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GERD (Gasto-Esophageal Reflux Disease)
By Renata Trister DO

When asking the average person on the street what causes heartburn, he/she will most likely answer “too much stomach acid.” Most of the ads on TV and in magazines seem to suggest the same.
However, there is a big problem with this explanation: the incidence of heartburn and GERD increases with age, while stomach acid levels generally decline as we get older.

Many studies have shown that stomach acid secretion declines with age. One study showed that over 30 percent of men and women past the age of 60 suffer from atrophic gastritis. Patients with condition produce little or no acid.
Another well established fact in scientific literature is that the risk of GERD increases with age.

Consequently if heartburn were caused by too much stomach acid, we should see teens requesting antacid medications, but of course the opposite is true.

In fact, when stomach acid of heartburn and GERD suffers is measured, it is almost always low, not high. Excess stomach acid is only found in a few rare conditions like Zollinger-Ellison syndrome), and GERD is hardly ever associated with too much stomach acid.

Moreover, many clinicians have found that giving hydrochloric acid supplements to patients with heartburn and GERD can relieve their symptoms. When nutritional changes are made and supplemented with hydrochloric acid and pepsin capsules
Symptoms and digestion are improved even further.

Symptom vs Cause

When people first hear that GERD is caused by a lack stomach acid, rather than excess, they are skeptical. After all, if this were true then why would antacid drugs provide relief?

The painful symptoms of heartburn and GERD are caused by stomach acid refluxing into the esophagus. Reducing or eliminating this “refluxed” stomach acid with medications will relieve symptoms.

It is crucial to understand is that ANY amount of acid in the esophagus is going to cause painful symptoms. The esophagus has a delicate lining that isn’t protected against acid like the stomach lining is.

We often focus on suppressing symptoms without paying attention to what is causing the problem. Symptoms are designed to alert one that there is a problem. Simply masking the symptom can lead to damage and exacerbation.
Furthermore, Americans spend more than $13 billion on acid reducing medications each year. If antacids were actually curing heartburn and GERD, this kind of expense would be justified. However, not only do these drugs fail to cure GERD, they make the underlying condition (low stomach acidity) worse. Subsequently creating a chronic, lifelong need for these medications.

GERD is caused by increased intra-abdominal pressure

GERD is caused by an increase in intra-abdominal pressure (IAP). Acid reflux occurs when increased intra-abdominal pressure, either secondary to gastric distention (bloating) or pressure changes outside the stomach, pushes acidic stomach contents through the LES (Lower Esophageal Sphincter) into the esophagus. Factors contributing to this are obesity, postprandial positional changes (bending over, lying down). Several studies have shown an association between obesity and GERD, and a paper in Gastroenterology concluded that increased intra-abdominal pressure was the causative mechanism.

The two primary causes of increased intra-abdominal pressure

In the book, Heartburn Cured, Dr. Norm Robillard argues that carbohydrate malabsorption causes bacterial overgrowth, resulting in IAP producing reflux. Dr. Robillard makes a strong argument that carbohydrate malabsorption plays a significant role in IAP. But what is causing the carbohydrate malabsorption? Are there other reasons for bacterial overgrowth? It seems that low stomach acid is key. Low stomach acid can contribute to both bacterial overgrowth (independently of carbohydrate intake) and can cause carbohydrate malabsorption.

Low stomach acid causes bacterial overgrowth

Stomach acid plays an important role in killing pathogens. At a normal pH of 3 or less, most bacteria will die in 15 minutes. However, if the acidity is insufficient this protective process is impaired. At pH of 5 + bacteria begin to thrive. This process is seen in the gastrin knockout mouse. These mice do not produce stomach acid and as a result suffer from bacterial overgrowth, severe inflammation, damage and precancerous polyps in its intestines. Likewise, use of strong/IV acid-suppressing medications in hospital patients can cause bacterial overgrowth. Long-term use of Prilosec, one of the most potent acid suppressing drugs, reduces the secretion of hydrochloric acid (HCL) in the stomach to near zero. In a trial of 30 people with GERD treated with a high dose of Prilosec (40g/day) for at least 3 months; 11 of the 30 Prilosec-treated people developed significant bacterial overgrowth.

Low stomach acid impairs carbohydrate digestion

Stomach acid (HCL) supports the digestion and absorption of carbohydrates by stimulating the release of pancreatic enzymes into the small intestine. If the pH of the stomach is too high, the pancreatic enzymes will not be secreted and the carbohydrates will not be broken down properly.

Bacterial overgrowth + maldigested carbohydrates = Increased Abdominal Pressure (IAP)

Although microbes are able to metabolize proteins and even fats, they prefer carbohydrates as an energy source. The fermentation of carbohydrates that haven’t been digested properly produces gas. The resulting gas increases intra-abdominal pressure, which is the driving force behind acid reflux and GERD. In the book Hearburn Cured, Dr. Robillard noted a study:

According to Suarez and Levitt, 30 g of carbohydrate that escapes absorption in a day could produce more than 10,000 mL (ten liters) of hydrogen gas!

If stomach acidity is sufficient, carbohydrates are properly broken down into glucose and rapidly absorbed in the small intestine before microbial fermentation can take place. Provided that carbs are eaten in moderation. However, if stomach acid is insufficient and/or carbohydrates are consumed in excess, some of the carbs will escape absorption and become available for intestinal microbes to ferment.

