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Posts Tagged ‘blood tests’

How to Interpret Your Blood Tests: Part I

Posted in common conditions, tagged , , on March 6, 2011| 2 Comments »

Analyzing blood chemistry can be a very helpful tool in determining what a patient needs to improve their health, and of course why a patient is experiencing certain signs and symptoms. A patient will often bring in their blood work to me and tell me that the doctor who ordered the tests said everything was normal. Whether or not I agree that their tests are normal, these patients never understand what all the tests mean and how to interpret them. Of course, that’s the doctor’s job, but there are many patients out there who do want to understand and wish their doctor would explain the meaning behind them. Because of this, I decided to write a series of articles explaining what these blood markers mean and how they are relevant.

There are hundreds of tests that can be ordered via blood, but the basics are a “Complete Blood Count” (CBC) and (comprehensive) “Metabolic Panel”. Very often a lipid (or cholesterol) panel is ordered as well. In this first article I’ll go over how to read and understand the red blood cell markers that are included in a CBC.

A CBC reports three different cell types in the blood: 1) red blood cells, 2) white blood cells, and 3) platelets.

Let’s begin. Red blood cells are responsible for delivering oxygen from the lungs to the body tissues, and to take up carbon dioxide from the tissues and bring it to the lungs. The CBC includes information on seven different aspects of red blood cells (RBC). I’ll go over each individually.

1) “Red Blood Cells” (RBC) – This value refers to the actual number of RBC in a given sample size. When this is decreased, it means there is an insufficient number of RBC available to supply adequate amounts of oxygen to the tissues. This would be considered “anemia”. There are many types of anemia that may be present and describing each is beyond the scope of this article. Also, keep in mind that someone can be anemic and have a normal number of RBC. Red blood cells can be low in number because of iron-deficient diets, blood loss [normal (as in menstruation) or traumatic or pathological], malabsorption, pregnancy, or during growth spurts. An increased number of RBC is more rare to see, and that would typically be a result of dehydration. This is because dehydration would increase the concentration (or total number) of RBC in sample of blood that has a low amount of water in it. Additionally, RBC may be increased due to a bone marrow disorder (where RBC are made), low atmospheric oxygen (e.g.: high altitude areas), poor lung function, or a malignancy.

2) “Hemoglobin” (Hgb) – Hemoglobin is the oxygen and carbon dioxide-carrying portion of the RBC and is responsible for giving blood it’s red color. As the name suggests it is composed of heme, which contains iron, in addition to the protein “globin”. The amount of Hgb in the RBC is directly related to the amount of oxygen the RBC can carry. When Hgb is low, it usually indicates (iron-deficiency) anemia. And as with RBC, if it is high, it would usually indicate dehydration or the other conditions mentioned above.

3) “Hematocrit” (HCT) – The HCT is the percentage of RBC in the entire blood sample, and therefore is a measurement of RBC production. This would be low in most types of anemia and high in a dehydrated person or the other conditions mentioned above regarding RBC and Hgb.

4) “Mean Corpuscular Volume” (MCV) – The MCV is a measure of the average size of the RBC. This marker is key for identifying anemia and differentiating between the many types of anemia. Red blood cells start out large and shrink in size as they mature to become fully functional. If the MCV is high (meaning the RBC are larger than normal), it typically indicates a deficiency of folic acid and/or vitamin B12 because these are the two nutrients required for RBC to mature (and shrink in size). When the MCV is low (meaning the cells are smaller than normal), it usually indicates iron deficiency as there is actually less volume to the cell because there is less mass with insufficient amounts of iron. There are other reasons this value can change due to other types of anemia, which is beyond the scope here.

5) “Mean Corpuscular Hemoglobin” (MCH) – The MCH is a measure of the average amount of Hgb in each RBC. This value helps with determining the severity of anemia. MCH is typically low in iron-deficiency anemia and might be high in B-12 and/or folate-deficiency (megaloblastic – meaning large cells). It would be high in megaloblastic anemia because the cell is larger and therefore has the ability to contain more Hgb.

6) “Mean Corpuscular Hemoglobin Concentration” (MCHC) – The MCHC is (just what it sounds like) a measure of the concentration of Hgb in a given amount of RBC, and will most likely be low or high for the same reasons as MCH. This value is especially useful in monitoring therapy for anemia.

7) “Red Blood Cell Distribution Width” (RDW) – The RDW is a value that measures the average size of all the RBC present in the sample. A low RDW would indicate that most RBC are too small as in the case of iron-deficiency. And a high RDW would point to there being too many large RBC as in B12 and/or folic acid-deficiency anemia. It would certainly be too high or low because of other types and causes of anemia.

