10.01.12

Find out which foods are making you sick!

Posted in Alternative Care, Headaches, Nutrition, Pain Management, Wellness at 12:31 PM by Dr. Greathouse

One man’s meat is another man’s poison…

The above idiom can be quite literal, as what you consume can and does adversely affect how you feel, and your health. The problem is we don’t realize it or simply ignore it!

The negative response to the food we eat can range from anaphylactic shock to fatigue and pain that seemingly comes from nowhere. Many food sensitivities symptoms are latent, and do not present until hours or evens days later, thus difficult to associate with what you’ve consumed.

There remains a significant population of individuals with chronic or recurrent symptoms that remain in a nonspecific pain or syndrome category, without a specific diagnosis. These individuals experience multiple signs & symptoms, such as, weight gain, fatigue, signs of ADD/ADHD, skin disorders, migraines, digestive problems and so on

The cause of these symptoms many times is manifested by what we consume. For some reason, our body’s immune system adversely reacts to certain foods we eat or drink. This is sometimes called Food Intolerance. Some experts call the reaction leukocytosis, which is an abnormally high level of white blood cell production. Chronic leukocytosis is very detrimental to ones health and now thought to be a leading cause of degenerative illnesses like cardiovascular disease, arthritis, dementia etc…

What slips through the cracks in healthcare are the people who just feel sick and tired but have no specific diagnosis. They get treated for their symptoms but the root cause of their symptoms goes undetected and many times are given a “surrogate” diagnosis.  I call this group, Prodromal People. People with generalized nonspecific signs & symptoms that may lead to a disease or illness.

This is commonly seen in practice, many times with a mechanical back or neck problem but also with the other signs and symptoms that fit no pattern. A great deal of the time it’s the foods and beverages that these patients are consuming that are causing their nonspecific illness symptoms.

The foods and processing/preservative chemicals causing this disturbance can be identified with lab testing in many instances. Once identified and managed, these signs and symptoms resolve.

Blood testing for food and chemical sensitivity is called the ALCAT Test

Go to ALCAT.COM.

Ask me about the ALCAT Tests.

Dr. James E Greathouse Jr., Chiropractic Physician

321 725-6314

07.09.12

Vitamin D With Calcium Decreases Mortality Risk in Older People

Posted in Alternative Care, Nutrition, Wellness at 6:31 PM by Dr. Greathouse

From Medscape Education Clinical Briefs

According to the current study by Rejnmark and colleagues, maintenance of adequate vitamin D status may be necessary for many physiologic functions, beyond that of the classic actions of vitamin D on bone and mineral metabolism. Cross-sectional and longitudinal studies have linked reduced vitamin D status with a number of cancers, adverse cardiovascular and immunologic outcomes, and increased all-cause mortality rates

This systematic review identifies individual patient data and trial-level meta-analyses to assess mortality risk among participants randomly assigned to either supplementation with vitamin D alone or vitamin D with calcium.

Check with your attending physician.

05.16.12

Weight Of The Nation

Posted in Wellness at 7:37 AM by Dr. Greathouse

Go to the link below to view the documentary.

http://theweightofthenation.hbo.com/films/main-films/Consequences

A new must see with regard to your health! Time to wake up and stop fooling yourself! Just do it! No more excuses.

03.19.12

Soda Heart & Disease

Posted in Nutrition, Wellness at 4:52 PM by Dr. Greathouse

A Soda a Day Raises CHD Risk by 20%

Lisa Nainggolan

March 12, 2012 (Boston, Massachusetts) — Sugary drinks are associated with an increased risk of coronary heart disease (CHD) as well as some adverse changes in lipids, inflammatory factors, and leptin, according to a new analysis of men participating in the Health Professionals Follow-up Study, reported by Dr Lawrence de Koning (Children’s Hospital Boston, MA) and colleagues online March 12, 2012 in Circulation [1].

“Even a moderate amount of sugary beverage consumption — we are talking about one can of soda every day — is associated with a significant 20% increased risk of heart disease even after adjusting for a wide range of cardiovascular risk factors,” senior author Dr Frank B Hu (Harvard School of Public Health, Boston, MA) told heartwire . “The increased risk is quite substantial, and I think has important public-health implications given the widespread consumption of soda, not only in the US but also increasing very rapidly in developing countries.”

The increased risk is quite substantial, and I think has important public-health implications given the widespread consumption of soda.

