12.08.10

Cold Laser (LLLT) & Elbow Pain

Posted in Uncategorized at 9:25 PM by Dr. Greathouse

From BMC Musculoskeletal Disorders
A Systematic Review With Procedural Assessments and Meta-analysis of
Low Level Laser Therapy in Lateral Elbow Tendinopathy (Tennis Elbow)

Posted 08/22/2008
Jan M. Bjordal, PT-MSc, PhD; Rodrigo A.B. Lopes-Martins, MPharm, PhD;
Jon Joensen, PT, MSc; Christian Couppe, PT, MSc; Anne E. Ljunggren,
PhD; Apostolos Stergioulas, PT, PhD; Mark I. Johnson, BSc, PhD, PGCHE

Conclusion
The available material suggests that LLLT is safe and effective, and
that LLLT acts in a dose-dependent manner by biological mechanisms,
which modulate both tendon inflammation and tendon repair processes.
With the recent discovery that long-term prognosis is significantly
worse for corticosteroid injections than placebo in LET, LLLT
irradiation with 904 nm wavelength aimed at the tendon insertion at
the lateral elbow is emerging as a safe and effective alternative to
corticosteroid injections and NSAIDs (non-steroidal anti-inflammatory
drugs).

LLLT also seems to work well when added to exercise and
stretching regimens. There is a need for future trials to compare
adjunctive pain treatments such as LLLT with commonly used
pharmacological agents.

The positive results for combining LLLT of 904 nm wavelength with an
exercise regimen, are encouraging. We would have thought that exercise
therapy could have erased possible positive effects of LLLT, but the
results showed an added value in terms of a more rapid recovery when
LLLT was used in conjunction with an exercise regimen. This may
indicate that exercise therapy can be more effective when inflammation
is kept under control. Adding LLLT to regimens with eccentric and
stretching exercises reduced recovery time by 4 and 8 weeks in two
trials.

Commentary
My clinical results with laser are good. They’re not perfect but a
relatively high percentage of the time it’s very effective; for acute
as well as chronic musculoskeletal problems. It seems the results are
more dramatic in chronic conditions. This I believe is because the
chronic low-grade inflammation is a stubborn condition that has simply
not responded to other forms of care, therefore, a positive response
seems more impressive if you’ve been suffering for a long time.
Laser is emerging as a safe and effective alternative to
corticosteroid injections and NSAIDs.

We get  good results with plantar fasciitis, carpal tunnel syndrome, ulnar neuritis, shoulder tendonitis, simple non-surgical knee pain conditions, bursitis, tendonitis, even with back and neck problems that fail to respond to mechanical forms of care.

