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Posts Tagged ‘fatigue’

Recently I’ve realized that the most popular search term that guides people to my website is “ileocecal valve” (and variations thereof). Because of this, I thought I should write a few more words about the significance of it. If you are not familiar with the ileocecal valve, please refer to this article first, which explains the basics.

As mentioned in the first article, the ileocecal valve can either be stuck “open” or “closed”. I put those words in quotes because that might not literally be the case; however, it gets to the point and keeps things simple. When the valve is causing a problem, it is usually found to be open about 95% of the time and closed about 5%. Symptoms of both can be similar, but constipation is certainly a hallmark of the closed variety.

The reasons for dysfunction are also similar, but a closed valve is basically caused a hypertonic or spasticity in the intestinal muscles. This can be caused by excessive abdominal workouts, especially if done isometrically (i.e.: simply contracting the muscles without moving the torso). The next most obvious reason is nutrient deficiencies that cause muscle spasms in the first place. Remember the intestines are made of muscle, not skeletal (or cardiac), but smooth muscle. The most common nutrient deficiencies would be magnesium, or lack of available/usable calcium, not necessarily a deficiency in calcium. Hypochlorhydria, or low stomach acid (and/or digestive enzymes) is also usually an issue. There may be other causes, but those are the ones I typically see.

Other issues that accompany (perhaps the result, not necessarily the cause of) a closed valve might be things like intestinal yeast overgrowth (or candida), parasites, protozoa, bacterial and viral infections in the intestines. This can be the cause or result of insufficient “good” bacteria in the gut. Think hypochlorhydria; excessive sugar, refined carbohydrate, and/or fruit consumption; food contamination, and drinking chlorinated water, when it comes to gut flora imbalances. Symptoms on the other hand would be anything that accompanies constipation, such as bloating, abdominal cramps, flatulence, fatigue, general poor digestion, headaches, halitosis, low back pain, etc..

An open ileocecal valve can be the result of poor abdominal or pelvic floor muscle tone, leading to a general ptosis (drooping) or flaccidity of the intestines because of lack of support. Usually however, this is also due to gut flora imbalances along with the presence of pathogens related to the reasons mentioned above. An open valve can also result from irritation to the lining of the valve and intestinal wall in general. This is mainly due to foods high in roughage such as: popcorn, chips, nuts, seeds, spicy foods, alcohol, and sometimes chocolate and caffeine. This is especially true if those foods are not chewed thoroughly. By the way, I’ve found an open valve in just about every person who adheres to a strictly “raw food” diet. Chew properly and thoroughly if this is you!

Symptoms of an open valve mainly include loose stools, bloating, flatulence, general poor digestion, low back pain and lumbar disc herniations (without an onset of obvious trauma – i.e.: not simply bending down to pick something up), fatigue, headaches, halitosis, etc.. Hmmm, sounds just like a closed valve right! Remember, this is essentially a digestive problem, just like the closed variety; with the main difference being a possible magnesium or calcium deficiency in a closed valve. Again, consider hypochlorydria and insufficient digestive enzymes as well.

Unresolved emotional issues should be ruled out in either case. And pelvic and lumbar spinal joint dysfunction must also be addressed because the nerves that control the intestines arise from those areas. The fist lumbar nerve root (or L1) directly innervates the ileocecal valve. But again, I would check the entire lumbar spine and pelvic joints, including the sacrum.

I hope this sheds some more light on the topic as it is an important one. I check it on just about every patient, every visit, and definitely in cases of low back pain, headaches, and digestive disturbances.

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

 

 

 

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Yesterday I was reading an article titled “Yawning? 6 surprising reasons why you are exhausted“, on the “Shine” section of Yahoo®. So now I’ll share my comments on it, and expand on some more ideas on why you may be exhausted. Before I get into the reasons mentioned in the article, I want to quickly share some of the biochemistry and physiology about energy production and fatigue in the body. I’ll keep it simple so don’t worry. By the way, I’ll use the words fatigue, tired(ness), and exhaustion interchangeably.