Keep in mind that this article does not cover all types and causes of anemia. It is intended as a guide to understanding the terminology used on blood tests and some of the most common reasons for abnormally high or low values. Additionally, the reference ranges for normal values can, and often do, vary from lab to lab. This is because the reference ranges are typically determined from averages that the labs have constructed based on the many samples that they have tested. As a result, I usually find these ranges too wide to assess the risk for disease before it develops. When the blood values are outside of the lab’s reference ranges, a disease (or disease process) is usually already in place. I prefer to assess blood work using more narrow, “functional” ranges that can detect disease before it is “full-blown”, and to prevent disease.

Clinical pearl: when a patient is doing “everything right” for themselves (i.e.: diet, exercise, proper supplements, etc.) but they do not respond to those treatments; usually a sub-clinical anemia can be found. Without proper oxygen supply to the body’s tissues, there is little to no chance the body will be able to heal or function better.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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Blood sugar regulation

Posted in common conditions, food, tagged , , , on September 23, 2009| 5 Comments »

I talk about blood sugar metabolism being so important to health and wellness that I figured I should start writing articles about it. It’s such an enormous topic and impacts health in so many ways…. Because of this, I thought we should start with the basic physiological mechanisms of blood sugar metabolism. Really basic, it’s not rocket science.

The body has built-in mechanisms designed to keep blood sugar levels in a normal range. And I’m not speaking of the ranges reported on your blood test. They are way too wide. I’m speaking generally, and that’s all that it’s important for now. Again, blood sugar needs to be in a certain stable range because it can be quite damaging otherwise, for a number of reasons.

Let’s now assume that your blood sugar level is normal (in the moment). BUT, you have an underlying problem with regulating sugar. Then you decide to eat sugars (pies, cakes, cookies, candies, ice cream, soda, doughnuts, brownies, etc.) and starches (bread, pasta, rice, and potatoes). Here is what happens. Your blood sugar “spikes” to a level deemed too high for what the body considers safe. Then, insulin, a hormone from the pancreas, gets released in order to pull the excess sugar out of the blood and into the cells. The problem is that your blood sugar was so high (from eating those foods), that your pancreas releases an excess amount of insulin. This results in the blood sugar going too low.

Next, as the body senses low blood sugar levels, it decides it needs to raise them. This is done through the release of stress hormones; namely cortisol and adrenaline. Now the blood sugar usually spikes again because the sugar levels went so low – and the body produced too many stress hormones to raise the blood sugar.

Do you see the peaks and valleys here? Blood sugar goes too high by eating sugars and starches. Next, insulin gets released in large amounts (because of the very high sugar levels), resulting in an excessive drop of blood sugar, and ultimately resulting in sugar levels being lower than normal. Then, the stress hormones “save the day” by surging, in order to raise the blood sugar levels. Then the blood sugar is too high (because of the unnatural surge) and excessive insulin release then comes along again and the sugar levels go too low; then excessive stress hormones get released; and sugar goes back up and too high; and so on with this vicious cycle of highs and lows in blood sugar.

At some point these mechanisms get “burned out” and result in insulin resistance. This means the cells don’t respond well to insulin’s message to take the sugar out of the blood. If this condition does not get under control, the result may eventually be type 2 diabetes.

The other main result is adrenal stress syndrome. When the stress glands that produce cortisol and adrenaline to raise the blood sugar, become “burned out”.

Signs and symptoms will certainly vary between individuals. Here are the most common I see: weight gain, insomnia (trouble falling and/or staying asleep), anxiety and panic attacks, irritability, yeast infections, frequent infections (bacterial, viral, etc.), fatigue (esp. late-afternoon), mood swings, depression, headaches, inability to heal from injuries, inflammation, high cholesterol and/or triglycerides, high or low blood pressure, etc., etc., etc….

So now you realize that eating sugars and starches can cause blood sugar instability. These foods can certainly be eaten IN MODERATION if you don’t have a blood sugar metabolism disorder. But please note that you do not need to be labeled “diabetic”, “hypoglycemic”, or “hyperglycemic” in order to actually have problems with blood sugar metabolism. The reason being – blood tests will show normal blood sugar levels until you are you are “far gone”. If a problem shows up on a blood test, there is a serious problem. However, many of your symptoms may be caused by faulty sugar metabolism and go unnoticed, because the tests look normal.

Remember that the body goes to great extents to keep blood sugar in normal range. So measuring blood sugar alone often misses the problem. A better way to check would be measuring fasting insulin levels as well. Usually, they’ll be high working to keep the sugar normal (or low). The problem is doctors don’t typically order fasting insulin tests. In my experience, patients need to have obvious, debilitating, blood sugar symptoms before this is ordered by their doctors.

Why isn’t this done? I truly don’t know. One thought is that some doctors look at the body as if: insomnia is a sleeping pill deficiency; anxiety is an anti-anxiety drug deficiency; yeast infections are an anti-fungal drug deficiency; high cholesterol and blood pressure is a deficiency in drugs to lower those; etc., etc., etc….

Shoot for a (12-hour) fasting blood sugar level of 80-90. The closer to 80 the better. And put the sugars and starches aside; except when celebrating birthdays, holidays, etc..

