cases where it is necessary.

To implement a program based on Dr. Rothfeld’s recommendations, you may order the following supplements:

OsteoPrime Forte (a nutritional formula designed to match the nutrients that have been shown to combat osteoporosis) 2 capsules after each meal

We don’t recommend taking hormonal substances like DHEA and progesterone except under a doctor’s care. In our office, we test the hormone levels in saliva assays before prescribing any hormone therapy, even progesterone creams and melatonin.

If you wish to have more information about salivary hormone testing, click here.

Other supplements that may be helpful for stress relief and sleep difficulties are:

Valsed (an herbal formula containing relaxing herbs and nutrients) 2 after each meal, 4 at night

SpectraChrome (a nutritional formula for low blood sugar) 2 after breakfast and lunch

We recommend the book by Dr. Alan Gaby, who designed the OsteoPrime Forte supplement. The book is called: Preventing and Reversing Osteoporosis. To order this book, click here.

[Please notify your doctor that you are planning on taking these supplements. This program is not a substitute for regular medical care, and does not purport to treat specific medical illnesses.]

Alternative View: Patterns of Disharmony
By Glenn S. Rothfeld, MD

According to a recent study in the New England Journal of Medicine, millions of patients are turning to so-called Alternative Medicine to treat their conditions, many times without discussing their plans with their primary physician. The slowness with which orthodox medicine has acknowledged the existence of Chronic Fatigue Syndrome, and the lack of a coherent pattern of diagnosis and treatment, have set many CFS patients along this course.

This paper will focus on one such alternative approach which is being used by many with CFS. Chinese Medicine (Oriental or Eastern Medicine are other terms) includes acupuncture, Chinese herbal medicine, and QiGong exercises and massage techniques. These treatments are sometimes used separately and sometimes together. All are based on principles of Chinese Medicine written some 2500 years ago and based on even older concepts.

The ancients studied the natural world, and described events in the human body in terms of those forces of nature. Because they revered their dead, they did not dissect or biopsy for information. Rather, their medicine was based on what they observed in the living patient, and what the pattern of symptoms were.

One can see why Chinese Medicine is an attractive way of approaching CFS. Firstly, Chinese Medicine starts with the concept of Qi (pronounced “chee”), translated as “energy” or “life force”. For a patient whose primary symptom is lack of energy (particularly fatigue which is highly variable, disabling, and invisible to the outside world), a system which at least acknowledges the existence of life energy as a concept is refreshing.

Secondly, there is no question of whether this is a “real” illness in Chinese Medicine. That is to say, ANY combination of symptoms and patient presentation is seen in terms of the imbalance of energy, and treated as such. There is no division of mind and body (or of “spirit” for that matter: more on that later) in this medicine. An emotion is seen as the non-physical representation of an illness. There is no hierarchy of physical and mental, and no need for a patient to plead for a SPECT scan to prove that they don’t need a psychiatrist.

Thirdly, because Chinese Medicine focuses on patterns of presentation and on the interrelationship of body systems rather than on causative factors and discrete organ pathologies, one can easily explain the global effects of an illness such as CFS. The myriad symptoms of the neurologic, psychologic, gastrointestinal, reproductive, respiratory, hematologic, dermatologic, and immunologic systems can confound (and sometimes, cause “turf wars” between) Western medical specialists. For Chinese Medicine, they are different hues to paint a more complete picture of imbalance.

Finally, since the forces of nature never change, the patterns described in CFS are familiar ones to a practitioner of Oriental Medicine. The diagnosis and treatment is based on the skill of the practitioner and does not change rapidly with advances in immunology and pharmacology.

A full discussion of Chinese medical diagnosis is beyond the scope of this article. But, here are some patterns of disharmony commonly seen in CFS. The organ names (Kidney, Spleen, etc.) are NOT referring to the anatomical organs, but to energetic functions related to the organs, as the Chinese understood them. top

Yin/Yang Disharmony

All of life involves an interplay of active and passive principles: day/night, summer/winter, hot/cold, exterior/interior, sympathetic/parasympathetic. The Yang part of the Qi is that part of us which is in movement, warms us, is active, external, and lifts us up. The Yin part is interior, replenishes, anchors and nourishes us, creates stillness, and is cool and fluid.

