Fibromyalgia is a common and very complex condition which is characterized by chronic and widespread musculoskeletal pain, fatigue, sleep disturbances, and physical and psychological impairment.

Before about 10 years ago, patients who presented with these symptoms with told that they were depressed and should take a SSRI drug. These patients realized it was not depression, but they were told it was all in their mind. Within the last years the American College of Rheumatology has finally acknowledged this diagnosisand even given it an ICD-9 code.

In my office we see and treat many patients with this fibromyalgia. We usually use an interdisciplinary approach to helping them. We give the patients anti-inflammatory natural supplements as well as change them to  an anti-inflammatory diet. We also give them support for their adrenals and other stress organs, as well as liver support. In addition, the patients will get acupuncture and bodywork. Bodywork is especially important because often these patients have poor posture and "backwards breathing" and need to learn how to stand and walk sit and breathe in a correct way.

Now I am delighted to see a randomized trial of Tai Chi for fibromyalgia being published in the prestigious New England Journal of Medicine. For those of my readers who do not know, Tai Chi is a mind-body practice which began in China as a martial art. It includes meditation along with slow, gentle, graceful movements as well as deep breathing and relaxation. The idea of it is to move the body's life force called "Chi" throughout the body. The beauty of it is that integrates physical psychosocial, emotional, spiritual and behavioral components. It was thought that because of its mind and body attributes that tai chi would be especially well-suited to the treatment of fibromyalgia.
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All of my pregnant patients take a prenatal vitamin based on what would be best for the developing fetus. I have even found a prenatal vitamin that I like so much that I put my own private  label on it.

Now a new study published in the New England Journal of Medicine has  been published showing the importance of vitamin A and its relationship to lung development in the womb.

In this study, that was led by Wiliam Checkley, M.D., over 1600 children in Nepal were evaluated. Some of the mothers were given vitamin A pills during pregnancy and others were given placebo. An additional set of women was given beta-carotene which is a derivative of vitamin A.
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All pregnant women are given a prenatal vitamin by their obstetrician. The implication is that what is in the prenatal is all the extra vitamins that a pregnant mother needs for herself and her fetus.

Recently after an enormous amount of data in the medical literature many prescription prenatal vitamins have start to add an essential fatty acid capsule that is necessary for brain development of the fetus in the uterus.

Integrative medicine doctors have been prescribing this essential fatty acid known as DHA for over 20 years. The information has been in the medical literature but not that literature that is commonly read by obstetricians. More and more studies have shown that DHA during pregnancy and in the first four years of a child's life are necessary to optimize the child's neurological and brain development.

There are other nutrients that the medical literature shows that are essential for pregnancy, and one that has been overlooked by all of the prescription prenatal vitamins that I have seen, is called CHOLINE.

Choline is an essential nutrient and it is usually considered part of the vitamin B complex. It is found in the fat that makes up cell membranes and in certain neurotransmitters. Choline has been found to be essential for the normal functioning of all cells, liver metabolism and the transportation of nutrients throughout the body. Choline can be produced within the body but the amount the body makes is often not sufficient to meet the individuals needs. Therefore choline must be consumed in the diet. Recent research has shown that only 10% or less of older children, men, women, and pregnant women in America are getting sufficient levels of choline on a daily basis.

High amounts of choline is found in foods such as eggs, chicken liver, beef liver, beef steak, cod, broccoli, peanut butter, and milk. I am happy to see that because choline is especially high in egg yokes, the Egg Industry has created a website that talks about choline.

In a pregnant woman choline works with folic acid to help promote brain and memory development in growing fetuses and newborn infants.
Now a new study has been published that shows in mice that a diet low in choline and vitamin B2, during pregnancy influenced the development of the fetus' heart. Specifically the mice that were born to choline deficient mothers had more heart defects, which were specifically ventricular septal defects. The vitamin B2 deficient mothers gave birth to  late embryos and smaller embryos. In addition, vitamin B2 deficiency resulted in decreased thickness of the offsprings' left ventricle in the heart.

The conclusion of the authors of this article were: "Low dietary choline and riboflavin affect embryonic growth and cardiac development in mice. Adequate choline and riboflavin may also play a role in the prevention of these pregnancy complications in women."

Given the increasing preponderance of evidence that choline is essential during pregnancy I have been using a specific prenatal vitamin that is fortified with choline. I believe that choline is the next nutrient that will be found to be essential for all pregnancies. I can only guess how many years it will be until the prescription prenatal vitamins will contain this nutrient. But I am happy to be using one that does contain this nutrient for all my pregnant patients. I like it so much that I have begun to private label it under my name.

Does your prenatal or your family's prenatal's include choline or are you making and sure enough that you are eating enough of the choline containing foods to get enough for the fetus? Let me know if you think I should make my Prenatal vitamin available on my website for the public?

REFERENCE

Other resources and articles:

Egg Nutrition Center

Choline: Critical Role During Fetal Development and Dietary Requirements in Adults

USDA Database for the Choline Content
of Common Foods

 

Most people believe that acupuncture is just for pain control. In fact it is an active medical modality which I use to treat almost all medical problems.  Now a new study shows that acupuncture can help people with heart disease.

The recent study by Kristin AV and others, has recently been published in the medical journal Heart.

In this specific study they looked at congestive heart failure. This is a condition where the heart, due to illness is unable to pump sufficient blood to the rest of the body. It can vary from very mild, to the extreme that a person is unable to walk without oxygen. 4.8 million Americans have this condition. This includes 10% of people over the age of 70.

In this study the authors took 17 patients who were stable with congestive heart failure. All of them were already receiving an optimized medication program for  their heart failure when they entered the study.

The study is all the more impressive because they did use a control group. One group of patients got real acupuncture in the other group received "sham" acupuncture.

After the series of acupuncture treatments, the group that received the real acupuncture significantly increased their ability to walk with less symptoms,. In addition in this group, they found a significant improvement in their "recovery" in regards to their ability to breathe after the exercise.

Furthermore heart rate variability which is a sign of the health of the heart increased after the real acupuncture but actually decreased after the "sham" acupuncture

In addition the "general health" score and "body pain" score improved after the real acupuncture.

In a press statement the research group noted that heart failure is recognized to be much more complex than had previously been assumed. Specifically it involves an imbalance in the autonomic nervous system, as well as in various neurotransmitters.

In a press release the authors were quoted as saying "This is precisely where acupuncture may intervene, by bringing these processes back into balance — it influences the autonomic sympathetic nervous system (excitation), boosts the parasympathetic nervous system (relaxation), and also has an anti-inflammatory affect,"

Furthermore, Dr.Arnt Kristen, one of the authors of the study stated "The blood level of a certain messenger, tumor necrosis factor alpha (TNF alpha) actually drops after the real acupuncture treatment. Since TNF alpha leads to a reduction of muscle mass and muscle strength among other things, this would explain the positive effect (of acupuncture) on skeletal muscle function"

I've been using acupuncture in my practice on a regular basis for the last 30 years. I've seen remarkable results in almost every medical condition with acupuncture over and over again. It is wonderful that these types of studies are now coming out that objectively show the benefits of acupuncture for much more than just pain control. This will encourage conventional doctors to begin to be open to the use of acupuncture in congestive heart failure.

Let me know — do you have loved ones who have congestive heart failure? Have they tried acupuncture as an adjunct to their medications? I look forward to hearing from you.

REFERENCE