The Safe Chemicals Act

 Legislative Issue: The Safe Chemicals Act of 2011

Sarah Piestrup, Graceland University

NURS 6330-1

In 1976 the Toxic Substances Control Act (TSCA) was passed giving the United States Environmental Protection Agency (EPA) the authority to require “reporting, record-keeping and testing” of chemical substances and/or mixtures (EPA, 2011). According to the S. 847, the current bill attempting to update this 35 year old legislation only 200 of the 80,000 new chemicals produced and used in the United States have been tested to date and 5 chemicals have been regulated under this law (United States Senate Committee on Environment and Public Works [EPW], 2012).  The history of TSCA includes incinerator approvals to rapidly remove PCBs (polychlorinated biphenyls) in 1981, rules to test for asbestos in schools in 1982, asbestos hazard emergency response act in 1986 and the indoor radon abatement act of 1988 (EPA, 2011).  Then the list stops.  The ANA gives an overview of how chemicals are affecting the US population with cancer, reproductive disorders, developmental disorders and asthma linked to a long lists of chemicals.  These diseases affect 133 million people in the US, almost half the US population, with 70% of deaths and 75% of US healthcare costs included (ANA, 2011). 

The list of potential harm, shown injury and proven metabolic disruption is almost endless.  This does not mean we should turn our heads and ignore the chemicals that are literally killing us, because the total load of what we are asking our bodies to deal with with can still be reduced.  In 2002 a husband was arrested for trying to kill his wife because the warnings issued by the EPA and wood manufacturers failed to protect her from high levels of arsenic she absorbed while building a cabin with him (Liptak, 2002).  The levels were so high authorities were convinced the poisoning was intentional until the husband was tested.  To spite having no symptoms, he had higher levels of arsenic in his blood than his wife.  How many people are walking around filled with xenobiotic substances that are affecting their health without any awareness of that effect?  What will we find when we start looking more closely at the interrelation of these compounds on our varied genetic make ups and our total body burdens? 

Atrazine, a pesticide banned in the European Union and clearly linked to endocrine disruption and untold potential harm to humans and animals was found in 80% of the public drinking water samples taken in 2007-2008 and has been directly linked to reproductive harm and mammary tumors in animals (Natural Resources Defense Council, 2009).  The EPA reports that this damage is not expected in humans based on minimal research mostly conducted for Syngenta, the European manufacturer who also happens to own Astra Zeneca, a company that makes billions of dollars treating breast tumors with drugs like tamoxifen (EPA, 2011).  Persistent organic pollutants are literally everywhere, making it all the way to an Inuit woman’s breast milk (Rountree, 2010).  Known neurotoxic, immunotoxic and genotoxic metals like lead and mercury are still prevalent and are continually accidentally ingested and purposefully placed into humans by medical professionals (Rountree, 2010).  The National Adipose Tissue Survey, which was stopped in 1986 due to budget cuts, uncovered a long list of xenobiotic compounds found in the adipose tissue of Americans in 1982 including styrene, dioxin and other toxic xenobiotics found in 100% of the samples taken (Rountree, 2010).  Now, non-profit agencies like The Environmental Working Group (EWG) are picking up the slack with small sample size studies showing that our total body burden includes 171 chemicals and 53 carcinogens in the average sample taken in one study, and 232 toxic chemicals found in the cord blood of minority infants in another (EWG, 2011).  To say that this 1976 legislation needs to be updated may be the largest health related policy understatement of all time. 

In April of 2011 Frank Lautenberg, a democratic Senator from New Jersey who recently underwent chemotherapy treatment for cancer, sponsored S. 847, the Safe Chemicals Act of 2011 (govtrack.us, 2012; EPW, 2012).  The bill then entered the first stage of the legislative process and was referred to the Senate Committee on Environment and Public Works which includes Senator Barbara Boxer, a democrat from California, Senator James Inhofe, a republican from Oklahoma, Senator Lamar Alexander, a republican from Tennessee and senator John Barrasso, a republican from Wyoming (Govtrack.us, 2012).  The last action reported by Govtrack.us (2012) was for November 17, 2011 when a hearing was held with the Committee on Environmental and Public Works and the Subcommittee on Superfund, Toxics and Environmental Health.  This subcommittee consists of Democrats; Frank R. Lautenberg (Chairman), Max Baucus, Thomas R. Carper, Jeff Merkley and Kirsten Gillibrand; and Republicans Mike Crapo (Ranking Member), Lamar Alexander, Mike Johanns, and John Boozman (EPW, 2012). 