It follows that gas produced by microbial fermentation of carbohydrates causes distention, and increased IAP. This pressure pushes acidic gastric contents into the esophagus causing reflux. Thus, reflux can be treated by 1) reducing bacterial overgrowth or 2) reducing carbohydrate intake. A study showing that administration of erythromycin significantly decreased esophageal reflux supports this. Only a couple small trials have been performed to test the effects of carbohydrate restriction on GERD. Both had positive results. Many case reports show an almost immediate resolution of GERD symptoms in obese individuals who are put on a very low-carb diet.

In summary, low stomach acid contributes to bacterial overgrowth in the bowel which in turn can lead to carbohydrate mal-absorption. This may be so in most cases, but there are patients on a very low carbohydrate diet that still experience heartburn, which improves when stomach acidity is increased. In part 2 of this article we will look at important roles of stomach acid and the significant damage of long term hypochlorhydria.

By Renata Trister DO
ADAPTOGENS

The American Academy of Family Physicians estimates that approximately two-thirds of all office visits are due to stress-related complaints. Although stress itself is not an illness, its impact on the physiology of our bodies is immense. Impatience, anxiety, irritability are just a few of its more obvious consequences. Patients are often not sure what is wrong with them as a stressed mind has difficulty interpreting signals from the body. Under stress, people forget to eat (or overeat), are unable to sleep well, consume alcohol, become very tense and can make poor choices. The stressors have changed over time, but human physiology has remained the same and reducing the impacts of stress on the body and mind is very important.

Humans developed a powerful stress reaction living with a risk of being attacked by wild animals or hostile people. The body responds to threats by producing powerful hormones hormones that change our physiology, enhancing our ability to flee or defend ourselves. Termed “fight or flight,” this stress response causes an intense stimulation of the sympathetic nervous system and the adrenal glands resulting in faster respiration rates, increased heart rate and contraction force, higher blood pressure. There is also decrease in digestive secretions. These mechanisms are designed to divert all available resources to protect oneself from danger. In acute stress, the situation is often resolved quickly, returning to normal state. However if stress is chronic, this response can become detrimental.

The body expends a great amount of energy keeping itself in a heightened state of readiness. Prolonged stress weakens the body in a multitude of ways. Furthermore, lack of sleep, poor diet, chemical toxins in the environment compromise the body’s ability to maintain homeostasis, resulting in illness. Adaptogenic herbs have traditionally helped prevent the imbalances that can result from stress.

An adaptogen is a substance that demonstrates a nonspecific enhancement of the body’s ability to resist a stressor. The term was first introduced in 1947 by Russian scientist N.V. Lazarev. He was first to describe the unique action of a material claimed to increase nonspecific resistance of an organism to an adverse event. In 1958, I.I. Brekhman, a Russian holistic medical doctor, and his colleague I.V. Dardymov, established the following definition of an adaptogen: It “must be innocuous and cause minimal disorders in the physiological functions of an organism, it must have a nonspecific action, and it usually has a normalizing action irrespective of the direction of the pathological state.”

There are many herbs that have these properties. In keeping with the definition, an adaptogenic herbs are plants with properties that have a normalizing effect on the body. They do not stimulate nor inhibit normal body function.

The adaptogen’s main action is the ability to help the body cope more effectively with stress. Adaptogens recharge the adrenal glands, which are the key endocrine organ, responding to stress and emotional change. The adrenals, which cover the upper surface of each kidney, synthesize and store dopamine, norepinephrine and epinephrine. These compounds are responsible for the changes that occur during the fight-or-flight reaction. An adaptogen, is used to reduce stress, both mental and physical. To put it simply: Adaptogens help you adapt.

The list of plants with adaptogenic qualities as the definition of the term is broad. considered the “gold standard” of adaptogens is red ginseng from Asia (called either Chinese, Korean, or Japanese ginseng). Other commonly accepted adaptogenic herbs include the white American ginseng, Siberian ginseng, ashwaganda, astragalus, licorice, schisandra, and Rhodiola rosea. The mushrooms reishi, shiitake and maitake are also considered as adaptogens.

Asian ginseng (Panax ginseng) is considered a chi tonic–more specifically a tonic for the yang chi–in traditional Chinese medicine. It is considered an adaptogen, providing non-specific protection against various mental, physical and environmental forms of stress. This ginseng is usually given to people who display yang deficiency–weakness in muscles, voice and constitution, for example–and is generally best avoided by those who are well muscled and large with a tendency to bursts of anger. Numerous studies support Asian ginseng’s effectiveness at improving a person’s ability to withstand stress, improve work performance and quality, and enhance mental function. It has also been shown to increase the release of adrenocorticotropic hormone (ACTH), which stimulates an increase in adrenal hormone secretion. It also can counteract the shrinkage of the adrenal gland caused by corticosteroid drugs.

Researchers from Okayama University Medical School in Japan found that Asian ginseng extract inhibited hydroxyl radical formation. The authors postulate that this antioxidant effect may be responsible for ginseng’s wide range of pharmacological applications. In a double-blind controlled study, 36 noninsulin-dependent diabetic patients were treated with Asian ginseng for eight weeks. Patients were given either 100 mg or 200 mg of Asian ginseng or placebo. The ginseng elevated participants’ moods, improved physical activity and performance, improved glycosylated hemoglobin, and reduced fasting blood sugars and body weight.
(ref. Sotaniemi, E., et al. “Ginseng therapy in non-insulin-dependent diabetic patients,” Diabetes Care, 18(10): 1373-75, October 1995.)

Asian ginseng has been shown to increase RNA and protein content in the muscle and liver tissue of laboratory animals. That same process may be the biochemical mechanism that makes ginseng such a highly regarded tonic. Asian ginseng is said to tone the chi and the lungs while strengthening the spleen and stomach and calming the spirit. Studies show this ginseng to be antidepressant, antidiabetic and antihypertensive.

