Healthy Life Newsletter, September/October 2022
Patient of the Month: Mike Crowley
I had pain in my upper left leg and hip: “sciatica.” It had lasted three months. I took no medications, but the pain was so bad that I was limping. I could hardly walk. The left knee would often buckle and I came close to falling several times. My medical doctor suggested physical therapy or a chiropractor. I tried acupuncture but it was not enough.
I had been to Dr. Mha Atma 30 years ago for a neck injury which he cured. I figured if he was still in practice after 30 years he must be doing something right. 30 years ago I had some doubt he could help me but after that experience I had extreme confidence he could help me again.
I was impressed by Dr. Mha Atma’s very special easy manner. Very easy being in his presence—like driving through Malibu. He gave me adjustments twice weekly at first and some excellent effective exercises which I do daily. The result of his treatment: Relief, relief, relief! After a few weeks I felt much better and was able to walk freely again. Dr. Mha Atma’s long experience paid off again!
It seems that life stresses caused the vertebrae to shift and strangle the sciatic nerve. Dr. Mha Atma’s treatments hit the sweet spot of life and were just what my body was pleading for!
I have three women at my church who are very interested in coming to see Dr. Mha Atma and have told several others about my experience. Chiropractic works! I’m living proof.
This is the last part of a longer article about pain, opioids and chiropractic. To read the whole thing go to linkedin.com
The Natural Impact of Chiropractic on Pain
Chiropractic care is not only drug-free, but is also highly effective for managing both acute and chronic neuromusculoskeletal pain.
Studies have shown that initial visits to chiropractors or physical therapists are associated with substantially decreased early and long-term use of opioids. This is significant since insurance claims data suggests that opioids are the most commonly prescribed class of drug for back pain, and more than half of regular opioid users report back pain as a complaint.
In addition to optimizing joint function throughout the body, chiropractic care can also offer exercises to strengthen and stabilize muscles and joints, address muscle spasm and recommend nutrition or supplements that can work to reduce inflammation in the body.
DC’s also work with integrated care teams with recommendations for other drug-free approaches such as acupuncture or biofeedback and can interface with prescribing doctors for strategies when patients are tapering off of harmful medications. Chiropractic offers a natural care plan that addresses the needs of the entire patient.
Vitamin D’s Effect on Fertility and on the Risk of Pre-term Births
Vitamin D is necessary for all stages of the life-cycle, and especially for pregnancy. Numerous studies have found that higher vitamin D levels during pregnancy reduce the risk of adverse maternal and infant outcomes. Vitamin D levels in the range of 40-60 ng/ml (100-150 nmol/L) have been shown to reduce complications including preterm birth, hypertensive disorders of pregnancy (preeclampsia) and gestational diabetes. The Pregnancy Disease Risk Reduction Chart provides an illustration of some of the findings from studies that have compared prenatal and newborn health outcomes to vitamin D levels. It shows the percent lower risk at a given vitamin D level compared to a common reference level of 25 ng/ml (62 nmol/L), which is the approximate average level of the U.S. population.
Vitamin D is also involved in the process of conception, implantation and the development of the placenta, and vitamin D levels in both men and women can have an effect on fertility and the chances of having a live birth. A paper by Várbíró et al. reviewed findings from recent research on vitamin D in men and women, fertility, IVF success rates, and pregnancy among women with or without Polycystic Ovary Syndrome (PCOS).
For more and to see the charts go to myemail.constantcontact.com
How Do Race and Vitamin D Levels Affect the Risk of Having a Preterm Baby?
We have previously summarized the main results from a published GrassrootsHealth study showing a 62% lower risk of preterm birth for women with vitamin D levels at or above 40 ng/ml (100 nmol/L) compared to women with levels less than 20 ng/ml. Below, we look at another analysis from that paper which assessed the association between vitamin D and preterm birth risk for white and non-white women. This was important to look at due to the racial and ethnic differences in preterm birth rates, with Black women having higher rates compared to other groups.
Among the women in the study (N=1,064), 10% of white women and 15% of non-white women had a preterm birth. Black women accounted for a majority (69%) of the non-white births and had a 19% preterm birth rate. For those with vitamin D levels at or above 40 ng/ml compared to women with levels less than 20 ng/ml, there was a 65% lower risk of preterm birth among white women (p=0.03) and a 68% lower risk among non-white women (p=0.008). The similar decreased risk suggests that improvements in vitamin D status may decrease the disparity in preterm birth rates between racial/ethnic groups.
For more go to:
Matthew’s Tips for Good Sleep (from Matthew Walker, PhD’s excellent book “ Why We Sleep; Unlocking the Power of Sleep and Dreams“)
\1. Stick to a sleep schedule
We should aim to go to bed and wake up at the same time each day. People generally have a hard time adjusting to changes in sleep patterns. Unfortunately sleeping late on weekends doesn’t make up for poor sleep during the week. If necessary, set an alarm for bedtime. Matthew emphasizes this is the #1 priority from the list; stick to a regular sleep schedule.