I viewed this hearing in an archived webcast.   Senator Lautenberg presented the bill stating that the statistics from the centers for disease control identified 212 industrial chemicals including 6 carcinogens “coursing through American’s bodies.”  He mentioned Lisa Jackson, an EPA representative, who recently testified to the senate that the EPA lacks the tools it needs to regulate high-risk chemicals.  Senator Lautenberg showed that the 35-year-old TSCA is considered a high-risk area of law that is harmful to the health of citizens as well as the businesses involved in the chemical industry.  Many experts were heard including the director of the Department of Ecology in the State of Washington, Ted Strudevant, who stated that they have no means to understand how to save or protect the highly polluted estuary of the Puget Sound on the coast of my beautiful state.  Charlotte Brody, a Registered Nurse, and director of Chemicals, Public Health and Green Chemistry for the Blue Green Alliance made the point that if she practiced nursing like she did when she first started, around the same time TSCA was passed, she would be in prison for gross negligence and malpractice because of what we have learned about human disease, including chemicals, since that time.  She used clear striking examples like Agent Orange, which was originally thought to only cause a simple skin rash.  The American Chemical Council representative spoke quickly and cautiously stating that they did not approve of this bill but supported the modernization of TSCA.  Lawyers supported corporations by presenting the fact that the S. 847 would not properly protect secrete formulas like coke, post it notes and others.  The meeting ended in debate and accusations that the chemical industry has blocked every form of legislation and the chemical industry response that they wanted change but had not yet seen a compromise. 

I started by sending an automated email to my Senators through a form on the American Nurses Association site where I was able to add in my personal message (ANA, 2011).  I did not hear back after a few days, so looked into the details of where the bill was, making sure I was contacting the correct level of government and looking into the latest actions so I could make an educated statement.  I called both offices and spoke to a representative who was easily reached on a Tuesday morning in both cases.  I received similar standard responses that neither Senator Patty Murray nor Senator Maria Cantwell of Washington State had a position on the issue.  This shocked me.  It’s not like this has not been a prevalent and important issue for the last 35 years and even if the bill has not yet been formally introduced to them I expected at least a statement on the issue in general but to spite asking further questions of the representatives in hopes to get some sort of opinion I was unable to get even a clue as to how my Senators feel about the toxic chemical issue, or any information about where the bill stood to date.  I had looked up the status via govtrack.us but I would have liked to get a more current and official update from my Senators, which did not happen so I made a recorded statement urging them to support this bill.  I eventually received form emails that addressed the category of issue, thanked me for my input, and stated that my opinion would be considered without anything more specific.  I shared the form the ANA created online in multiple professional and personal groups such as “Acupuncturists on Facebook” and “Acupuncture” that I am a part of on LinkedIn, Twitter, Facebook, and Google Plus.  I received minimal feedback so it is hard to tell if this made much of an impact.

            After searching for weeks for a current relevant issue, tracking down that issue through my legislators and the internet, and doing my best to make an impact, I can see that a more precise course of action is in order.  After watching the actual Senate sub-committee meeting, I can see that there are specific people that can be lobbied and contacted that have a stake and a say in what will happen next in the process of reforming TSCA.  Because taking part on an individual level can be like a drop of water in an ocean, it seems linking with organizations like the Environmental Working Group, the American Nurses Association and so on could be quite helpful.  Updates on the current status of the bill as well as the issue are things that need to be constantly monitored and researched and summarized by educated professionals like nurses, and I could send a simple letter with references to help those in charge, or seek a position to take part from the inside of these organizations.  Given that the bill is still in committee it seems that addressing the committee members directly would be a more well received and currently effective process.  It would be beneficial for organizations like the ANA to have this type of information on their site, and a simple referenced email or letter could encourage this.  I could make a blog or web page myself that includes a govtrack.us widget that offers real time updates and links to sites like http://epw.senate.gov/ where people can watch the bill being discussed via a webcast to gain further understanding like I have.  This could be presented on social media in a way that is more easily accessible and actionable so people can contact their senator, and those constituents of the senators currently and directly involved could be targeted to put pressure most directly where it is needed most. 

I don’t think there is any lack of awareness in the chemical industry, but the defiance to health is beyond what should be tolerated so campaigns could start against those blocking bills such as this to build consumer pressure against the companies directly causing harm to the citizens which would also help save lives as people would be simultaneously learning and avoiding what chemicals cause them harm.  This is another place where organizations like the Environmental Working Group, National Resources Defense Fund, American Nurses Association or any other environmental or health related group or organization could be powerful collaborators. 

            I felt like I was ready for political action before this assignment.  Now I feel like my perception of the system has been dimmed by seeing how slowly action is being taken on such a critical issue that no one argues should have been updated already.  Similar bills were introduced 2 years prior to this one with similar discussions.  One bill was produced by the Chemistry Council that did not meet outside standards for safety.  Towards the end of the subcommittee meeting, arguments between Senators and the chemical industry ensued about how reform of TSCA is not moving forward fast enough (EPW, 2012).  I saw personally the professionals in charge of the issue not being able to come to common ground or even communicate clearly with each other about why they are not moving forward as Senators questioned Chemical executives about their true intentions.  I have taken action on bills that were further along in the legislative process on a regular basis but I had not had an experience where I tracked down the details to this level on a bill that had not yet reached a stage of action. 