I’ll discuss the complications mentioned in detail, in other articles.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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Potential causes of hypothyroidism

Posted in Applied Kinesiology, common conditions, tagged , , , , , , , on September 15, 2009| 3 Comments »

The previous article titled “Hypothyroidism” was written to allow for an understanding of the function of the thyroid gland; the symptoms of hypothyroidism; and the medical approach to treatment. In this article I will focus on what I see as the potential causes of hypothyroidism in the first place based on my experience. Remember, many people have the same “diagnosis” but for different reasons. That is why I focus on treating patients and not their diagnosis or blood tests. By the way, I have yet to see the cause as a deficiency of taking drugs.

OK, in the first article I mentioned 7 different possible reasons for clinical or sub-clinical hypothyroidism. Let’s begin.

1) Structural imbalances in the cranium or TMJ (possibly affecting the pituitary)
The pituitary is nestled in the brain and sits in a little “saddle” that’s part of the sphenoid bone. This bone happens to be the center of cranial bone motion. If there are muscular imbalances in the muscles of the neck and TMJ, you can be sure that undue stress will be placed on the pituitary. Remember, structure determines function, not the other way around. There is even a particular cranial fault, which is corrected via the “pituitary drive technique” in applied kinesiology. It targets sphenoid bone motion specifically. But you must correct the muscle(s) involved as well, as muscles move bones; the “heart” of applied kinesiology principles. Just like adjustments to the spine and extremities; if the muscles haven’t been balanced, you can be sure the joint problem will come right back. I unfortunately don’t have research on this topic, as I wouldn’t be surprised if the government or drug companies are NOT handing out grants to people interested in researching structural stress on the pituitary. I could be wrong though.

2) Weakened/stressed out adrenal glands
The adrenal glands are the “stress” glands. They produce the hormone cortisol (and others) and neurotransmitters adrenaline and noradrenaline. One quick mention about thyroid hormone first. T3 is a much more (perhaps 90-95%) metabolically active hormone than T4. T3 is “made” by a conversion of T4 into T3, by removing one of the iodine molecules on the T4 (hence 3 molecules instead of 4). This is enormously important for the thyroid hormone to ultimately do its job appropriately. High or low levels of cortisol can however inhibit that conversion of T4 to T3. As a result, the circulating thyroid hormone will not work very effectively, and often cause the symptoms of hypothyroidism. One more thing – high or low cortisol can cause the body to convert T4 into “reverse T3”. This is when the iodine is pulled off the wrong part of the T4 molecule. This will result in a metabolically inactive hormone, that may even get tallied into the total T3 reading on blood tests. So it may look like there is plenty, but much of it may be inactive “reverse T3”. Reverse T3 can be ordered on blood tests, but I’ve never seen it, unless I instructed the patient about it and they asked for it to be ordered. There are ranges of normal on the test results for reverse T3, but there is usually a clause saying it’s not been studied enough to determine it’s accuracy. I would still look to get it in normal ranges if this is the suspected cause (you’ll see how soon). By the way, the reasons for imbalances in cortisol levels are too plentiful to mention here; but poor blood sugar metabolism is of prime importance (this does not mean you need to be diagnosed with diabetes or hypoglycemia). Most people have faulty have blood sugar metabolism (and stressed adrenal glands) to some degree.

3) Heavy metal toxicity
By now you probably know that heavy (toxic) metals can cause a wide array of problems. Well, here’s one more. Just like high or low cortisol, heavy metals can cause an inhibition in the conversion of T4 to the more active T3. Especially consider mercury, cadmium, and lead; but I wouldn’t stop there. By the way I often say “toxic” metals because aluminum is not “heavy”, it is actually “light” in molecular weight – and I wouldn’t want to avoid including it, as it is certainly toxic. [aside: check those salt packets you get from the deli – you just may find an aluminum compound on the list of ingredients]

4) Imbalances in estrogen and progesterone (commonly thought of as female hormones) – however, males also produce these hormones
According to Janet Lang, DC, an imbalance in estrogen and progesterone can lead to thyroid hormone being inactive at the cellular level. I’m not sure of the exact mechanism she proposes, but I agree, as I’ve seen it in patients who have these imbalances (usually a condition known as “estrogen dominance”). Janet Lang has dedicated almost all of her research to (functional) hormone problems.

5) Vitamin, mineral, and amino acid deficiencies
First, the amino acid tyrosine and the mineral iodine are the raw material to make T4 and T3. The “T” stands for tyrosine and it is an essential (must be obtained from diet) amino acid we get from eating protein. The number “4” or “3” refers to the number of iodine atoms attached to the tyrosine. So these are obviously necessary. Next, the mineral selenium in necessary for the conversion of T4 into the more active T3. A deficiency in this mineral would not allow for that conversion. Additionally, there are a number of vitamins and minerals that are necessary for the thyroid hormone receptor (where it “docks” in to the cells) to function properly; and for the manufacturing of the hormone. These include, but are certainly not limited to: iron; zinc; potassium; manganese; vitamins A, B1, B2, and E. Don’t forget digestion and absorption of these nutrients.