First, there are really only two basic reasons that a person will be exhausted or have low energy. These are a simply a deficiency in nutrients required to run the energy cycles, or a toxic reaction in the body. Both of these represent a “stress” to the system. And keep in mind that there can (and usually) will be a combination of both. Because a lack of sufficient nutrients will cause toxins to accumulate and toxins will cause a depletion of nutrients (required for detoxification). When I talk about toxins I am  referring to both chemicals internally produced and from environmental or food exposure. A “true”, so to speak exhaustion or fatigue can often be relived by rest, once the body gets the energy cycles up and running again. Of course you still need nutrients. However, you can be tired and feel exhausted because of temporarily burning through them (especially in reference to exercise). If you find that rest (or sleep) doesn’t relieve your fatigue, there is a good chance that you are toxic, especially after a sufficient amount of sleep. Generally, if you don’t feel rested after 9 hours of sleep, there is a good chance you are toxic to some degree.

When I think of biochemicals and the cycles run in the body that are necessary to produce energy I think of these four basic things: 1) ATP (adenosine triphosphate) – one main “energy” molecule; 2) the citric acid (or Kreb’s cycle); 3) the electron-transport chain; and 4) a process known as glycolysis. OK, that’s as technical as I’ll get, promise. The nutrients required to allow ATP to be produced and the three processes mentioned include: magnesium; manganese; phosphorus; lipoic acid; co-enzyme Q10; and vitamins B1, B2, B3, B5, and B6. There may be some more, but that’s a great start. Do you now see why many people say B-complex supplements give you energy? OK, now that we have that out of the way we can talk about the 6 reasons for exhaustion from article. They do say “6 surprising reasons”, so I am acknowledging that they are not claiming them to be the only reasons.

1) “A hidden UTI” (urinary tract infection) – the article states: “In some cases, fatigue may be the only sign of a urinary tract infection, reports WebMD. If you suspect something’s up (and you have pain and burning when you pee) talk to your doc.”    This is surprising isn’t it. I simply want to add that any hidden (or overt) infection can cause exhaustion including fungal, yeast (candida), bacterial, viral, parasitic, and protozoal. The main reason for this is that chemicals (mainly known as cytokines) produced from stress to the immune system can cause the Kreb’s cycle to malfunction. These organisms may also produce fatigue-inducing chemicals independent of the immune system.

2) “Your diet” – The article says that not eating enough calories (calories are “more or less” energy, measured in Joules) could cause fatigue. Do you think that’s most of the “developed” world’s problem though? Come on now, I believe the obesity rate in America is around 2/3’s of people, and something tells me it’s not from eating too little calories. Obesity is often associated with fatigue. According to a study published in the Archives of Internal Medicine, obesity accounts for a significant portion of fatigue symptoms. Try getting double the recommended calories you truly need from pasta, bread, soda, and sugary desserts and let me know how that goes. The foods I just mentioned are empty calories from processed foods. The key is to eat enough calories through a variety (to ensure a wide range of nutrient consumption) of whole-foods.

3) “Food allergies you didn’t know you had” – This will cause the some of the same problems as #1, because of the stress on your immune system. Please see my article titled “Food Allergies and Sensitivities.”

4) “Caffeine overload” – They say: “You probably reach for more coffee when you’re tired, but experts say that too much caffeine can sometimes backfire, causing you to feel more fatigued. Maybe skip the triple-venti today.” I agree, although 1 cup (normal-sized mug), which is not “overload”, should be fine (but not in all cases). Generally this will cause adrenal gland burn-out as it can affect the release of stress hormones. These hormones (and the caffeine) will burn through detoxification nutrients in order to clear them from the bloodstream. This will also tax your blood-sugar handling mechanisms which will always result in energy imbalances (later if not sooner). Everyone in modern society has some degree of adrenal gland stress – it just depends if it is eustress (beneficial – glad to wake up out of bed type of stress) or distress. It’s a huge topic I’ll discuss in-depth another time.

5) “Undetected thyroid problems” – Here the article notes: “Fatigue is one symptom of a thyroid condition called hypothyroidism. Fortunately, this is such a treatable thing (I have it, and just pop a pill each day–no biggie). Most health experts concur that every woman should have her thyroid levels tested every few years (just a simple blood test) to rule out any such conditions (they’re common in women).” You can read my two articles titled “Hypothyroidism” and “Potential causes of hypothyroidism“. And in case you weren’t sure, I’m not so keen on the “just pop a pill each day – no biggie” idea. No, definitely not thrilled they wrote that. And I’m not saying medication is “bad” and no one needs it. And… moving forward. Please read my two articles on the topic.

6) The sixth was added at the end and is “your snoring man”. Obviously sleep is a no-brainer, and please recall what I said above about sleeping, and then waking up feeling un-rested…

Briefly, remember that it’s any toxin – which includes toxic (heavy) metals, pesticides, fragrances, artificial sweeteners, etc.; and let’s even throw in radiation which is hopefully not the problem.