            While I was shocked by the lack of information I got from my representatives, I was inspired by people and organizations doing their best to promote such important change.  If a nurse like Charlotte Brody can make clear powerful statements to a Senate Committee through an organization that represents multiple environmental agencies, and a non-profit group like the Environmental Working Group can produce studies that are cited in legislation like S. 847 and make it to massive populations of the affected citizens than we can all make a difference.  I am not encouraged by learning that to spite huge amounts of evidence and massive efforts by the legislature, citizens and groups, that the chemical industry’s lack of flexibility to comply with what outsiders think needs to be done to protect the citizens of the United States has succeeded in preventing any legislation for 35 years.  It was clear from the subcommittee meeting that this is the problem.  I am not at all convinced that my phone calls or any amount of pressure on my senators will make a difference, but I don’t think we should stop trying to get them to have a position on such an important issue that is presented year after year in their arena.

References

American Nurses Association.  (2011).  The safe chemicals act of 2011.  Retrieved from https://secure3.convio.net/ana/site/Advocacy?cmd=display&page=UserAction&id=343&ct=1

United States Senate Committee on Environment and Public Works.  (2012).  Subcommittees: Superfund, Toxins and Environmental Health.  Retrieved from http://epw.senate.gov/public/index.cfm?FuseAction=Subcommittees.Subcommittee&Subcommittee_id=01dbc44f-664e-493f-a883-13b89b0f5cc3

Govtrack.us.  (2012).  S.847: Safe chemicals act of 2011.  Retrieved from http://www.govtrack.us/congress/bill.xpd?bill=s112-847

Liptak, A.  (2002, June 26).  The poison is arsenic, and the suspect is wood.  The New York Times.  Retrieved from http://www.nytimes.com/2002/06/26/us/the-poison-is-arsenic-and-the-suspect-wood.html?pagewanted=all&src=pm

Natural Resources Defense Council.  (2009).  Atrazine: Poisoning the well.  Retrieved from http://www.nrdc.org/health/atrazine/

Rountree, B. (2010, October).  Toxins and biotransformation part I genetic and environmental determinants: Toxins, toxicity and biotransformation.  In David S. Jones (Chair), Applying functional medicine in clinical practice.  Symposium conducted at the meeting of The Institute for Functional Medicine, Portland, OR. 

The Environmental Working Group.  (2011).  The environment: Body burden.  Retrieved from http://www.ewg.org/featured/15

United States Environmental Protection Agency.  (2011).  Summary of the Toxic Substances Control Act.  Retrieved from http://www.epa.gov/lawsregs/laws/tsca.html

United States Environmental Protection Agency.  (2011).  Atrazine Updates.  Retrieved from http://www.epa.gov/opp00001/reregistration/atrazine/atrazine_update.htm#cancer

Resolving stress

We all have to deal with some level of stress.  Stress can be beneficial and sometimes saves your life, especially if you have to run from a tiger (or other similar situation).  As your amazing body shunts the blood to vital areas so you can flee, or fight or get everything done that you have to do that day, you have extra power to move and act.  However, when we are using our reserves because we have created a pattern of unnecessary stress due to our reactions to daily life, we are literally burning up our life force faster than we can build it back up, just like burning our candle at both ends, or even throwing the candle in the fire.  These patterns can be hard to break once we have become accustom to them, it is hard to see how we could exist any other way.  The problem is that when you are using your blood in your muscles and not to digest and assimilate your food and nutrients, or running instead of restoring your muscles and tendons, your body will literally break down leading to increased injury, illness and a shorter life.

So how do we change these patterns and find balance?  Starting with simple routine can be quite profound.  There are cycles of hormones, like cortisol, going on in your body signaled by light, food, and time.  If you work with these patterns transitions into balance can seem effortless.  

The following recommendations are based on extensive research on biomollecular physiology and have been shown to have measurable effects on health:

•  Keep patterns of waking, sleeping and eating that are in line with the light of day.

  

•  Eat 3 healthy meals a day that include 7-9 servings of a variety of fruit and vegetables in a variety of colors.

•  Have breakfast between 7-9, within 2 hours of waking.  

•  Include protein and fat, and avoid all processed carbohydrates (flour, sugar, processed oatmeal, or any bread or pastries) especially in the morning.  

•  Have a snack (not refined carbs) around 11 am, and 2 pm.

•  Have dinner before 7 pm and 2 hours before bedtime.

• Practice finding peace in your heart and mind through meditation, prayer, breathing exercises or anything that works for you on a daily basis.  Coherence is a term used to describe the heart and brain connection that can be measured by proven tools such as an EmWave2® so you can evaluate whatever method you choose for effectiveness on your own or in a class.

•  Adaptogens like ginseng, rhodiola and others can help put a cap on the stress response and nutrients like L-Tyrosine, theanine and others can help support the neurotransmitters and hormones that maintain stability in the body and brain.  Always consult your practitioner to get a personalized recommendation plan prior to purchasing these types of supplements as type and timing should be individualized for optimum benefit and safety.

Dietary considerations are important, so here is some more information about the basics in relation to stress:

Every bite of food affects our entire body, it's chemistry and neurons.  Sugar, including processed carbohydrates like bread, quickly raise your glucose level.  Your body has to process that glucose to maintain balance so it quickly absorbs the energy, uses what it can and stores what it can't use now as fat, often flooding the body with insulin to help with the process.  If we eat a diet that often raises our blood sugar quickly (high glycemic index) this system can be overwhelmed leading to insulin resistance, inflammation and a vast array of diseases, not just diabetes.