Evaluating the effect of Asian ginseng in various forms–cooked, dried and fresh root–in 1,987 cancer cases, researchers found that the risk of developing certain cancers in a population that used ginseng for at least one year was less than the risk for the general population. In the study, ginseng was found to protect against cancers of the mouth, esophagus, lung, stomach, colorectum, and pancreas. The authors conclude that ginseng has a protective effect. (ref. Yun, T.K. & Choi, S.Y. “Preventative effect of ginseng intake against various human cancers: A case-control study on 1,987 pairs,”
Cancer Epid, Biomarkers and Prev, 24(3): 221-29, June 1995.)

American ginseng (Panax quinquefolius), is in the same genus as Asian ginseng, is considered a yin tonic rather than a yang tonic. As such, American ginseng is indicated for a hotter, more aggressive constitution. It contains many of the same properties as its Asian counterpart and has similar effects on the body.

Siberian ginseng (Eleutherococcus senticosus), as can be seen by its Latin name, is not actually a ginseng, but it has been called one because of its similar properties. Legislation passed in the US now prohibits Wucha, or “Elethero” from being labeled Siberian ginseng. It is found in Russia, Asia, northern China, Japan and Korea and, in fact, Russian researchers consider it to be even more effective than Asian ginseng. Studies of Wucha’s effects on human performance conducted in both Russia and China show that Wucha increases human tolerance to a broad range of stress factors, including heat, noise and increased exercise. Wucha, taken on a regular basis, for several months, increases work output, endurance, athletic performance and mental alertness. Wucha also shows remarkable protective benefits under conditions of serious oxygen deprivation. Wucha is popular among factory workers, miners, soldiers, deep sea divers and others who engage in physically and mentally demanding occupations.

Ashwaganda (Withania somnifera) also called Indian ginseng. It is seemingly grouped with the ginsengs because of its similar actions. Though unrelated to other ginsengs, it appears to share their many properties and actions. Considered a tonic, an alterative, an astringent and a sedative, ashwaganda has been used in Ayurvedic medicine for more than 2,500 years. Of all the medicinal plants used in India’s several millennia old tradition of Ayurveda, Ashwagandha, Withania somnifera, is the most highly prized. Recent studies show ashwaganda to be immuno-modulating and to aid in cases of anxiety and other psychological complaints.

Astragalus (Astragalus spp) is one of the more famous tonic herbs from China. In traditional Chinese medicine it is said to tonify the blood and spleen and aid the defensive chi. Astragalus is often added to formulations used to treat weak patients. It is also used in combination with other herbs to enhance recovery following an illness or prolonged stress and to boost vitality. Astragalus is said to protect and enhance the functioning of distressed organs. Numerous studies show the herb enhances immune function by increasing natural killer cell activity, increasing T cell activity, and enhancing macrophage activity [20] in immune-compromised patients.

(ref. Yang, Y.Z., et al. “Effect of Astragalus membranaceus on natural killer cell activity and induction with Coxsackie B viral myocarditis,” Chin Med J, 103(4): 304-7, 1990.

Zhos, K.S., et al.
“Enhancement of the immune response in mice by Astragalus membranaceus extracts,”
Immunopharmacol, 20(3): 225-33)

Licorice root (Glycyrrhiza glabra and G. uralensis), used in Chinese medicine, is said to tonify the spleen and strengthen chi. Licorice is perhaps the only herb claimed to benefit all 12 meridians in Chinese medicine. Rich in both saponins and flavonoids, it is anti-inflammatory because the saponins have a structure similar to that of corticosteroids. Licorice root also promotes or enhances immune system functioning and has a stimulating effect on the adrenal cortex.

Components of licorice exhibit numerous pharmacological actions, including aldosterone like action. Licorice root has also been used to treat addison’s disease and following steroid use. Today the primary uses of licorice root are as an expectorant for coughs and bronchial catarrh (inflammation of a mucus membrane with a free discharge), and for treating gastritis and ulcers. Glycyrrhizin, a constituent of licorice root demonstrated antiviral, antimicrobial, anti-inflammatory, hepatoprotective, and blood pressure-increasing effects in vitro and in vivo.
Caution: Because of its aldosterone like effect, licorice root may cause sodium retention and thus contribute to high blood pressure in some people.

Schisandra (Schisandra chinensis, also called wuweizi by the Chinese) can be used as an adaptogenic tonic to counter the effects of stress and fatigue. The berry of Schisandra chinensis owes its name Wu Wei Zi (five flavored berry) to the fact that it is sweet, sour, salty, bitter and pungent. Scientific studies show it has normalizing effects in cases of insomnia and improves mental coordination and physical endurance. Research suggests schisandra may actually influence electrical discharges in the brain.

Rhodiola Rosea is well studied adaptogen, Rhodiola defends the body overall, and protects general health and well-being. Its anti-stress and fatigue-fighting properties make it one of the most popular botanicals in all of Siberia. A 2014 study published in Journal of Phytomedicine, concluded that “Rhodiola exhibits a multi-targeted effect on transcription to regulate the cellular response, affecting the various signaling pathways and molecular networks associated with beneficial effects on emotional behavior, particularly aggressive behavior, and with psychological, neurological, cardiovascular, metabolic, endocrine, and gastrointestinal disorders. Each of the purified compounds has its own pharmacological profile, which is both similar to and different from that of the total Rhodiola extract. In general, several compounds contribute to the specific cellular or/and physiological function of the extract in various diseases”.
(ref: Phytomedicine. 2014 Sep 25;21(11):1325-48. doi: 10.1016/j.phymed.2014.07.008. Epub 2014 Aug 7.
Mechanism of action of Rhodiola, salidroside, tyrosol and triandrin in isolated neuroglial cells: an interactive pathway analysis of the downstream effects using RNA microarray data.
Panossian A1, Hamm R2, Wikman G3, Efferth T2.)

