Northeast Natural Medicine, LLC - Articles by Dr. Carney

The following articles have been featured in The Natural Nutmeg. These articles may not be reproduced or copied without the written permission of Dr. Shawn M. Carney.

CLICK HERE TO GO TO THE LIBRARY

Carpal tunnel syndrome (CTS), a condition marked by abnormal sensations in one or both hands due to compression of the median nerve, is arguably the most common peripheral mono-neuropathy and has now been shown to be effectively treated by combining a time-honored antioxidant with an essential fatty acid.

In a European clinical trial published this year (1), 112 patients with severe CTS were divided into two groups for 90 days: one receiving a combination alpha-lipoic acid (ALA) 600 mg/day with gamma-linolenic acid (GLA) 360 mg/day while the other group ingested a multivitamin B complex which contained 150 mg of B6, 100 mg of B1, and 500 micrograms of B12. The ALA/GLA group did substantially better than the other group when assessed from multiple perspectives, including significant reductions in both reported symptoms and functional impairment using scales and questionnaires that have demonstrated reliability in previous studies (2). Electromyography, which detects the electrical potential generated by muscle cells, also showed a statistically significant improvement in the ALA/GLA group but not the multivitamin group.

For those unacquainted with these nutrients, both ALA and GLA have impressive histories of clinical application. Alpha-lipoic acid is a water-soluble and fat-soluble anti-oxidant which has the ability to recycle other antioxidants, such as ascorbic acid and glutathione, thereby ultimately recycling vitamin E. It is well established for improving glucose tolerance and insulin sensitivity and was even successfully used to mitigate oxidative stress and improve organ function among children who were exposed to radiation during the Chernobyl disaster (3). Gamma-linolenic acid is an omega-6 essential fatty acid shown to help relieve premenstrual breast pain, premenstrual syndrome of bloating, irritability, and depression (4) as well as have positive effects on eczema and slowing deterioration in multiple sclerosis(5).

Vitamin D continues to be full of surprises. Its role as a hormone in the body seems to be the subject of an ever-expanding volume of research. One of the most recent contributions to better understanding and more adeptly using this nutrient comes to us from the synergistic realms of neurology and immunology where it has been discovered that vitamin D3 has the ability to augment the immune system’s removal of the pathologic plaque debris found in Alzheimer’s disease (AD) patients (1).

Curcumin, derived from the yellow curry spice tumeric, has a well-established role as both antioxidant and anti-inflammatory and can cross the blood-brain barrier (2). It is therefore consistent and has been clinically demonstrated that curcumin can suppress oxidative damage, inflammation and cognitive deficits in the brain. Furthermore, curcumin has also been shown to have a molecular structure conducive for binding to the amyloid beta plaques associated with AD patients and was shown to reduce amyloid accumulation more effectively than either ibuprofen and naproxen (2,3). Encouraging as this is, there is the potential for greater therapeutic results if the curcumin can enlist more of the immune system in reversing the accumulation of plaques, for curcuminoids have been shown to stimulate only some types of immune system macrophages, not all.

Now what happens when blood samples from AD patients are taken and incubated with amyloid, curcumin, and vitamin D3? The results showed, as above, curcumin facilitates the binding of amyloid beta to some macrophages; however, the presence of vitamin D3 further enhanced this reaction, so that macrophages had an increased ability to clear the amyloid. Furthermore, the macrophages not stimulated by curcumin were now also prompted to similar amyloid debris removal, thereby resulting in an increased effectiveness in immune system activity.

Last year the journal of Psychopharmacology released a study showing that aqueous preparations of Kava (Piper methysticum) were safely used to reduce anxiety and depression. Their conclusion found Kava’s abilities “highly significant” with a “substantial effect size”, when compared with the effectiveness of a placebo, and without adverse effects on the liver when used for a short duration.

This study was reportedly the first human clinical trial to assess anti-depressive and anxiety lowering effects from ingesting tablets made from an aqueous extract of Kava while also assessing liver safety. Researchers gathered 60 adult participants who had suffered with at least one month of elevated generalized anxiety for this 3-week, placebo-controlled, double-blind crossover trial. Dubbed the “Kava Anxiety Depression Spectrum Study”, participants had either five placebos or five tablets of Kava a day, which each had 50 mg of kavalactones for a therapeutic daily total of 250 mg of kavalactones a day. Kavalactones, also called “kava pyrones”, come from a resin of the Kava’s dried root, which originates from islands in the Pacific Ocean. They are believed to be the most therapeutically significant constituent of the plant and are accordingly the benchmark by which standardization of supplements is made.

Results from the study were very impressive with the aqueous extract of Kava showing highly significant relative reductions of anxiety and depression across several scaling systems. The data used for evaluation was collected on weekly clinical assessments and self-rating questionnaires. Scoring systems used in the assessment included the Hamilton Anxiety Score, which has been widely used for decades in both clinical and research settings, with participants’ symptoms being reduced by -9.9 when compared with the placebo, which lowered scores only -0.8. Other highly significant improvements were observed using the Beck Anxiety Inventory and the Montgomery-Asberg Depression Rating Scale.