Fats have gotten a bad name because most of the fats we eat have been destroyed with processing, and chemicals.  The science that originally showed fat was causing disease did not take sugar into account as a variable.  We have just begun to explore the incredible importance and complexity of this vital category of nutrition.  Good fats digest slowly helping us maintain our stable blood sugar preventing inflammation and keeping our mind, body and spirit nourished and stable.  Fats make our cell walls, our brain (which is 60% fat), and our hormones and can be slowly broken down or easily excreted if the energy is not needed, helping us to loose weight.  The idea that calories are calories is antiquated as we clearly understand now that not all food acts the same in the body and different forms of calories (even from the same food, like fruit juice vs. fruit) act completely differently in our body.  Fats like coconut oil are even being used successfully for weight loss, and being prescribed by all sorts of practitioners, allopathic and alternative to prevent and treat disease.  Omega 3's have been shown to help with heart problems, inflammation, ear infections, allergies, and more (references will be added at a later date, please contact me if you have any questions about the research to support any part of this post).

Protein is another crucial building block of our bodies, muscles, immunity and more.  It also stabilizes blood sugar and can be used to help maintain and rebuild our bodies.  Too much protein fat or carbs can cause imbalance.

Not having essential nutrients that we get from eating a wide variety of vegetables can create unnecessary stress on the body.  I recommend a basic nutrient supplement along with a healthy diet for everyone because to ensure adequate nutrient and co-factor intake.  Co factors such as zinc or magnesium are crucial for many processes in the body that have to do with maintaining balance and preventing and recovering from stress.  Different people will benefit from different 

The Need for Relevant Acupuncture Research

A paper written for Graceland University 

by Sarah Piestrup EAMP, Dipl OM, RN

Some promising research is being conducted that sheds light on a few of the mechanisms behind the effects of acupuncture. These include adenosine, endomorphin-1, beta endorphin, encephalin, and serotonin release and fMRI changes (Cabyoglu, Ergene, & Tan, 2006; Fang, et al., 2004; Goldman, et al., 2010; Hui, et al., 2005). There is even theory that shows a plausible explanation for the physical existence of acupuncture channels just under the skin and between muscles (Silberstein, 2009). However, most research looking at acupuncture for allopathic diagnoses in humans is simply irrelevant.

Because acupuncture is based on an ancient Asian conceptual framework it is difficult to transfer meaning into modern allopathic scientific understanding. Studies that look at “Traditional Chinese Medicine for treatment of fibromyalgia” are as irrelevant as a study looking at “Allopathic medicine for heart fire.” With detailed study design it can be done, and scientific studies have shown some benefits of acupuncture as compared to placebo (Cao, Liu & Lewith, 2010). However, because fibromyalgia does not have one equivalent diagnosis in Traditional East Asian Medicine (TEAM), the meaning of this word is irrelevant to what points or modalities are chosen to treat an individual patient. In other words, the individual patient would normally be diagnosed with a TEAM diagnosis that would be different for different patients with the allopathic diagnosis of fibromyalgia, and different treatments would be rendered based on that individual TEAM diagnosis. There are many ways to treat this one allopathic diagnosis based on the person’s underlying constitution, their specific symptoms and how they all relate to their specific lifestyle. Indeed, there are many different styles in the TEAM system that could be used, making conducting a controlled study very difficult.

Some levels of control, like consistency of treatment details, such as specific point use, would render the study irrelevant because they would remove the theoretical basis and diagnosis of acupuncture when used with placebo needling which is sure to stimulate a nearby point. In this type of case we are left with a study that is comparing bad acupuncture to bad acupuncture. It would be just as irrelevant as an allopathic study on an acupuncture diagnosis that has no relevance to modern terminology and no allopathic diagnostic equivalent.

Volker Scheid helped shed some light on some of the deeper aspects of this problem (such as a lack of consistency within the acupuncture community in regards to terminology and diagnoses) with his papers and research that scientifically examines the system of Chinese medicine. He illustrates how the terms used to describe patterns such as menopause are westernized in modern acupuncture schools and textbooks. These oversimplify the medicine and ignore the meaning of the time-tested system (Scheid, 2008). He also had a hand in research looking critically at this problem with a review of the literature on the treatment of menopause with TEAM (Scheid, et al., 2010). This type of refinement is crucial for TEAM to be critically analyzed with any relevance. It is useless to study it without a clear understanding of the basic diagnosis and terminology that define a medicine.

TEAM is the longest continually practiced literate medicine used consistently worldwide with the first known evidence of acupuncture on Otzi the Iceman; a 5,300 year old mummy found in Austria who had tattoos of acupuncture points used today for lumbar lordosis of which his spine showed evidence. This long history must not be lost to modern confusion because TEAM is a far too important and valuable system of medicine to loose.



References

Cabyoglu, M. T., Ergene, N. & Tan, U. (2006). The mechanism of acupuncture and clinical applications. International Journal of Neuroscience, 116, 115-125.