6) Imbalances in the output of pituitary and/or hypothalamic hormones
I spoke about this above regarding cranial and TMJ imbalances. The hypothalamus, which “controls” the pituitary can also be a problem in hypothyroidism. In addition to cranial treatments, there are some specialized supplements that can help the function of these glands.

7) Liver toxicity or malfunction
The liver is one of the main sites where the conversion of T4 to T3 takes place. An imbalance in liver function, for any number of reasons (usually toxicity or a build up of fat) can impede this conversion. For these cases, detoxification through diet, lifestyle and targeted nutrition is usually necessary.

Notice how the list of 7 problems above, doesn’t even mention the thyroid! That’s because I’ve never encountered a problem with the thyroid directly that causes a problem. I suppose that makes sense because most problems that exist arise through lifestyle (nutrition, stress, etc.) complications. Even a liver, adrenal, nutrient deficiency or absorption, or structural problem isn’t THE problem – it is the result. There is usually a combination of the factors mentioned that contribute to thyroid problems; which of them is primary depends on the person.

By the way, there are many people taking thyroid hormone in the form of drugs, and they still exhibit the signs and symptoms of hypothyroidism. I find that this is usually a nutrient deficiency that presumably prevents the thyroid hormone receptors from working properly. Unfortunately, the conventional approach to this is usually to simply increase the dose, which may help temporarily.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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Hypothyroidism

Posted in Applied Kinesiology, chiropractic, common conditions, tagged , , , , , on September 11, 2009| 4 Comments »

The thyroid is a butterfly-shaped endocrine (hormone secreting) gland located in your neck beneath the cricoid cartilage, or “Adam’s apple” (as it’s referred to in  males). Essentially its job, or the hormones it secretes, is to control your body’s metabolism. That is, it determines the rate at which your body builds, maintains, and breakdowns biochemicals (and ultimately energy). It is controlled by hormones released from the pituitary gland, which in turn is controlled by the hypothalamus. It secretes three hormones – T4(thyroxine), T3(triiodothyronine), and calcitonin. This article will focus on a common disorder known as hypo-thyroidism (decreased output of thyroid hormone), which refers to the levels of T4 and T3, as they are the two associated with metabolism. The “T” refers to the amino acid tyrosine, and “3” or “4” refers to the number of iodine atoms atttached to it. Calcitonin as its name implies helps regulate calcium metabolism.

Some of the thyroid’s main functions are to convert food into energy, help control body temperature, and basically affect the speed and efficiency of all biochemical processes. Additionally, it can have a profound effect on emotions, mood, cravings, and addictions because T3 influences brain chemistry.

I won’t go into the exact mechanisms of how these hormones exert their effects on the body, but I will discuss the end results. This leads me to the main signs and symptoms of hypothyroidism. The main thing you want to think about is fatigue. Typically, the person with hypothyroidism will experience fatigue ALL day long. There is one major caveat regarding this however. These people may not completely notice how fatigued they really are. I say this because based on my experience in working with patients, they’ll tend to pack their day with things to do in order to keep going and going. Obviously they may be tired, but it won’t be as noticeable because they often stay so busy and can become preoccupied. Aside from fatigue, the next major symptom would be weight gain (or inability to lose weight); don’t be fooled by this though, as many normal or underweight individuals have (sub-clinical) hypothyroidism. Cold hands and feet is another common one; and I still have yet to see this symptom related to circulation, especially in people under 60 years-old. Dry skin, poor memory, constipation, goiter (swelling of the gland), muscles cramps (and musculoskeletal pain), high cholesterol, swelling of the extremities and face, carpal tunnel syndrome, depression and addictions, and chronic colds and flu can also be added to the list. Some cases will result in a loss of the outer-third of the eyebrows. This is not known why to my knowledge, however it’s interesting to note that the acupuncture meridian related to the thyroid ends at the outer edge of either eyebrow.

OK, so what causes hypothyroidism or a low output of thyroid hormones? According to the Mayo Clinic, the most common reported cause is Hashimoto’s thyroiditis. This is an inflammation of the thyroid due to an autoimmune reaction when the body attacks its own thyroid gland (no cause of this condition is mentioned). The next are medical treatments for hyperthyroidism (designed to slow the thyroid), radiation treatment for cancers of the head and neck, thyroid surgery (removal of some or all of the gland), or side effects of drugs for other conditions.

Great, so now what? I was expecting the medical community to at least mention iodine deficiency. But all the major medical information I found basically states the same as Mayo Clinic as the “cause” for hypothyroidism. No wonder the first thing patients are recommended is drugs that contain synthetic (or sometimes natural) thyroid hormone.

