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Saturday, October 6, 2018

Mercury Fillings - A lot of hype about nothing?



Image result for mercuryThere seems to be no end to the number of speculations surrounding why people suffer from disease and ways in which to improve health status by way of alternative interventions and procedures. Due to the warranted concern surrounding overconsumption and/or exposure to mercury, some have suggested that the use of amalgam fillings in dentistry may be the cause of multiple maladies such as cognitive decline and chronic degenerative conditions. Though there is little dispute concerning the potential harm procured by the over ingestion or exposure to mercury, the causative nature of this substance in regard to significant disease markers requires further investigation to determine its legitimacy.
According to a statement made by the Food and Drug Administration (FDA), the elemental mercury contained within dental amalgam releases low levels of mercury vapor, leading to the potential for inhalation or absorption by the lungs.1 Further, the FDA states that exposure to high levels of mercury are associated with adverse brain and kidney effects.1 Conversely, the FDI World Dental Federation and the World Health Organization (WHO) concluded that though rare cases of local side effects of allergic reactions exist, no controlled studies have demonstrated systemic adverse effects stemming from the use of amalgam fillings in dentistry.2 In addition, these organizations have stated that the mercury release resulting from the placement or removal of such fillings has also  been unproven in regard to causing adverse side effects.2  
There is a growing trend leading to the idea that not only does the exposure to mercury fillings lend itself to causing general health complaints but that the removal of amalgam fillings may also contribute to the improvement of degenerative disorders such as multiple sclerosis, Alzheimer’s disease, Parkinson’s or autoimmune disease. Clearly, drawing such conclusions must be based upon credible evidence prior to the determination of validity. Both a look at the use of amalgam fillings in relation to the onset of disease as well as the improvement of disease following amalgam removal may shed light on the so-claimed relationship. Therefore, with controversy rising regarding this topic, there is reason to investigate this body of information before drawing definitive conclusions. Looking at a couple of articles may shed further light on this issue.
A longitudinal analysis of the connection between dental amalgam removal, urine mercury levels and a set of 14 self-reported health symptoms was performed with 955 Canadian participants.3 With the premise that mercury vapor poses a health threat to those in constant contact with it, researchers studied the effects of amalgam filling removal on health compared to lack of filling removal.3 With the use of urine analysis, researchers concluded that those who had amalgam fillings measured double the urine mercury as those in the control group who did not have amalgam fillings, yet according to Health Canada, the urine mercury levels did not pose an adverse health risk.3 Results showed that participants in the treatment group who underwent amalgam removal experienced decreased levels of urine mercury.3 Outcomes of the study demonstrated that removal of amalgam fillings led to a reduced likelihood of self-reported symptoms as well as an improvement of existing symptoms when compared to those who retained their dental fillings.3 At the conclusion of the study, researchers deduced that amalgam fillings produced adverse effects on health and the removal of fillings produced favorable symptom outcomes among those tested.3 Of note, the study was funded by Pure North S’Energy Foundation, an organization focused on helping Canadians feel better and live longer by creating tailored programs for individuals interested in preventing chronic disease and living healthier lives.3 Though initially sounding credible, the organization appears to focus on questionable health practices as well as giving credence to several topics of little significance, therefore pulling into question their bias towards the topic of amalgam removal. Despite this fact, the information contained in the study ought not be completely disregarded, but should encourage caution at taking the information contained as solid proof of evidence.3 In addition, study results were largely dependent upon self-reports which are oftentimes inaccurate, again presenting need for caution when interpreting results.3
A risk assessment taking into account the literature obtained through 2005 was performed in regard to amalgam and the warranted nature of its use.4 Authors presented that though amalgam has been used in dentistry for 150 years, it is to blame for a significant contribution to the human mercury load due to continuously released mercury vapor emerging from the amalgam restorations.4 Further, authors stated the accumulation of mercury in the organs, particularly the brain, is a result of mercury’s ability to bind to proteins in a manner stronger than that of other heavy metals.4 In addition, mercury has been considered as a highly toxic, non-radioactive element which points to its potentially ill-warranted use in the human body.4Authors noted that recent publications suggest the influence of mercury toxicity on kidney damage,  neuropsychological impairments, induction of autoimmune diseases or sensitizations, increased oxidative stress, autism, skin and mucosal reactions, AD, MS and nonspecific discomfort.4 In addition, authors suggested the possible presence of hereditary, acquired or interindividual sensitivities in regard to the initiation of symptoms or disease.4 Though the assessment of the available literature points to the questionable safety profile of mercury levels in amalgam, authors of the current review appeared aware of the necessity of obtaining solid and evidential research in regard to making definitive claims of the healing nature of amalgam removal.4 More specifically, authors stated, “Due to methodological deficiencies, some amalgam studies are only partially usable in their statements. In some studies, amalgam removal in a relevant part of the patients could permanently improve or cure various and mostly chronic conditions. Due to the consideration of all available data, amalgam can neither be designated a medically, occupationally, nor ecologically safe dental filling material”.4
 Following scrutiny of the research provided above, it is likely safe to assume that there is some truth to the possible effect of dental amalgam on health outcomes. However, it does not appear that the preponderance of the evidence points to undeniable proof of mercury’s detriment to the mind and the body in the form of dental fillings. It is important to assess the risks and benefits associated with any procedure prior to initiation of the process. In terms of amalgam removal, discomfort of procedures, increased symptom load directly following removal, lack of symptom improvement and costs involved all contribute to the risks of the decision. Whether or not these risks outweigh the possible benefits suggested by prior research must be individually assessed. As with all procedures, no options exist without risk. In summary, determination of the most warranted decision is not accompanied by certainty but rather personal judgement.