Cao, H., Liu J., & Lewith, G. T. (2010). Traditional Chinese Medicine for treatment of fibromyalgia: A systematic review of randomized controlled trials. Journal of Alternative and Complimentary Medicine, 16(4), 397-409.

Fang, J. L., Krings, T., Weidemann, J., Meister, I. G. & Thron, A. (2004). Functional MRI in healthy subjects during acupuncture: different effects of needle rotation in real and false acupoints. Neuroradiology, 46(5), 359-62.

Goldman, N., Chen, M., Fujita, T., Xu, Q., Peng, W., Liu, W., ... Nedergaard, M. (2010). Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature Neuroscience, 13, 883-888. Retrieved from http://www.nature.com/neuro/journal/v13/n7/full/nn.2562.html

Hui, K. K., Liu, J., Marina, O., Napadow, V., Haselgrove, C., Kwong, K. K., Kennedy, D. N., & Makris, N. (2005). The integrated response of the human cerbro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. Neuroimage, 27(3), 479-96.

Otzi the iceman. (2011). In Wikipedia. Retrieved from http://en.wikipedia.org/wiki/%C3%96tzi_the_Iceman

Scheid, V., Ward, T., Cha, W., Watanabe, K. & Liao, X. (2010). The treatment of menopausal symptoms by traditional East Asian medicines: Review and perspectives. Maturitas. doi: 10.1016/j.maturitas.2009.11.020

Silberstein, M. (2009). The cutaneous intrinsic visceral afferent nervous system: A new model for acupuncture analgesia. Journal of Theoretical Biology, 262(4), 637-642.

The Clinically Relevant Value of Meditation

A paper written for Graceland University
by Sarah Piestrup, RN, EAMP

Meditation is a cost effective and clinically proven tool that can benefit a myriad of health disorders. Aftanas and Golosheykin (2005) looked at electroencephalograms (EEGs) in a controlled environment to empirically show that meditators have more control over their reactions to stressful situations or “intensity of emotional arousal” (p. 894). According to the studies reviewed by Koopsen and Young (2009), meditation can provide physiological benefits such as a decrease in: oxygen consumption, blood lactate levels, cortisol levels, heart and respiratory rates, blood pressures, muscle tension, and pain and an increase in: skin resistance, alpha waves, and psychological benefits. These emotional and physiological effects have far reaching benefits to the health of a patient as well as the effectiveness of a health care provider if they too engage in conscious awareness.

Astin, Shapiro, Eisenberg, & Forys (2003) review a collection of cumulative clinical evidence that “lends strong support to the notion that medicine should indeed adopt a biopsychosocial rather than exclusively biologic-genetic model of health” (p. 141). They identify meta-analyses and randomized controlled trials that have shown mind-body medicine has effective benefits with: chronic low back pain, coronary artery disease, headache, insomnia, surgical procedure preparation, symptoms of cancer and its treatment, arthritis and urinary incontinence (Astin, et al., 2003). Grossman, Niemann, Schmidt, & Walach (2004) find that improvements in health are consistently seen in a variety of standardized mental health measures and measures of disability with mindfulness-based stress reduction. Other health parameters such as medical symptoms, sensory pain, physical impairment and functional quality of life estimates were also found to have benefits from mindfulness-based stress reduction (Grossman, et al., 2004).

Jung, et al. (2010) give us some clues about the background physiology of these positive effects. They looked at 67 subjects who regularly engaged in mind-body training vs. a control group of 57 healthy subjects and compared their plasma catecholamine (norepinephrine, epinephrine, and dopamine) levels as well as their positive and negative affect scores, and showed: lower stress, higher positive affect, and higher plasma dopamine levels in the meditation group.

A state of heart centered consciousness that can be achieved through meditation or even quick redirection of attention is contagious. A high state of “coherence” affects others in the room to also a achieve a high state of coherence (McCraty, Atkinson, Tomasino & Bradley, 2006). Coherence has been measured with reliable instruments and has shown health benefits in numerous studies over the past 20 years (McCraty, et al., 2006). Practitioners can have positive effects on their patients during a therapeutic encounter if they practice coherence (McCraty, et al., 2006). Nursing literature has examined similar phenomena under the term “presence” and researchers like Zyblock (2010) identify presence as having a sustained therapeutic effect. The Annals of Internal Medicine even has articles on healing skills for physicians that outline themes such as being open, listening, removing barriers and sharing authority (Churchill & Schenck, 2008).

Simple meditations can be easily taught by trained physicians and ancillary staff in a short amount of time and patients can be referred to a growing number of highly trained individuals who specialize in a variety of forms of mindful practices. With so many options and variations, all patients and providers should be able to find some form of mediation that works for them and implement them into daily practice.



References

Aftanas, L., Golosheykin, S. (2005). Impact of regular mediation practice on EEG activity at rest and during evoked negative emotions. International Journal of Neuroscience, 115: 893-909. doi: 10.1080/00207450590897969

Astin, J. A., Shapiro, S. L., Eisenberg, D. M. & Forys, K. L. (2003). Mind-body medicine: State of the science, implications for practice. Journal of the American Board of Family Practice, 16(2), 131-147.