See my website at greathousechiropractic.com

Truths About Back & Neck Pain Part One

Posted in Truths About Back & Neck Pain at 9:23 PM by Dr. Greathouse

This is an introspective look at an age-old problem.
I have nothing but empathy for back pain sufferers because they are faced with an impossible decision process on what to do about their pain in a world of indefinite opinions by a multitude of health care providers (HCP) that rarely agree on a diagnosis or a treatment approach; even among same specialties. The last time I counted there were at least 22 specialties that addressed back pain.
Back pain is truly a diagnostic conundrum. Regardless of what diagnosis your doctor or therapist gives you, it’s likely not supported in the literature. It may make sense and you may even agree with it because it seems so sensible, but the truth is, 85% of all back pain has no specific diagnosis and is categorized as “non-specific” by all health care guidelines. This is not a diagnosis!
Gunnar Andersson states…  “Our treatment success rate can be no better than our diagnostic success rate.”  Gunnar Andersson, MD, PhD, Chairman, Department of Orthopaedic Surgery, Rush University Medical Center
An inaccurate diagnosis poses a big problem! Without an accurate diagnosis the prescribed treatment cannot be accurate either, thus leading to poor outcomes. The back pain sufferer unwittingly rolls the dice in high hopes that the recommended doctor or clinician will make them better. When treatment doesn’t help, ongoing doctor shopping commonly ensues, resulting in a great deal of lost time and money, not to mention the suffering in some cases.
For example, in spite of the fact that we can see arthritic changes, disc degeneration and even disc herniation on x-ray or MRI, doctors cannot reliably state that those findings are the cause of your symptoms. Chiropractors cannot find a vertebra out of place; much less put it back in place. Massage therapists can’t diagnose tight muscles as a cause and physical therapists cannot reliably prescribe exercises that will make you better. Of course, I don’t want to bore you with the entire list, but there are very few models of assessment and care that are valid and reliable.
The only way these theories can pass the muster is when specific criteria can be met, and to date (December 2010), very few qualify.
This is likely one reason why outcomes are actually worse today than in the past and cost continues to skyrocket ($90 billion in 2009 for low back pain)! Back pain is big business! One has to wonder whom the care is designed to benefit, the patient or the provider of care! This might be why providers are slow to embrace more valid & reliable methods of assessment and care.
Finding the answers has been my “Holy Grail” over the past 28 years of my career. I’ve spent over 450 post doctorate continuing education hours and countless hours online reading the literature, looking for the most valid & reliable methods and protocols to better assess and treat back pain. The best I’ve found thus far is the McKenzie method, AKA, Mechanical Diagnosis and Treatment (MDT) method. It’s unsurpassed by any other protocol available!
Let’s put things in some perspective. We know that certain forms of care do work. For example, manual therapy or manipulation or “adjustments” do work! Massage helps, physical therapy in all its forms sometimes helps. All of these forms of care work some of the time, but none of them work consistently all of the time. Science hasn’t determine when or why they work. So, these forms of care are really put forth in a global fashion; much like treating all chest pain with an antacid.
What has proven to work is subcategorization.  Most experts would agree that pain is produced either by inflammation (chemical) or mechanical means (abnormal stress on tissue), and both, in some circumstances. That might be why an anti-inflammatory helps a little, but, an adjustment or manipulation seems to help in addition to the anti-inflammatory medication.
The MDT method reliably identifies some specific mechanical subgroups (causes) of spine pain in the nonspecific group of pain sufferers. This is HUGE in the field of physical medicine because with that information we can more reliably address the 85% non-specific population and further break it down into subgroups that we know will more likely respond to mechanical forms of care, as well as those who might additionally benefit from ant-inflammatory care.
With this, two very important things happen: Ø First, once a specific mechanical fault can be reliably identified, outcomes improve dramatically.Ø Second, it identifies those who will not likely improve with mechanical means of care thus eliminating the ongoing trial & error care that we’ve grown accustom to, saving time & money.
Not only does MDT identify those who should respond to mechanical forms of care it also provides specific algorithmic means of treatment protocol to follow, which further eliminates trial & error physical medicine approaches to care.
Just remember, there’s a lot of hype out there among all disciplines (all healthcare providers). I’m offering an honest contemporary appraisal of your problem followed by a more specific treatment approach on my part with physical medicine procedures or a referral to the appropriate health care provider that best suits your needs.
Last but not least, if you or someone you know is considering spinal surgery for a disc problem please encourage them to consider this alternative. All avenues of conservative care should be exhausted before surgery. This method literally works wonders on disc problems in many cases.