\2. Don’t exercise too late in the day
Exercise is great, and we should try to exercise at least 30 minutes on most days. But try to time it no later than 2-3 hours before bed.
\3. Avoid caffeine & nicotine
Colas, coffee, teas (that aren’t herbal) and chocolate contain caffeine, which is a stimulant. Even consuming these in the afternoon can have an affect on your sleep. Nicotine is also a mild stimulant, and smokers will often wake up earlier than they would otherwise, due to nicotine withdrawal.
\4. Avoid alcoholic drinks before bed
The presence of alcohol in the body can reduce your REM sleep, keeping you in the lighter stages of sleep.
\5. Avoid large meals and beverages late at night
A lights snack before bed is okay, but a heavy meal can cause digestive issues, which interfers with sleep. Drinking too many fluids can cause freuqent awakenings to urinate.
\6. Avoid medicines that delay or disrupt your sleep (where possible)
Some commonly prescribed heart, blood pressure or asthma medications, as well as some over the counter and herbal medicines for coughs colds or allergies can disrupt sleep patterns. If you have trouble sleeping, it may be worth speaking to your doctor or pharmacist to see if any of the drugs you’re taking may be contributing to this. It may be possible to take them earlier in the day.
\7. Don’t nap after 3pm
Naps are great, but taking them too late in the day can make it hard to fall asleep at night.
\8. Make sure to leave time to relax before bed
It’s important to have time before bed to unwind. Try to schedule your days so that there is time to relax before bed.
\9. Take a hot bath before bed
The drop in body temperature after a bath may help you to feel sleepy, and the bath can help you to slow down and relax before bed.
\10. Have a dark, cool (in temperature), gadget free bedroom
We sleep better at night if the temperature in the room is kept on the cool side. Gadgets such as mobile phones and computers can be a distraction. Additionally the light they emit, especially the blue light, suppresses the secretion of melatonin. Melatonin being a hormone that regulates sleep/wake cycles - with it increasing in the evening to induce sleep. There are things we can do to reduce the blue light at night, including:
Using blue light filters on our phones & tablets. iOS 9.3 or later (iPhone 5S & iPad 2 onwards) has this built in -called Night Shift. On Android there are apps for this, a popular one being Twilight .
Using blue light filters on our computers. For MacOS &Windows f.lux is a popular solution. Windows 10 also has a built in “ Night Light” function that offers similar functionality.
Using blue light filters on our home lighting system. A popular solution to this are Philips Hue bulbs, which connect wirelessly to your router, and can be programmed to reduce blue light during certain times of day. So for example, if your bedtime is 11pm, you can set the bulbs to reduce blue light from 10pm onwards… which will increase your melatonin level, preparing you for sleep.
A comfortable mattress and pillow can set you up for a good sleep. Those with insomnia will often watch the clock, turn it away from view so you don’t have to worry about the time while trying to sleep. Use these tips to optimize your sleeping space.
\11. Get the right sunlight exposure
Sun exposure during the day helps us to regulate sleeping patterns. Try to get outside in the natural sunlight for at least 30 minutes per day.
\12. Don’t stay in bed if you (really) can’t sleep
If you find yourself still in bed for more than 20 minutes, or you’re starting to get anxious in bed, get up and do something else until you feel sleepy. Anxiety whilst trying to sleep can make it harder to fall asleep.
Why Magnesium Levels Decline with Age & What to Do About It
by Jennifer Chesak
This Macromineral Is Essential for Health — But We Lose It as We Age
Magnesium is required for a whole lot of physiological pathways in the body. The mineral plays a role in healthy blood sugar and blood pressure levels, relaxation and sleep quality, electrolyte balance, muscle and nerve transmission, the transport and actions of other nutrients in the body, and immune system support. Magnesium is paramount to the health of our bodily structures and functions—from our bones down to the tiny mitochondria in our cells.
Magnesium is a macromineral, meaning we need much more than trace amounts to keep our bodies running smoothly. But unfortunately, many of us don’t get enough magnesium, especially as we get older.
Why magnesium levels often decline with age.
Getting enough magnesium through diet alone is challenging at any age. Soil depletion in farming has resulted in a steady decline of magnesium in the foods we eat. And food processing results in a loss of the mineral as well, according to a review in the journal Nutrients. These days, over 40% of people in the United States don’t get the recommended daily amount of magnesium through foods.
So what does aging have to do with it? “As a person ages, a big factor in their magnesium decline is that their appetite and [nutrition] intake also decline,” explains Christina Fitzgerald, M.S., R.D., a registered dietitian and sports nutrition expert. “So they’re taking in much less dietary magnesium.”
Plus, aging involves a lot of changes within the body that can simultaneously (negatively) affect magnesium levels: According to functional registered dietitian Alex D’Elia, R.D., changes in urination, intestinal absorption, and bone health status are “three of the most common reasons magnesium insufficiency is seen in the aging population.”
How to maintain healthy magnesium levels for life:
Add a supplement.
