Healthy Life Newsletter, November 2019
Study shows opioid use for low back pain greatly reduced if first visit is NOT to a primary care or emergency room medical physician
Despite increasing public and professional awareness, the numbing numbers still stand out: an estimated 130 deaths a day due to an opioid overdose. Could a lasting solution be as simple as visiting a doctor of chiropractic (DC) or other conservative care provider first? A new national study comparing first provider choice with early and long-term opioid use in patients with low back pain (LBP) indicates that could be the case.
Published in BMJ Open, this study evaluated short- and long-term opioid use based on initial provider type seen: chiropractor, acupuncturist, physical therapist) or primary care medical physician (PCP).* Participants included 215,000+ U.S. adults diagnosed with new-onset low back pain and “opioid naive.”
The study defined early opioid use as “an opioid fill within 30 days of the index visit” and long-term use as “an initial opioid fill within 60 days of the index date and either 120 or more days’ supply of opioids over 12 months, or 90 days or more supply of opioids and 10 or more opioid prescriptions over 12 months.”
Researchers evaluated inpatient / outpatient claims from patient visits and pharmacy claims to correlate first provider type seen with opioid use, finding that LBP patients whose initial visit was with a DC were a staggering 90 percent less likely to use opioids early compared to patients who saw a PCP first.
Significantly reduced odds for early opioid use were also noted for acupuncture and physical therapy patients (91 percent and 85 percent reduced odds of early opioid use, respectively). LBP patients who first visited a doctor of chiropractic or other conservative provider were also less likely to use opioids long term compared with patients visiting a PCP.
*Emergency Room (ER) physicians, orthopedic surgeons, neurosurgeons and rehab physicians were also included in the analysis. Patients visiting any of the above first also had lower odds of early opioid use compared to PCPs (although not as significant as visiting a conservative-care provider), with the exception of ER physicians (dramatically higher odds for early use compared with PCPs). However, odds for long-term use were not significantly different compared to PCPs for all of the above, with the exception of rehab physicians (still significantly lower odds).
(Comment from Dr. Mha Atma–Note that this next article is about vitamin D, but at the end it also mentions the vital anti-inflammation properties of magnesium and of omega-3 fatty acids –ie fish oil. Consumption of all 3 plus a diet low in refined sugar and flour products can reduce pain and transform a person’s health.)
How Much Vitamin D? Don’t Stop at the RDA
By David Seaman, DC, MS, DABCN
Vitamin D deficiency officially emerged as an important risk factor for chronic disease in the early 2000s. This finding was a product of scientific research, rather than a consensus statement from a health policy group or government organization. It was not until around 2010 that the Institute of Medicine (IOM) of the National Academies of Sciences, Engineering and Medicine came out with an updated official statement about vitamin D needs. The IOM [now known as the National Academy of Medicine] is actually a private entity that advises the U.S. government. The IOM set the estimated requirement at 400 IU/day for all age groups and set the upper-level intake at 4,000 IU/day for anyone age 9 or older.
What’s the Basis for the RDA?
This IOM report was met with harsh criticism from vitamin D researchers, none of whom was invited to participate in process that led to the recommendations. For example, Drs. R.P. Heaney and M.F. Holick stated:
The IOM recommendations for vitamin D fail in a major way on logic, on science, and on effective public guidance. … We have deliberately avoided a mind-numbing laundry list of the vast number of factual inaccuracies and misinterpretations of the report. … For now, our recommendation to the American public is that the IOM report should be taken with a grain of salt (another nutrient the IOM finds risky).
In short, by following the IOM guidelines, many people will still not achieve adequate vitamin D levels [measured as 25(OH)D], which most labs set at 30-100 ng/mL. Some vitamin D researchers argue that 40 ng/mL should be considered the low end of normal, likely because many people do not achieve the bone protection effect of vitamin D until this level is achieved. My personal impression is that we should try to maintain a 25(OH)D level of at least 70 ng/mL.