Churchill, L. R. & Schenck, D. (2008). Healing skills for medical practice. Annals of Internal Medicine, 149, 720-724.

Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindful-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomic Research, 57, 35-43.

Jung, Y. H., Kang, D. H., Jang, J. H., Park, H. Y., Byun, M. S., Kwon, S. J., ... Kwon, J. S. (2010). The effects of mind-body training on stress reduction, positive affect, and plasma catecholamines. Neuroscience Letters, 479(2), 138-42.

Koopsen, C. & Young, C. (2009). Integrative health: A holistic approach for health professionals. Boston, MA: Jones and Bartlett Publishers.

McCraty, R., Atkinson, M., Tomasino, M. & Bradley, R. T. (2006). The coherent heart. Boulder Creek, CA: The Institute for HeartMath

Zyblock, D. M. (2010). Nursing presence in contemporary nursing practice. Nursing Forum, 45(2), 120-124.

A new view of statins fats and cholesterol

A quick look at some new compelling research on statins, fat and cholesterol : 
Cholesterol is not just pathogenic, in fact it is what our brains, and artery walls are made of.  In a review of 136,905 hospitalizations for CAD almost half had LDL levels less than 100, and more than half had HDL levels less than 40 with less than 10% greater or equal to 60. While the authors of this drug company funded study conclude this may mean that the goals may need to be lower for LDL, this could mean that LDL is less associated with CAD than was previously thought (Sachdeva, et. al., 2009).  A recent Cochrane review on statins for primary prevention notes: “evidence of selective reporting of outcomes, failure to report adverse events and inclusion of people with cardiovascular disease” (Taylor, et al., 2010).

It is also concluded that raising HDL is an important priority. In a critical reappraisal of the JUPITER trial which claimed benefit for statin drugs in primary prevention Lorgeril, et. al. (2011) present evidence that the results do not in fact support this conclusion and conclude that “troubling questions” were raised about the role of commercial sponsors. Side effects such as: mytosis and myalgia (from muscle pain fatigue and weakness to rhabdomyolysis) as well as mitochondrial effects have been identified which may affect the brain, heart and other organs that have similar mitochondrial mechanisms. Mitochondial defects predispose to adverse reactions on statins, and statins predispose to mitochondrial defects in all users and to a greater degree in vulnerable individuals (Golomb, et al., 2008).

Astrup, et al. (2010) found no clear benefit of replacing saturated fats with carbohydrates.  There was a benefit in replacing saturated fats with polyunsaturated fats.  The authors concluded that the effects of particular foods on cardiovascular disease can not be predicted only based on their saturated fat content because of the individual saturated fatty acids and other constituents in the food may have effects on cardiovascular disease.  A recent meta-analysis of prospective studies with 5-23 year follow up including a total of 347,747subjects that showed no significant evidence to conclude that dietary saturated fat was associated with coronary artery disease or cardiovascular disease (Siri-Tarino, Sun, Hu & Krauss, 2010). However, trans-fatty acids have specific atherogenic, inflammatory, and pro-thrombic effects (Stachoska, 2004; Mozaffarian, et al., 2004).

Many studies have shown higher lipid levels with an increased risk of coronary artery disease with diets high in added sugars and high refined carbohydrate intake (especially greater than 10% of calories) (Astrup, et al., 2010; Jakobsen, et al., 2010; Sieri, et al., 2010; Wesh, et al., 2010).

These are critical details to consider for individual people.  Educated, logical decisions about statin use and fat intake should include thought about what is right for the whole body and relate to actual health outcomes and not just biomarkers that are loosely related to disease in some people. 


Translation : There is clearly no reason to recommend a statin for primary care prevention.  The evidence that shows some benefit with statin use is on white men, but not women, under age 65 who have hyperlipidemia and could be related to statins anti-inflammatory effect rather than their lipid lowering capability (more to come on this aspect).  Your HDL cholesterol cleans up the extra cholesterol from your artery walls and is more consistently related to cardiovascular disease.  


It's not saturated fat that is the issue, it's destroyed fats and carbohydrates, so anything processed at high heat (including refined oils, or over heating an oil with a low flash point like olive, or old or even slightly heated highly unstable oils like flax, unrefined canola or walnut).  There is a short list on my website, and a link to a book on the subject if you would like even more details on fats.  Sugar and carbohydrates are stored as energy in your body as fat, while fat is used as energy.  So while fat has more calories per gram, it is absorbed more slowly so it helps keep your blood sugar stable and your stress response in check.  Refined carbohydrates lower your HDL or good cholesterol and increase your triglycerides and should be limited or avoided in general.  Even saturated animal fat has beneficial and necessary nutrients for you body.  That being said this means animals that ate their native diets such as grass, NOT GRAINS (even if they are "finished" on grain for the last 3 months of their life) like most of the meat you find at the store and even some called "grass fed" that are "finished."  Here are some resources to find healthy sources of animal protein and organic vegetables.  Never limit nutrient filled vegetables and fruits and eat for variety, of colors, of fats and of all fresh unprocessed foods ! 