Even if you try your best, dietary changes might not be enough to sustain optimal magnesium levels—this is where a supplement can be useful.
D’Elia recommends supplementing with magnesium glycinate (also called bisglycinate), which has the added bonus of promoting quality sleep.* There are many forms of magnesium available, but here are 16 that the mbg team has identified as high-quality.*
If you do take a supplement, follow the dosing instructions on the label and check with your physician to make sure it’s safe and effective for you.
Change your diet.
You can up your intake of this essential mineral by making a habit of eating more magnesium-rich foods. “Include a variety of sources daily, such as legumes, nuts, seeds, whole grains, and leafy veggies in addition to fortified cereals and milk and yogurts,” Fitzgerald says. “These can easily be included in both meals and smoothies.”
The bottom line.
Our magnesium levels tend to decline with age for several reasons, including normal changes in the body. Although we can always aim to eat more magnesium-rich foods to counteract low levels, getting enough of the mineral from diet alone is tough daily. Taking a supplement can help support your body’s magnesium count for better health at any age.*
(The numbers in the text of this article refer to the references at the bottom. Folks who are considering epidurals might want to share this with their doctor.)
Spinal Steroid Injections (Epidurals): Assessing Risks vs. Benefits
By Ronald Feise, DC
What does the current research demonstrate? Let’s investigate the risks and benefits of steroid spinal injections, starting with the risks.
Steroid Injections: The Risks
A case-control study assessed the effects of lumbar epidural steroid injections on the risk of subsequent vertebral body fracture. This study was published in the Journal of Bone & Joint Surgery, a top-tier peer-reviewed journal for orthopedists.1 This research team randomly selected 3,000 patients who had been exposed to steroid injection and 3,000 patients who had not been exposed. There were no differences between the injected and non-injected groups with respect to age, sex, race, hyperthyroidism or oral steroid use. The researchers assessed the incidence of vertebral body fractures in each group.
The study found that each steroid injection increases the risk of fracture by 21 percent.
Another study examined postmenopausal women and demonstrated diminished bone density in the hip after a single lumbar steroid injection.2 Multiple research teams now caution against using these injections in women and underweight individuals.
Numerous other adverse events are associated with steroid injections. Although the vast majority are minor and transient in nature, serious complications, including nerve damage, paralysis, strokes and death, may also result.3 Infection is another possible risk that should not be ignored. Several years ago, an outbreak of fungal meningitis from tainted steroids killed 64 people and seriously sickened 751 others.
Steroid Injections Have Failed to Demonstrate Benefit
Scientists use double-blind, placebo-controlled, randomized clinical trials to examine the benefits of interventions because this research design can accurately measure effects. Combining the results of multiple trials in a meta-analysis adds a level of reliability to the conclusions of the individual studies.
A research team conducted systematic review and meta-analysis to investigate the efficacy of epidural corticosteroid injections compared with placebo injections in reducing leg pain (primary outcome) and disability in patients with sciatica. ( 4) They included in their review 25 placebo-controlled, randomized clinical trials that provided data from a total of 2,470 sciatica patients.
Researchers found that while epidural steroid injections are more effective than placebo injections in reducing leg pain immediately after injection (e.g., the first two weeks), the effect fades rapidly. Epidural steroid injections were not better than placebo injections for leg pain at any point after two weeks. Additionally, epidural steroid injections were not effective in reducing back pain or improving disability at any point in time.
Multiple medical research teams performing independent systematic reviews (5, 6) agree that there is no evidence to support the use of injections for the treatment of low back pain, spinal stenosis or sciatica. Although some patients will experience a few weeks of pain relief, the benefit does not last. Based on multiple randomized trials, steroid injections are not better long term than placebo injections with saline solution.
Summary
In the case of spinal steroid injections, the risk of harm is considerable, serious and predictable, and the benefits are extremely limited (14 days). Therefore, patients with sciatica, low back pain or spinal stenosis should avoid this invasive treatment and instead receive chiropractic care.
Also note that the FDA has not approved injectable corticosteroids for use through spinal injection, but these products continue to be used “off-label.”
References
Mandel S, Schilling J, Peterson E, et al. A retrospective analysis of vertebral body fractures following epidural steroid injections. J Bone Joint Surg (U.S.), 2013;95:961-4.
Al-Shoha A, Rao DS, Schilling J, et al. Effect of epidural steroid injection on bone mineral density and markers of bone turnover in postmenopausal women. Spine, 2012;37:E1567-71.
Abbasi A, Malhotra G, Malanga G, et al. Complications of interlaminar cervical epidural steroid injections: a review of the literature. Spine, 2007;32:2144-51.
Oliveira CB, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections for sciatica: an abridged Cochrane systematic review and meta-analysis. Spine, 2020;45:E1405-E1415.
Chou R, Hashimoto R, Friedly J, et al. Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis. Ann Intern Med, 2015;163:373-81.
Pinto RZ, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Ann Intern Med, 2012;157:865-77.