Authors: Amy D Proal , Paul J Albert, Trevor G Marshall

Institution: Autoimmunity Research Foundation

The human body is a superorganism in which the human genome continually interacts with the millions of microbial genes from the microbiome. Pathogens have now been identified in tissue and blood previously considered sterile. Those capable of persisting inside the nucleated cells can directly alter cellular transcription, translation, and DNA repair mechanisms. Dysregulation of VDR nuclear receptor activity by a number of prominent pathogens can slow innate immune activity to the point where microbiome composition shifts away from a state of homeostasis. Under these conditions, a person may develop an inflammatory disease, the nature of which varies depending upon many factors. These include the location and virulence of the pathogens they acquire and the semi-infinite number of ways in which the proteins and metabolites created by these pathogens can cause dysfunction by dysregulating the body’s metabolic pathways.

The comorbidities so frequently observed among patients with a wide range of both physical and neurological conditions support the possibility that different inflammatory conditions may develop from common underlying mechanisms. Babies begin to harbor a microbiome just weeks after birth, the composition of which reflects the microbiome of their parents and even those of extended relatives. Thus, the familial aggregation characteristic of inflammatory disease may well result when components of the microbiome are inherited.

The theory of autoimmunity was developed at a time when the human body was believed to be largely sterile. However, as the thousands of species within the microbiome are increasingly characterized, it is more likely that the autoantibodies detected in patients with autoimmune disease are generated in response to pathogens rather than “self.”

Immunosuppressive therapies for inflammatory disease may provide short-term relief by slowing the cytokine and chemokine release associated with a healthy immune response towards acquired pathogens. However, pathogens are able to spread with much greater ease over the long term, leading to relapse and instability. Indeed, during the period that immunosuppressive therapies have become the standard of care in the United States, the incidence of nearly every chronic disease has increased. The secosteroid vitamin D has immunosuppressive properties, and should subsequently be evaluated in this context.

It is urgent that we re-evaluate the long-term efficacy of immunosuppressive therapies. In lieu of slowing the innate immune response in patients with inflammatory disease, it seems we should seek to activate it, so that chronic pathogens might be successfully targeted. However, patients on an immunostimulative therapy will inevitably experience immunopathology as toxins and debris generated from microbial death enter the bloodstream. While the resulting symptoms may be difficult to manage, the root cause of the disease is being addressed.

There is a pressing need for researchers to focus on developing tests that might better characterize and measure immunopathology in a clinical setting. Additionally, the current standard of care prioritizes symptom palliation. This means that physicians have few guidelines with which to evaluate the symptom and metabolite fluctuations characteristic of immunopathology. Development of techniques that might help patients better manage the reaction must also become a priority.

Evolution and inherent Design

Evolution has left us with a “kluge” –  an ill-assorted collection of parts assembled to fulfill a particular purpose. These  collections of parts are often far from ideal suited to accomplish the tasks we face.

1.To achieve a working whole by putting together kluges, each kluge in itself needs to be formed. The formation of kluge can not solely be dependent on selection of possibilities created out of random variation.

2.Design is evident when a number of separate , interacting components are ordered in such a way as to accomplish a function beyond the individual components. The greater the specificity of the interacting components required to produce the function, the greater is our confidence in conclusion of design.

3. To call evolutionary design “intelligent” carries an unnecessarily connotation of an agent.

A more appropriate description of that design is “inherent”.

Acknowledging the inherent self-organizing processes that form attractors, stabilities far from equilibrium , enriches evolutionary theory;

Inherent design plays an important role in the science of evolution.

A complete theory of evolution needs to be based on the contextual interrelatedness of all parts of living beings and the interrelatedness of living beings themselves.

A self-organizing diversity and refinement in design is continually being created by these relationship.

By Renata Trister, DO

The Ayurvedic Approach to Mental Illness

Mental dysfunction is pervasive in our society, manifesting from mild loss of memory or lack of concentration to severe disabilities such as Alzheimer’s disease. Virtually everyone is touched directly or indirectly by mental dysfunction, imparting a serious impact on our personal health. Ayurveda uses revitalizing, balancing and nourishing herbs that have a long history of traditional use in improving mental function, such as gotu kola (centella asiatica) and brahmi (bacopa monniera). Some of these herbs are currently being investigated phytochemically to better understand their actions.

 Mental dysfunction

The problems associated with mental dysfunction such as loss of memory, Alzheimer’s disease, loss of clarity or acuity and other related conditions are very common. For example more than four million Americans has this debilitating disease, with the number expected to reach 14 million by the year 2040.

Those who are at greater risk for mental dysfunction include the elderly, the young with inherited or acquired disabilities, those who engage in highly stressful activities, those with diseases, and anyone exposed to toxic chemicals or lack of oxygen. Considering this, everyone is at risk to some degree at some time in his or her life. Whether suffering from “mental fog” or the early symptoms of a more serious problem, nearly everyone can benefit from a daily revitalization of mental function.

According to Ayurveda, an imbalance causing mental dysfunction is related to individual “doshas” or the elements of Vata, Pitta, or Kapha (air, fire or water). For example, a disturbance in Vata may contribute to poor memory, nervousness. Imbalances that may contribute to mental dysfunction are often related to Vata dosha, but may also be related to Pitta and Kapha dosha, which could dominate an imbalance. The element Vata is related to the control of the nervous system and the processes of intuition, nerve force, short term memory, intellectual concepts, mental dexterity, depression, insomnia, anxiety, attention deficit, hyperactivity, fear, loss of short term memory and over-sensitivity. Vata is also associated with kinetic movement in general, including nerve impulse movement, peristaltic motion, tissue growth movements, and other physiological motions.