The researchers did not find an increased risk of CHD with artificially sweetened beverages in this analysis, however. “Diet soda has been shown to be associated with weight gain and metabolic diseases in previous studies, even though this hasn’t been substantiated in our study,” says Hu. “The problem with diet soda is its high-intensity sweet taste, which may condition people’s taste. It’s still an open question whether diet soda is an optimal alternative to regular soda; we need more data on this. ”

Hu says water is the best thing to drink, or coffee or tea. Fruit juice is “not a very good alternative, because of the high amount of sugar,” he adds, although if diluted with water, “it’s much better than a can of soda,” he notes.

And Hu says although the current results apply only to men, prior data from his group in women in the Nurses’ Health Study [from 2009] were comparable, “which really boosts the credibility of the findings.”

Inflammation could be a pathway for impact of soda upon CHD risk

Hu and colleagues explain that while much research has shown a link between the consumption of sugar-sweetened beverages and type 2 diabetes, few studies have looked at the association of these drinks with CHD.

Hence, they analyzed the associations of cumulatively averaged sugar-sweetened (eg, sodas) and artificially sweetened (eg, diet sodas) beverage intake with incident fatal and nonfatal CHD (MI) in 42 883 men in the Health Professionals Follow-up study. Beginning in 1986 and every two years until December 2008, participants answered questionnaires about diet and other health habits. A blood sample was provided midway through the study.

There were 3683 CHD cases over 22 years of follow-up. Those in the top quartile of sugar-sweetened-beverage intake had a 20% higher relative risk of CHD than those in the bottom quartile (RR 1.20; p for trend < 0.001) after adjustment for age, smoking, physical activity, alcohol, multivitamins, family history, diet quality, energy intake, body-mass index, preenrollment weight change, and dieting.

Adjustment for self-reported high cholesterol, high triglycerides, high blood pressure, and diagnosed type 2 diabetes only slightly attenuated these associations, which suggests that drinking soda “may impact on CHD risk above and beyond traditional risk factors,” say the researchers.

Consumption of artificially sweetened drinks was not significantly associated with CHD (multivariate RR 1.02; p for trend=0.28).

Intake of sugar-sweetened drinks, but not artificially sweetened ones, was also significantly associated with increased triglycerides and several circulating inflammatory factors — including C-reactive protein, interleukin 6 (IL-6), and tumor-necrosis-factor receptor 1 (TNFr1) — as well as decreased HDL cholesterol, lipoprotein (a) (Lp[a]), and leptin (p < 0.02).

“Inflammation is a key factor in the pathogenesis of cardiovascular disease and cardiometabolic disease and could represent an additional pathway by which sugar-sweetened beverages influence risk,” say Hu et al.

Cutting consumption of soda is one of easiest behaviors to change

Hu says that one of the major constituents of soda, high-fructose corn syrup, is subsidized in the US, making such drinks “ridiculously cheap” and helping explain why consumption is so high, particularly in lower socioeconomic groups.

Doctors should be advising people with heart disease or at risk to cut back on sugary beverages; it’s almost a no-brainer.

“Doctors should set an example for their patients first,” he stresses. “Then, for people who already have heart disease or who are at high risk, physicians should be advising them to cut back on sugary beverages; it’s almost a no-brainer, like recommending that they stop smoking and do more exercise. The consumption of sugary beverages is a relatively easy behavior to change.”

And although this particular study included mostly white subjects and there are few data on the risk of cardiovascular disease associated with the consumption of soda in people of other ethnicities, there are data on its effect on type 2 diabetes in these groups, he says.

“It has been shown for minority groups — such as African Americans and Asians — that they are more susceptible to the detrimental effects” of sugary drinks on diabetes incidence, he notes.

The authors report no conflicts of interest.

References

  1. de Koning L, Malik VS, Kellogg MD et al. Sweetened beverage consumption, incident coronary heart disease and biomarkers of risk in men. Circulation 2012; DOI: 10.1161/CIRCULATIONAHA.111.067017. Available at: http://circ.ahajournals.org.

02.06.12

Vitamin D Supplementation News

Posted in Nutrition, Wellness at 2:42 PM by Dr. Greathouse

Vitamin D Supplementation: An Update

Christine Gonzalez, PharmD, CHHC

Posted: 11/11/2010; US Pharmacist © 2010 Jobson Publishing

Abstract and Introduction

Introduction

An estimated 1 billion people worldwide, across all ethnicities and age groups, have a vitamin D deficiency.[1–3] This is mostly attributable to people getting less sun exposure because of climate, lifestyle, and concerns about skin cancer. The 1997 Dietary Reference Intake (DRI) values for vitamin D, initially established to prevent rickets and osteomalacia, are considered too low by many experts.[4] DRI values are 200 IU for infants, children, adults up to age 50 years, and pregnant and lactating women; 400 IU for adults aged 50 to 70 years; and 600 IU for adults older than 70 years. Current studies suggest that we may need more vitamin D than presently recommended to prevent chronic disease. Emerging research supports the possible role of vitamin D in protecting against cancer, heart disease, fractures and falls, autoimmune diseases, influenza, type 2 diabetes, and depression. Many health care providers have increased their recommendations for vitamin D supplementation to at least 1,000 IU.[5] As a result, more patients are asking their pharmacists about supplementing with vitamin D.