Unfortunately, sub-clinical hypothyroidism is very common. This is when the blood tests show normal levels of thyroid hormones but the patient (sometimes, not always) has “all” (or some) of the signs and symptoms of an under-functioning thyroid. The obvious problem here is if a patient accepts that there is nothing wrong with them because their thyroid hormone levels are normal (sometimes the pituitary hormone- TSH is elevated, but not always). So then what? The usual scenario is that they go back year after year (while slowly getting worse, assuming they haven’t changed anything in their lifestyle) until the tests finally pick it up – then it’s “official”; and there is something that can be done about it. Drugs of course – again, synthetic or natural thyroid hormone. OK, it’s time to stop whittling people down to numbers on a piece of paper!!! Let’s pay attention to our patient’s symptoms and concerns, and not just their blood test results. Let’s look for the causes and begin treating ASAP! Keep in mind that some doctors will immediately start the patient on drugs (usually only if the TSH is high).

Here is what I see as the major contributors to sub-clinical or clinical (shows up on blood tests) hypothyroidism; in no particular order.

1) Structural imbalances in the cranium or TMJ (possibly affecting the pituitary)
2)Weakened/stressed out adrenal glands
3) Heavy metal toxicity
4) Imbalances in estrogen and progesterone (commonly thought of as female hormones) – however, males also produce these hormones
5) Vitamin, mineral, and amino acid deficiencies
6) Imbalances in the output of pituitary and/or hypothalamic hormones
7) Liver toxicity or malfunction

In order to not make this article too lengthy, I’ll leave it there and get into those 6 specific things in the next article.

I first wanted to get you familiar with the functions of the thyroid; the signs and symptoms of hypothyroidism; and the medical approach. See you soon.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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Food Allergies and Sensitivities

Posted in common conditions, food, tagged , , on September 8, 2009| 7 Comments »

I find that roughly 50% of my patient’s conditions stem from the foods they eat. Think about it. Other than an obvious injury or emotional stressor, there really is not much else other than food that will cause problems. Many people and doctors think genetic factors are the cause of their problem, but genetic limitations can almost always be overcome through lifestyle. Other causative factors in health conditions may stem from chemical exposure. However, if you are eating well, your body will be able to cope much better assuming the chemical is not present in large amounts over a long (or short) period of time. If you are interested in general dietary guidelines, click here. This article will focus on food allergies/sensitivities specifically. And I may use the terms interchangeably, though technically, there is a difference.

I don’t want to go too in-depth between the differences of an allergy and sensitivity. Essentially, the body’s response differs in that it involves different areas of the immune system being activated depending on if you are truly allergic as compared to sensitive (or intolerant). And it is not uncommon for blood tests to completely miss a sensitivity (as opposed to an outright allergy) that may be the cause for your major health concern. Additionally, the body can respond to a food via a lectin reaction. Please read more about lectins here, as they are beyond the scope of this article. Just know for now that they are in some foods (especially grains) that can potentially cause cell damage and conditions just as allergies and sensitivities do. By the way, those who experience this are the “classic” patients who come back with normal blood tests and no explanation for their symptoms.

There really is no limit to the symptoms or conditions that can be caused or exacerbated by foods. The most common symptoms that I see in patients are: fatigue, digestive complaints or abdominal pain, “foggy-headedness”, chronic pain/arthritis, skin rashes (including eczema and psoriasis), inability to lose weight, headaches or migraines, phlegm in the throat, itchy and watery eyes, sneezing “attacks”, yeast infections, irritable bowel syndrome, ADHD (often caused or exacerbated by food additives), fibromyalgia, sinus problems, sleeping difficulties, elevated cholesterol, mood changes, asthma, and hypertension (high blood pressure). [A quick aside to hypertension and foods. It is not uncommon to have normal blood pressure and then experience low blood pressure after removing an offending food. Presumably, the body was releasing too many stress hormones (i.e.: adrenaline/epinephrine) which raised the blood pressure to begin with.] One of the most common musculoskeletal conditions I see as a result of food sensitivities is knee pain. Patients have even showed me how arthritic their knees were on an x-ray; however, after they avoid the foods we discovered as being a problem, the pain often “disappears”. [Anything can cause anything, and an x-ray is only one measurement. A doctor should not simply make assumptions based on what appears “obvious”.]

OK, now for the major foods out there that result in allergic/sensitivity/lectin reactions. Wheat, corn, dairy, and soy are the most common by far. One of my mentors, Dr. Tim Francis claims that everyone is sensitive to these four, but in varying degrees. However, he still has ALL of his patients avoid them. The next most common in no particular order are eggs, citrus fruits, beef, peanuts, chocolate, fish and tree nuts (almonds, pecans, walnuts, etc.). Let’s not forget gluten, contained in the following foods: wheat (and foods and drinks made from it), barley, rye, spelt, kamut, oats (through cross-contamination only), triticale, and farro. Don’t forget beer, whiskey, and scotch usually. Gluten is one of the most common “problem-causing” food ingredients that gets missed time and time again on blood tests.