A Practical Guide to Reduce Problems Associated With Sitting

Posted in Spinal Hygiene at 9:22 PM by Dr. Greathouse

Common Problems Associated With Sitting

Low back pain, neck pain, headache, eye strain, headaches, shoulder and arm pain, wrist, hand and finger pain or symptoms, leg and foot symptoms, tired achy muscles and fatigue.
Practical Techniques To Reduce Stress1.     **Take breaks, reverse posture and move at least every 20 minutes. Tissue integrity begins to weaken after about 15 to 20 minutes of load/stress from prolonged position.  Although this happens on a microscopic scale, the effect is cumulative over time and predisposes one to injury. 2.     *Avoid slumping; the use of a lumbar support pillow or a rolled towel adds significant low back support.3.     Prolonged positioning reduces circulation, thus, movement breaks re-circulate blood flow to the tissues.4.     Forearm to upper arm angle is best maintained at 75 — 90 degrees.5.     A footrest is required when the feet cannot be firmly placed on the floor.6.     Thigh and trunk (body) angle should be at 90 degrees.7.     Knee angle should be at 90 degrees.8.     Make use of your swivel chair; avoid twisting your back when turning.9.     Practice relaxation & movement techniques during a break.10.  Computer screens are best situated 14 to 30 inches in distance from the face.11.  The center of the computer monitor should be most comfortable at chin level.12.  Materials on your desk, which are used at high frequency intervals, should be placed for easy access.13.  Bracing a telephone between head and shoulder is a common cause of neck problems and should be avoided.14.  Direct light from a window or lamp can cause visual interference/screen glare producing eyestrain.  Glare screens can reduce this problem.15.  Too much heat from the sun through a window or too much cold from the AC can cause discomfort and muscular reactions.16.  Excessive room noise can be stressful.  Modular room dividers can be very helpful at reducing this problem.17.  Frequently changing your field vision will reduce eyestrain.18.  Bifocal glasses requiring backward head tilting can precipitate neck pain.19.  Leaning forward with an unsupported back will produce back pain.20.  Constant one-sided twisting or leaning will produce muscular and spinal imbalance leading to pain and stiffness.21.  Source documents should be at the same level as the screen if possible. 22.  A neutral wrist angle is best to avoid hand & wrist problems.23.  Avoid resting your wrist on sharp edges.24.  Your keyboard should be adjusted to compensate for wrist comfort.  25.  Your seat pan angle should be adjusted or changed to reduce pressure on your thighs.26.  Sitting on a wallet will produce imbalance, poor circulation and sciatic nerve compression.27.  Headaches are frequently produced from neck strain and/or eyestrain.28.  Practice mini-breaks with desk exercises.29.  Your desk chair should have adjusting capabilities for both vertical and horizontal changes for better back support.

Back Surgery? Not So Fast!

Posted in Disc Data at 9:18 PM by Dr. Greathouse

Recently a patient and I discussed his back problem. He has a low back disc herniation that responds well to mechanical therapy. He remarked about a friend who recently had injection therapy, which helped his radiating leg pain. He wanted to know how long that would last. Obviously nobody really knows the answer to that question, everybody is different. The patient said the injection was reportedly very painful and for that reason he would opt for laser back surgery if he had to go beyond my form of care. He explained he has discussed the issue with a few people who heard of great results with laser surgery.. As with anything else in health care, you cannot base your decision on 
a survey done with just a few people. Science has statistics out there and 
they aren’t that great for any form of treatment of low back or neck pain. So, the last thing you want to do is pick one of the most expensive and 
one that is invasive, unless the diagnosis absolutely matches the treatment. And there in lies the problem; 85% of all back problems have no valid 
or reliable diagnosis. I mentioned the lack of specificity of CT Scans 
and MRI’s and the patient remarked that a local orthopedist calls MRI findings 
”MRLies” because of the lack of specificity. These diagnostic studies 
are very sensitive, as a matter of fact many times they reveal a 
multitude of abnormalities that science can’t reliably confirm are related to your back or neck complaints. Fact: Just because a disc 
herniation is present doesn’t mean that’s the cause of your problem (non-specific). Reliable studies show that a relatively high percentage of people have disc herniations but have no symptoms at all.Fact: A very high percentage of spinal disc herniations with leg or 
arm symptoms respond favorably to conservative non-surgical care. With 
a proper mechanical evaluation this can be ascertained quickly. A 
mechanical assessment that points to a more specific diagnosis/ subgrouping has a high positive outcome prognosis. Fact: Cost for back care is astronomical in the United States, 
approaching 100 billion per year but the outcomes are not getting better, they are worse! So don’t let anybody fool ya’. High tech hasn’t improved a thing in the overall 
scope of things either. Unless you have progressive nerve damage or intractable pain, don’t have back surgery until you’ve exhausted conservative care. Fact: There’s much higher potential for significant adverse side affects with surgery as compared to conservative mechanical therapy.Fact: Cost…. Mechanical therapy is significantly less expensive
Disc herniations are reducible by means of mechanical therapy! Even large disc herniations! For more info on Valid & Reliable conservative back care go to my website: Website: http://greathousechiropractic.com/ Look under Disc Herniation Care. Also check out the section on McKenzie.
Jim Greathouse, D.C.