Disease Prevention

Cancer

Vitamin D decreases cell proliferation and increases cell differentiation, stops the growth of new blood vessels, and has significant anti-inflammatory effects. Many studies have suggested a link between low vitamin D levels and an increased risk of cancer, with the strongest evidence for colorectal cancer. A Creighton University study found that postmenopausal women given 1,100 IU of vitamin D3 (plus calcium) versus placebo were 77% less likely to be diagnosed with cancer over the next 4 years.[10] In the Health Professionals Follow-up Study (HPFS), subjects with high vitamin D concentrations were half as likely to be diagnosed with colon cancer as those with low concentrations.[11]

Some studies have shown less positive results, however. The Women’s Health Initiative found that women taking 400 IU of vitamin D3 (plus calcium) versus placebo did not have a lower risk of breast cancer.[12] Many critics have argued that this dosage of vitamin D is too low to prevent cancer. A 2006 Finnish study of male smokers found that those with higher vitamin D concentrations had a threefold increased risk for pancreatic cancer, with cigarette smoking not found to be a confounding factor.[13] A 2009 U.S. study of men and women (mostly nonsmokers) did not confirm these results, finding no association between vitamin D concentrations and pancreatic cancer overall, except in subjects with low sun exposure.[14] In this subgroup, higher versus lower vitamin D concentrations had a positive association with pancreatic cancer.[14] A definitive conclusion cannot yet be made about the association between vitamin D concentration and cancer risk, but results from many studies are promising.

Heart Disease

Several studies are providing evidence that the protective effect of vitamin D on the heart could be via the renin-angiotensin hormone system, through the suppression of inflammation, or directly on the cells of the heart and blood-vessel walls. In the Framingham Heart Study, patients with low vitamin D concentrations (<15 ng/mL) had a 60% higher risk of heart disease than those with higher concentrations.[15] The HPFS found that subjects with low vitamin D concentrations (<15 ng/mL) were two times more likely to have a heart attack than those with high concentrations (>30 ng/mL).[16] In another study, which followed men and women for 4 years, patients with low vitamin D concentrations (<15 ng/mL) were three times more likely to be diagnosed with hypertension than those with high concentrations (>30 ng/mL).[17] As is the case with cancer and vitamin D, more studies are needed to determine the role of vitamin D in preventing heart disease, but the evidence thus far is positive.

Fractures and Falls

Vitamin D is known to help the body absorb calcium, and it plays a role in bone health. Also, vitamin D receptors are located on the fast-twitch muscle fibers, which are the first to respond in a fall.[18] It is theorized that vitamin D may increase muscle strength, thereby preventing falls.[5] Many studies have shown an association between low vitamin D concentrations and an increased risk of fractures and falls in older adults.

A combined analysis of 12 fracture-prevention trials found that supplementation with about 800 IU of vitamin D per day reduced hip and nonspinal fractures by about 20%, and that supplementation with about 400 IU per day showed no benefit.[19] Researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University have examined the best trials of vitamin D versus placebo for falls. Their conclusion is that “fall risk reduction begins at 700 IU and increases progressively with higher doses.”[18] Overall, the evidence is strong in support of supplementing with vitamin D to prevent fractures and falls.

Autoimmune Diseases and Influenza

Since vitamin D has a role in regulating the immune system and a strong anti-inflammatory effect, it has been theorized that vitamin D deficiency could contribute to autoimmune diseases such as multiple sclerosis (MS), type 1 diabetes, rheumatoid arthritis, and autoimmune thyroid disease. Scientists have suggested that vitamin D deficiency in the winter months may be the seasonal stimulus that triggers influenza outbreaks in the winter.[20] Numerous trials have evaluated the association between vitamin D and immune-system diseases.

A prospective study of white subjects found that those with the highest vitamin D concentrations had a 62% lower risk of developing MS versus those with the lowest concentrations.[21] A Finnish study that followed children from birth noted that those given vitamin D supplements during infancy had a nearly 90% lower risk of developing type 1 diabetes compared with children who did not receive supplements.22 In a Japanese randomized, controlled trial, children given a daily vitamin D supplement of 1,200 IU had a 40% lower rate of influenza type A compared with those given placebo; there was no significant difference in rates of influenza type B.[23] More studies of the influence of vitamin D on immunity will be emerging, as this is an area of great interest and it remains unclear whether there is a link.