**A more detailed review of the literature may be obtained upon request. 

References
1.      U.S. Food and Drug Administration. About dental amalgam fillings. Available at: https://www.fda.gov/medicaldevices/productsandmedicalprocedures/dentalproducts/dentalamalgam/ucm171094.htm. Accessibility verified September 17, 2018.
2.      American Dental Association. Statement on dental amalgam. Available at: https://www.ada.org/en/about-the-ada/ada-positions-policies-and-statements/statement-on-dental-amalgam. Accessibility verified September 17, 2018.
3.      Melchart, D., Vogt, S., K√∂hler, W., Streng, A., Weidenhammer, W., Kremers, L., et al. Treatment of health complaints attributed to amalgam. Journal of Dental Research. 2008; 87(4): 349–353.
4.      Mutter J, Naumann J, Walach H, Daschner F. Amalgam risk assessment with coverage of references up to 2005. Das Gesundheitswesen. 2005; 67(3): 204-16.

Monday, August 13, 2018

Ashwagandha...as amazing as they say?

Image result for ashwagandha
In my practice, I frequently get asked about certain supplements, oftentimes ones that claim to be effective at reducing stress and anxiety. I'm pretty clear on my stance that I haven't seen much credible research on the usefulness of these supplements and further, oftentimes the use of them can actually hinder success rather than help progress. The reason this problem exists is due to the fact that when a person relies on a substance, whether it is so-called natural or not, they are oftentimes less apt to delve into the core issues that caused the anxiety or depression in the first place. With that being said, however, I don't make claims without evidence-based backing. Therefore, I did some specific research on a plant that is frequently an ingredient in anti-anxiety "natural" blends or taken on its own for the same reason. Though at first it may seem like a great product, it may not provide quite the level of benefit it is oftentimes touted as producing. Let's take a look.

Ashwagandha: Overview, Efficacy, Risk
With the use of supplements being a popular practice, it likely comes as no surprise that a plant-based anti-stress and anti-anxiety supplement has been advertised extensively. Withania somnifera, more frequently referred to as ashwagandha, has been touted for its beneficial capabilities, with significant implications regarding its ability to reduce stress levels.1 Despite its many claims, however, sufficient information is questionable as to the benefits it provides. A further look at the history of its use as well as its evidential efficacy is warranted, particularly due to the widespread recommendations of its use.
History
Ashwagandha is a plant from which the root and berries have historically been used to create medicinal compounds. Utilized by Ayurvedic, Indian and Unani medicine, ashwagandha has been prescribed for a whole host of physical and mental maladies ranging from arthritis, tumors and tuberculosis to stress, difficulty thinking and anxiety.In a brief review article referencing ashwagandha, one author stated that the health implications for this plant are extensive, being consistently used in Indian and Ayurvedic medicine.2 Further the author stated that particularly noteworthy amongst uses were implications of benefit for tumors, inflammation, infectious diseases, fevers and inflammatory conditions.2, 3 However, despite the plethora of assumed uses, the author noted that the traditional use of this plant “may not be supported by scientific studies”.In addition to the long list of illnesses ashwagandha is suggested to treat, it is also commonly referred to as an adaptogen (possessing the ability to aid the body in the normalization and regulation of systemic stress).Ashwagandha has frequently been used as a naturally-occurring anti-stress and anti-anxiety agent, which will be the central focus of this paper.1
Efficacy
In a review of clinical studies, authors examined the research surrounding the evidential usefulness of plant-based medicines as anxiolytics.Of the 21 plants with research pertaining to human clinical trial evidence, 13 showed anxiolytic effects when used in durations longer than one day, one of which was ashwagandha.Though positive effect was observed, authors further stated that the difference between the outcome of ashwagandha administration compared to placebo was not statistically significant.Authors stated that conclusions should be taken cautiously as many of the studies contained study limitations such as small sample sizes, brief intervention periods, and non-replication.4