One last thing, the article states this in the beginning: “Sure, getting enough sleep is the biggest way to beat the 4:00 yawning session (I swear, there is something about this time–weirdly, I could fall asleep at 4 p.m. everyday!), but did you know that several other surprising things could be making you sleepy? Here are some unlikely yawn-inducers…”. It’s never a good idea to say 100% of the time. So, I’ll say 90%+ of the time, if you are sleepy at 4:00pm, it is a blood-sugar imbalance. This is an extremely common complaint. And reaching for the coffee, soda, or chocolate bar will simply exacerbate the problem unknowingly. The other give or take 10% of the time…check what you ate for lunch. By the way, yawning excessively without fatigue is an acid-alkaline imbalance usually; as the body is naturally “blowing off” a highly acidic build-up of carbon dioxide. For this you look to the diet, nutrient deficiencies, and the diaphragm (for better breathing capacity).

Good luck, and see if you can identify your source(s) of fatigue. By the way, I could probably add a few things to the list, but let’s rule those out first.

Sources include: Yahoo®, material published by Walter H. Schmitt, DC, DIBAK, DABCN and Chris Astill-Smith, DC, DIBAK.

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

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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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Nightshades are plants in the solanaceae family. Within that family are some common foods in almost everyone’s diet. These include: potatoes, tomatoes, eggplant, and all types of pepper (except black pepper).  According to Michael Lebowitz, DC, goji berries and ashwaganda (“Indian Ginseng”) contain the same potential toxin as nightshades. And the National Toxicology Program reports that apples, cherries, and sugar beets contain the chemical as well. Bilberry (huckleberry) is also in that list. Obviously, don’t forget about condiments and products that contain these foods. Lastly, tobacco is a nightshade.

OK, so now for the reasons these nightshades can cause a problem! These foods have a specific chemical in them known as solanine. First, according to one researcher, solanine may directly irritate the gastrointestinal (GI) tract. And additionally, when it is absorbed into the bloodstream, it can cause destruction of the oxygen-carrying red blood cells. I could not find the mechanism related to that effect.

Second, solanine is known as an aceytlcholinesterase inhibitor.  That means it acts to prevent the breakdown of the neurotransmitter acetylcholine (ACh), leading to an excessive build-up of ACh in the nerve receptor sites. Therefore, it will allow for a constant (over)stimulation of ACh receptors. Acetylcholine has many functions in the nervous system. Generally, it is responsible for stimulating the parasympathetic nervous system. To avoid boring you, I won’t go into all of the effects of ACh.

Instead, I’ll simply discuss the potential symptoms of nightshades as it pertains to their neurological effects. Don’t forget, as stated above, direct GI tract irritation can occur. And some researchers found that solanine can cause vomiting and enteritis (GI tract inflammation). In addition, nausea, diarrhea, and stomach cramps were reported. According to research by Michael Lebowitz, DC, solanine has the following potential attributes: “1- act as an endocrine disruptor especially to the thyroid; 2- cause chronic joint pain, arthritis (all forms), joint inflammation- this is due to solanine’s ability to remove calcium from the bones and deposit it in any weak or genetically predisposed area of the body; 3- for the same reason it can be a major contributor to osteoporosis (since it removes calcium from the bones) and arteriosclerosis (it can deposit the calcium in the blood vessels); 4- “leaky gut” as well as IBS; 5- appendicitis; 6- birth defects including spina bifida; 7- depression; 8- migraines; 9- can greatly interfere with calcium and vitamin D absorption, despite supplementation.” There may be more symptoms associated, but that’s a good start.

And for your information, “nerve gas” and certain pesticides act as acetylcholinesterase inhibitors as well. Strange to think of those foods acting like such toxic chemicals. Drugs that act as acetylcholinesterase inhibitors are used to treat Alzheimer’s disease and dementia.

Please be aware that not everyone will be affected by nightshades in the same way. However, if you are, you’ll want to know so you can avoid them. Some of my colleagues find solanine to be causing a problem in about one-third of their patients. You know I always ask the question: “Why?”, so let me address that. There can be many reasons why they affect an individual, and they are similar to why other potential toxins cause symptoms. They are: genetics, the ability to clear the chemical from the system (most likely liver and kidney metabolism), and the amount of exposure.  These are some of the main reasons affecting the body’s response to solanine. Additionally, it is unclear how long one will need to avoid ingesting solanine before their symptoms abate. It may be quite “difficult” to avoid eating nightshades, however, it will be well worth your while if something so simple can stop debilitating or annoying symptoms.