Type 2 Diabetes and Depression

Some studies have shown that vitamin D may lower the risk of type 2 diabetes, but few studies have examined the effect of vitamin D on depression. A trial of nondiabetic patients aged 65 years and older found that those who received 700 IU of vitamin D (plus calcium) had a smaller rise in fasting plasma glucose over 3 years versus those who received placebo.[24] A Norwegian trial of overweight subjects showed that those receiving a high dose of vitamin D (20,000 or 40,000 IU weekly) had a significant improvement in depressive symptom scale scores after 1 year versus those receiving placebo.[25] These results need to be replicated in order to determine a correlation between vitamin D and the risk of diabetes or depression.

Dosing

Only a few foods are a good source of vitamin D. These include fortified dairy products and breakfast cereals, fatty fish, beef liver, and egg yolks. Besides increasing sun exposure, the best way to get additional vitamin D is through supplementation. Traditional multivitamins contain about 400 IU of vitamin D, but many multivitamins now contain 800 to 1,000 IU. A variety of options are available for individual vitamin D supplements, including capsules, chewable tablets, liquids, and drops. Cod liver oil is a good source of vitamin D, but in large doses there is a risk of vitamin A toxicity.[26]

The two forms of vitamin D used in supplements are D2 (ergocalciferol) and D3 (cholecalciferol). D3 is the preferred form, as it is chemically similar to the form of vitamin D produced by the body and is more effective than D2 at raising the blood concentration of vitamin D.[27] Since vitamin D is fat soluble, it should be taken with a snack or meal containing fat. In general, 100 IU of vitamin D daily can raise blood concentrations 1 ng/mL after 2 to 3 months (TABLE 2).[28] Once the desired blood concentration is achieved, most people can maintain it with 800 to 1,000 IU of vitamin D daily.[28] Even though dosages up to 10,000 IU daily do not cause toxicity, it generally is not recommended to take more than 2,000 IU daily in supplement form without the advice of a health care provider.[29] Individuals at high risk for deficiency should have a vitamin D blood test first; a dosage of up to 3,000 to 4,000 IU may be required to restore blood concentrations.[29]

Table 2. Dosing and Blood Concentrations

Dosage Expected Increase in Blood Concentration
100 IU 1 ng/mL
200 IU 2 ng/mL
400 IU 4 ng/mL
800 IU 8 ng/mL
1,000 IU 10 ng/mL
2,000 IU 20 ng/mL

Source: Reference 30.

Drug Interactions

Vitamin D supplements may interact with several types of medications. Corticosteroids can reduce calcium absorption, which results in impaired vitamin D metabolism.[6] Since vitamin D is fat soluble, orlistat and cholestyramine can reduce its absorption and should be taken several hours apart from it.[6] Phenobarbital and phenytoin increase the hepatic metabolism of vitamin D to inactive compounds and decrease calcium absorption, which also impairs vitamin D metabolism.[6]

Future Research

While considerable research supports the importance of vitamin D beyond bone health, further trials are required before broad claims can be made about vitamin D and prevention of chronic disease. The Institute of Medicine (IOM) is reviewing the research on vitamin D and plans to report in late 2010 regarding any updates to the DRIs for vitamin D (and calcium).[30] Specifically, the IOM will consider the relation of vitamin D to cancer, bone health, and other chronic diseases.[30] An important study, the Vitamin D and Omega-3 Trial, was launched in early 2010 to determine whether 2,000 IU of vitamin D3 and 1,000 mg of EPA (eicosopentaenoic acid) plus DHA (docosahexaenoic acid) daily can lower the risk of cancer, heart disease, stroke, and other diseases.[31] This randomized trial, which will enroll about 20,000 healthy men and women, should provide more insight on vitamin D supplementation.

Conclusion

As the number of people with vitamin D deficiency continues to increase, the importance of this hormone in overall health and the prevention of chronic diseases is at the forefront of research. The best evidence for the possible role of vitamin D in protecting against cancer comes from colorectal cancer studies. Evidence also is strong for the potential role of vitamin D in preventing fractures and falls. At this time, further studies are needed to evaluate the role of vitamin D in protecting against heart disease, autoimmune diseases, influenza, diabetes, and depression.