In a double-blind, randomized, placebo-controlled study, researchers looked at the effect of ashwagandha extract capsules (formulated from the roots and leaves) on chronically stressed humans.The 98 subjects who completed the study were divided into four groups, three with various dosages and frequency of dosages and one control group.Results showed improvement of anxiety ratings in all of the treatment groups when compared to placebo, thus leading researchers to conclude that the claims regarding ashwagandha’s anxiolytic effects were warranted.However, it is important to note that not only was the research performed with the financial support of Natreon Inc., the patent holder of withania somnifera but several of the researchers were employed or worked voluntarily at Natreon  or NutraGenesis LLC, a retailer of withania somnifera.5 Therefore, the results of this study should be accepted cautiously, due to the financial investment and potential benefit these results may provide the companies involved.5
Looking at the anxiolytic efficacy of an ethanolic extract of withania somifera (tablet form), a double-blind, placebo-controlled evaluation was performed with 39 subjects diagnosed with ICD-10 generalized anxiety disorder, mixed anxiety and depression, panic disorder, and adjustment disorder with anxiety.6 Participants were evaluated at two and six weeks using the Hamilton Anxiety Scale, the Global Rating Scale and the Systematic Assessment for Treatment Emergent Effects (SAFTEE) symptom checklist.6 Commenting on participant dropout during the study, researchers stated that upon investigation, drop-outs occurred due to lack of benefit, adverse side effects, need for increased medication and undisclosed reasons.6 Following a review of results, researchers concluded that a demonstration of ashwagandha’s anxiolytic effects was evident and proved superior than placebo at the two-week follow-up and statistically significant at the 6-week follow-up.Once again of note, the research study was supported by a grant provided by Gufic LTD, Bombay, the manufacturer of the ashwagandha formulation tested.Though this acknowledgement does not infer automatic inferiority of the study results, it does give rise for additional caution of study bias.
In a randomized controlled trial, researchers examined the efficacy of naturopathic care for patients with anxiety.All participants suffered from moderate to severe anxiety for at least six weeks prior to the beginning of the study.Forty-one subjects received naturopathic care (NC) and forty subjects received standardized psychotherapy (PT), both for a duration of 12 weeks.Subjects in the NC group received several forms of treatment including dietary counseling, deep breathing relaxation techniques, a standard multi-vitamin and ashwagandha (extracted from the root).7 Similarly, the PT group engaged in several treatments including deep breathing relaxation techniques and placebo. Intended to measure anxiety, mental health, and overall quality of life, results were evaluated using the Beck Anxiety Inventory (BAI), the Short Form 36 (SF-36), Fatigue Symptom Inventory (FSI), and Measure Yourself Medical Outcomes Profile (MY-MOP).Participants were observed for at least eight weeks, during which time, BAI scores decreased by 56.5% in the NC subjects compared to 30.5% in the PT subjects.Further, significant differences presented with the two groups, with the NC group demonstrating greater clinical benefit in the areas of mental health, concentration, fatigue, social functioning, vitality, and overall quality of life.Though both groups demonstrated improvement in levels of anxiety, researchers concluded that the NC group benefited more from treatment when compared to the PT group.One limitation worth noting is the variety of NC treatments employed makes it difficult to draw conclusions regarding the efficacy of any one factor.7 Therefore, in regard to the positive effect of ashwagandha based on this research, it may only prove to be a potential element for benefit with the necessity of further research. Though results showed positive effect for naturopathic treatment, including the use of ashwagandha, the products used in the study were supplied free of charge by the company who makes them, thus possibly giving rise to caution yet again.7
One prospective, randomized, double-blind, placebo-controlled study was performed to determine the efficacy of a high-concentration, full-spectrum extract of ashwagandha root when administered to adults suffering from stress and anxiety.Based upon the premise that Ayurvedic medicine, animal studies and clinical studies all point to ashwagandha’s safe and effective role as an adaptogen, researchers looked at 64 participants with a history of experiencing chronic stress.Through the use of measured serum cortisol levels as well as stress-assessment questionnaires, researchers evaluated the effect of ashwagandha on the participants.Results indicated significant reduction in symptoms on all measures in the ashwagandha group when compared to the placebo group.Further, serum cortisol levels decreased substantially in the ashwagandha group when compared to the placebo group.Researchers concluded that the outcomes of this study suggested that administering high concentration, full-spectrum ashwagandha root had an anti-stress effect with little to no side effects and an overall positive improvement on self-assessed quality of life.8  Researchers admitted that the study was small and the duration was limited, thus recommending studies with larger sample sizes and longer treatment periods are warranted.8
In a randomized, double-blind, placebo-controlled study, researchers examined the effect of ashwagandha on generalized anxiety disorder (GAD).The study consisted of 86 patients diagnosed with GAD, divided into two groups.9 The treatment group received four grams of ashwagandha root in granule form three times a day for 60 days while the placebo group received four grams of placebo for 60 days.9 Researchers measured a variety of symptoms including tension, fear, insomnia, difficulty with concentration/memory, depressed mood, sensory and muscular complaints, and anxiety.9 Results  showed that on all measures both groups experienced highly significant improvement but on all measures except one, there was no significant difference between the treatment and placebo groups.9 Researchers stated that anxiety was the only factor that improved in a superior manner with the administration of ashwagandha compared to the placebo.9 However, researchers commented, “On the whole, despite having insignificant statistical difference in both the groups, Group A, Ashwagandha (Withania somnifera) granules, showed a better percentage improvement than Group B (placebo). Ashwagandha (Withania somnifera) granules have shown superior results in the management of GAD as compared to placebo granules. Hence, the alternate hypothesis is accepted i.e. Ashwagandha (Withania somnifera) is effective in the management of Generalized Anxiety Disorder”.9
Pratte and colleagues performed a systematic review of several of the above-mentioned studies and made several interesting comments regarding the outcomes and validity of the studies.10 Across the five studies fitting inclusion criteria, researchers reported consistently positive study results regarding the use of ashwagandha to lessen stress and anxiety.10 However, researchers illuminated multiple study limitations in all of the reports reviewed including researcher bias, small sample sizes, short duration of trials and lack of researcher blinding.10 Further, according to Cochrane criteria, none of the studies achieved low risk-of-bias rating.10 Therefore, researchers concluded that though the results of the studies showed ashwagandha’s superiority over placebo, the outcomes must be taken with cautionary optimism.10