Manual Therapy First For Back Pain!

Posted in Guidelines for Treatment at 9:17 PM by Dr. Greathouse

Manual Therapy First
These are recommended guidelines for treating back pain. National Institute for Health and Clinical Excellence (NICE) on best practice to improve the early management of persistent, non-specific back pain.

The guidelines recommend exercise, manual therapy or acupuncture as first-line treatments for those with back pain that has lasted more than six weeks. There is then a more comprehensive package of psychological and physical treatments for those who have not recovered after receiving these treatments.

The use of X-rays or injections in diagnosing non-specific back pain is not recommended in the new guidelines. In the vast majority of back pain cases, X-rays and MRI scans do not provide any useful information on where the pain comes from or how it may be treated.

The relevant piece– first refer to quality hands on conservative care before thinking of injection docs or ortho docs.

The National Institute for Health and Clinical Excellence (NICE) provides guidance, sets quality standards and manages a national database to improve people’s health and prevent and treat ill health.  Link To NICE Website: http://www.nice.org.uk/aboutnice/ Interesting to note, manual therapy was recommended first over more orthodox forms of medical intervention for back pain. You might be wondering what “non-specific back pain” is, well,
basically it’s 85% of all back pain. The other 15% involves a spinal disease, fracture or nerve root compression.

Also note that diagnostic studies don’t really provide useful information in most cases. As a matter of fact, they typically create
more intervention and a bleaker outlook. All of which cost more money and rarely results in better outcome. The more comprehensive package discussed above is referring to chronic back problems. We offer the therapeutic exercises as well.
Please forward this info to those in need.

Dr. Greathouse’s Website: http://greathousechiropractic.com/
Phone: 321 725-6314
Medical Disclaimer
Information on this site/email is provided for informational purposes
and is not meant to substitute for the advice provided by your own
physician or other medical professional. You should not use the
information contained herein for diagnosing or treating a health
problem or disease, or prescribing any medication. If you have or
suspect that you have a medical problem, promptly contact your medical
health care provider.

Reduction of Over Utilization – Passive Care Dependency – Chronic Pain Syndrome – Decondition Syndrome

Posted in Guidelines for Treatment at 9:04 PM by Dr. Greathouse

Talking Points
Can we predict poor outcome and if so what can be done about it?Whether it be contrived or due to extenuating circumstances beyond case management & patient control, there will be cases that even with the best care & management that will fall into the chronic pain quagmire. However, health-care providers  (HCP) should systematically and diplomatically avoid allowing passive care dependency to develop.
Because two-thirds of work injury monetary loss is derived from lost wages, prediction of probability outcome is important.  The potential for early prediction lies in finding appropriate treatment early in the course of care and eliminating ongoing ineffectual (over utilization) care.  Currently, few valid prediction instruments are available, the studies that exist are varied and many times contradictory.  However, there are multiple poor outcome indicators with potential and they do offer clues that enable the HCP to be more prudent and adroit about avoiding over utilization mistakes and making better management decisions.  These sentinel indicators should be in place as standards of care for work related injuries.
Prediction of outcome not only benefits the third party system, it benefits the patient as well. Although some believe secondary gain is an issue and that patients are looking for secondary gain, the true consensus is that these patients represent only a small fraction. So, potentially identifying poor outcome probability and appropriately addressing the issue early, actually benefits all concerned. Those who oppose this assessment system may have some valid concerns, but both sides of the issue have their own agenda and a balance must be kept.
The balance comes with maintaining the focus of the true goals, which are returning the patient to as near normal function as possible, empowering the patient with independent skills and reducing or averting ineffectual care that fosters the tendency toward disability. The check & balance system should be centered on the physician following good standards of care. Standards that require accountability, proof of efficacy, medical necessity and adherence to reasonable end points of care based on the natural history of the disease or malady.