Kapha is solid, liquid, inertial and organizing. Kapha may be associated with certain mental qualities such as deep intelligence, love, long term memory, steady emotions, loss of long term memory, deep depression, sadness, despair, resentment, sluggishness and slowness. Pitta may be related to certain mental qualities such as joy, happiness, enthusiasm, creativity, sharpness, intellectual discrimination, anger, rage, jealousy, irritability and hatred. The Ayurvedic approach for a condition such as mental dysfunction is to treat the whole person, including application of correct diet, lifestyle recommendations, and herbal supplements. Based on traditional use, Ayurvedic herbal formulas may be used to address specific individual health conditions with traditional herbs that are known to balance, or ameliorate an imbalance, and thereby improve health.

Medhya — Prominent Ayurvedic mental revitalizers

The traditional Ayurvedic herbs recommended for mental conditions are mainly mental revitalizers or Medhya (brain tonics), which are known to enhance general mental functioning. Specific Medhya herbs include bacopa (bacopa monnieria), gotu kola (centella asiatica) and ashwagandha (withania somnifera).

Bacopa

Bacopa, or brahmi, is a famous Ayurvedic mental revitalizing herb used traditionally for memory, insomnia, epilepsy, insanity and as a mild sedative.6 It is tridoshic, or balancing, for all body types. There is a connection of the name of the herb and its use for the mind. The name brahmi comes from the word Brahma, which is a name for the creator of the universe. Brahma is credited as manifesting his thoughts as the creation and everything is a manifestation from the mind of Brahma. If there was only one choice of Ayurvedic herb for general mental function revitalization it would probably be bacopa. There is a legend that describes bacopa as a favorite food of elephants, animals known for their long memories. It may be a favorite food of elephants because they are slow and dominated by Kapha and tend toward inertia, so they need to eat bacopa to be more alert and mentally revitalized. In any case, bacopa has been known for centuries as a common and popular Ayurvedic herb for general mental revitalization.

Contemporary phytochemical research has revealed evidence that bacopa acts as a potent antioxidant in inhibiting lipid peroxidation, which could be one of the reasons why it acts as a good mental revitalizer.6 Antioxidants have been linked to improved brain and nervous system function. Studies on the effect of the active constituents (bacosides) of bacopa on the mental retention capacity of rats have shown that the herb has a facilitatory effect on acquisition, consolidation and retention of newly acquired behaviors in response to both positive and negative reinforcement.

Gotu kola

The Ayurvedic herb, gotu kola, is used traditionally as a brain tonic for improving memory and intelligence, for mental stability, and as a sedative. Numerous animal studies have been conducted to evaluate the influence of the gotu kola leaf extract on the central nervous system. The studies demonstrate that the extract produces anxiolytic (anti-anxiety), sedative, and antidepressant effects comparable to the drugs, diazepam and imipramine, without any apparent toxicity.

Ashwagandha

Ashwagandha is used extensively in the Ayurvedic system of medicine to promote health and longevity by arresting the aging process, revitalizing the body, promoting memory and intellect and reducing stress.

The likely active principles of ashwagandha appear to be withanolides. The antioxidant activity of these active principles have been investigated on rat brain concentrations of the free radical scavenging enzymes superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX). Active withanolides administered once daily (10 and 20 milligrams per kilograms) for 21 days induced a dose-related increase in SOD, CAT and GPX activity in the frontal cortex and striatum, areas highly susceptible to oxidative damage. This antioxidant effect may explain, at least in part, the reported anti-stress, cognition facilitating and anti-aging effects of ashwagandha.

Ayurveda: A holistic approach

The tradition of Ayurveda offers some explanations for the function of mentally revitalizing herbs and their effects. The following sections will address how 1) balancing the constitutional elements can improve mental function, 2) how directly nourishing a tissue system or dhatu can improve mental function and 3) how improving digestion can enhance mental function.

Balance of the doshas and mental function

Balancing the doshas or elements in the body can improve mental function. For example, if the water element or Kapha dosha is over accumulated in the body it may create an imbalance that develops excess inertia, leading to an experience of mental sluggishness or dullness. An herb that may help to balance this condition by reducing the water element and increasing the air and fire elements, thereby creating balance and improving mental clarity, is nutmeg (myristica fragrans). Another example is the imbalance caused by an excess of the air element, or Vata dosha, which can affect memory and cause nervousness. Ashwagandha is another herb that helps to balance this condition by reducing the air element and increasing the water element, thereby bringing about balance and improving memory.

Triphala, a combination of three herbs including amla fruit (emblica officinalis), Indian gall fruit (terminalia chebula) and beleric myrobalan fruit (terminalia belerica), is known to encourage a general balancing of the doshas in all body types. An improvement in the general balancing of the elements in the individual as a whole can improve mental function along with other physiological functions, because in the Ayurvedic approach optimal balance is equivalent to optimal health. If the mental dysfunction is associated with an imbalance due to the over accumulation of Pitta dosha in the body, then cooling and anti-Pitta herbs such as amla fruit, asparagus (asparagus racemosus) and heart-leaved moonseed (tinospora cordifolia) may be given to balance the condition and improve mental function.