Adequate Levels, Toxicity and Other Considerations
To achieve adequate vitamin D levels, we must either get adequate sun exposure or take a vitamin D3 supplement. Unnecessary fear often enters a person’s mind when they consider how much supplemental vitamin D3 is safe. Dr. Heaney, whom I mentioned above, has explained that 10,000 IU/day should be the safe upper limit. I realize 10,000 may see like a lot, but that is because we typically think of supplementation in milligram (mg) or gram (g) amounts.
With this in mind, it should be understood that 40,000 IU of vitamin D3 is just 1 mg. In other words, 10,000 IU is just .25 mg or 250 mcg.
The IOM’s report states that “very high levels of vitamin D (above 10,000 IUs per day) are known to cause kidney and tissue damage.” In contrast, the DRI [Dietary Reference Intakes] book published by the IOM5 says 10,000-40,000 IU per day is the threshold for toxicity.
It is important to understand that vitamin D toxicity cannot be determined based on how much vitamin D3 is taken on a daily basis; it is correlated to serum 25(OH)D levels. The IOM’s DRI book for vitamin D and calcium states that vitamin D toxicity is not identified until serum 25(OH)D reaches 200-240 ng/mL or higher. Based on this, you can see why it is foolish to worry about the supplemental dose of vitamin D3. Even worse, it is especially problematic that the IOM would suggest taking 10,000 IU/day causes kidney and tissue damage.
The, dare I say, sole focus related to vitamin D supplementation should be one’s 25(OH)D level. The minimum goal should be to reach at least 40 ng/mL, all the while knowing 100 ng/mL is within the normal range and signs of toxicity will not typically appear until at least 200 ng/mL is exceeded.
This means there should be zero emotion about taking vitamin D3 supplements. If you have normal serum 25(OH)D because you are in the sun a lot, then there is no need to supplement. Otherwise, your supplemental level should be tailored to keep your 25(OH)D at 40 ng/mL higher. This is why the RDA or RDI fails: for vitamin D, it is not about your intake, it is about achieving a proper 25(OH)D level.
Why Vitamin D Matters: A Profound Micronutrient
Here is why you should care about your 25(OH)D level. Vitamin D is involved in the modulation of more than 1,000 different genes. In particular, vitamin D modulates immune cell expression. A deficiency in vitamin D leads to an overproduction of pro-inflammatory Th1 cells and an underproduction of anti-inflammatory Th2 and T-regulatory cells. The outcome is an overproduction of pro-inflammatory cytokines, such as IL-1, IL-6 and tumor necrosis factor; and an underproduction of IL-10, which is a key anti-inflammatory cytokine.3
The same shift to overproduce pro-inflammatory cytokines occurs when one lacks magnesium and omega-3 fatty acids. Obesity also leads to the same state of chronic inflammation. This should alert you to the reason why just supplementing with vitamin D to achieve normal levels may not relieve patients from pain, depression and other pro-inflammatory conditions.
Studies that report about the ineffectiveness of vitamin D do not comment on the other nutritional factors that promote the same state of chronic inflammation as vitamin D deficiency.
My suggestion is to normalize the many pro-inflammatory markers that are easy to measure, of which vitamin D is just one. Lipids, glucose, body mass index and waist:hip ratio are other examples to take into account.
(go to link above to see references)
Sugary Drinks (Even 100% Fruit Juice) Increase Cancer Risk
Too much sugar is dangerous, even if it comes from 100 percent fruit juice. In fact, it can up your risk of developing cancer.
Researchers tracked more than 100,000 adults for an average of five years after gathering baseline data on consumption of sugary drinks including sugar-sweetened beverages, artificially sweetened beverages and 100 percent fruit juice drinks. Repeated 24-hour dietary recall questionnaires were utilized throughout the study period to assess participants’ usual consumption of sugary drinks, and researchers evaluated whether associations existed between beverage consumption and cancer risk.
Consumption of sugary drinks increased the likelihood of developing cancer in general and breast cancer specifically. Consumption of 100 percent fruit juice also increased the risk of overall cancer. Consumption of artificially sweetened beverages did not increase cancer risk, either overall or by specific type.
The moral to the story, as we stated right off the bat: Too much sugar is dangerous! Aim for a diet high in fresh vegetables, lean sources of protein, whole grains, legumes, nuts / seeds and other high-nutrient, low-sugar sources of sustainable energy and cancer-protecting compounds. You’ll be thankful you did.
