Trauma and Injuries
Fiona Demel
WHIPLASH AS A PUBLIC HEALTH EPIDEMIC: A HARD ...
WHIPLASH AS A PUBLIC HEALTH EPIDEMIC: A HARD LOOK AT REAL DATA TO CALL IT WHAT IT IS
Neurology
Fiona Demel
Vertigo from the neck or inner ear ? The swivel ...
Vertigo from the neck or inner ear ? The swivel test
Neurology
Fiona Demel
ADOLESCENT ATHLETIC MIGRAINES AND FERRITIN
ADOLESCENT ATHLETIC MIGRAINES AND FERRITIN
Nutrition
Fiona Demel
VITAMIN D STACKING OVERLOAD
VITAMIN D STACKING OVERLOAD
Nutrition
Fiona Demel
Some light on the dark subject of eating ...
Some light on the dark subject of eating disorders

The long rap sheet and hidden sources of artificial sweeteners

A while back I blogged about MSG as a differential diagnosis to always consider in cases of mysterious headaches, since it can be an unrecognized trigger to episodic headaches, all the more difficult to pinpoint since MSG is frequently listed under different name in food labeling. Today I want to talk about the equivalent for chronic mysterious abdominal pain and bloating episodes: artificial sweeteners, in particular in the sugar alcohol family. They have become excessively common, inserting themselves in a multitude of foods, especially "healthy foods", and unbeknownst to a lot of people, creating havoc on the guts.

Artificial sweeteners come in a variety of forms. None of them good. The list of problems associated with artificial sweeteners and the negative research associated with them only continues to grow, unfortunately not always matched with popular publicity, much less personal practices of cutting them out altogether. If anything, the trend of popular perception goes in the other direction, with patients being increasingly lulled into thinking that those are benign food additives that cause no problem, and if anything help them maintain normal weight.

What prompted this blog entry was two patients back to back dealing with rather profound but episodic abdominal pain bloating and nausea, which had been extensively medically worked up but remained a mystery. In both instances, through a set of accidental circumstances, the culprit was found to be a sugar alcohol that was added to foods without the patient's awareness . In both instances, there was an accidental change of normal dietary pattern leading to the removal of the offending artificial sweetener, then the reintroduction, with matching resolution and recurrence of the symptoms that finally led to the correct problem identification.

Sugar Alcohols are particularly high on my hit list because of their prevalence and the problems that they cause. They are a form of very small carbohydrates that give a sweet taste to our tongue but cannot be used for energy production like regular sugar, and in many cases, cannot be absorbed (with a few notable exceptions like allulose) . A few of them occur in very very small amounts in nature, thus leading to the fallacy that because they are "natural" we can use them in large synthetic amounts. However, the amounts found in actual exposure to things like fruit has a vastly different metabolic effect from the concentrated synthetic variants. Among other things, they cause a significant disruption of our gut microbiome, and tend to ferment in our G.I. causing pain, bloating, flush diarrhea, and essential nutrient malabsorption. In addition, they can be associated with liver dysfunction, metabolic dysfunction, and increasing insulin resistance.

What makes them all the more pernicious is that they are often added to foods that patients perceive as healthy alternatives, such as protein bars, and often in places where you do not suspect them, such as protein powders, gum, powdered beverages, electrolyte powders, etc. Even if the amount in each source may not be all that high, the combination of 2 or 3 sources during the day can be enough to tip someone into full-blown abdominal pain, unexplained.

Some of those sugar alcohols include xylitol, sucralose, erythritol, mannitol, and allulose. Should try to avoid all of them whenever possible, and remember that small amounts of naturally occurring sugar have been around for several millennia and our body is tolerant and adapted to them, while some of these newer synthetic chemicals are not. In this case, there is no shortcut to eating smart and simply healthy. For more information, please refer to this excellent blog entry from the Kresser Institute

https://chriskresser.com/the-unbiased-truth-about-artificial-sweeteners/

CAN NECK PROBLEMS CAUSE SWALLOWING DIFFICULTIES ?