Side Effects and Risk
Though ashwagandha has been reported as a “possibly safe” plant for ingestion, it is important to investigate the overall side effect profile as well as the potential risk of use.1 Some state that large doses of the plant may produce stomach upset, diarrhea and vomiting and further, that the long-term safety of its use has not yet been determined.1 In addition, some caution has been recommended for those suffering from various diseases, based upon possible risks associated with interactions of medications or disease progression.Others suggest ashwagandha may lower blood sugar levels or interfere with medications in diabetic patients, decrease blood pressure in people with hypotension, irritate the gastrointestinal tract, increase immune system activity in autoimmune patients, slow down the central nervous system thus causing complications with anesthesia, and increase thyroid hormone levels in those suffering from thyroid disorders.These potential side effects and risks present the importance of using ashwagandha with discretion. For the current analysis, the studies previously reviewed shed further light on the side effect profile of this so-termed medicinal plant.
When human clinical trials were reviewed in regard to the anxiolytic effects of plant-based medicines, researchers concluded that ashwagandha was well tolerated by subjects and did not produce any heightened levels of adverse effects when compared to placebo.4
Of the 98 subjects who participated in a double-blind, randomized, placebo-controlled study on the effect of ashwagandha on chronically stressed humans, researchers reported that adverse effects were absent in all subjects, including those who dropped out of the study.Researchers clarified further, stating that the lack of adverse effects was observed regardless of dosage or frequency of administration.5
When an ethanolic extract of ashwagandha was used in a double-blind, placebo-controlled study involving patients diagnosed with anxiety disorders, the plant was not only well tolerated by participants but adverse side effects were comparable to those demonstrated in participants using placebo.Researchers stated a percentage of subjects dropped out of the study, reportedly due to adverse effects, yet fewer came from the ashwagandha group when compared to the control group.6 Further, adverse effects were observed early in the study and were reportedly easily managed by way of dosage adjustment. Of additional importance, though abrupt withdrawal was initiated at six weeks, no withdrawal symptoms appeared in the participants, thus leading researchers to state ashwagandha’s superiority to the conventional anxiolytic drugs such as benzodiazepines, tricyclic antidepressants, and buspirone which oftentimes have adverse withdrawal effects.6
In a randomized study performed to determine the effectiveness of naturopathic care on measures of anxiety compared to standardized psychotherapy treatment, researchers looked at the benefit of several treatments including ashwagandha.7 Researchers did not observe any serious adverse reactions from the dispensation of ashwagandha.7
When used in a prospective, randomized, double-blind, placebo-controlled study, high concentrations of full-spectrum extract of ashwagandha root produced favorable results with few side effects.8 Follow-up interviews were conducted over the phone on days 15, 30, and 45 to evaluate treatment compliance as well as evaluation of any adverse reactions.8  Additional safety and efficacy evaluations were performed on day 60.8 Out of the 61 subjects reviewed, only six adverse events were reported, a minimal number particularly when compared to the five adverse events reported in the placebo group.8 Reported side effects were nasal congestion, constipation, cough/cold, drowsiness and decreased appetite in the treatment group compared to dry mouth, fatigue, fever, headache, abdominal pain, diarrhea and tremors in the legs in the control group.8 Researchers further stated that all adverse events were mild and “no known mechanisms relate these adverse events to the study drug”.8
Researchers in a randomized, double-blind, placebo-controlled study examined the effect of ashwagandha on generalized anxiety disorder (GAD) in 86 patients previously diagnosed with this disturbance. Outcomes of the study indicated a lack of adverse side effects for those ingesting ashwagandha over the course of the investigation.9
Conclusions
From the above-reviewed studies, it appears that ashwagandha may have beneficial potential for aiding in the reduction of symptoms pertaining to stress and anxiety. It is important to note that in some studies, though positive benefit was observed, the favorable outcomes were not deemed statistically significant.
A point worth mentioning is the fact that despite the varied nature of administration, it did not appear that the manner in which the plant was distributed (i.e. tablet form, pill form, granule form), the dosage or the frequency of ingestion significantly influenced the outcomes of the plant’s efficacy rating. Of significant note is the lack of reported adverse side effects as well as the lack of negative feedback in regard to withdrawal symptoms. Though side effects, adverse reactions and withdrawal symptoms may have been underreported, there did not appear to be evidence pointing to their frequency or significantly problematic nature. These factors point to the possible positive nature of ashwagandha in those dealing with symptoms of anxiety and heightened stress without the added concern of contracting adverse reactions.
As previously mentioned, limitations did exist across all of the studies, giving rise to caution when drawing conclusions yet the preponderance of the evidence points to the prospective but cautionary use of ashwagandha as an effective way treat symptoms associated with stress and anxiety. However, it is important to recognize that though the use of ashwagandha to ameliorate unpleasant symptoms may provide relief, it serves primarily as a symptom manager. In other words, the underlying cause of the anxiety and stress does not get addressed at the core if surface symptoms are simply alleviated. Therefore, if this plant is used to aid in the process of treatment, it may be advisable to utilize it as a complementary modality rather than a primary method of therapy.
Clinical Note
Within a practice setting, I would likely veer away from recommending such a supplement due to the potential for it becoming a crutch and thus preventing clients from delving into the real issues at hand. However, I am not sure I would spend a whole lot of time talking a client out of using such a product if he/she is set on using it, namely because it does not appear that ashwagandha presents significant risks or side effects. If a client chose to utilize this supplement as a symptom reliever, I would be sure to explain the research behind it, my reservations regarding its use, and ultimately the importance and necessity of the client making a personal and informed decision about it.