Common Yin/Yang disharmony in CFS patients presents as Yang Deficiency (collapsed fatigue, difficulty waking in the morning, cold limbs, sluggish digestion and other body processes, diminished libido) and/or Yin Deficiency (restless fatigue and insomnia, hot flushes, stiffness and deep aching pain). top

Shao Yin (Kidney) Disharmony

In Chinese Medicine, the Kidney Qi is the deepest energy and holds the reserves and the will. Therefore, any chronic illness will eventually deplete the Kidney Qi, especially the Yin aspect which is like an underground spring: deep, refreshing, and liquid. Kidney Yin Deficiency is a common pattern in CFS, as it is in AIDS and in other chronic debilitating conditions. (The similarity of some AIDS and CFS symptoms cause confusion and frustration in the research, clinical and political worlds; in Chinese Medicine they can be seen as different degrees of the same disharmony patterns.)

Kidney Yin Deficiency can show up as frequent urination, severe exhaustion, weak legs and knees, dizziness and tinnitus, dry mouth and throat, disturbed, restless sleep which does not relieve the fatigue, night sweats, fearfulness and lack of resolve and willpower.

The Shao Yin channel also includes the Heart energy, which holds the Spirit, or “Shen.” This Shen, the spark of liveliness within us, is not really a mental process in Chinese Medicine, but has to do with our potential to live life fully. I have had patients who have had their “spark” drained by their constant battle with chronic illness, such that they became flat and hopeless. Every so often, they awake feeling some energy, and they put a smile on and fill their day with activity. Yet, these patients are frequently treated as having endogenous depression, and given mood elevators. top

Wei Qi Disharmony

The Lung governs the Wei, or Protective Qi, which prevents our receiving foreign influences (viruses, toxins). A weakness in the Wei Qi will lead to repeated episodes of viral-like illnesses, scratchy throat, slight fever (especially later in the day), shortness of breath, and a dry cough, as well as exhaustion. top

Damp-Heat Syndrome

This frequently comes from an infection (a common precipitant in CFS) or from unhealthy lifestyle patterns. Dampness is the term given to the waste products of metabolism and digestion, which can accumulate in the channels of energy. This leads to aching and tiredness in the muscles, heaviness of body or head, fatigue after any exertion, bloating and sour digestion, and a lack of concentration and clouded feeling in the brain. With heat (from infection, or depletion of yin) can come burning on urination, foul gas and vaginal discharge. top

Circulation-Sex Syndrome

Five Element acupuncture, popularized in the West by Professor J.R. Worsley, includes the concept of the Heart Protector (or Circulation-Sex channel), which guards the Heart (frequently likened to the Pericardium). Thus, when one’s intimacy is breeched (by rape, abuse or even “heartbreak”) the Heart Protector is adversely affected, so that external factors are allowed in which should not be, and those which should get in are kept out. This can manifest as environmental sensitivity (overreacting to things which should not be threatening), as issues involving intimacy, or as tightness in the chest and as coldness and paresthesias of the limbs (Qi staying close to the Heart.) top

Therapies:

Acupuncture

There are approximately 8,000 acupuncturists in the U.S., 1/4 of whom are MDs. Acupuncture involves the placement and manipulation of thin needles in “points” along the channels of energy, or meridians. This facilitates the movement of stuck Qi, and helps repair the dysharmonies. Points also may be stimulated by a burning herb (called “moxa”), by electrical current, magnets, or lasers. A typical course of acupuncture involves treatments 1-2 times per week. CFS, as a chronic illness, takes a while to treat effectively, but common results after a few weeks of treatment are less heat sensations, less muscle and joint pains, and an increased sense of well-being. top

Western Perspective

Acupuncture was first introduced in the U.S. as an alternative to anesthesia, and most of the Western research has still focused on this, somewhat peripheral, use. The discovery that acupuncture needles stimulate the type 3 afferent muscle fibers to release endorphins, and that acupuncture releases ACTH and TRH in the central nervous system helps to understand the effects which (unlike TENS machines) last for days after the needles are removed. However, it is the application of electromagnetic field theory and of quantum physics to the neuro-endocrine system which is beginning to articulate a basis for understanding how acupuncture works. top

Chinese Herbal Medicine

There are hundreds of Chinese herbs, and they are combined into formulas, which are then given in pill, powder or tincture form, or cooked whole until the liquid extracts the resins and is drunk. A course of therapy is usually several weeks, after which the prescription is altered according to response.

