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New thoughts on cholesterol

Posted by Mark Croucher
on June 21, 2016
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Interesting study questioning the relationship of LDL cholesterol and cardiovascular disease.

  • A recent study in BMJ medical journal found that high LDL-Cholesteral may be consistent with living longer in most people over 60 years.  This finding is opposite of the cholesterol hypothesis (ie, that cholesterol, particularly LDL-C, causes clogged arteries and early death). It seems that elderly people with high LDL-C live as long or longer than those with low LDL-C.  This analysis provides reason to question the validity of the cholesterol hypothesis. This study provides the rationale for a re-evaluation of guidelines recommending drugs to reduce LDL-C in the elderly as a component of heart disease prevention strategies.

Strengths and limitations of this study ▪ This is the first systematic review of cohort studies where low-density lipoprotein cholesterol (LDL-C) has been analysed as a risk factor for all-cause and/or cardiovascular mortality in elderly people. ▪ Lack of an association or an inverse association between LDL-C and mortality was present in all studies. ▪ We may not have included studies where an evaluation of LDL-C as a risk factor for mortality was performed but where it was not mentioned in the title or in the abstract. ▪ We may have overlooked relevant studies because we have only searched PubMed. ▪ Minor errors may be present because some of the authors may not have adjusted LDL-C by appropriate risk factors. ▪ Some of the participants with high LDL-C may have started statin treatment during the observation period and, in this way, may have added a longer life to the group with high LDL-C and some of them may have started with a diet able to influence the risk of mortality. ▪ We may have overlooked a small number of relevant studies because we only searched papers in English.

http://bmjopen.bmj.com/content/6/6/e010401.full.pdf

 

 

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Low CARB

Posted by Mark Croucher
on April 21, 2016
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lchf_food“CONCLUSION:
Our findings suggest that a low-carbohydrate diet is effective in lowering the HbA1c and triglyceride levels in patients with type 2 diabetes who are unable to adhere to a calorie-restricted diet.”

Although caloric restriction is a widely used intervention to reduce body weight and insulin resistance, many patients are unable to comply with such dietary therapy for long periods. The clinical effectiveness of low-carbohydrate diets was recently described in a position statement of Diabetes UK and a scientific review conducted by the American Diabetes Association. However, randomized trials of dietary interventions in Japanese patients with type 2 diabetes are scarce. Therefore, the aim of this study was to examine the effects of a non-calorie-restricted, low-carbohydrate diet in Japanese patients unable to adhere to a calorie-restricted diet.

Intern Med. 2014;53(1):13-9.  A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes.

The normal range for the HbA1c – (hemoglobin A1c) test is between 4% and 5.6%. If your hemoglobin A1c levels are between 5.7% and 6.4% you are at risk of diabetes, and levels of 6.5% or higher indicate diabetes.

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Chiropractic care for older patients with chronic lower back pain

Posted by Mark Croucher
on April 18, 2016
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IMG_3750Chiropractic care for older patients with chronic lower back pain seems to offer cheaper and faster pain relief.

A recent study (February 2016) in the Journal of Manipulative and Physiological Therapeutics examined older patients with multiple health problems who used chiropractic care during their chronic lower back pain episodes.  They found that these patients had lower overall costs of care, shorter episodes, and lower cost of care per day than patients in the other treatment groups.

Costs were even lower for patients who used a combination of chiropractic care and conventional medical care when compared to those patients who did not use any chiropractic care.

 

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How old is your brain?

Posted by Mark Croucher
on March 20, 2016
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How old is your brain?

Neurobiology of Aging Home

Differences between chronological and brain age are related to education and self-reported physical activity  April 2016 Volume 40

IMG_3750

My take away from this study is pretty straight forward. It appears that if we continue to exercise routinely and focus on continued learning, we may be doing our future selves a great bit of benefit with regard to our brain function.  

 

Conclusions: These results demonstrate that higher levels of education and daily FOSC (flights of stairs climbed) are related to larger brain volume than predicted by CA (chronological age) which supports the utility of regional gray matter volume as a biomarker of healthy brain aging.