Going Green Helps You Live Longer
We’ve talked a great deal over the years about the power of a vegetable-rich diet, particularly green vegetables, in optimizing health and minimizing disease risk. Going green in another way helps you stay healthy and live longer, too, and all it takes is a commitment to going outdoors as much as possible, particularly during certain months of the year.
Spending as much time as possible in green, natural environments may increase longevity by promoting physical activity and social engagement, lowering stress and reducing exposure to unhealthy environmental variables such as pollution, noise and extreme temperature. A recent study emphasizes this potential, tracking 108,630 women enrolled in the Nurses Health Study for nearly a decade.
Exposure to seasonal greenness was estimated based on satellite imagery that captured vegetation patterns surrounding each study participant’s home address. Women living in areas with the highest cumulative average greenness during the study period had a 12 percent lower rate of all-cause, non-accidental mortality (particularly respiratory and cancer mortality) compared to women living in areas with the lowest cumulative average greenness. These findings were consistent even when the study author’s accounted for other potential longevity variables such as age, race, smoking, socioeconomic status, etc.).
There’s no doubt about it: Going green, whether it’s the foods you eat or where you live, is good for you! Make green a part of your life and reap the longevity benefits.
(Comment from Dr. Mha Atma about next item: Dr. Greger is a bit of a vegan fanatic in that, while he is absolutely correct and has the research to prove it that a plant-based diet free of processed foods can be transformatively healthy –and I am mostly vegan myself–, there is also plenty of evidence that an anti-inflammatory diet free of sugar, flour products, vegetable oils, and processed foods that also includes animal products can also be very healthy. But this article is a powerful clarification of the fact that most disease and premature death in our culture is caused by FOOD – the wrong kind – and the vast majority of medical doctors pay little attention to that fact!)
Read this article on line (with links)
How Not to Die from Heart Disease
By Michael Greger M.D. FACLM
The most likely reason most of our loved ones will die is heart disease. It’s up to each of us to make our own decisions about what to eat and how to live, but we should make these choices consciously by educating ourselves about the predictable consequences of our actions.
Atherosclerosis, or hardening of the arteries, begins in childhood. The arteries of nearly all kids raised on the standard American diet already have fatty streaks marking the first stage of the disease—by the time they are ten years old. After that, the plaques start forming in our 20s, get worse in our 30s, and then can start killing us off. In our heart, it’s called a heart attack, and in our brain, it can manifest as a stroke. So for anyone reading this who is older than ten years old, the choice isn’t whether or not to eat healthfully to prevent heart disease—it’s whether or not you want to reverse the heart disease you likely already have.
Is that even possible? When researchers took people with heart disease and put them on the kind of plant-based diet followed by populations who did not get epidemic heart disease, their hope was that it might slow down the disease process or maybe even stop it. Instead, something miraculous happened. The disease actually started to reverse. It started to get better.As soon as patients stopped eating artery-clogging diets, their bodies were able to start dissolving away some of the plaque, opening up arteries without drugs and without surgery, suggesting their bodies wanted to heal all along but just were never given the chance. That improvement in blood flow to the heart muscle itself was after only three weeks of eating healthfully.
Let me share with you what’s been called the best-kept secret in medicine: Sometimes, given the right conditions, the body can heal itself. Take, for instance, what happens when you accidentally whack your shin really hard on a coffee table. It gets red, hot, painful, swollen, and inflamed, but it’ll heal naturally if you just stand back and let your body work its magic. What would happen, though, if you kept whacking your shin in the same place, day after day, or three times a day (breakfast, lunch, and dinner)? It would never heal! You might turn to your doctor, complaining of shin pain, and would probably limp out of the office with a prescription for painkillers. You’d still be whacking your shin three times a day, but the pain would be a little duller, thanks to those pills you’d be popping.
It’s similar to people taking nitroglycerine for crushing chest pain. They may get tremendous relief, but they’re not doing anything to treat the underlying cause. Our body wants to come back to health if we let it, but if we keep re-damaging ourselves three times a day, we may never heal.