Findings such as these are not new to research with Kava. The efficacy of standardized kava liquid extracts, which use alcohol as a solvent and preservative, has been well documented in animal and human studies. It has repeatedly been shown to decrease anxiety and relax the body without loss of mental acuity. In fact, Kava has traditionally been used for centuries in its indigenous areas as a ceremonial and intoxicating drink. It was even commented on by the famous eighteenth century explorer Captain James Cook during his voyage through the South Seas. However, this study reported being the first clinical trial to specifically examine the anti-anxiety and anti-depressive abilities of an aqueous extract from Kava.

Another purpose of this study was to address the ongoing controversy over Kava’s potentially toxic effects on the liver, called hepatotoxicity. In recent years, Kava has been withdrawn from European, Canadian, and British markets due to concerns over hepatotoxicity and the World Health Organization recommended further research into aqueous extracts of the herb. Many professionals believe hepatotoxicity is very rare and such regulations excessive. For example, in 2008 The European Journal of Gastroenterology and Hepatology published a study which reviewed causal relationships among 26 patients who experienced liver damage while using Kava. Causality was assessed using criteria of the Council for International Organizations of Medical Sciences for objective probability scoring. Ultimately, only one case was unequivocally verified because others had not adhered to the regulatory recommendations for the prescribed dosing, duration time of treatment, or had cases clouded by use of other medications at the time of liver injury.

While the three-week Kava Anxiety Depression Spectrum Study raised no major health concerns regarding the extract used, researchers believed larger studies were required to confirm the herb’s safety. The lead researcher, in an interview posted on www.elements4health.com, implicated an erroneous extraction process itself as the possible cause of health concerns with Kava in recent years. “Ethanol and acetone extracts, which sometimes use the incorrect parts of the Kava, were being sold in Europe. That is not the traditional way of prescribing Kava in the Pacific Islands. Our study used a water-soluble extract from the peeled rootstock of a medicinal cultivar of the plant, which is approved by the Therapeutic Goods-Administration of Austrailia and is currently legal in Austrailia for medicinal use”.

Kava, which is still available in the U.S., is certainly not the first botanical medicine to get a bad reputation and be outlawed due to rare and controversial cases of toxicity and I would like to remind proponents of such regulations to review the facts around acetaminophen and liver toxicity, just to put things in perspective. Acetaminophen is one of the best-selling pain relievers in the country and is sold over-the-counter to over 200 million Americans a year, under brand names such as Tylenol. Yet it is one of the leading causes of acute liver failure in the United States, accounting for more than 56,000 emergency room visits, 2,600 hospitalizations, and an estimated 450 deaths per year. Most cases occur among people that have exceeded the recommended amount of medication but a study by the U.S. Food and Drug Administration (FDA) showed that about 20% of people with acetaminophen-related liver toxicity had taken less than the recommended daily amount.

Feeling anxious with difficulty sleeping, aches and pains after a hard day at the office - or farm for that matter? Then turn your attention to some traditional wisdom which has withstood the test of time, being shown effective in both clinical trials and rabbit testimonials.

In August of 2009, The Journal of Clinical Psychopharmacology published what was reportedly the first controlled clinical trial of chamomile extract for generalized anxiety disorder (GAD). The researchers’ conclusion, consistent with other findings for anxiety and insomnia, suggested that chamomile was effective in helping to ease concerns among persons with mild to moderate GAD.

The study was conducted as a randomized, double-blind, placebo-controlled efficacy and tolerability trial of Matricaria recutita, commonly known as ‘German Chamomile’, among patients with mild to moderate anxiety. Approximately 60 patients were divided between the placebo and intervention groups for a duration of 8 weeks. Subjects in the intervention group were started with 220 mg/day of chamomile extract, standardized to 1.2% apigenin, for the first week. This dose was then doubled to 440 mg/day during the second week, with participants being evaluated using the Hamilton Anxiety Rating (HAR) scoring system. If a participant’s HAR did not decrease by more than 50%, the therapeutic dose prescribed would be increased by 220 mg/day each week until the maximum dose allowed was attained, which was 1100 mg/day.

Chamomile has a long history of safe use for a wide variety of conditions, with different preparations for different populations. It has been used for anxiety, insomnia, menopausal depression, gastric ulcers, stomachache, diarrhea, colic, muscle pains from flu infections, inflamed skin, hives, and teething among children, to name a few. It is recommended to seek the care of a licensed healthcare professional when treating any such ailment with botanical medicines.

A recent study from the United Kingdom examined success variability among weight loss program participants who underwent intense exercise protocols while eating different amounts of food (1). Their conclusion was that despite consistent rigorous exercise, a strategic Mediterranean style diet was more influential in determining the ultimate amount of weight lost.