Is passive care dependency fostered?The literature is replete with “fostered care dependency”. I’m sure that any health expert in their respective specialty would agree that fostered care dependency exists.
Caveat: First and foremost, differentially diagnose the patient.  Even bona fide hypochondriacs develop serious illness and disease.  Management should remain adroit and prudent.

Actual Physiologic Time Frame for Soft-tissue Healing

All soft tissue injuries go through three basic stages of healing within a relatively standard physiologic time frame, regardless of most complicating issues. The literature supports the following;·      Acute Inflammatory Phase: 3 to 5 days.·      Fibroblastic Repair Phase: 3 to 8 weeks.·     Remodeling Phase: Up to one year.·      Inflammatory response is still detectable at 12 weeks.This should be used as a fairly standard template for treatment time frames.
Management should be algorithmic in progression. These algorithms are already established.

Identify Complicating Issues

Complicating issues should be identified and factored into the management equation.  This might include pre-existing degenerative arthritis, more severe injury, structural/anatomical anomalies, smokers, overweight, and other medical conditions such as diabetes.  These issues factored in will help the third party component as well as and more importantly, the patient, to understand the potential for protracted care and recovery.  Nonetheless, it is to be understood that returning the patient to full or as near full function and independence remains paramount as the end goal.

Transition Is the Key

Transitioning the patient from pain modulating modalities and medication to more active forms of care is a critical key to avoiding fostered, passive care dependency and potential chronic pain. Many physicians do not do this, which is like Russian roulette when it comes to exposing that low percentage of people who may be predisposed to becoming chronic pain patients. By not transitioning to active therapy, even in its simplest forms, the patient can become predisposed, a precursor if you will, to developing activity aversion which leads to activity intolerance, which is the first step in the chronic pain cascade. Patients can experience, to varying degrees, delayed maturation of collagen, muscle atrophy, joint lubrication deficits, ligament atrophy and even bone loss due to too lack of activity. In turn this leads to decline in muscle endurance, tone, cardiovascular aerobic capacity and decreased mobility.  With decreased mobility one develops proprioception, agility and coordination deficits.
With the above scenario of decreased physical capacity and abnormal overload feedback mechanisms, a vicious cycle of recurrent pain and/or re-injury may occur, as is commonly experienced by chronic pain syndrome sufferers.
A Proposed Standard of Care To Avoid Passive Care Dependency and Over Utilization
·      A four-week trial probationary period of care should be adhered to.·      By four weeks with the exception of up to six weeks with more severe injuries such as disc herniation, the attending physician should be able to demonstrate objective & subjective improvement.·      Objectively this might include reduced muscle spasm, increased gross passive range of motion, increased active range of motion, reduced straight leg raise or nerve root tension signs as well as other initially positive orthopedic signs/tests.·      Subjectively the patient should demonstrate decreased intensity, frequency and duration of pain or symptoms.  This should be quantified by grading the pain on a 0 to 10 scale and percentage improved as rated by the patient or some other valid symptom or pain rating scale. ·      Additionally, standard subjective outcome assessment questionnaires shouldbe utilized, demonstrating clear progress, including functional improvement as well. Use of subjective outcome assessment tools are now becoming a more accepted standard of care and should be expected by the third parties (insurance companies) as part of justifying continued care.
·      If the HCP cannot demonstrate that the patient is progressing with the treatment program within the trial probationary period, a second medical opinion and discharge of the patient is in order.  This should be considered a pivotal point in the management process. Beyond this point continued care providing only short-term palliative relief, without demonstrable remedial therapeutic efficacy, should be considered inappropriate and without clinical merit.
This may seem an overstatement of the obvious but on many if not most independent medical reviews or exams, subjective and objective progress is not reflected in the notes, long after treatment should have been stopped or changed.
·      If the patient is progressing, a transition should be seen from passive to active care and should be clearly indicated in the treatment plan.  Passive treatment should reduce in frequency.
·      Active care in the form of rehabilitation should be specific and based on a valid physical capacity assessment, directed specifically at the individual’s deficits. Generic exercise programs should be avoided, as they may subterfuge care with contraindicated or inappropriate procedures. Tear sheet exercise handouts are not acceptable standards of care.. ·      All patients partaking in exercise should be appropriately screened for potential risk factors associated with exercise and trained in proper protocol and execution of the exercises.
·      As a rule, passive care is remedially therapeutic through 6 to 8 weeks, thus the active care component should begin by at least 6 to 8 weeks.
·      Most patients will not require ongoing attendance by a trainer/therapist or extensive rehabilitation.
·      Most patients do require some level of rehabilitation and without this vital component the risk of chronicity and or recurrence remains higher. It’s penny wise and dollar foolish for third parties to deny this component of care.
·      As with treatment, if rehabilitation is indicated, the same burden of proof of medical necessity and efficacy of treatment should be required by the healthcare practitioner.