References

  1. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–281.
  2. Gordon CM, DePeter KC, Feldman HA, et al. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004;158:531–537.
  3. Lips P, Hosking D, Lippuner K, et al. The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Intern Med. 2006;260:245–254.
  4. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Chapter 7. Vitamin D. www.nal.usda.gov/fnic/DRI//DRI_Calcium/250–287.pdf. Accessed August 2, 2010.
  5. Harvard School of Public Health Nutrition Source. Vitamin D and health. www.hsph.harvard.edu/nutritionsource/what-should-you-eat/vitamin-d/index.html. Accessed August 30, 2010.
  6. NIH Office of Dietary Supplements. Dietary supplement fact sheet: vitamin D. http://ods.od.nih.gov/factsheets/vitamind.asp. Accessed August, 4, 2010.
  7. Nair S. Symptoms of low vitamin D levels. www.buzzle.com/articles/symptoms-of-low-vitamin-d-levels.html. Accessed September 2, 2010.
  8. MedlinePlus. 25-hydroxy vitamin D test. www.nlm.nih.gov/medlineplus/ency/article/003569.htm. Accessed August 4, 2010.
  9. Moyad MA. Vitamin D: a rapid review: side effects and toxicity. www.medscape.com/viewarticle/589256_10. Accessed September 2, 2010.
  10. Lappe JM, Travers-Gustafson D, Davies KM, et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007;85:1586–1591.
  11. Ahn J, Peters U, Albanes D, et al. Serum vitamin D concentration and prostate cancer risk: a nested case-control study. J Natl Cancer Inst. 2008;100:796–804.
  12. Chlebowski RT, Johnson KC, Kooperberg C, et al. Calcium plus vitamin D supplementation and the risk of breast cancer. J Natl Cancer Inst. 2008;100:1581–1591.
  13. Stolzenberg-Solomon RZ, Vieth R, Azad A, et al. A prospective nested case-control study of vitamin D status and pancreatic cancer risk in male smokers. Cancer Res. 2006;66:10213–10219.
  14. Stolzenberg-Solomon RZ, Hayes RB, Horst RL, et al. Serum vitamin D and risk of pancreatic cancer in the Prostate, Lung, Colorectal, and Ovarian Screening Trial. Cancer Res. 2009;69:1439–1447.
  15. Wang TJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation. 2008;117:503–511.
  16. Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-Hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008;168:1174–1180.
  17. Forman JP, Giovannucci E, Holmes MD, et al. Plasma 25-hydroxyvitamin D levels and risk of incident hypertension. Hypertension. 2007;49:1063–1069.
  18. Liebman B. From sun & sea: new study puts vitamin D & omega-3s to the test. Nutrition Action Healthletter. November 2009:3–7.
  19. Bischoff-Ferrari HA, Willett WC, Wong JB, et al. Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med. 2009;169:551–561.
  20. Cannell JJ, Vieth R, Umhau JC, et al. Epidemic influenza and vitamin D. Epidemiol Infect. 2006;134:1129–1140.
  21. Munger KL, Levin LI, Hollis BW, et al. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA. 2006;296:2832–2838.
  22. Hyppönen E, Läärä E, Reunanen A, et al. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001;358:1500–1503.
  23. Urashima M, Segawa T, Okazaki M, et al. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010;91:1255–1260.
  24. Pittas AG, Harris SS, Stark PC, Dawson-Hughes B. The effects of calcium and vitamin D supplementation on blood glucose and markers of inflammation in nondiabetic adults. Diabetes Care. 2007;30:980–986.
  25. 25. Jorde R, Sneve M, Figenschau Y, et al. Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial. J Intern Med. 2008;264:599–609.
  26. 26. Cannell JJ, Vieth R, Willett W, et al. Cod liver oil, vitamin A toxicity, frequent respiratory infections, and the vitamin D deficiency epidemic. Ann Otol Rhinol Laryngol. 2008;117:864–870.
  27. 27. HealthTree.com. Vitamin D and calcium supplements. www.healthtree.com/articles/vitamin-d/source/supplement. Accessed September 2, 2010.
  28. 28. Moyad MA. Vitamin D: a rapid review: dosage of vitamin D needed to achieve 35 to 40 ng/ml (90–100 nmol/L). www.medscape.com. Accessed August 4, 2010.
  29. 29. The Nutrition Source. Ask the expert: vitamin D and chronic disease. www.hsph.harvard.edu/nutritionsource. Accessed August 4, 2010.
  30. Institute of Medicine. Dietary Reference Intakes for vitamin D and calcium. www.iom.edu/Activities/Nutrition/DRIVitDCalcium.aspx. Accessed August 2, 2010.
  31. The Vitamin D and Omega-3 Trial (VITAL). www.vitalstudy.org. Accessed August 2, 2010.
  32. Lau AH, How PP. The role of the pharmacist in the identification and management of secondary hyperparathyroidism. US Pharm. 2007;32(7):62–72.
  33. Cannell JJ. Vitamin D pharmacology. www.vitamindcouncil.org/vitaminDPharmacology.shtml. Accessed August 30, 2010.