There are some more “advanced” lab tests rather than standard blood analysis. One great test is known as the ALCAT Test. One problem I have with some tests, even the advanced ones, is that a person often comes back sensitive to 50 or more foods. If that’s the case, you have other problems going on that need to be addressed (probably first and foremost). Restricting yourself of 50+ foods must sound a bit ridiculous to you as well. When I see that, I look to a gut problem (most often leaky gut syndrome) and/or a weakened immune system.

One way to determine if a specific food is causing you a problem is to simply avoid it. The time-frame may vary between individuals though. For example, the food may cause symptoms minutes after you eat it or even a week (more rarely) after you eat it; this is known as a delayed-onset reaction. Remember, even though food sensitivities may be a problem, you may not notice a change in symptoms if you only avoid one at a time if you actually have 2 or more sensitivities causing the same symptom.

One more thing. It’s very common to crave the foods you are sensitive to. Unfortunately, I could not find solid references to back this up. Some say it occurs because of withdrawl symptoms that may follow; similar to drug addiction. Frankly, I’ve never see withdrawl symptoms (caffeine is a different story and not usually an allergy). The second reason I’ve been told seems more likely. It’s that the body responds by increasing the output of stress hormones, which may give the person a “boost” of energy causing them to quickly feel better, thus continuing to reach for that food. Regardless, one of the most common things I here from patients after identifying an offending food is: “But I love…” or, “I eat that all the time”. This concept of allergy and craving is worth paying attention to.

Please keep this in mind also! Food allergies, sensitivities, and lectin reactions are by far one of the most common causes of chronic (often undetected) inflammation. And specific inflammatory markers in the blood may not pick this up.

I choose to use applied kinesiology muscle testing most of the time when I suspect foods may be causing a problem. I don’t diagnose food allergies, sensitivities, or lectin reactions; I simply see how your nervous system responds.

Come back soon to learn more about potential problems with some more specific foods we enjoy most, like avocado, banana….

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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High cholesterol? What about high homocysteine???

Posted in common conditions, remedies, tagged , , , , , , , on September 3, 2009| 3 Comments »

These days cholesterol still gets all the attention when it comes to heart disease. In fact, I think way too much attention. There are other, often better predictors of heart disease than standard cholesterol tests. And these are routinely missed, even when the patient’s (and doctor’s) motive is to assess the potential risk of future cardiovascular events. I’ll talk about one very important one of those risk factors now. It is an amino acid called homocysteine.

Homocysteine was discovered by a man named Dr. Kilmer McCully. He is a Harvard Medical School graduate; and discovered this amino acid was responsible for arteriosclerosis (or hardening of the arteries) while researching a rare condition called homocysteinuria, forty years ago. He was researching two cases where an eight year-old child and and a two-month old child both had arteriosclerosis. Through further research he eventually made a connection between homocysteine and arteriosclerosis. Unfortunately though, when he first voiced this discovery, he was shunned by just about every medical professional. In 1976, the (“new”) chairman at Harvard said the “elders” at the school “felt” he had not proved his theory; and unless he could get grant money he would lose his position. They went as far putting his lab in the basement so he would have no contact with others, and then he decided to leave. For the next 27 months he could not find a single position in North America that would allow him to continue his research. McCully was later told that Harvard and Massachusetts General Hospital did not want to be associated with his work, because it did not go along with the conventional wisdom that cholesterol and fats caused heart disease. You can read more about that story in an interview with McCully here. By the way, one main reason that he was discredited might be because one of the most common ways to treat excess homocysteine levels is through nutritional supplements.

Anyhow, homocysteine is naturally produced in the body through the necessary breakdown of the essential amino acid, methionine. However, just because it is naturally produced does not mean that it is benign. An article in the Journal of the American Medical Association concluded this: “An increased plasma total homocysteine level confers an independent risk of vascular disease similar to that of smoking or hyperlipidemia” (or high blood lipids/fats). There are many more studies in existence that speak of the risk of high homocysteine levels in relation to (cardio)vascular disease so I won’t bore you with repeating this information.

Homocysteine causes several problems. For instance, it can oxidize cholesterol (making it harmful to blood vessels), cause scarring inside the lining of blood vessels, and increase blood clotting. Essentially, high levels of homocysteine will ultimately damage cells and the walls of the blood vessels. As a result, cholesterol will get deposited in the arteries in an attempt to “patch” up the damage. That is why cholesterol can “cause” cardiovascular events such as heart attacks and strokes. Also, this damage can lead to peripheral arterial disease, usually in the legs and feet, which in a worst case scenario can eventually result in the need for amputation like in diabetics. So does cholesterol really “cause” vascular problems? Well, that can be argued, but it is really the body’s attempt to heal. Hmmm, I guess cholesterol is not so bad to begin with. I will talk about that in another article. By the way, there are many causes of blood vessel damage.

High homocysteine levels have been implicated in coranary artery disease, heart attack, stroke, deep vein thrombosis, rheumatoid arthritis, osteoporosis, Alzheimer’s disease and more.