Board Certified in Rehabilitation by the American Chiropractic Association ACRB

Identify Who Will Benefit From Spinal Manipulation

Posted in Guidelines for Treatment at 8:35 PM by Dr. Greathouse

A healthcare practitioners guide.
Click the link below

http://www.annals.org/content/suppl/2004/12/16/141.12.920.DC1/Childs_video_141-12-920-DC1-1.swf

12.07.10

Do we need supplements?

Posted in Nutrition at 12:36 PM by Dr. Greathouse

My relatively educated opinion is yes.
Good web site for learning about supplements…

http://www.healthdefence.com/rdas_are_not_enough_01.html

Consider a few of these issues:
The soil we grow crops in today is likely a real issue with respect to the vitality of the food we eat. By vitality I mean nutrient value. There is ample evidence that our farm soils are depleted of much of the nutrients (primarily minerals) that our food sources used to give us. Plants can generated much of the vitamins we need but they cannot make minerals. Even plants need minerals to make healthy vitamin rich fruits and veggies. (Scroll down to “soil depletion”)

I’ve read some studies of the loss of nutrient value in selected veggies and fruits and it would amaze you as to how much loss there is today as compared to yesteryear. Many if not most of the crops are harvested prematurely. Vine ripening is where much of the nutrient production takes place.
So even if, and that’s a big if, you are getting the recommended daily servings of veggie, fruits, beans and grains; it’s likely the essential nutrient value isn’t what it should be. Many health professionals feel that many signs and symptoms that we experiences are due to subtle marginal deficiencies in essential nutrients and these issues contribute to slow progressive degenerative illness.

Bear In Mind
Supplements work synergistically; meaning that most of the time a single essential nutrient will not help you if the synergists aren’t available. For Example: Iron needs folic acid, pyridoxine, ascorbate, tocopherol, cobalamin and zinc to work efficiently in the body. (p 228 OSN Colgan) So popping a single this or that vitamin likely will not benefit you.The whole business of supplements is quite complex and much too involved for a simple newsletter such as this to give individual advise. We all have different needs. However, reasonable supplementation will likely benefit your health, physically and mentally. If you take medication or have special needs you must consult your health care advisor to rule out contraindications to certain supplements.

My basic premise is that if you do not have the foundation materials available, it doesn’t matter what you are doing i.e. glucosamine sulphate for joints, St John’s Wort for depression, etc… Without the
essential nutrients you will never achieve your optimum health potential.

Standard Dosage Recommendation
The Recommended Dietary Allowances (RDAs) were originally set up by the National Academy of Sciences during World War II as general guidelines for feeding the country’s soldiers. These recommendations have grown to be guidelines for the general public and were last revised in 1997 and given a new name. RDAs are now known as Daily Values (DVs). Another term you may see is DRVs (Daily Reference Value), which are dietary guidelines for protein, carbohydrates, fat, saturated fat, cholesterol, fiber, sodium, and potassium. Another new term is RDIs (Reference Daily Intake), which are guidelines for essential vitamins and minerals. Daily Values (DVs) are made up of both DRVs and RDIs.