US Pharmacist © 2010 Jobson Publishing

10.05.11

CPR New Rules

Posted in Uncategorized, Wellness at 6:12 AM by Dr. Greathouse

Study Summary

Change from “A-B-C” to “C-A-B.” A major change in basic life support is a step away from the traditional approach of airway-breathing-chest compressions (taught with the mnemonic “A-B-C”) to first establishing good chest compressions (“C-A-B”). There are several reasons for this change.

  • Most survivors of adult cardiac arrest have an initial rhythm of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), and these patients are best treated initially with chest compressions and early defibrillation rather than airway management.
  • Airway management, whether mouth-to-mouth breathing, bagging, or endotracheal intubation, often results in a delay of initiation of good chest compressions. Airway management is no longer recommended until after the first cycle of chest compressions — 30 compressions in 18 seconds. The 30 compressions are now recommended to precede the 2 ventilations, which previous guidelines had recommended at the start of resuscitation.
  • Only a minority of cardiac arrest victims receive bystander CPR. It is believed that a significant obstacle to bystanders performing CPR is their fear of doing mouth-to-mouth breathing. By changing the initial focus of resuscitation to chest compressions rather than airway maneuvers, it is thought that more patients will receive important bystander intervention, even if it is limited to chest compressions.

Basic life support. The traditional recommendation of “look, listen, and feel” has been removed from the basic life support algorithm because the steps tended to be time-consuming and were not consistently useful. Other recommendations:

  • Hands-only CPR (compressions only — no ventilations) is recommended for the untrained lay rescuers to obviate their fears of mouth-to-mouth ventilations and to prevent delays/interruptions in compressions.
  • Pulse checks by lay rescuers should not be attempted because of the frequency of false-positive findings. Instead, it is recommended that lay rescuers should just assume that an adult who suddenly collapses, is unresponsive and not breathing normally (eg, gasping) has had a cardiac arrest, activate the emergency response system, and begin compressions.
  • Pulse checks by healthcare providers have been de-emphasized in importance. These pulse checks are often inaccurate and produce prolonged interruptions in compressions. If pulse checks are performed, healthcare providers should take no longer than 10 seconds to determine if pulses are present. If no pulse is found within 10 seconds, compressions should resume immediately.
  • The use of end-tidal CO2 (ETCO2) monitoring is a valuable adjunct for healthcare professionals. When patients have no spontaneous circulation, the ETCO2 is generally ≤ 10 mm Hg. However, when spontaneous circulation returns, ETCO2 levels are expected to abruptly increase to at least 35-40 mm Hg. By monitoring these levels, interruptions in compressions for pulse checks become unnecessary.

CPR devices. Several devices have been studied in recent years, including the impedance threshold device and load-distributing band CPR. No improvements in survival to hospital discharge or neurologic outcomes have been proven with any of these devices when compared with standard, conventional CPR.

Electrical therapies

  • Patients with VF or pulseless VT should receive chest compressions until a defibrillator is ready. Defibrillation should then be performed immediately.
  • Chest compressions for 1.5-3 minutes before defibrillation in patients with cardiac arrest longer than 4-5 minutes have been recommended in the past, but recent data have not demonstrated improvements in outcome.
  • Transcutaneous pacing of patients who are in asystole has not been found to be effective and is no longer recommended.

Advanced cardiac life support. Good basic life support, including high-quality chest compressions and rapid defibrillation of shockable rhythms, is again emphasized as the foundation of successful advanced cardiac life support. The recommendations for airway management have undergone 2 major changes: (1) the use of quantitative waveform capnography for confirmation and monitoring of endotracheal tube placement is now a class I recommendation in adults; and (2) the routine use of cricoid pressure during airway management is no longer recommended.

As they did in 2005, the AHA acknowledges once again that as of 2010, data are “still insufficient …to demonstrate that any drugs improve long-term outcome after cardiac arrest.”

Several important changes in recommendations for dysrhythmia management have occurred:

  • For symptomatic or unstable bradydysrhythmias, intravenous infusion of chronotropic agents (eg, dopamine, epinephrine) is now recommended as an equally effective alternative therapy to transcutaneous pacing when atropine fails;
  • As noted above, transcutaneous pacing for asystole is no longer recommended; and
  • Atropine is no longer recommended for routine use in patients with pulseless electrical activity or asystole.