One of the most amazing things I learned in all my medical training was that within about 15 years after you stop smoking, your lung cancer risk approaches that of a lifelong nonsmoker. Isn’t that amazing? Your lungs can clear out all that tar, and, eventually, it’s almost as if you never smoked at all. Just think, every morning of your smoking life, your body started on that path to healing, until…wham!…you inhaled on that first cigarette of the day, reinjuring your lungs with every puff. In the same way, we can reinjure our arteries with every bite. But, all we have to do all along—the miracle cure—is just stand back, get out of the way, stop re-damaging ourselves, and let our body’s natural healing processes bring us back towards health. The human body is a self-healing machine.
Sure, you could choose moderation and hit yourself with a smaller hammer, but why beat yourself up at all? I don’t tell my smoking patients to cut down to half-a-pack a day. I tell them to quit. Sure, smoking a half pack is better than two packs, but we should try to put only healthy things into our mouths.
We’ve known about this for decades. Take the case of Mr. F.W., for example, as published in 1977 in the American Heart Journal. He had such bad heart disease he couldn’t even make it to the mailbox without crushing chest pain. But he started eating strictly plant-based and a few months later he was climbing mountains without pain.
There are fancy new anti-angina drugs out now. They cost thousands of dollars a year, but at the highest dose, they may only be able to prolong exercise duration for as long as… 33.5 seconds. It doesn’t seem as though patients choosing the drug route will be climbing mountains anytime soon.
Plant-based diets aren’t just safer and cheaper. They can work better because they let us treat the actual cause of the disease.
Good Spinal Health Key to Feeling Great
Movement Enhances Your Quality of Life.
By Donald Petersen Jr.
While we usually talk about the spine as a single part of the body, it’s much more than that. Your spine allows you to do almost everything you do. Proper spinal function allows you to do things well - and most of the time, pain-free. Poor spinal function forces you to do things poorly or not at all, not to mention the agony spinal distress can cause.
Consider for a moment everything you did today. Almost every movement you made, from getting out of bed in the morning until you got back into bed at night, required your spine to work in very complex ways that you’ve probably never thought twice about. Not only did your spine perform delicate mechanical functions, but it also facilitated the majority of your nerve function, another aspect of proper spinal function that most people never
consider … until there’s a problem.
Your spine consists of 26 bones, called vertebrae, which run from the “atlas” your head sits on to your “coccyx” or tailbone. These vertebrae essentially stack one on top of the other in your vertebral column, floating on intervertebral discs. Every other bone in your body is attached in some way to your spinal column.
When you move, your spinal column moves in some combination of four ways:
flexion - bending forward;
extension - bending backward;
lateral bending - bending from side-to-side;
rotation - twisting.
If your spine were just one solid bone, it couldn’t perform any of the variety of body movements; but as a stack of 26 bones, your spinal column can twist and bend to accommodate your every activity. This is accomplished by each spinal segment doing its job. When your spine moves, each movement of your vertebrae is choreographed through the rest of your body via a wonderfully designed system of muscles and ligaments that work together.
Your spine also has 31 pairs of spinal nerves that exit at some point from your spinal column. These delicate spinal nerves can become irritated, or inflammation can occur, when your spine fails to function properly.
These irritations or inflammation are thought to impact the nerve flow to the vital organs throughout your body.
In a healthy spine, each vertebra moves just a little each time you bend or twist. Even when you use your arms and legs, your spine plays a role. When you walk, your spine rotates just enough to allow your feet to move forward without tripping on the ground. The nerves inside and around your spine are protected and function comfortably when your vertebrae move within their normal range.
Should one or more of your vertebrae fail to move (hypomobility), other vertebrae would have to move more than they should (hypermobility) in order to compensate and still allow your body to perform the function it needs. When this happens, the muscles and ligaments connected to your spine can become fatigued and cause you pain. This abnormal movement of your vertebrae will also cause pressure and irritation to your spinal nerves. Should this abnormal movement continue over an extended period of time, more chronic ailments would develop. Your muscles, ligaments, vertebras, discs and organs attached to your spinal nerves would all be adversely affected. These deviations from normal often can be easily corrected with specific spinal manipulations and some helpful guidance on proper exercise.