References
1.      WebMD. Ashwagandha. Available at: https://www.webmd.com/vitamins/ai/ingredientmono-953/ashwagandha. Accessibility verified August 4, 2018.
2.      Michigan Medicine: University of Michigan. Ashwagandha. Available at: https://www.uofmhealth.org/health-library/hn-2039005#hn-2039005-uses. Accessibility verified August 4, 2018.
3.      Duke JA. In: CRC Handbook of Medicinal Herbs. 2nd ed. Boca Raton, FL: CRC Press; 2002: 41-42.
4.      Sarris J, McIntyre E, Camfield DA. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013; 27(4): 301-19.
5.      Auddy B, Hazra J, Mitra A, Abedon B, Ghosal S. A standardized withania somnifera extract significantly reduces stress-related parameters in chronically stressed humans: a double-blind, randomized, placebo-controlled study. Journal of the American Nutraceutical Association. 2008; 11(1): 50-56.
6.      Andrade C, Aswath A, Chaturvedi SK, Srinivasa M, Raguram R. A double-blind, placebo-controlled, evaluation of the anxiolytic efficacy of an ethanolic extract of withania somnifera.  Indian Journal of Psychiatry. 2000; 42(3): 295-301.
7.      Cooley K, Szczurko O, Perri D, et al. Naturopathic care for anxiety: a randomized controlled trial ISRCTN78958974. PLoS ONE. 2009; 4(8): 1-10.
8.      Chandrasekhar K, Kapoor J, Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian Journal of Psychological Medicine. 2012; 34(3): 255-262.
9.      Khyati S, Anup T. A randomized double-blind placebo-controlled study of ashwagandha on generalized anxiety disorder. International Ayurvedic Medicine Journal. 2013; 1: 1–7.
10.   Pratte MA, Nanavati KB, Young V, Morley CP. An Alternative Treatment for Anxiety: A Systematic Review of Human Trial Results Reported for the Ayurvedic Herb Ashwagandha (withania somnifera). Journal of Alternative and Complementary Medicine. 2014; 20(12): 901-908. 

