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. 

1.      U.S. Food and Drug Administration. About dental amalgam fillings. Available at: Accessibility verified September 17, 2018.
2.      American Dental Association. Statement on dental amalgam. Available at: 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, 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.