Some nutritionists believe that the DV has not kept pace with the latest nutritional research and believe that some of the recommendations may be thirty years out of date. The DV’s have particularly come under fire regarding the recommended level of antioxidant nutrients, such as vitamin C, E, and beta carotene. Some nutritionists believe the DV’s for these health-promoting nutrients should be at least two to five times the current values. On the other hand, the DV’s may be too high for some individuals. They were initially figured for young, active, military males, which means they may be less appropriate for the very young, very old, or for women. A valid, but unavoidable criticism of the concept behind the DV is that it does not respect the biochemical individuality of each person.

The DV’s are based upon measures of physical health, not mental or psychological. Thus, the RDAs do not reflect the suspicion that some emotional and behavioral difficulties of school children could be the result of nutritional deficiencies.

UL: Tolerable Upper Intake Level UL is the highest level of daily nutrient from dietary and supplement
sources that is likely to pose no risk of adverse health effects for almost all individuals in a population. As intake increases above the UL, the potential for risk of adverse effects increases. Exceeding dosages over the UL for a long period of time is not recommended, but may be beneficial and tolerated by some individuals in some circumstances. Generally, there is no need to take supplements at the level of UL. Always be aware of a product’s UL and how much of that product you are taking.

While dietary supplements can indeed fill in a lot of gaps in your nutritional needs, they will never replace the role of a good, balanced, and varied diet. Time has attested the benefits of eating
lots of fruits, vegetables, fiber and lean protein sources. And this should always be your top priority before any efforts at vitamin supplementation.

What’s A Good Product?
When shopping for vitamin supplements, look for “USP” on the label. This means the stands of the U.S. Pharmacopeia have been meet under exacting laboratory conditions. Not all quality vitamins will carry this mark, but it can help you determine if a brand you are not familiar with is reputable, especially if the price is remarkably low.

NSF Dietary Supplement Certification NSF’s Dietary Supplement Certification Program is designed to help consumers and health care practitioners identify supplement products that have been tested by a third-party organization. Product formulations and labels are tested to ensure: Products contain the identity and quantity of ingredients listed on the label. Products are free of any undeclared contaminants. Testing for NSF Dietary Supplement Certification is voluntary and available to all manufacturers. Standards for certification were developed by NSF and the American National Standards Institute (ANSI); known as NSF/ANSI 173.

NSF Contact Information
Address NSF International
P.O. Box 130140
789 N. Dixboro Road
Ann Arbor, MI 48113-0140, USA
Telephone Number 800-NSF-MARK
(734) 769-8010
Fax Number (734) 827-6108
Email i…@nsf.org
Website www.nsf.or

A good vitamin supplement should contain 100% of the Daily Value of Vitamins D, B1, B2, B3, B5, B12 and folic acid. There should be a minimum of 20 micrograms of vitamin K as well. There should be 5,000 IU or less of vitamin A and 40-50% of that vitamin A should be beta carotene.

Choose a mineral supplement that contains 100% of the Daily Value for copper, zinc, iodine, selenium and chromium. It can also contain some magnesium. Additionally, minerals should come in a “chelated” form for better absorption!