When I find this problem with patients, I also use supplement(s) to help clear the solanine from the system, to provide faster symptom relief. And with the in-office procedures I use, it is simple to tell “on the spot” if solanine may be causing you problems. My patients appreciate this because it prevents them from unnecessarily avoiding some of their favorite foods. This problem can be both a blessing and a curse. See you soon.

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

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According the Associated Press (AP), every single fish tested from nearly 300 streams in the US were found to be contaminated with the toxic metal mercury.  However, “only about a quarter had mercury levels exceeding what the Environmental Protection Agency says is safe for people eating average amounts of fish”.  The EPA states on their website that “a variety of fish and shellfish can contribute to heart health and children’s proper growth and development”.  And then go on to say the following “women and young children in particular should include fish or shellfish in their diets due to the many nutritional benefits”.  “For most people, the risk from mercury by eating fish and shellfish is not a health concern.”  “Yet, some fish and shellfish contain higher levels of mercury that may harm an unborn baby or young child’s developing nervous system.”  Finally they state the obvious – “The risks from mercury in fish and shellfish depend on the amount of fish and shellfish eaten and the levels of mercury in the fish and shellfish.”

Some more specifics of what the EPA has to say: “Do not eat Shark, Swordfish, King Mackerel, or Tilefish because they contain high levels of mercury.  Eat up to 12 ounces (2 average meals) a week of a variety of fish and shellfish that are lower in mercury.  Five of the most commonly eaten fish that are low in mercury are shrimp, canned light tuna, salmon, pollock, and catfish.  Another commonly eaten fish, albacore (“white”) tuna has more mercury than canned light tuna. So, when choosing your two meals of fish and shellfish, you may eat up to 6 ounces (one average meal) of albacore tuna per week.  Check local advisories about the safety of fish caught by family and friends in your local lakes, rivers, and coastal areas. If no advice is available, eat up to 6 ounces (one average meal) per week of fish you catch from local waters, but don’t consume any other fish during that week.”

Before I continue on the dangers of ingesting mercury, I want to mention how mercury winds up in fish to begin with.  Basically, it is from coal-burning power plants that emit smoke stacks of pollution.  These emissions obviously get into the air and then settle into the oceans, lakes, rivers, streams, and ground near this water.  Oh wait, I presume the mercury in that pollution must also get into our reservoirs, but I haven’t seen that mentioned.  Perhaps because people are focusing on fish, when it comes to mercury.  Anyhow, the legislation that was supposed to be implemented forcing companies to control those emissions has been disgustingly delayed.  About.com had an article stating this: “By law the Environmental Protection Agency is obligated to require power plants to cut roughly 90 percent of their emissions of mercury and other toxic pollution by 2008. Instead, in March 2005 the agency let polluters off the hook, requiring much smaller reductions and giving electric companies more than two decades to accomplish them. What’s more, the agency essentially allowed polluting companies to do nothing for the next 12 years.”  Please see the link as there are more facts about fish and not just the politics behind the pollution.

Mercury is known to be extremely toxic to the nervous system in particular.  The EPA states that mercury can cause harm to the brain, heart, kidneys, lungs, and immune system in people of all ages.  For fetuses, infants, and children the major effect is impaired neurological development.  Lastly, the EPA says (and I can’t get over this one!): “In addition to the subtle impairments noted above (referring to the previous sentence), symptoms of methylmercury poisoning may include; impairment of the peripheral vision; disturbances in sensations (“pins and needles” feelings, usually in the hands, feet, and around the mouth); lack of coordination of movements; impairment of speech, hearing, walking; and muscle weakness. People concerned about their exposure to methylmercury should consult their physician.”  Bold type-face, underlining, and statement in parentheses added by me.

OK, now I’ll comment.  How does the EPA know what’s safe for you?  What symptoms must occur for certain amounts to be considered unsafe?  Also, I unfortunately can’t find information on how they determined safe levels, and of course, the state of the health of those people (presuming tests were done on humans?).  Please comment if you know.  But regardless, do they know the toxic burden (of all toxins) that already exists in you?  Do you know?  Remember, we ALL have some level of a toxic burden of chemicals and metals in us; from simply breathing the air, consuming conventionally grown foods, etc….the list is endless.  Do you have all the necessary nutrients to drive the kidney detoxification pathways?  We often think of the liver as the main detox organ, however, toxic metals are water-soluble and will be excreted through the kidneys into the urine.  As an aside, any time I find a patient’s most “stressed” organ(s) to be the kidneys or bladder, I think toxic metals first.