References:

Astrup A., Dyerberg J., Elwood P., Hermansen K., Hu F. B., Jakobsen M. U., … Willett, W.  (2010). The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: Where does the evidence stand in 2010? The American Journal of Clinical Nutrition. Advance online publication. doi: 10.3945/ajcn.110.004622

Golomb, B. A., Evans, M. A. (2008). Statin adverse effects: A review of the literature and evidence for a mitochondrial mechanism. American Journal of Cardiovascular Drugs, 8(6), 373-418.

Jakobsen, M. U., Dethelfsen, C., Joensen, A. M., Stegger, J., Tjonneland, A., Schmidt, E. B., Overvad, K. (2010).  Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: Importance of the glycemic index.  American Journal of Clinical Nutrition, 91(6), 1764-1768.  doi 10.3945/​ajcn.2009.29099

Lorgeril, M., Salen, P., Abramson, J., Dodin, S., Hamazaki, T., Kostucki, W., ... Rabaeus, M. (2011).  Cholesterol lowering, cardiovascular diseases, and the rouvastatin-JUPITER controversy: A critical reappraisal.  Archives of Internal Medicine, 170(12), 1032-1036.

Mozaffarian, D., Pischon, T., Hankinson, S. E., Rifai, N., Joshipura, K., Willett, W., & Rimm, E. B. (2004). Dietary intake of trans fatty acids and systemic inflammation in women. The American Journal of Clinical Nutrion,79(4), 606-12

Sieri, S. Krogh, V., Berrino, F., Evangelista, A., Agnoli, C., Brighenti, F., … Panico, S. (2010).  Dietary glycemic load and index and risk of coronary heart disease in a large Italian cohort: The EPICOR study. Archives of Internal Medicine 170(7), 640-7.

Sachdeva, A., Cannon, C. P. , Deedwania, P. C., Labresh, K. A., Smith, S. C., Dai, D. ... Fonarow, G. C. (2009).  Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitilizations in Get with The Guidelines.  American Heart Journal, 157(1), 111-117.  

Stachowska, E., Dolegowaska, B., Chlubek, D., Wesolowska, T., Ciechanowski, K., Gutowski, P., … Turowski, R. (2004). Dietary trans fatty acids and composition of human atheromatous plaques. European Journal of Nutrition, 43, 313-318. doi: 10.1007/s00394-004-0479-x

Taylor, F., Ward, K., Moore, H. M. T., Burke, M., Davey Smith, G., Casas, J., & Shah, E.

(2011). Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systemic Reviews, 1. (accession No. 00075320-100000000-03785).

Welsh, J. A., Sharma, A., Abramson, J. L., Vaccarino, V., Gilespie, C., Vos, M. B. (2010).  Caloric sweetener consumption and dyslipidemia among US adults.  Journal of the American Medial Association, 303(15), 1490-1497.

Nutrition Influence on Estrogen Metabolism

Link to original Hall (2001) article.  

Is acupuncture more effective than placebo, and who should you trust?

I have been hearing some questioning lately, as some studies are being quoted on the radio and in the news and wanted to clarify a few things about the science behind acupuncture.  First of all, let me say that acupuncture is the oldest, professional, continually practiced, literate medicine that has been used world wide.  It is well over 2,000 years old possibly older than 5,200 years old and continues to thrive due to it's effectiveness.  There is more science behind acupuncture from China (that has been recorded for the last 2,000 years) than we will have for western medicine for a very long time.  In the United States, however, the science is often poor, limited and sometimes misleading due to the way acupuncture is studied using a western context that is not equatable to Traditional East Asian Medicine (which includes detailed acupuncture and herbal theory).

The placebo controlled acupuncture studies that are considered to be the highest level of evidence in modern medical science are designed to eliminate variables.  They often use the same points on every subject, given one diagnosis, and this is simply not how acupuncture is done. There are in-depth theories behind acupuncture, none of which equate with any western diagnosis.  So if a patient has fibromyalgia, (or even something as simple as low back or knee pain) there are a multitude of acupuncture diagnosis that may be associated with one western diagnosis, and every patient must be evaluated separately according to the Traditional East Asian Medicine diagnosis in order to effectively treat them with acupuncture.  Then, they use placebo needles, now this is where it just gets silly... have you ever seen a placebo massage study or a placebo surgery study?  Usually the answer is no.  There is no place on the body you can place a needle or even a "sham" needle (that is not fully inserted or just taped on) that does not stimulate the nervous system as an acupuncture needle would.  Don't get me wrong, we know that there is a difference in the effects of points used properly vs placebo, there have been many studies showing changes in the brain, chemicals released, heat changes, and electromagnetic changes associated with the proper acupuncture points.  This does not mean that a placebo needle is an effective way to study any more than a placebo massage would be.  Remember they are using a western diagnosis and one treatment for all the participants in most cases so they are comparing bad acupuncture to bad acupuncture and amazingly we still often get a 30% effective rate (average placebo effective rate is 20% or less) proving even bad acupuncture works !  It is also important to note that there are far more studies showing acupuncture's effectiveness for a myriad of diseases than there are studies showing it’s ineffectiveness.  Even the World Health Organization has long stood behind this long list of conditions effectively treated  with acupuncture.  Also, many of the poorly designed studies do not even meet the criteria for clinical relevance by even western medical standards. 