This study investigated the relationship between education and physical activity and the difference between a physiological prediction of age and chronological age (CA). Cortical and subcortical gray matter regional volumes were calculated from 331 healthy adults (range: 19–79 years). Multivariate analyses identified a covariance pattern of brain volumes best predicting CA (R2 = 47%). Individual expression of this brain pattern served as a physiologic measure of brain age (BA). The difference between CA and BA was predicted by education and self-report measures of physical activity. Education and the daily number of flights of stairs climbed (FOSC) were the only 2 significant predictors of decreased BA. Effect sizes demonstrated that BA decreased by 0.95 years for each year of education and by 0.58 years for 1 additional FOSC daily. Effects of education and FOSC on regional brain volume were largely driven by temporal and subcortical volumes.

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Spinal Stenosis

Posted by Mark Croucher
on March 15, 2016
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A recent paper in Pain Medicine spoke to the management of lumbar spinal stenosis.  The authors conclude that the condition is common among older adults with chronic lower back pain and that management can be accomplished without surgery.  There are a number of problems that accompany lumbar spinal stenosis. These may include:

  • chronic back pain
  • leg pain
  • leg weakness
  • leg numbess
  • the need to sit all the time
  • the need to bend forward
  • difficulty walking through a grocery store without a cart
  • difficulty with standing
  • exercise is difficult due to leg fatigue and back pain

Lumbar spinal stenosis exists not uncommonly in older adults with CLBP and management often can be accomplished without surgery. Treatment should address all conditions in addition to LSS contributing to pain and disability 1.

I believe that treatment focus should be on addressing improvements in spinal function, leg strength and endurance, cardiovascular health and reducing back pain.  A comprehensive chiropractic approach deals with these issues head on.

At our office we use a number of therapeutic interventions to deal with this issue. One of the therapies we use is lumbar flexion distraction.  This is another method of manual therapy, where the patient is lying in a comfortable face down position with the lumbar spine flexed, like when you bend over a little. Manual pressure is slowly applied to the spine, stretching the vertebra apart.  This technique is used to restore damaged spinal nerves and surrounding structures by reducing the stricture of the spinal ligaments, increasing the movement of metabolites in discs, reducing the stress and internal pressure imposed on the posterior discs through the opening of the spinal facet joints, and expansion intervertebral foramens 2.

In our clinic we find that combining flexion distraction with instrument assisted manipulation, targeted spinal exercise and recumbent bike training to be a very effective approach.

1. Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part VI: Lumbar Spinal Stenosis. Fritz JM, et al. Pain Med. 2016.
2. Computed tomographic investigation of the effect of traction on lumbar disc herniations.   Onel D, Tuzlaci M, Sari H, Demir K  Spine (Phila Pa 1976). 1989 Jan; 14(1):82-90.
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25 years

Posted by Mark Croucher
on March 4, 2016
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Chiropactic Conference chiro conference

 

 

 

 

 

 

 

 

25 years!

25 years has passed and I’m still the best of friends with my compatriots from chiropractic school.  We had a great time together again at the National Chiropractic Leadership Conference in Washington DC.  Every year we get together to participate with the American Chiropractic Association.  We lobby congress on issues like increased chiropractic care in the V A for active and retired military folks.  We attend numerous continuing education seminars.  And…we have a great time together at our Nation’s Capital!

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High Heels Hurt

Posted by Mark Croucher
on March 4, 2016
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high healCONCLUSIONS:
High-heeled shoes in adolescents can lead to the development of postural disorders, among which stands out the forward head posture, lumbar hyperlordosis, pelvic anteversion, and knee valgus. The height and width of the heels are characteristics that exert most influence in the emergence of postural changes and body imbalance.