My points above are meant to reflect the concept that you probably won’t experience the above OVERT and OBVIOUS symptoms of mercury toxicity as reported by the EPA, by consuming fish alone.  That is from my personal experience with patients.  The problem arises when people have sub-clinical symptoms from mercury toxicity.  These might include fatigue, irritability, “foggy-headedness”, depression, anemia, hypothyroidism, digestive complaints, and more.  Sub-clinical mercury (or other toxic metal) toxicity often results in the scenario of: “Mr./Mrs. Smith, all of your tests came back normal”. Let me expand on this.  It will be extremely uncommon for a person to have mercury levels elevated in their blood.  To date, out of literally hundreds of patients of I’ve seen with mercury-related symptoms, or other toxic metals, ONLY 1 actually showed elevated levels on blood tests.  And this is how conventional doctors often go about checking for it.  The problem is often that the metals get lodged into the cell/soft tissues and don’t get fully released into the bloodstream.  When in the cells/soft tissues, they can cause impairments of normal functioning leading to the above symptoms.  Fortunately, there are functional lab tests (especially urine) that can be used to detect levels of metals in the soft tissues.  Even though urine is a reflection of blood, the test involves “provoking” the metals out of the cells to get an accurate measurement of total body burden in the soft tissues.

The amount of mercury-laden fish you can consume without harm or causing symptoms will depend on a variety of factors; mainly your current “toxic-burden” and detoxification abilities.  And as you know, your symptoms may already be stemming from mercury (or other toxic metal) exposure; so perhaps you shouldn’t consume any fish at all.  It would be prudent to have functional (in-office and lab) tests performed to find out!  Lastly, I have helped many patients with symptoms related to toxic metal exposure by correcting simple and easily identifiable nutrient deficiencies, and education on avoiding further exposure.

I still can’t understand why some practitioners in the dental community consider it OK to put mercury in their patients’ mouth!!!  By the way, there is a right way and a wrong way to have mercury amalgams removed.  It can be more harmful to have mercury fillings removed, when done “improperly”.  Feel free to e-mail me if you have concerns about that.

One more thing.  You may go “MAD” if you are exposed to too much mercury.  The phrase “mad as a hatter” comes from the hat-making industry dating back to the 1800’s when some hat-makers apparently went “mad” because of breathing mercury fumes from a solution they used to make fur into felt.

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

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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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It is quite common for a (female) patient to come to my office and tell me she is anemic. And very often, she has been diagnosed with it several months ago. My question is always: “Why are you still anemic if you found out about several months ago?” With the exception of some (rare) complications and rare types of anemias, there is generally no reason anyone should have iron-deficiency anemia for more than about four months.  And this type tends to be the most common, at least in my patients.  Let’s discuss why it occurs and how it can be incredibly simple to correct.  To start, anemia refers to “a condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume”.  If you are not sure, red blood cells need iron to carry and distribute oxygen around the body by way of the hemoglobin molecule.  By the way, the oxygen carrying molecule in muscles is known as myoglobin.

Iron-deficiency anemia is a “no-brainer” as to why it occurs; that is, lack of sufficient amounts of iron.  The question is always: Why?  There are three answers: a) you are not consuming enough iron, b) you are not absorbing enough, or c) you are losing blood faster than you are making it.  These can all exist together, too.

For answer “a” – this is simply not consuming enough iron-containing foods.  I almost always see this mostly in vegetarian or vegan patients.  Now, I’m not at all against being vegetarian or vegan, but I am against being deficient in vital nutrients that may come as a result of a particular diet.  Unfortunately, for vegetarians and vegans, iron is most abundant (by weight/mass) in animal foods.  Some good sources are: beef, chicken, turkey, pork, liver (beef, chicken, etc.), oysters, egg yolks and other animal foods; and kidney beans, blackstrap molasses, spinach, raisins, peas, dates, broccoli, almonds, apricots, and some other vegetarian/vegan foods.  Check the nutrition information on the foods for the exact amounts.  Here is a chart listing the recommended daily allowance (RDA) for iron according to the National Institutes of Health.