The researchers above considered how appetite and food choices, or “energy intake”, affected people in a supervised and monitored five day a week fitness protocol. The study consisted of fifty-eight obese men and women who were prescribed exercise, at an expenditure of up to 500 kilocalories per session with a frequency of five times a week for twelve weeks and an intensity of 70% maximum heart rate. Note that while the 500 kilocalories per session stipulation translates into approximately an hour of jogging at 5 mph, digging and gardening, active swimming, using a cross country ski machine, or hiking (2), the intensity stipulation helps to ensure that the activity is being done at an adequate and fruitful level. Body weight, composition and foods consumed were recorded four times through the duration of the study.

Though the average reduction in body weight was 7.04 lbs (+/- 4.3 lbs) and considered statistically significant, there was substantial individual variability (-32.34 to +5.94 lbs). “This large variability could be ... attributed to the differences in energy intake over the twelve week intervention. Those participants who failed to lose meaningful weight increased their food intake and reduced intake of fruits and vegetables”. Thus the authors concluded that regardless of high energy expenditure, adherence to strategic eating patterns is a better indicator for successful weight loss and that eating patterns associated with the Mediterranean diet were notably beneficial. In this way, even if one part of your strategy is daily strenuous exercise, successful weight loss relies more on mindful dietary patterns used with three meals a day and carefully chosen snacks between.

The Mediterranean diet has been clinically demonstrated to protect against cardiovascular disease, diabetes, metabolic syndrome, cancer and now even improve weight loss (3). It consists of daily fruits, vegetables, beans, nuts, olive oil, and grains while animal products are greatly minimized: fish or fowl being consumed weekly and red meat monthly. As a dietary strategy, it has also been compared with many alternative ways to lose weight and shown to be the most efficacious (4), especially when combined with medical food meal replacements which have additional ways to optimize physiologic reactions conducive to losing weight and ingredients shown to lower cholesterol, stabilize blood sugar, and help normalize hormones.

A renowned program which ties together exercise, the Mediterranean diet, medical food meal replacements and low glycemic food choices is called FirstLine Therapy. This medically supervised program consists of a series of office visits to assess changes in body tissues, construct sample menus, and offer support such as recipe ideas. Readers can go to http://www.metagenics.com/patients to find a practitioner certified in FirstLine Therapy in their area.

Last summer the professional journal “Nutrition” published a study assessing the effectiveness of cognitive-behavioral therapy for treating obesity when a Mediterranean dietary pattern is used (1). Their findings not only showed that behavioral therapy based on Mediterranean dietary principles was a successful way to lose weight, but also illustrated the fruitfulness of practical clinically orientated techniques, such as recording food intake and attendance of group therapy.

Both cognitive-behavioral therapy and the Mediterranean diet have been well documented to be clinically effective for achieving different ends and research integrating the practices was perhaps an inevitable strategy for attaining desirable results. Cognitive-behavioral therapy is a form of interventional psychology which emphasizes utilizing formulated strategies, cultivated through self-awareness, to alter specific behaviors. It is a blend of two different psychotherapy theories which ultimately share an emphasis on using the present moment to re-structure our ways of being in the world, whether the emphasis is on thoughts or behaviors or both. This action-orientated method has been widely researched for decades and empirically shown to be beneficial in many different clinical conditions (2). The Mediterranean diet, as a strategy for eating, consists of abundant and minimally processed plant foods, with fresh fruit as a typical daily dessert and olive oil as the primary source of lipids; there is little by way of meat or dairy products. Adherence to the Mediterranean diet decreases risk of cardiovascular disease, cancer, diabetes, increases longevity, and can improve outcomes for people with autoimmune disease, Alzheimer’s disease, allergies, and arthritis, as shown in epidemiological, clinical, and pharmacological studies (3-9).

In terms of this study, the principals of cognitive-behavioral therapy were employed when determining barriers to losing weight as well as individuals formulating strategies based off those identified barriers. The researchers enlisted 1,406 obese individuals between the third and seventh decades of life from southeastern Spain to participate in the weight loss program. Obstacles to success were identified using a “Barriers to Weight Loss” checklist. Progress was tracked by assessing weight, body fat distribution, biochemical variables, blood pressure changes, average duration of treatment, percentage attrition, and one’s ability to fulfill a Mediterranean diet plan.

The results were favorable though not overly impressive, with an average weight loss of almost 17 lbs over a treatment duration of 34 weeks. Eighty-nine percent of subjects fulfilled the Mediterranean principles during the program, and all the variables studied were significantly improved. Stress was the most frequent reason for participants not seeing the study through to completion and the main obstacles to weight loss were “losing motivation”, being “prone to stress-related eating”, and being liable to eat when bored. Keeping written records of what was eaten through the day as well as attending group therapy were considered factors contributing to the success of many participants.