Monday, June 18, 2018

The Power of Movement



Image result for exerciseMovement...we've all heard about it's benefits. There's the current craze about the detriments of a sedentary lifestyle. In fact, a term has even been coined to describe this problem - "Sitting Disease".
I don't think there is any doubt or debate about this topic. With that idea established, however, we can probably all attest to the fact that knowing something and doing something are oftentimes mutually exclusive! I know that for me, I am good about doing minimal exercise daily. By that I mean, I have no problem taking my 20-30 minute brisk walk every day but I struggle much more with adding on to that minimal amount of exercise. In reality, strength training is equally important, especially as we age. If we don't consistently tone those muscles and work to strengthen them as we age, we gradually lose more muscle mass and have the tendency to become flabby and saggy! I don't know about you but that is something I never want to be and am determined never to allow in my own body! And of course, that takes consistency.

So it comes as no surprise to you that an active lifestyle is more beneficial, right? We could take it a step further replace the word "movement" with "exercise" and agree that the act of intentional movement by way of actual exercise is even better. Clearly there is a difference between being up and moving in your daily life and engaging in an exercise routine.

Now, you may get the idea that this post is all about the benefits of exercise in regard to weight loss or general toning and strengthening and though I have mentioned those aspects and believe they are vitally important to a healthy lifestyle, that's not why I am writing this post. On the contrary, I want to provide another reason to get exercising.

For the remainder of this article, I want to speak specifically to those suffering from Rheumatoid Arthritis (RA). Along with a number of diet and lifestyle changes, people who struggle with consistent joint pain, can benefit significantly from consistent exercise.
In a study of 220 patients with RA, subjects were divided into a class exercise group, a home exercise group and a control group. Subjects were measured at base line and subsequently at six and 12-week marks. Results displayed that in the class exercise group, grip strength, walk time and fatigue greatly improved. Further, overall symptoms of pain and depression were all positively affected in the class exercise group. Though some improvements were made in the home exercise group, they were not as significant in the class exercise group, despite the similarity of exercises completed, possibly due to the differing levels of intensity. Researchers concluded that exercise was a positive influence on RA symptoms.