So what’s the solution? Some fancy well-marketed drug? No, B-vitamins of course! That’s right vitamins B6, B12, and folic acid (in addition to other biochemicals) will metabolize homocysteine properly and prevent high levels in the bloodstream. Folic acid and B12 will recycle homocysteine back into methionine and B6 will convert it down to cystathionine (and then hopefully down into cysteine and sulfate). So if these vitamins lower homocysteine levels, then a deficiency in them can cause high blood levels. McCully also reports other causes such as imbalances in thyroid and “female” hormones, in addition to kidney problems.

Please don’t get me wrong, many doctors are aware of homocysteine, but not enough in my opinion. I have seen blood tests from patients with known peripheral artery disease and cardiovascular complications without reporting their homocysteine levels. Also, some patients show me their blood tests with normal cholesterol levels (but no homocysteine); and report that their doctor has told them they don’t need to be concerned with heart disease. Also, look at a recent blood test of your own and (depending on the lab) you may find that they claim to determine your heart disease risk factor based on cholesterol levels alone.

One more thing, measuring homocysteine can also be used to find out if you have a deficiency in these B-vitamins. Again, there could be other causes, but it’s as simple as doing a follow-up test after supplementation for a few months.

PS: One common sign I have discovered in patients, which stems from high homocysteine (perhaps B-vitamin deficiency) is easy bruising. Bruising is basically damage to blood vessels. This is true even in those who “should” be bruising like some of the professional aerial acrobats (or intense athletes) I work with; but it’s also common in people who are not extremely active. The flip side to easy bruising would therefore also mean an inability to heal the vessels as well. And interestingly your body will not produce collagen (a main component of blood vessels and other structures) properly if your homocysteine levels are too high. But that concept, along with the other necessary nutrients to make proper collagen is for another discussion. Now don’t go trying to judge your homocysteine levels based on if you bruise easily or not; that’s just one observation I’ve made working with patients. It is worth asking your doctor to run this test – and remember those B-vitamins are necessary for a lot more functions than homocysteine metabolism.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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Folic Acid/B12-deficiency anemia (megaloblastic & pernicious anemia)

Posted in common conditions, remedies, tagged , , , , , , , on August 19, 2009| 4 Comments »

Let’s talk about two common types of anemia I see in my patients.  They are self explanatory like iron-deficiency anemia.  Megaloblastc anemia refers to a deficiency of folic acid and/or vitamin B12, and pernicious anemia refers to B12-deficiency specifically.

Every single cell in your body requires folic acid and vitamin B12 in order to “mature” and therefore function properly.  All cells start off immature (and large in size) and become smaller when they mature.  Thus, the term “megaloblastic” refers to the fact the cells stay large in size (mega) without these vitamins. “Macrocytic anemia” is also a term for this condition.

In regards to folic acid deficiency, we run in to some of the same situations as in iron-deficiency – when asking the question: Why is their a deficiency?

The answers are either: a) insufficient consumption of foods containing folic acid; b) lack of absorption; c) an inability to convert folic acid to its active form, and d) complications of its utilization from certain drugs.

In regards to answer “a”, you must obviously consume folic acid through the foods you eat. Some of the best foods that contain high amounts of folic acid (or folate as it is referred to when in food) are: lentils, beans peas, broccoli, spinach, collards, okra, asparagus, and citrus fruits.

As far as answer “b”, regarding absorption – this could result from:

1) Your intestinal villi are literally clogged up due to poor food choices, thus not allowing for absorption of folic acid (and most definitely other nutrients as well).  To “fix” this, you would need to change your diet, and probably have to take supplements that would help detoxify the small intestine.  Examples would be a whole food diet and/or fiber (to “scrub” them clean), bentonite clay (to absorb the toxins), and/or mucilaginous herbs that could help “dissolve” out the toxins.

2) Digestive conditions that can compromise the absorption of folic acid (and any nutrients) are: Crohn’s disease, ulcerative colitis, irritable bowel syndrome, leaky gut syndrome, colon cancer, and perhaps others.

Now for answer “c”.  Folic acid (or folate) needs to be converted to 5-methyltetrahydrofolate (5-MTHF) in order to actually perform its necessary functions at the cellular level.  This inability to convert usually results from a genetic defect. If there is a genetic defect, you may have to take a dietary supplement that contains the converted form.

The medications that interfere with folic acid utilization are: anticonvulsants (dilantin, phenytoin, and primidone), metformin (for diabetes), sulfasalizine (for Crohn’s disease and ulcerative colitis), triamterine (a diuretic), and barbituates.

Wait!  A few more things regarding less common causes (that I see) of folic acid deficiency are: alcohol abuse, kidney dialysis, and liver disease.  And as you’ll see below, more is required during pregnancy and lactation to prevent neural tube defects in the fetus; and for the growing baby.