A short minute of video of explanation probably worth more than several paragraphs of my writings. I have also included below an anatomy drawing of the front of the neck with superficial layers resected so that you can better see how close the esophagus is to the deepest anterior neck muscles ( longus colli). Some acute neck injuries can cause spasm in the longus colli, which will make it difficult and painful to swallow due to their proximal spacial relationship

https://www.youtube.com/shorts/THNja9a_WE4

SCIATIC NERVE STRETCH

I was mulling recording a video on the subject but it's not until 1 of my staff walked down the hallway with her bright yellow leggings that I finally had found an inspiring canvas to do the demonstration.

The term "sciatic nerve stretch" is actually a little bit of a misnomer. This maneuver helps glide the sciatic nerve underneath external rotators of the hip, in particular the piriformis,

which is in closest proximity to the sciatic nerve in the buttock. It would fall in the category of what we commonly refer to as "nerve flossing" stretches: movements that help improve normal glide between soft tissue structures, and in this case between the peripheral nerve and its surrounding soft tissues such as muscles.

This stretch needs to be done with extreme attention to starting positioning, as well as slowly and deliberately to avoid stinging the nerve. 1 of the most common mistakes that I see is that the patient feels to maintain flexion of the hip and knee with the internal rotation of the leg when they start combining knee extension and dorsiflexion with knee flexion and plantar flexion.

https://www.youtube.com/watch?v=kqDexohUB4E

MODIFIED COBBLER STRETCH FOR LOW BACK PAIN

The cobbler stretch is a great anterior hip opener, which we use in many situations including for people who have chronically tight hip flexors from prolonged sitting. However it sometimes is not accessible for some patients because the position of the traditional cobbler with the heels in line with the pelvis, can create a little too much lumbar curve for some people. Steve and I recorded this modified version of the cobbler which still achieves its main goal but with a slight accommodation that virtually eliminates most cases of lower back pain from the stretch.

https://www.youtube.com/watch?v=p7uSwPHLvto

Another option in the "anti-inflammatory tool box": black cumin seed oil

When it comes to chronic neuromusculoskeletal pain, especially with an osteoarthritis degenerative component, a routine question I find myself fielding is what kind of nutritional supplements may be beneficial along with patient's chiropractic treatment plans.

As always, there is not a single pat answer. There are several reasons for that:

– the mechanism by which patients develop chronic pain and the biochemistry of the individual problem is variable. As such, each patient needs to assess their own likely biochemical imbalances and use therapeutic agents directed at that problem

– some common imbalances include systemic inflammatory tendencies (which in turn can be along various chemical pathways, from essential fatty acid imbalances, to activated complement cascade, to neuroendocrine abnormalities etc.), oxidative stress from imbalance and free radical with poor bodily reserves of antioxidants, decreased peripheral blood flow to soft tissues with inadequate tissue oxygen perfusion, nutritional deficiencies from dietary patterns and certain medications, hormone imbalances and deficiencies (especially cortisol, estrogen, and thyroid hormones), just to name a few.

– Some common agents used to rectify abnormal biochemistry include high-grade curcumin, botanical anti-inflammatories in the white willow family, CBD products, omega-3 fatty acids, capsaicin

One product that has not been receiving a lot of attention for its potential application in the area of neuromusculoskeletal pain, in particular osteoarthritic pain, is black cumin seed oil. It's known to be a pretty potent antioxidant and a botanical anti-inflammatory but a lot of the research has focused on non-neuromusculoskeletal applications, such as autoimmune thyroid, and asthma. I think that black cumin seed oil is definitely an agent we need to start incorporating more frequently in anti-inflammatory protocols for chronic pain, but it is probably going to be more effective when it's not used as a standalone product but combined with other agents, especially botanical anti-inflammatories like white willow in curcumin. Its safety profile is remarkably safe, and in particular it has few absolute medication contraindications, although the dosage may need to be adjusted and gradually increased with certain medications.