The American Medical Association
“Healthy adult men and healthy adult nonpregnant, nonlactating women consuming a usual, varied diet do not need vitamin supplements. Infants may need dietary supplements at given times, as may pregnant and lactating women. Occasionally, vitamin supplements may be useful for people with unusual lifestyles or modified diets, including certain weight reduction regimens and strict vegetarian diets. “Vitamins in therapeutic amounts may be indicated for the treatment of deficiency states, for pathological conditions in which absorption and utilization of vitamins are reduced or requirements increased, and for certain on-nutritional disease processes. “The decision to employ vitamin preparations in therapeutic mounts clearly rests with the physician. The importance of medical supervision when such amounts are administered is emphasized. Therapeutic vitamin mixtures should be so labeled and should not be used as dietary supplements.” The American Medical Association reviewed the statement which follows. They stated that this statement was consistent with their statement.
Recommendation
The author of this NebFact recommends that if a typical adult wants to take a supplement, that supplement should be a multivitamin- multimineral, one that contains vitamins and minerals at U.S. RDA
levels. Many multivitamin-multimineral supplements containing 100 percent U.S. RDA levels are on the market. The consumption of this level of supplement will not be harmful to health and may or may not be helpful. The best advice is to obtain vitamins and minerals by eating a wide variety of foods. If an individual chooses to take a multivitamin- multimineral supplement, a balanced diet also should be consumed. This is because knowledge is inadequate as to all of the essential nutrients needed by adults — all required nutrients may not be present in the supplement.

Soil Depletion
Perhaps the best summary is by Dr. William A. Albrecht, Chairman of the Department of Soils at the University of Missouri, who said: “A declining soil fertility, due to a lack of organic material, major
elements, and trace minerals, is responsible for poor crops and in turn for pathological conditions in animals fed deficient foods from such soils, and that mankind is no exception.” Dr Albrecht goes further to unequivocally lay the blame: “NPK formulas, as legislated and enforced by State Departments of Agriculture, mean malnutrition, attack by insects, bacteria and fungi, weed takeover, crop loss in dry weather, and general loss of mental acuity in the population, leading to degenerative metabolic disease and early death.”

1992 Earth Summit Statistics 1992 Earth Summit Report* indicate that the mineral content of the
world’s farm and range land soil has decreased dramatically.

Percentage of Mineral Depletion From Soil During The Past 100 Years,
By Continent:
North America 85% **
South America 76%
Asia 76%
Africa 74%
Europe 72%
Australia 55%
* You may remember the 1992 Earth Summit by the fact that President Bush wouldn’t sign any of the treaties. ** Some US farms are 100% depleted and some are 60% depleted, the average is 85% depletion as compared to 100 years ago. This is worse than in any other country in the world because of the extended use of fertilizers and “maximum yield” mass farming methods.

More Quotations
“In the future, we will not be able to rely anymore on our premise that the consumption of a varied balanced diet will provide all the essential trace elements, because such a diet will be very difficult to obtain for millions of people.” 
Dr. Walter Mertz, U.S. Department of Agriculture, told to congress in 1977. Dr. Linus Pauling the two-time Nobel Prize winner states that: “You can trace every sickness, every disease, and every ailment to a mineral deficiency. “Mineral insufficiency and trace elements insufficiency are more likely to occur than are vitamin insufficiency states. Because of differing geologic conditions, minerals and trace elements may be scarce in the soils of certain regions and rich in those of other regions. Thus, you can live in some areas, eat a perfectly ‘balanced’ diet and still develop mineral deficiencies or trace element deficiencies that can only be averted through dietary change or supplementation.” The Doctor’s Vitamin and Mineral Encyclopedia In Dr. Jensen’s book, Empty Harvest, he talks about how many of our illnesses are correlated with our improper stewardship of the land. Our immunity very much parallels the immunity of the land. Of special mention is that trace minerals are very depleted in our soils. Veterinarians have long since known this, which is why there are some 45 trace minerals added to dog and livestock food. They would much rather spend a few cents everyday than hundreds of dollars on vet bills! Dr. Charles Northen, MD researcher reports that, “In the absence of minerals, vitamins have no function. Lacking vitamins, the system can make use of the minerals, but lacking minerals vitamins areuseless.” Gaylord Hauser, from his book, “Diet Does It”, concurs by stating, “Minerals are certainly as important to us as vitamins, yet minerals are overlooked, neglected and their value underestimated.”

So, there you have it!
You decide…
All the body systems & organs & tissue; nervous, skeletal, muscle, hormonal, immune, respiratory, circulatory, cardiovascular etc…, require essential nutrients to function at optimum levels.

To Your Health
Dr. James E. Greathouse Jr.
Chiropractic Physician