An herbal prescription usually contains the herbs of main action (e.g. Kidney tonic herbs for treating Kidney Deficiency syndrome), secondary herbs to help correct the imbalances, and herbs to ameliorate any side effects (e.g. herbs to protect the stomach from irritation). This allows the herbalist to use smaller (and therefore safer) doses of any single herb, and still get a powerful cumulative effect. The current push in psychiatry toward poly-pharmacy, and the “step” approach in antihypertensive therapy use similar principles. top

Western Perspective

The current interest in the antineoplastic drug Taxol, produced from the Pacific Yew tree, and the investigation of trichosanthes (Chinese cucumber) and various mushrooms have brought Chinese herbal medicine to the attention of Western scientists. When studied, various herbs have antimicrobial (isatis, astragalus), antiparasitic (…), antineoplastic (…) and antihypertensive (…) effects. There are also resins called terpins and saponins that are prevalent in herbs such as ginseng, astragalus and licorice, which have what is called an “adaptogenic” effect on the adrenal and other endocrine organs. However, studies of the prescriptions themselves rather than the component herbs, are just beginning to appear in Western journals. top

Qi Gong

The PBS/Bill Moyers special “Healing and the Mind” has brought QiGong (formerly spelled Ch’i Kung) to prominence. QiGong literally means “energy exercise” and can include anything from Tai Ch’i (a dance-like series of movements) to Kung Fu and other martial arts. A QiGong practitioner will teach a patient exercises to build the Qi, and to encourage it to circulate within the patient’s channels. The exercise form is not stressful, and can be done by patients who are otherwise disabled. QiGong can also involve treatment with a form of massage called acupressure, which the patient can be taught to self-administer. top

Western Perspective

There is some controversy over the use of exercise in CFS. QiGong is actually similar to yoga in that the mind and the breath are used with gentle movements and postures. Whereas yoga and meditation have been studied some, studies of QiGong await the acceptance in the West that concepts like “energy” and “well-being” are real and tangible to patients. top

Conclusion

In 18.., Dr. Ehrlich published … and began what is known as the search for the Magic Bullet. This paradigm, that there is an infectious cause of a disease and therefore a discrete curative substance which merely awaits discovery, has dominated medicine through the current century. This in turn has led to major medical successes over bacterial and related diseases. But it has also steered us down an increasingly expensive path of capsular protein antigen assays and fourth-generation antibiotics.

Chronic Fatigue Syndrome, with its wide range of symptoms and of target organs, its insidious onset and variable course, and its focus on the patient’s own report of their energy, poses an elusive and complex problem for this model. Chinese Medicine and its therapies give CFS patients a different perspective of their illness, and offer some the hope of an effective adjunct or primary form of treatment.

By Glenn S. Rothfeld, MD

In the alphabet soup of vitamins, one of the main players has gotten the short end of the tick for a long time.   Almost all of the vitamins have varied and sexy stories around them.  Vitamin A has two forms, vitamin A itself and “pro-vitamin A”, which we call carotene (beta carotene being the most famous).  It’s these carotenes that help to give the luscious orange and yellow colors to fruits and vegetables.  Vitamin A has long been known to strengthen the immune system, promote skin and mucous membrane healing, and help sharpen and sustain the vision.  And those of use who passed through medical school beyond a decade ago surely remember the ONE nutritional fact that was drummed into us, that if you eat too much polar bear liver, you will undoubtedly suffer from “hypervitaminosis A”, or vitamin A poisoning (I’m not making this up. Ask any doctor if they don’t remember this cautionary tale from medical school).B vitamins have all sorts of uses and stories, including the use of B1 (thiamin) for alcoholics, B2 (riboflavin) to prevent migraines (in addition to its traditional use to ward off beri-beri), and folic acid in a myriad of indications from preventing birth defects to lowering homocysteine and therefore lowering heart disease risk.  Vitamin C (ascorbic acid), of course, is the star of the vitamin family, having been promoted for anything from stress reduction to cold prevention to wound healing to cancer therapy.  And according to the recent book Napoleon’s Buttons, when Admiral Lind finally insisted that his sailors (later called Limeys) be given lime juice on their long sea voyages, therefore assuring that they would be hale and hardy and free of the scurvy that plagued all sea voyagers, he set the course of history, insuring the victory of the English fleet over the scurvy-ridden Spanish and Portuguese ships.  (It is suggested that the Spanish and Portuguese captains withheld citrus from their crew, preferring to keep them slightly weaker and sicker, and therefore less mutinous).