Here's an interesting piece of research on black cumin seed oil for knee osteoarthritis, incidentally with an extremely well-designed study ( triple arm, double blind randomized control trial)

https://onlinelibrary.wiley.com/doi/10.1002/fsn3.3708?utm_source=klaviyo&utm_medium=email&utm_campaign=%28Email%20-%20Chris%20Kresser%20General%20News%29%20Chris%E2%80%99s%20Friday%20Favorites&utm_term=new%20triple-blind%20randomized%20controlled%20trial&utm_content=new%20triple-blind%20randomized%20controlled%20trial&_kx=ZpXBDTeEF9QJhwDqQXXrImrT_HpFsBz1ZlYMbsx_Vq0%3D.my75y6


When to consider vitamin K2

When it comes to fat-soluble vitamins, vitamin D3 has been getting the lion's share of the attention and probably for good reasons. It has ramifications in a multitude of areas from bone mineral deposition to immune system function to cognitive and mood function to inflammation control. And vitamin D3 levels can be hard to sustain because of lack of skin exposure to sunlight in colder climates, as well as increased requirement in our diet from a variety of environmental factors, to poor absorption etc.

In this blog, I wanted to briefly talk about the forgotten cousin to vitamin D3 which is vitamin K 2. In reality, we should be talking about the balance of all fat-soluble vitamins together (D3, K2, straight vitamin A, and a vitamin E isomers), but for the sake of simplicity and brevity, I'm just going to touch on vitamin K 2 today.

Vitamin D3 and vitamin K2 under ideal circumstances exist in a balance which help them regulate in particularly calcium deposition and metabolism. Vitamin D3 is involved in increased absorption of calcium through the gastrointestinal tract, as well as mobilization of blood levels of vitamin D3 in general for a variety of purposes. Vitamin K2 also has a variety of metabolic activities, including the very important function of ensuring that calcium is deposited in bony matrix, rather than remain in the serum, where elevation may lead to deposition of the calcium in tissues where they are not beneficial, such as soft tissues and blood vessel walls.

Vitamin K 2 is found in meaningful amounts in a relatively narrow number of foods. In the standard American diet, it's mainly going to be naturally fermented cheeses, as well as egg yolks, but in other parts of the world, fermented foods such as fermented soy, or any fermented vegetables like sauerkraut will also provide meaningful amounts. Vitamin K 2 may be functionally insufficient in people's diet for several reasons, including the most common ones below that we encounter in our practice:

– patients on a restricted diet such as dairy intolerance or allergy, which limits 1 of the most common sources in the standard American diet. Vegan diets tend to also be very low and vitamin K2

– several G.I. issues, especially chronic G.I. inflammation, can lead to malabsorption

– patients on very high doses of vitamin D for a variety of reasons, from immune support, to concern over osteoporosis and osteopenia. High doses of vitamin D3 without proper concurrent supplementation of vitamin K 2 will lead to depletion of vitamin K2 over time.

– Patients with a history of calcium deposition disease, such as chronic calcific tendinitis, strong tendency towards osteophyte formation, tendency towards vascular calcification, and kidney stones. Those patient populations may need and benefit from isolated K2 supplementation

Vitamin K2 is surprisingly well-tolerated when supplemented, has an extremely low toxicity even at higher doses. The only area of real contraindication is patient taking anticoagulants in the warfarin family, while it's notable that the new generations of anticoagulants actually does not interact with vitamin K 2. There are no really good vitamin K 2 lab tests available in routine clinical practice, except for a few surrogate markers. Deciding to supplement vitamin K2 often boils down to taking a good history, and an empirical trial of care. We are slowly shifting our clinical practice patterns of recommending supplementation to recommending some vitamin K 2 along with vitamin D3 above 1000 IUs of daily supplementation in the majority of patient who do not have natural cheeses and eggs as part of their daily diet, or who have some of the above listed medical conditions where therapeutic doses of vitamin K 2 beyond normal dietary intake is indicated.