Mental revitalization and nourishment of the dhatu

Mental function may be improved by directly nourishing the bone marrow tissue system or Maiji dhatu to revitalize that tissue system. For example, if the brain and nervous system are fatigued from stress and over work, herbs such as bacopa, gotu kola, ashwagandha, asparagus, heart-leaved moonseed and giant potato root (pueraria tuberosa) may be used to directly nourish the Maiji dhatu or the bone marrow, brain, and nervous tissue system. Because Maiji dhatu comprises the brain and related nervous system, when it becomes nourished, it is revitalized and this revitalization enhances associated mental function.

Improving digestion and mental discrimination

Discrimination and digestion are both controlled by agni or fire which is related to Pitta, or the fire element. According to Ayurveda, poor digestion can negatively affect mental discrimination because mental discrimination and digestive discrimination are directly related. As an example, eating toxic foods may cause indigestion interfering with the digestive system’s ability to discriminate between what foods should and should not be processed for digestion. This may lead to headache or mental sluggishness, disabling clear intellectual discrimination. By improving digestion, digestive discrimination and mental discrimination can be improved. For the purpose of improving digestion, herbs such as ginger (zingiber officinale), Triphala (amla fruit, beleric myrobalan fruit, and Indian gall fruit), nutmeg, cardamom seed (elettaria cardamomum) and asparagus may be applied.

Ayurvedic herbs and contemporary science

Current phytochemical research demonstrates some links between a number of the Ayurvedic herbs used for enhancement of mental function and the respective biochemical basis for their effectiveness. For example, ginger has been shown to possess strong antioxidant activity, anti-inflammatory properties and digestive-promoting qualities that may protect brain and nerve tissue from free radical damage.  Amla fruit is known to be an antioxidant herb naturally high in vitamin C.  As another example, nutmeg acts as a smooth muscle relaxant and offers a sedative action.  It is generally known that a sedative action can produce a palliative effect on the brain and nervous system related to nervous mental conditions. It is believed that Indian valerian (valariana wallichi) may also have a sedative action.  A traditional Ayurvedic mixture focused on harmonizing gut, brain, muscle, and nervous system functions resembles a contemporary strategy for managing mental dysfunction — control the production of inflammatory prostaglandins, protect sensitive neurological tissue from free radical damage, improve digestion and assimilation to ensure optimal nutrition and improve circulation by controlling platelet aggregation.

For those who are interested about this approach please visit www.evmedcenter.com

By Renata Trister, DO

Musculoskeletal Healing Supplements: A Summary

When injury to a ligament or tendon occurs, a sequence of events begins that initiates healing. The healing process involves inflammation, repair, and remodeling. Research suggests that modulation of these events can be achieved nutritionally, to speed up tissue healing and recovery time.

The Inflammatory Response

Inflammation is in fact a protective and restorative response to injury. However, when inflammation becomes excessive or prolonged it may be harmful to the body. The classic signs of inflammation local redness, swelling, heat, pain, and loss of function are caused and regulated by the activity of a large number of chemical mediators, including eicosanoids.

Eicosanoids There are anti-inflammatory eicosanoids and inflammatory eicosanoids. The standard American diet promotes the production of those that are inflammatory. Fortunately, many substances inhibit inflammatory eicosanoids or promote the production of anti-inflammatory eicosanoids a classic mechanism for controlling inflammation.

Nutrients & Herbs That Modulate the Inflammatory Response

Essential Fatty Acids Omega-3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are precursors of primarily anti-inflammatory eicosanoids. In addition, the omega-6 fatty acid, gamma-linoleic acid (GLA), also supports the production of anti-inflammatory eicosanoids.

Ginger (Zingiber officinale) and Turmeric (Curcuma longa) These herbs have long been used in folk medicine for a variety of both acute and chronic inflammatory conditions. Studies suggest that both herbs may block activity of the enzymes cyclooxygenase and lipoxygenase. These enzymes are necessary for the production of inflammatory eicosanoids.

Cayenne Pepper (Capsicum annuum) Capsaicin, the main constituent of cayenne pepper, may play a role in inhibiting inflammatory eicosanoid synthesis by blocking cyclooxygenase activity.   Capsaicin may also reduce tissue sensitivity by selectively depleting a neuropeptide needed to transmit pain impulses to the central nervous system.

Boswellia Boswellia gum resin, derived from the Boswellia serrata tree, is a traditional Ayurvedic remedy used for inflammation. Boswellic acids, the main constituents of the gum resin, have been found to specifically inhibit 5-lipoxygenase. Preliminary research also suggests that boswellic acids may inhibit the complement system—a part of the immune system whose sustained activation is implicated in a variety of inflammatory disorders.

Bioflavonoids Bioflavonoids, such as quercetin, are an extensive group of compounds present throughout the plant kingdom.  Their roles in addressing injury, pain, and inflammation include antioxidant activity and protection of connective tissues, inhibition of enzymes involved in inflammatory eicosanoid production, and inhibition of cell movement to the site of inflammation.

Proteolytic Enzymes The anti-inflammatory effects of proteolytic enzymes, flavonoids, and vitamin C in comparison to NSAIDs

The term “proteolytic” refers to the group of enzymes that break down proteins. In the body, proteolytic enzymes including trypsin, chymotrypsin, bromelain, and pancreatin are produced in the pancreas. Because numerous studies have revealed their wide ranging benefits, these enzymes are available in supplemental form.

According to Dr. J.P. Tarayre and Dr. H. Lauressergues in Drug Research, “The proteolytic enzymes, trypsin and chymotrypsin in particular, possess anti-inflammatory properties which have been known for some years now.” Additional research has demonstrated the ability of proteolytic enzymes to accelerate recovery after minor injury and reduce the pain and stiffness that often accompany rheumatoid arthritis.