Vitamin E was, decades ago, known as the vitamin without a deficiency disease, is now known to play a very important role in protecting the lipid membranes of the brain, cardiovascular system and skin cells (for my comments on the recent vitamin E studies and the controversy that surrounds them, see my website http://www.wholehealthne.com/).  Vitamin K, of course, is mostly known in terms of clotting, and usually isn’t considered an issue unless it’s blocked by medications (although it has a poorly understood job in protecting antioxidants in the body).

Amongst all these well-known siblings, vitamin D has thus far been relegated to a second tier, mostly known for it’s association (when severely deficient) with rickets, a problem with bone growth leading to softening of bones.  The exact job of vitamin D in protecting bones has to do with its role in calcium metabolism.  Calcium is essential for proper muscle and nerve function, and the amount of calcium in the blood is a critical factor.  Vitamin D has the job of maintaining the proper amount of circulating calcium.  When calcium in the bloodstream gets too low, vitamin D boosts its absorption from the digestive tract.  So, it’s always been thought of as a vitamin with a fairly simple function.

But vitamin D is not so simple as that.  First of all, it is derived, not from food sources (although it can come from foods) but from sunlight.  Enzymes in our skin are altered by sunlight, resulting in vitamin D levels in the body.  The more sunlight, the more vitamin D.   And here’s where it gets interesting.  Studies of epidemiology have suggested that certain diseases, including some cancers and auto-immune associated diseases such as MS and ulcerative colitis, are more prevalent in northern climates than southern climates.  This led scientists to study a role for vitamin D in the immune system, and a fascinating thing has resulted.  We are now finding out that vitamin D is a controller of proper immune function.  In fact, it hardly acts like a vitamin at all (vitamins generally act by being co-factors in enzyme reactions, or by carrying electrons in oxidation-reduction reactions).  It acts more like a hormone for the immune system, and some scientists are suggesting that it be reclassified.

In any case, the research has been fascinating.  In animal models meant to mimic MS, vitamin D resulted in a profound decrease in inflammation of brain tissue, increase in proper immune system function, and a boost in the protective function of the blood-brain barrier.  Other studies have confirmed a crucial function of vitamin D in balanced immune function.

Meanwhile, the studies that associate vitamin D levels with certain disease prevention pile up.  Prevalence of MS is inversely correlated with the amount of sunlight; so is type I (insulin-dependent) diabetes and ulcerative colitis, among other auto-immune illnesses.  Several cancers are also inversely correlated with sunlight, particularly some lymphomas.  There is some suggestion that prostate cancer incidence can be lowered as much as 40% with high levels of vitamin D in the blood.  Many cancers have vitamin D receptors (VDRs) including breast, colon, skin, lung and bone cancer cells.  Cancers do their damage by rapid growth and lack of differentiation (that is, the cancer cells are more immature and not as well formed as normal cells.)   We know that vitamin D promotes cell differentiation and slows down proliferation (rapid growth).  Thus, there are clear mechanisms to explain vitamin D’s anticancer effects.

Another interesting thing that has come to light about vitamin D is the importance of adequate levels in the blood.  Currently, most labs have very broad range that is considered normal.  The lower limits of normal is usually around 9 ng/ml.  However, the risk of both cancer and auto-immune illnesses appears to increase when the blood levels are less than 35 ng/ml (around 80 nmol/L).  The recommended oral doses of vitamin D (currently 400 iu daily) are probably inadequate for most people to maintain these levels.  That’s where sunlight comes in: daily exposure to sunlight, particularly ultraviolet-B (UVB) radiation from sunlight, leads to synthesis of vitamin D in the skin.

But in fact, at latitudes like Boston’s, there is not nearly enough sunlight to provide adequate vitamin D to support immune system boosting levels.  For four months per year, there is no vitamin D produced in the skin of most Bostonians.  Furthermore, the successful public health campaign to cover up in the sunlight and wear heavy UVB blocking sunscreens can be helpful in lower skin cancer rates, but it clearly has a negative effect on vitamin D levels.

So, a more effective dose of vitamin D is about 1,000 iu per day, and should be in a form called D3, or cholecalciferol.  For people with cancer or autoimmune disease, including MS, 2,000 iu may be more appropriate.

Apitherapy, the medicinal use of honey bee products, has been practiced since ancient times. In the modern world honey bee venom has found wide uses in treating arthritis and other inflammatory and degenerative diseases. The world scientific literature contains more than 1500 articles on bee venom. The French and Russian equivalents of the N.I.H. have been involved in clinical studies of honey bee venom, and in the U.S. the Army has looked extensively at the chemical compounds in bee venom.