A literature review looked at the benefits of exercise for RA patients and also found a positive level of effect. Authors deduced that exercise in general showed a clear and proven method of treatment that provided an improvement in overall function for RA patients. An additional meta-analysis and literature review of studies looked at the effect of cardiorespiratory aerobic exercise for RA patients in regard to quality of life, function and clinical and radiologic outcomes. Collective results showed that cardiorespiratory aerobic exercise proved to be a safe method of treatment, providing improvement in some of the most important outcome measures for RA.

Another meta-analysis examined the efficacy of resistance exercises in RA patients. Following the study of a total of 10 randomized, controlled trials with 547 patients, authors concluded that not only was resistance exercise in RA patients safe, but it also showed improvement in most outcomes and was statistically significant as well as possibly clinically significant for the outcome of RA disability measures. Further, subgroup analysis also revealed a trend towards increased efficacy in programs with high-intensity resistance exercise.


So, not only does exercise provide positive benefit for the general population, but it significantly improves the symptoms of a disease typically treated with pharmaceutical options. Whether you have RA or not, the power of movement is essential for an optimal lifestyle.



Monday, June 4, 2018

Hand Grip Strength as a Predictor of Health

I was recently asked if hand grip strength is a predictor of overall health outcome and decided this would be a great topic to address here.


Image result for hand gripThis concept makes sense from the standpoint of looking at muscle mass and body strength - we know that physical fitness does has something to do with health. However, muscle strength alone is not sufficient for a picture of optimal health. So, what does the research say?

A study of 4,654 participants in the UK was performed to determine the association between hand grip strength and cardiac structure and function for an adult population in the United Kingdom. Results showed that hand grip strength was related to cardiovascular magnetic resonance based measures of cardiac structure and function which in turn have shown to be predictive of less cardiac hypertrophy (an abnormal enlargement or thickening of the heart muscle) or cardiac remodeling (alterations in the size, shape, structure and function of the heart). Furthermore, these factors have been shown to be negatively associated with the incidence of cardiovascular disease, implying a relationship between hand grip strength and overall cardiac health. 
In a 25-year prospective cohort study (Honolulu Heart Program) Japanese-American men living in Oahu, Hawaii were studied in regard to hand grip strength and functional limitations and disability. Among healthy men aged 45-68 years old, results showed that hand grip strength was uniquely predictive of both functional limitations and disability when re-measured 25 years later. Researchers concluded that the maintenance of good muscle strength in midlife may create a protective effect against disability of old age, in large part by creating a greater safety margin and threshold of disability. 


An additional study examined 2,987  59-73 year old men and women to determine the possible connection between hand grip strength and health-related quality of life. Researchers concluded that lower grip strength was associated with negative outcomes in regard to reduced health related quality of life. Results suggested that low hand grip strength may present a link between sarcopenia (loss of muscle mass due to the natural aging process) and generalized frailty. Researchers stated that improvement of muscle mass and strength prior to the onset of chronic disorders would behoove the population and possibly prevent low health related quality of life measures. 



One study  looked at the association between grip strength and cardiovascular, respiratory and cancer outcomes in addition to all-cause mortality. This prospective cohort study of half a million UK participants showed a strong connection between grip strength and all cause mortality as well as mortality specifically from cardiovascular, respiratory, chronic obstructive pulmonary and cancer diseases. Researchers suggested that adding hand grip strength as a regular screening tool for health may be warranted.

Though it appears that hand grip strength may be a moderate predictor of health, there is far more involved in health outcomes than one screening tool or health measure. Therefore, it would behoove all of us to take into consideration all components of diet and lifestyle and stay away from relying on one test to measure overall health. Maintaining a pattern of dietary excellence, exercising regularly (5-6 times a week), for appropriate durations (45-60 minutes),  with adequate intensity, and staying hydrated will round out the approach of overall health a little more and present far greater results. 

Thursday, April 19, 2018

Pause...Update on Healthy on Purpose

Image result for pause
It has been a crazy long time since I posted here. Due to a number of events over the past few months, this season has been riddled with much outside my control - thus the delinquency in keeping up with posts and such. In addition, I have been blessed beyond comprehension with the growth of my practice (more on that later!) and my schedule has been full to the brim. However, the summer months are approaching and my schedule will have significantly more margin available. So, I apologize for the lack of information posted here, thank you for your patience as I have pressed pause and look forward to providing new information very soon! Stay tuned:-)