To further confirm these findings, researchers compared the anti-inflammatory effects of trypsin and chymotrypsin to seven well known non-steroidal anti-inflammatory drugs (NSAIDs). The proteolytic enzymes were combined with flavonoids and vitamin C other substances known to reduce inflammation.

Researchers injected carrageenan a seaweed extract that has been shown to induce inflammation and edema in the hind paw of experimental rats. After determining the degree of inflammation and swelling in each animal, researchers examined the anti-inflammatory effects of trypsin and chymotrypsin combined with flavonoids and vitamin C.

Researchers concluded that “The combination studied…shows a more [profound] action than that of the non-steroidal anti-inflammatory substances [without] any side effects.”

Nutrients Involved in Connective Tissue Repair

Controlling inflammation is directly linked to the next phase of the healing process repair and remodeling. Following connective tissue injury, it is critical to supply the raw materials and proper nutrients that support tissue recovery and new tissue synthesis. These include:

Amino Acids Supplying amino acids may support the formation of collagen a critical connective tissue. Collagen fibers are made up of long chains of amino acids, of which one-third is glycine. Proline, hydroxyproline, and hydroxylysine are also prevalent.

Bioflavonoids Bioflavonoids are thought to benefit connective tissue by preventing the degradation of elastic  fibers via inhibition of enzymes released as a result of inflammation.

Glucosamine and Chondroitin Sulfate Glucosamine and chondroitin sulfate are building materials that are vital for the synthesis of new connective tissue as well as for the healing process. In addition, supplemental use in those with arthritis has been reported to result in decreased pain and inflammation.

Antioxidants It is thought that excessive free radical production is a major consequence of the inflammatory response—may aggravate an injury, propagate the inflammatory process, and delay or prevent adequate healing. Vitamins E and C are major antioxidants that quench free radicals in most tissues. Additionally, vitamin C is required for collagen fiber synthesis, a vital process for tissue repair and healing. Copper, zinc, and manganese further protect tissues by supporting the activity of superoxide dismutase—an enzyme that converts damaging superoxide free radicals into less harmful molecules.

Effects of copper supplementation in rheumatoid arthritis patients

Copper is an essential trace mineral that may facilitate the activity of ceruloplasmin and copper-zinc superoxide dismutase. These compounds have antioxidant and anti-inflammatory properties that may prevent the onset of chronic joint conditions.

However, according to Dr. Robert DiSilvestro and colleagues in the Journal of the American College of Nutrition, “Several surveys have shown that copper consumption of many Americans falls below even the Estimated Safe and Adequate Daily Dietary Intake recommended for healthy people…”

Copper deficiency can be caused by anemia, protein malnutrition, and frequent diarrhea. A deficiency in copper resulting in reduced activity of ceruloplasmin and copper-zinc superoxide dismutase may be associated with the onset and continuation of rheumatoid arthritis. In fact, it has been shown that patients diagnosed with rheumatoid arthritis show serious copper deficiencies.

Investigators conducted a study in which 23 rheumatoid arthritis patients received 2 mg per day of copper supplementation for 4 weeks. As a means of comparison, investigators also recruited 47 healthy volunteers. Upon completion of the study, investigators noted that copper supplementation increased copper-zinc superoxide dismutase activities by 21% in 18 of the 23 rheumatoid arthritis patients.

Homeopathic Remedies

Homeopathic remedies for injury have been used for over 100 years. Believed to provide an “energetic” stimulus to the natural healing qualities of the body, homeopathic remedies are reported to be highly effective and safe.

Muscle Mechanics, Relaxation, and Rest

Proper muscle use, joint alignment, and biomechanics during tissue remodeling are critical for preventing reduced range of motion due to scar tissue formation. In addition, injury can give rise to increased anxiety, stress, and poor sleep, resulting in prolonged and unfavorable healing. Calcium, magnesium, and various herbs, including passion flower, valerian root, hops and kava root, promote relaxation of the muscles and help to reduce the psychological anxiety and stress resulting from injury.

For those who are interested about this approach please visit www.evmedcenter.com

By Renata Trister DO

HERBAL ANTIMICROBIALS

Bacterial Infections and Ayurvedic Botanicals

Bacteria are a natural, and necessary, part of life. These microscopic, single-cell entities abound on inanimate surfaces and on parts of the body that make contact with the outer world, including the skin, the mucous membranes and the lining of the intestinal tract. While we live in harmony with most bacteria, and indeed rely upon many bacteria for their beneficial properties, certain pathogenic bacteria do give rise to serious, often deadly, diseases. Since the advent of the antibiotic era in the early 1940s with the clinical use of penicillin, an ever-growing arsenal of antibiotics has provided an effective therapy against major bacterial pathogens. However, the development of antibiotic resistance is now a serious worldwide problem, caused primarily by the misuse and overuse of antibiotics. We must broaden our view of how to prevent and treat microbial infections to include alternatives that are not centered upon standard antibiotic therapy or we risk the possibility of eventually having no defense against these microbes. The Ayurvedic approach to the prevention and treatment of microbial infection recognizes the emergency use of modern drugs, but recommends traditional herbal combinations and extracts known to balance the individual and improve health, as well as herbs that help to combat or prevent microbial infections. The Indian plants possessing significant anti-microbial activity are Indian lilac or neem (azadirachta indica), long pepper fruit (piper longum), heart-leaved moonseed stem (tinospora cordifolia) and amla fruit (emblica officinalis), among others.