Honey bee venom contains at least 18 active substances. Melittin, the most prevalent substance, is one of the most potent anti-inflammatory agents known (100 times more potent than hydrocortisol). Adolapin is another strong anti-inflammatory substance, and inhibits cyclooxygenase; it thus has analgesic activity as well. Apamin inhibits complement C3 activity, and blocks calcium-dependent potassium channels, thus enhancing nerve transmission. Other substances, such as Compound X, Hyaluronidase, Phospholipase A2, Histamine, and Mast Cell Degranulating Protein (MSDP), are involved in the inflammatory response of venom, with the softening of tissue and the facilitation of flow of the other substances. Finally, there are measurable amounts of the neurotransmitters Dopamine,Norepinephrine and Seratonin.

Bee Venom therapy can be useful in a wide variety of medical situations. Charles Mraz, a beekeeper in Middlebury, Vermont who has popularized bee venom therapy for the past 60 years, says that it is reasonable to try bee venom therapy in any clinical situation where nothing else works. However, there are four situations which are most frequent:

Arthritis and other systemic inflammations. Bee venom therapy can be useful in both rheumatoid and osteoarthritis, helping with both pain and swelling. In the case of rheumatoid arthritis, rheumatoid nodules can lessen in size. Other connective tissue diseases such as scleroderma have been (anecdotally) helped by BVT. Even systemic inflammations not related to joints, such as ulcerative colitis or even asthma, may warrant a trial of bee venom. This is presumably due to stimulation of endogenous cortisol through the hypothalamus-pituitary-adrenal axis.
Acute and chronic injuries. Bursitis, tendonitis and other areas of injury respond well to bee venom therapy. In this case, the effect is probably a local anti- inflammatory effect, involving the humoral and cellular immune responses to a foreign protein. Chronic back and neck pain may respond, as can other aches and pains.
Scar tissue. Keloids and other scar tissue are broken down and softened by the substances in the venom, and can flatten out and fade in color. Internal scar tissue, such as adhesions from previous surgery, may respond to treatment over the area.
Multiple Sclerosis. This use of bee venom is poorly understood, and needs to be studied further. Recently, the MS Associat ion of America awarded a grant to an immunologist, Dr. John Santilli, to prepare the venom in extract form to study its effect on MS patients. Hundreds of patients with MS currently seek out bee venom therapists and beekeepers. The treatment is prolonged and not for the squeamish, but the common responses are increased stability, less fatigue, and less spasm.
Bee Venom Therapy can be performed by a beekeeper, or by a patient or partner who is taught to use the bees. A bee is removed from a jar or hive with tweezers, held over an area of the body, which it then stings. The number, sites, and frequency of the stings depend on the patient and the problem. A simple tendonitis might just take a few stings, perhaps 2-3 at a session for 2-5 sessions. A more chronic problem like arthritis can take 2-3 times per week, several stings at a time, for 1-3 months. Multiple sclerosis takes months to respond, though sometimes patients feel more energetic after a few times. MS patients who use bee venom insist that one must keep it up 2-3 times per week for 6 months in order to give it a full trial.

There are physicians around who use bee venom therapy in their practices. This is done by obtaining the venom (in sterilized vials) and injecting it under the skin, sometimes mixed with a local anesthetic. Some say that collecting the venom in vials loses some of its potency, but in many situations this is more realistic than finding a beekeeper or handling bees.

Side effects of bee venom therapy are generally limited, since the inflammation, swelling, itching, etc. are desired effects. However, the risk of an anaphylactic allergic reaction to bee venom is real, and it is always wise to have a bee sting allergy kit on hand. Fortunately, most “bee” sting allergic reactions are actually to yellow jackets or wasps. Honey bee venom does not necessarily cross-react, and some studies show honey bee stings to account for less than 5% of all adverse stinging insect reactions. In addition, many people who have had severe local reactions to bee stings, which an apitherapist would consider a positive effect, are incorrectly considered to have allergy to bees.

Finding a beekeeper who is willing to sting someone is a matter of calling local beekeepers and organizations. There is also the American Apitherapy Society, headquartered in Vermont. Charles Mraz of Middlebury Vermont is also a source of wisdom and information regarding apitherapy. Books of interest include Bees Don’t Get Arthritis by Fred Malone(Academy Books) and Bee in Balance by Amber Rose (Starpoint Ltd).

The American Apitherapy Society,Inc.
P.O. Box 54
Hartland Four Corners, VT.05049,
(Voice) 800-823-3460 (Fax) 802-436-2827
(International) 802-436-2708