Post-cardiac arrest care. Post-cardiac arrest care has received a great deal of focus in the current guidelines and is probably the most important new area of emphasis. There are several key highlights of post-arrest care:

  • Induced hypothermia, although best studied in survivors of VF/pulseless VT arrest, is generally recommended for adult survivors of cardiac arrest who remain unconscious, regardless of presenting rhythm. Hypothermia should be initiated as soon as possible after return of spontaneous circulation with a target temperature of 32°C-34°C.
  • Urgent cardiac catheterization and percutaneous coronary intervention are recommended for cardiac arrest survivors who demonstrate ECG evidence of ST-segment elevation acute myocardial infarction regardless of neurologic status. There is also increasing support for patients without ST-segment elevation on ECG who are suspected of having acute coronary syndrome to receive urgent cardiac catheterization.
  • Hemodynamic optimization to maintain vital organ perfusion, avoidance of hyperventilation, and maintenance of euglycemia are also critical elements in post-arrest care.

Viewpoint

The AHA 2010 guidelines represent significant progress in the care of victims of cardiac arrest. Most important is the stronger emphasis on post-cardiac arrest care. Induced hypothermia is underscored, and perhaps the most important advance is the recommendation for urgent percutaneous coronary intervention in survivors of cardiac arrest. The wealth of data thus far indicate that post-arrest percutaneous coronary intervention may be the most significant advance toward improving survival and neurologic function since defibrillation was first introduced decades ago.

In reviewing these guidelines, I must admit, however, that I was disappointed that AHA hesitated to adopt the concepts of “cardiocerebral resuscitation” (CCR). CCR also promotes the “C-A-B” approach to resuscitation, but it fosters even further delays in airway intervention — withholding any form of positive pressure ventilations, in favor of persistent chest compressions, for as long as 5-10 minutes after the cardiac arrest. The current guidelines recommend withholding positive pressure ventilation for a mere 18 seconds. First described in 2002,[1] CCR has been studied more recently as well and demonstrated marked improvements in rates of resuscitation and neurologic survival.[2-4] I think that CCR should be incorporated into basic life support protocols for victims of primary cardiac arrest as quickly as possible to further improve outcomes.

Optimal management of cardiac arrest in the current decade can be summarized simply by “the 4 Cs”: Cardiovert/defibrillate, CCR, Cooling, and Catheterization.

07.07.11

Olive Oil Reduces Stroke Risk – Diabetes – Cancer

Posted in Wellness at 10:07 AM by Dr. Greathouse

Try this Link: http://www.webmd.com/healthy-aging/news/20110615/olive-oil-linked-to-reduced-stroke-risk (Ccpy & paste in browser for website)

Healthy Heart Benefits

Atherosclerosis, also called hardening of the arteries, occurs when particles of LDL cholesterol stick to the walls of the arteries. Eventually these particles build up and form plaque. This plaque narrows the blood vessels and increases the work load of the heart in an effort to get oxygenated blood to the entire body. The result can be a heart attack or stroke.

Olive oil is rich in monounsaturated fat and antioxidants like chlorophyll, carotenoids and vitamin E. Scientists have identified a compound in olive oil called oleuropein which prevents the LDL cholesterol from oxidizing. It is the oxidized cholesterol that sticks to the walls of the arteries and forms plaque. Replacing other fats in your diet with olive oil can significantly lower blood pressure and reduce the risk of heart attack.

Cancer Inhibitor

A study published in the January 2005 issue of Annals of Oncology has identified oleic acid, a monounsaturated fatty acid found in olive oil, as having the ability to reduce the affect of an oncogene (a gene that will turn a host cell into a cancer cell). This particular oncogene is associated with the rapid growth of breast cancer tumors. The conclusion of the researchers was that oleic acid when combined with drug therapy encouraged the self-destruction of aggressive, treatment-resistant cancer cells thus destroying the cancer. Olive oil has been positively indicated in studies on prostate and endometrial cancers as well.

Unlike other fats, which are associated with a higher risk of colon cancer, olive oil helps protect the cells of the colon from carcinogens. A study published in the November 2003 issue of Food Chemistry Toxicology suggests that the antioxidants in olive oil reduce the amount of carcinogens formed when meat is cooked.

Blood Sugar Controller

Diabetics or those at risk for diabetes are advised to combine a low-fat, high-carbohydrate diet with olive oil. Studies show this combination is superior at controlling blood sugar levels compared to a diet that consists entirely of low-fat meals. Adding olive oil is also linked to lower triglyceride levels. Many diabetics live with high triglyceride levels which put them at risk for heart disease.