The research was conducted in the Scopus, SciELO and PubMed databases between 1980 and 2011, searching for articles written in English and Portuguese with the following key-words: “posture”, “center of gravity”, and “high-heeled shoes”. Among 55 retrieved articles, 20 were analyzed regarding posture of the spine and lower limbs, the center of gravity, and the effects of high-heeled shoes in the musculoskeletal system in adolescents.

http://www.ncbi.nlm.nih.gov/pubmed/23828066

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Okay…it’s a rat study but still.

Posted by Mark Croucher
on February 24, 2016
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Chronic post surgical pain – Neuropathy.

Possibly great news for patients who continue to suffer with post-opperative pain and/or what is called neuropathic pain.  With neuropathic pain, the nerve fibers in the area of pain may be damaged or injured. They simply function badly.  These damaged nerve fibers send incorrect signals to the brain.  A recent study in the Journal of Manipulative and Physiological Therapeutics demonstrated that repetitive instrument delivered spinal manipulation therapy had a substantial effect on the simulated neuropathic pain and postoperative pain and the therapy increased anti-inflammatory response in the subject!  Mind you…the study was on rats.  But the little guys felt better!

These findings show that spinal manipulation may activate the endogenous anti-inflammatory cytokine IL-10 in the spinal cord and thus has the potential to alleviate neuropathic and postoperative pain.

Seriously though…we see this type of result in practice with several different types of manual therapies.  There are unfortunately, not any long term studies on neuropathic pain in humans that demonstrate the positive results.  As we say in our line of work;  A lack of evidence in the literature, does not equate to a lack of effectiveness in practice.  More study is needed for sure.

Attenuation Effect of Spinal Manipulation on Neuropathic and Postoperative Pain Through Activating Endogenous Anti-Inflammatory Cytokine Interleukin 10 in Rat Spinal Cord.  January 2016

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Notes from Dr. Daniel Carlson

Posted by Mark Croucher
on February 24, 2016
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HANG ON TO YOUR HIPPOCAMPUS

By Dr. Daniel Carlson

 

 

sneakersIt’s been known for several years that people who are aerobically fit have less mechanical back pain so as soon as our patients are able we remind them to resume their walking, biking or running program.

 

For those who haven’t been doing aerobic exercise we try to motivate them to start by pointing out that as little as a 30 minute session 5 days a week is associated with less heart disease, fewer strokes, reduced colon and breast cancer and better insulin sensitivity.  We determine their age-related target heart range and teach them to take their own pulse if necessary.

 

We may be able to add building more brain cells to the list of aerobic benefits.  An upcoming study to be published in the Journal of Physiology compared aerobic with high intensity interval and resistance training in laboratory rats.  The animals doing voluntary running had 2 to 3 times more hippocampal neurons at the end of the experiment than the other two groups.  This was observed after 6 to 8 weeks of exercise.

 

The hippocampus is a part of the brain associated with learning and the formation of new memories and is severely shrunken in Alzheimer’s disease patients.

 

Anyone concerned with this devastating disease (is there anyone who isn’t?) should be aware of this Alzheimer’s-hippocampus relationship and the impact that a minor amount of regular aerobic exercise has.

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What about PT for back pain

Posted by Mark Croucher
on February 22, 2016
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A recent study was published including of 4597 patients who underwent physical therapy for back pain. The findings showed that a significant percentage of patients did NOT improve to minimal clinical standards.  How Effective is Physical Therapy for Common Low Back Pain Diagnoses? A Multivariate Analysis of 4597 Patients.      Spine: February 15, 2016

Prior studies have also shown that spinal manipulation/mobilization (chiropractic care) showed significantly greater improvement than exercise therapy in patients with chronic low back pain. The effects were reflected on all outcome measures, both on short and long-term follow-up.  Manual Therapy and Exercise Therapy in Patients With Chronic Low Back Pain: A Randomized, Controlled Trial With 1-Year Follow-up Spine:  15 March 2003 – Volume 28 – Issue 6 – pp 525-531

Meanwhile a number of studies have indicated that chiropractic treatment combined with exercise can work better than either individually for treatment of chronic neck pain.

 

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