There are plenty of studies showing acupuncture's effectiveness beyond placebo that are well designed.  As for the most recently widely publicised study about knee pain that showed acupuncture was not more effective than placebo, the study was too short (3 months) and other similar studies over longer periods (6 months) do show effectiveness for knee pain, showing us that it takes time, which was no secrete, knee pain can be a more tenacious problem to treat, not to say I have not had patients walk out pain free after their first treatment for knee pain.

Before I go on I would like you to know that I am nothing but amazed by the value of standard western medical practice and I am currently devoting part of my time to becoming a Family Nurse Practitioner so I can use this valuable modern medicine that saves and prolongs lives.  However, when it comes to the actual science I have been astonished that; according to the text from my research class I took for my Nurse Practitioner degree Melnyk & Fineout (2005), an "alarming number" of health care providers do not utilize research in their daily practice and it takes an average of 17 years for new findings to reach standard medical practice.  Much is being done about this as we move toward evidence based practice, as we should.  Also, your doctors clinical and theoretical knowledge are vast and invaluable and should be respected and investigated with the utmost respect.  Not to say that you should do what you are told with out question.  Any good practitioner (if time permits) should be open to your questions and concerns and help to empower you about your health.  No one person will ever have all the answers, and the answers may not yet be known to mankind either, but we do know a lot about the human body, and that knowledge is more powerful when all aspects are clearly understood.  So trust your doctor, they have a lot of education behind them, but never stop questioning. 

Unfortunately, even your doctor may have been unknowingly mis-lead.  First, there is publication bias, where only positive studies are published readily and negative studies are held to the way side only to be discovered years later.  A recent blaring example of this is the drugs used to treat depression which when all the evidence was gathered and evaluated turned out to be just as effective as placebo in most cases unless there as a severe depression (minute number of cases for the total prescribed).  What is particularly alarming about this fact is that we do know that the side effects can cause suicide, worsening depression as the brain chemicals like serotonin are depleted by the drugs, and many other unnecessary uncomfortable effects (especially for children).  On the same issue of publication bias, I just wrote a detailed paper on statin drugs and dementia, and found an international meta-analysis that was not available on a pub-med search that showed the massive publication bias in this field (feel free to contact me for details).  Statins are much more likely to cause harm than good when it comes to long-term brain health, which would make sense because every cell in our brain and nervous system is made from cholesterol why would taking it away help?

Once again, before I go on I want to acknowledge that drugs save lives and that drug companies are responsible for the vast majority of modern medical research.  However, beyond publication bias there are new alarming facts being produced about the blatant lies coming from some drug company funded studies.  Avandia has been literally killing people and your doctor had no way of knowing this since a major study used to keep the drug on the market was falsified.  Now, PLEASE do NOT blame your doctor !  It's not their fault that they are given false information and mislead into believing they are helping.  It is, however, a good idea to ask about a treatments effective rate on health outcomes like death rates and not lab or test values.  In the case of type II diabetes, it turns out that lowering your blood sugar with drugs (many drugs including insulin were included) may also be causing more harm than good.  Treating the symptom like blood sugar, and not the root (insulin resistance in this case) is like taking the smoke alarm out of a burning building (thank you to Mark Hyman for the analogy).

We need more good direct science to base our health care on, and until then please make careful decisions and rely on what we do know with absolute certainty, your life style, including diet and exercise matter immensely and are often more important factors than what drug you are on.  Diet and exercise can alter your genes so you have no reason to blame things like your weight solely on genetics.  You can get to better health more readily with the time tested methods that may not be as easy as a pill but with all this information you should now know there is sometimes no other answer.  Of couse, the individual always matters and I mean the individual drug and the individual person.  Drugs do save lives but it may be less often than we would like and every one is different.  The FDA is currently trying to ban the chemo drug Avastin as it has been shown not to increase life when looked at broadly, this does not mean it has not saved individual lives but it does mean it is being over-prescribed to the wrong people.  Avastin was shown to change test results and x-rays for the positive but LiFe is what matters and you can have a nice x-ray and lab report but if you are dead in 3 months what does that matter?  We now know that the Epo drugs were probably hastening death in many chemo patients and they were handed out like water to cancer patients for many years while the drug companies that studied them made billions of dollars.  It is important to get new treatments out there as soon as possible but we must use caution and reason in doing so.

So, is acupuncture more effective than placebo?  Yes it is.  Its effects are subtly profound but it's safety is undeniable and its history shows us that it may be one of the safest effective treatments for many conditions that do not have any other option.  As for the western doctors (which will include me in a few years) you should trust your doctor, but know that you are the master of your health and no pill or quick fix can have the same benefit as prevention in the first place.  So please, take care and let me or your trusted provider know if you have any questions about how to best solve your heath problems !

References in links and

Melnyk, B. M. & Fineout-Overholt, E. (2005). Evidence-Based Practice.  Philadelphia, PA: Lippincott Williams & Wilkins.