An Ayurvedic approach to microbial infections

Western allopathic medicine emphasizes the use of antibiotics and other medicines and approaches to defend against “germs” or microbes believed to be the primary cause of many health conditions and diseases. Ayurveda recognizes the microbial approach to some degree, but generally does not recognize microbes as the primary cause of disease. According to the Ayurvedic approach, anyone who has developed an imbalance in their bodily elements, or “doshas,” and has thereby weakened their immune system, may be subject to a microbial infection which is considered a symptom of that imbalance. Ayurveda recognizes as useful anything that will save the patient in an emergency, including antibiotics, but takes exception to the “magic bullet” approach of preventing and treating microbial infections strictly with antibiotics. Ayurveda recommends that balance be established in the individual for the prevention and treatment of microbial infection.

From the Ayurvedic perspective, an individual who is balanced and healthy has a strong immune system and, therefore, it will be difficult for microbial infection to take hold. Balance in Ayurveda is equivalent to health, which is equivalent to a strong and well-functioning immune system capable of defending against microbial infection. The Ayurvedic approach is to treat the whole person, including application of correct diet, lifestyle recommendations and herbal supplements. When a person develops an infection, the design of an Ayurvedic herbal formula reflects the holistic approach. Based on traditional use, herbs are selected and combined for their ability to inhibit microbial overgrowth in various parts of the body and support those organ systems responsible for detoxification and immune function.

The herbs listed below are traditionally used to manage cold, flu and infection. The chemical composition of each of the following plants tends to confirm their traditional use. Interestingly, each herb appears to possess properties that work on multiple biochemical pathways capable of influencing several organ systems simultaneously. The ancient practice of combining and concentrating several plants by decoction (extracting together in boiling water) that have a similar yet slightly different organ system focus, produces a finished product that treats the whole person along with the presenting complaint.

Indian lilac or neem (azadirachta indica)

• Used traditionally in Ayurveda both topically and internally for microbial infection including those infections related to the skin such as acne, fungi, wound healing, antiseptic treatment, oral hygiene, parasite infection, fevers and general infections.
• Neem oil is excellent for skin and hair usef skin diseases, ulcers and wounds.
• Neem oil and two of its bitter principles, nimbidin and nimbidol, have exhibited antibacterial, antifungal and spermicidal activity.

Ginger rhizome (zingiber officinale)

• Used traditionally for colds, other microbial infections, and the removal of mucous and toxins associated with microbial infections.
• Most well known use as a digestive aid.

Guggulu gum (commiphora mukul)

• Used traditionally in oral hygiene and skin diseases.
• Acts as a bitter and carminative (prevents gas), stimulating the appetite and improving digestion.
• The oleoresin portion of the plant causes an increase of leucocytes in the blood and stimulates phagocytosis.

Indian madder root (rubia cordifolia)

• Used traditionally for uterine and urinary system conditions including infection.
• Dried root acts as an emmenagogue, astringent and diuretic.

Amla fruit (emblica officinalis)

• Used traditionally for fevers.
• The fruit extract exhibits antibacterial and antiviral properties.

Boswellia gum resin (boswellia serrata)

• Used traditionally for urinary disorders including infections.

Heart-leaved moonseed stem (tinospora cordifolia)

• Used traditionally for antitoxin action and as a febrifuge (antipyretic/fever reducing)
• Also used for urinary diseases, skin diseases and bronchitis.
• One study showed that an ethanolic extract of tinospora cordifolia appeared to improve the phagocytic activity of the mononuclear phagocyte system in mice.

Long pepper fruit (piper longum)

• Used traditionally for colds, other microbial infections and the removal of mucous and toxins associated with microbial infections.
• The essential oil of the fruit shows antibacterial, antifungal and anthelmintic activity.
• An ethanol extract of the piper longum fruit showed antiamoebic activity both in vitro and in vivo, curing 90% of rats with caecal amoebiasis.
• An Ayurvedic herbal medicine prepared from piper longum and butea monosperma and prescribed for the treatment of chronic dysentery and worm infestations was tested for anti-giardial and immunostimulatory activity in mice infected with giardia lamblia trophozoites. The preparation produced up to 98% recovery from the infection and induced significant activation of macrophages as evidenced by increased macrophage migration index and phagocytic activity.

Osteopathy of Cranial Field
What is it?
Osteopathy of Cranial Field is an exceptionally gentle yet extremely powerful form of treatment, increasingly recognized for the depth of its influence, the comprehensive range of its therapeutic effects, and its ability to resolve issues that are not helped by other means.
It is a profound healing process which can release the deeply held patterns of disease – both physical and psychological – which accumulate throughout life as a result of injury and illness and become held into the body tissues, leading to ill-health and dysfunction.
It is a therapy whose principal purpose is to establish a strong underlying vitality and the free flow of this inherent vitality throughout the body, thereby enabling the healing forces within to overcome disease and disturbance, and to release tensions and restrictions, so that symptoms, conditions and their underlying causes can be resolved. It can be of benefit to most people and can help in most conditions – from minor aches and pains to severe and persistent chronic health issues.
What does it involve?
Osteopathy of Cranial Field is most often carried out with the patient lying down, fully clothed, in a quiet and peaceful environment. Treatment involves a very gentle touch of the practitioner’s hands. This light contact may be taken up on the Cranium (head) the Sacrum (tail-bone) the feet, the trunk, or any other part of the body as appropriate. Treatment is generally experienced as a profound relaxation which may pervade the whole person, physically, mentally and emotionally, often accompanied by a feeling of lightness and ease.
The gentle approach of this type of OMT is entirely non-invasive. The subtle interaction of the two systems – brought together by this light contact – stimulates and enhances self healing mechanisms within the body to respond, release and open up to a more balanced healthy state.