Age Males
(mg/day)
Females
(mg/day)
Pregnancy
(mg/day)
Lactation
(mg/day)
7 to 12 months 11 11 N/A N/A
1 to 3 years 7 7 N/A N/A
4 to 8 years 10 10 N/A N/A
9 to 13 years 8 8 N/A N/A
14 to 18 years 11 15 27 10
19 to 50 years 8 18 27 9
51+ years 8 8 N/A N/A

For answer “b” we come to the issue of iron absorption.  This can be caused by many factors.  Here are the most common ones I see.
1) Your intestinal tract can become literally be clogged up!  Iron is absorbed in the duodenum and upper jejunum of the small intestine.  There are little hair-like protrusions lining your small intestine which act to literally take up the food for absorption.  If your villi are clogged with old, undigested food from poor dietary choices, you may not be absorbing iron sufficiently (along with other nutrients as well).

2) You might not be fully breaking down the foods you are eating.  This can be due to improper chewing, or lack of hydrochloric acid and/or other digestive enzymes.  Deficiencies in minerals that stimulate the production of these digestive enzymes are one thing to consider; and possibly an enzyme supplement to help “prime the pump” while you are restoring those minerals.  By the way, iron-deficiency in a male or post-menopausal woman who is consuming enough iron in thier diet almost always results from lack of sufficient amounts of hydrochloric acid in the stomach.

3) Additionally, an outright digestive disorder like irritable bowel syndrome, Crohn’s disease, ulcerative colitis, and others may not allow for proper absorption of iron (and other nutrients).  So these conditions would need to be addressed as well.

By the way, iron from animal sources is called “heme” and from vegetable sources it’s called “non-heme”.  Please be aware that a non-heme source will be absorbed much better when combined with vitamin C in the same meal.  And phytic acid (or phytate) which is high in legumes and grains (e.g.: soy, kidney beans, wheat, rye, oats, barley, corn, and peanuts) will substantially inhibit iron (and other mineral) absorption.  However, vitamin C will also help to counteract the effect of phytic acid.

Lastly, answer “c” has to do with the issue of losing blood, faster than you are making it.

1) The most common cause that I see related to this is when women have a heavy menstrual cycle.  This is usually the result of hormone imbalances, especially a condition known as estrogen dominance.  I’ll discuss that in another article.  This is a rampant problem for females due to many reasons; and you won’t necessarily have heavy periods because of it.

2) Men and post-menopausal women (in particular) may become iron deficient due to gastrointestinal blood loss from digestive conditions like ulcers, Crohn’s disease, ulcerative colitis, irritable bowel syndrome, colon cancer and other digestive disorders.  Also, excessive intake of aspirin or other non-steroidal anti-inflammatory medications (e.g.: Advil®, Motrin®, Aleve®, etc.) can cause blood loss through the gut.  These tend to be the most common reasons for blood loss, however their certainly are others.  And these conditions can obviously occur in menstruating women as well.
Let’s hope you are not losing blood because of undetected internal bleeding!

Now for the symptoms of iron-deficiency anemia.  Some common ones are as follows: pallor (pale skin and mucous membranes – nail beds and inner membranes under the eyeball can often/not always be spotted), fatigue, irritability, brittle nails, cold hands and feet (usually hypo-thyroid though), trouble concentrating, shortness of breath, irrregular heartbeat, mild depression, muscle fatigue/lack of endurance, and perhaps more.

Another strange symptom is called pica which a craving to eat ice (probably most common), soil, paper, soap, chalk, and other things I won’t mention.  This can be especially common in children.  The jury is still out on why it relates to iron deficiency.

The best blood test to run for iron-deficiency is ferritin (the amount of stored iron in your body.  But I’d also want to see levels of actual blood iron, total iron-binding capacity (TIBC), and transferrin (the molecule that transports iron).  And of course of complete blood count, which will measure total red blood cells, hemoglobin, hematocrit, RDW (random distribution of weight) and MCV (mean corpuscular volume).  Beware however, functional/sub-clinical iron deficiency can still (and often does) exist because the reference ranges considered normal by blood labs are extremely wide – so you will be quite deficient if you fall below the lab’s “normals”.

There are several applied kinesiology functional muscle tests that can cause me to suspect iron deficiency, especially one involving muscle fatigue/endurance.  And also in-office, cross-checks to help verify.  But I definitely consider it prudent to have blood levels checked for functional ranges; as an overload of iron can be very dangerous.  Get the blood tests and have them evaluated for functional ranges, it’s simple.

Finally, it can easily be corrected through diet and/or supplements.  And will most likely take a minimum of four months to correct, because the life-span of a red blood cell is about 120 days.  Hope this helps!

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

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