Let’s now discuss vitamin B12 deficiency.  Why would someone be deficient?  The answers here are either: a) insufficient consumption of foods containing vitamin B12; b) failure to properly absorb B12; c) lack of a substance called intrinsic factor in the stomach (related to absorption); and d) inactive or oxidized B12.

Let’s start with answer “a”. Please be aware that B12 is only contained naturally in animal foods!  You can get certainly get it in vegetarian food sources, but that means it has been “fortified”.  Also, even though the algae product known as spirulina lists B12 on the label; apparently it is simply an analogue of B12 and may actually cause you to become even more B12 deficient.  Read this is you are concerned.  Foods high in B12 are basically every animal product known.

Answers “b” and “c” relate to an inability to absorb B12.  One possibility is for the same reasons as folic acid.  See above. Additionally, vitamin B12 requires a substance called intrinsic factor which is produced by (parietal) cells in the stomach, in order for proper absorption.  Stomach tumors, atrophic gastritis, pancreatic enzyme insufficiency, resection of the part of the small intestine that absorbs B12, autoimmunity towards the stomach cells or intrinsic factor itself, and an excess consumption of alcohol may be prevent B12 absorption through intrinsic factor complications.  See a reference here on the above.  “Pernicious anemia” refers to B12-deficiency anemia when the cause is specifically related to atrophic gastritis/destruction of parietal cells or destruction of intrinsic factor (usually from an autoimmune reaction).

Lastly, I’ll talk about “d”.  Vitamin B12 is known as cobalamin.  This is because the mineral cobalt a necessary part of the B12 complex.  B12 needs to be converted to methylcobalamin or hydroxycobalamin to actually get used properly, which depends on genetic factors.  If this conversion does not occur, B12 will be inactive.  Also, a person under oxidative stress (too many free radicals) may cause cobalt to become oxidized and again not allow B12 to work properly.  In this case, it’s possible to have normal B12 levels on blood analysis, but it will be inactive at the cellular level and thus not work. These people will need to decrease their exposure to free radicals; and mostly likely have to supplement with antioxidants and B12 also.

RDA’s for folic acid and B12 are in the following charts provided by the National Institutes of Health:

Folic Acid

Age
(years)		 Males and Females
(μg/day)		 Pregnancy
(μg/day)		 Lactation
(μg/day)
1-3 150 N/A N/A
4-8 200 N/A N/A
9-13 300 N/A N/A
14-18 400 600 500
19+ 400 600 500

Vitamin B12

Age
(years)		 Males and Females
(μg/day)		 Pregnancy
(μg/day)		 Lactation
(μg/day)
1-3 0.9 N/A N/A
4-8 1.2 N/A N/A
9-13 1.8 N/A N/A
14-18 2.4 2.6 2.8
19 and older 2.4 2.6 2.8

In conclusion, symptoms of folic acid deficiency are as follows: fatigue, diarrhea, loss of appetite, weight loss, weakness, sore tongue, headaches, heart palpitations, irritability, forgetfulness, and high blood levels of homocysteine (to be discussed in another article).

Symptoms of vitamin B12 deficiency are: fatigue, weakness, constipation, loss of appetite, weight loss, numbness and tingling in the hands and feet, difficulty maintaining balance, depression, confusion, dementia, poor memory, and soreness of the mouth or tongue.

Blood tests can be run to determine folic acid and B12 status.  Especially a complete blood count (with “random distribution of weight” or RDW; and “mean corpuscular volume” or MCV) to check for the red blood cells’ size and associated anemias.  A blood test can also confirm a problem with the gene associated with failure to convert folic acid to its active form.

Vitamin B12 can be measured in blood, but remember if your cobalt has been oxidized, it can show normal levels when in fact the B12 isn’t working.  Methylmalonic acid is a good test (and rarely or never run) for B12 status.

And finally, homocysteine levels can spot a folic acid and/or B12 deficiency.  Homocysteine is related to cardiovascular and neurological problems.  Again, I’ll discuss that in another article.

I also use in-office, applied kinesiology muscle tests when I suspect deficiencies in these vitamins. HOWEVER, I still consider it prudent to use blood tests to see exactly what my patient’s levels are.

ANOTHER VITALLY IMPORTANT POINT! The blood lab’s ranges are often too wide to pick up sub-clinical deficiencies in these vitamins, that may still be causing your symptoms. I use narrower functional ranges for myself and my patients.

Proper food choices and quantities and/or supplements can correct deficiencies.  HOWEVER, do not take more than 1,000 micrograms of folic acid without B12.  This is because folic acid supplementation this high can trigger B12 deficiency symptoms.  In particular, it can cause IRREVERSIBLE nerve damage because of B12 deficiency.  Most supplements contain both vitamins together to prevent this. And the only supplements I’ve seen with 1,000 micrograms (and NO B12) in one tablet or capsule are prescription only. Go figure.

Well, that’s a lot to consider for just two vitamins.  But then again, they are obviously extremely important!

Some information in this article was derived from the National Institutes of Health website.

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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