06.27.11

Regular Exercise Lowers Risk for Atherosclerosis Progression

Posted in Wellness at 4:58 PM by Dr. Greathouse

Regular Exercise Lowers Risk for Atherosclerosis Progression CME

Regular physical activity remains the key to the prevention of atherosclerosis progression, even when patients are also receiving intensive lipid and glucose management through medication and diet.
Clinical Review, June 2011

06.02.11

Death of the Tomato & Sad Truths About Our Agricultural System

Posted in Wellness at 9:51 AM by Dr. Greathouse

Why the Modern Tomato is Flawed: Inside Tomatoland

By Kurt Michael Friese

First let’s get one persistent canard out of the way. Yes, the tomato is technically a fruit, not a vegetable, but for purposes of economics the USDA classifies it as a vegetable, and as such it is the second most popular vegetable in the nation after that other burger staple, lettuce. This is surprising in only one respect: A vast majority of the tomatoes consumed in the U.S. every year ($5 billion worth), are devoid of the flavor and nutritive value they once had.

Sure, that plant your neighbor gave you that’s just beginning to enjoy the summer heat will produce lots of delicious, succulent tomatoes come August or September. But in his new book, Tomatoland: How Modern Industrial Agriculture Destroyed our Most Alluring Fruit, two-time James Beard Award-winning journalist Barry Estabrook tells us why the modern factory-farmed tomato in most grocery stores is a poster child for nearly everything that is wrong with industrial agriculture. A recent USDA study, he points out, says that the average tomato of today, the kind on your Whopper or Taco Bell taco, has “30 percent less vitamin C, 30 percent less thiamin 19 percent less niacin, and 62 percent less calcium than it did in the 1960s. But that modern tomato does shame its 1960s counterpart in one respect: It contains 14 times as much sodium.

This is because the tomatoes grown in the fields in and around Immokalee, Florida, where nearly one third of the tomatoes consumed in the U.S. are grown, are bred for one thing and one thing only. And it’s not flavor, and it’s not nutrition. It’s shipability, period. To qualify as grade A in that department, it needs to be a specific size, and a specific shape, and it needs to be picked while still green and rock hard. In fact, Estabrook relays a story of nearly losing control of his car as it was pelted with the tough green orbs bouncing off the back of a tractor-trailer on a Florida highway. The fruits hit the pavement at 60 mph and rolled to the gravel shoulder unscathed.

That truck was likely headed to one of the many enormous warehouses in the area, which “force-ripen” the fruit by smothering them with ethylene gas. This process does make them red, but it does not truly ripen them. Thus the sugars are nowhere near as developed as the ones in your back yard will be and the result is the mealy pink baseballs in your grocer’s produce section right now.

Our enormous appetite for having pretty much any food available to us at anytime of year has led to a system where yes, you can have a tomato in February, but the cost is a lot more than the $1.25/lb you’re likely to pay at your local Wal-Mart. It comes at the cost of enormous environmental damage and shocking worker abuse. It utilizes thousands of migrant workers, some of whom are undocumented, and many of whom live and work in literal slave conditions. And since the muggy lowlands of Florida are not native habitat, a tomato plant there can fall victim to as many as 27 separate insect species and 29 different diseases, necessitating a plethora of chemicals that are as hard on the workers and the land as they are on the pests. Then there’s the 31 different fungicides in use. The list goes on.

Tomatoland is based on Estabrook’s James Beard Award-winning 2010 article “The Price of Tomatoes,” and is an in-depth investigation of what’s wrong with the modern tomato (and by extension, modern agriculture). It is vital information that every conscientious eater-and parents of eaters-ought to know. Hopefully, as more people read the book, they will begin to look beyond price, and start considering cost.

06.01.11

Coffee linked to lower risk of fatal prostate cancer

Posted in Wellness at 10:53 AM by Dr. Greathouse

Click on link for news story or copy & past to browser.

http://www.cnn.com/2011/HEALTH/05/17/coffee.prostate.cancer/index.html

STORY HIGHLIGHTS

  • Drinking six or more cups per day can lower a man’s risk of fatal prostate cancer
  • Decreased risk of cancer was seen in men with both decaf and caffeinated

“It’s an important source of antioxidants and also has positive effects on glucose metabolism and insulin levels, and it’s thought that insulin plays a role in the progression of prostate cancer.”

Drinking as many as three 8-ounce cups a day has proven health benefits. But skip it if you have high blood pressure, an overactive thyroid, or suffer from anxiety, says Loren Wissner Greene, MD, a professor at the New York University School of Medicine.

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