Spa Therapy

Uggghhh! Monday morning after a long holiday weekend. Not quite feeling the whole work thing today? Feeling guilty about those Thanksgiving pounds you packed on over the 4-day eating orgy?

Maybe what you need is a spa break! In case, you’re not yet in agreement – here’s another reason to consider swapping your business suit for a bathing suit.  According to a pilot study from the Jefferson-Myrna Brind Center of Integrative Medicine a weeks retreat at a spa is not only relaxing and nourishing, but can lead to marked changes in physical and emotional well-being.

The research evaluated 15 participants before and after their visit to a health and wellness spa in Desert Hot Springs, California.  The week-long program included meditation and colonic hydrotherapy, hatha and Vishnu flow-yoga programs, and a very low calorie diet of approximately 800 calories per day. Stress management was provided through daily structured meditation and personal meditation encouraging deep breathing, heightened awareness and a calming effect.

In preparation, participants were asked to modify their diet three to four days prior to arrival by replacing a normal diet with fruit, sprouts, raw and steamed vegetables, salads, vegetables, herbal teas, prune juice in the morning, laxative teas or herbal laxatives nightly and avoiding pasta, meat, cheese, caffeine, alcohol and processed foods.

The participants, 13 women and two men between the ages of 21 and 85, with no history of significant medical, neurological or psychological conditions each underwent a physical evaluation including weight, height, Body Mass Index (BMI), blood pressure and an EKG. They also received a complete blood count (CBC), liver function tests, tests measuring cholesterol and triglycerides, thyroid hormone testing, and the concentration of metals such as mercury and lead. In addition, psychological and spiritual measures before and after their arrival were measured.

An evaluation of the results showed that undergoing a spa program resulted in a weight decline of an average of 6.8 lbs., a 7.7% decrease in diastolic blood pressure as well as a decrease in mercury, sodium and chloride levels and a 5.2% decline in cholesterol level and mean BMI. Hemoglobin increased 5.9 percent. No statistically significant changes in liver or thyroid function and no EKG changes were noted.

No serious adverse effects were reported by any individual, but the study noted changes in the participants’ sodium and chloride concentrations, suggesting that those interested in going to a spa program should check with their physician to make sure they do not have any medical problems or medications that could put them at risk for electrolyte disturbances.

Improvements in anger, tension, vigor, fatigue and confusion were also noted as was a statistically significant improvement in anxiety and depression levels measured by the Speilberger Anxiety Scale and the Beck Depression Index.

Participants also reported significant changes in their feelings about spirituality and religiosity.

“Programs such as these have never before been formally evaluated for their safety and physiological effects,” says Andrew Newberg, MD,  lead author on the study.

While beneficial, it is not possible to differentiate the effects of each of the individual elements of the program to determine which components were responsible for the changes observed. “This,” says Newberg “will require an evaluation of one or more elements—such as yoga, very low calorie diet or colonics—in isolation to determine which elements have the most significant effects.”

In the future, Newberg and colleagues plan to study the effects of a spa stay on specific disease population, i.e. diabetics.

Complete findings will be available in the December issue of Integrative Medicine, A Clinician’s Journal.

In the meantime, it’s back to our desks. We can but daydream of downward dogs and diets!

Falling for Pumpkins

Here in the nation’s capital, the cooler temperatures and brilliant colors of Fall are upon us. Pumpkin patches are opening everywhere and among the neighborhood kids, the countdown to Halloween has begun. This year, rather than throwing out the pumpkin seeds after carving lanterns or making pie, nutritionists are suggesting that we eat them. Pumpkin and its seeds provide many nutritional benefits including:

• Vitamins: vitamin C, E, iron, zinc, magnesium, potassium, both beta & alpha carotenoids (anti-oxidants which help prevent cell damage), and lutein (to support healthy eyes)

• Protein: pumpkin seeds are high in protein

• Essential fatty acid oils: to help maintain healthy blood vessels, nerves, tissues and hair

 Snack on a quarter-cup of pumpkin seeds and you will receive 46% of the daily value for magnesium, 29% for iron, 52% for manganese, 24% for copper, 16.9% for protein, and 17% for zinc.

It’s claimed that pumpkins can also support kidney, bladder and prostate health; minimize osteoporosis, help get rid of parasites & tapeworms, and lower cholesterol due to the high levels of phytosterol.  Pumpkin seeds may also alleviate symptoms of depression as they contain L-tryptophan.

Dr. Helen Lee of ChicagoHealers.com recommends four ways to incorporate pumpkin into your everyday diet.

1.  A handful of raw pumpkin seeds as a snack or mixed with trail mix, on top of cereal
2. Pumpkin seed butter spread on toast
3. Pumpkin pie/desserts/pancakes/waffles
4. Pumpkin baked or browned with spices in risotto, chili, rice, spaghetti

SRxA‘s Word on Health’s personal favorite is pumpkin seed oil, a wonderful thick, green- oil that is produced from roasted pumpkin seeds. Try it drizzled on pumpkin soup or mixed with balsamic on salads. If you’re feeling adventurous you can even do as the Viennese, and add a few drops on vanilla ice cream.

Go on, share your favorite pumpkin recipe with us!

What Matters More?

The doctor’s…or the patient’s perception of their treatment?  Interesting question!  Even more interesting, it is one that was posed in an editorial in the current edition of the New England Journal of Medicine.

The question arose after a new study showed that patients’ self-assessed outcomes in clinical trials can mask a real lack of an objective effect. The accompanying editorial took a completely different stance – asking, “What is the more important outcome in medicine: the objective or the subjective, the doctor’s or the patient’s perception?”

The double-blind, crossover study in question was led by Michael Wechsler, MD, an SRxA Advisor.  It set out to determine whether responses to placebo differ from the physiological changes that occur without any intervention in patients with asthma. To address this, they compared the effects of an albuterol inhaler, two placebo interventions (an inert inhaler and sham acupuncture needle) versus “no treatment” in which patients were told to wait for several hours and then return home.

46 patients with stable asthma underwent each of four treatments over a series of visits. At each visit, lung function was measured by spirometry every 20 minutes for 2 hours.  Also at each visit, patients were asked to score any perceived improvements in asthma symptoms on a visual-analogue scale with scores ranging from 0 (no improvement) to 10 (complete improvement). Patients were also asked whether they thought they had received a genuine therapy or placebo.

Among the 39 patients who completed the study, improvement in maximum forced expiratory volume in 1 second (FEV₁) was significant only after albuterol, however albuterol provided no incremental benefit with respect to the self-reported outcomes.

In other words… from the patients’ perspective all the interventions, except waiting, worked.

While the authors acknowledged that placebo effects can be clinically meaningful and can rival the effects of active medication in patients with asthma, they argued that from a clinical-management and research-design perspective, patient self-reports can be unreliable.  They concluded: “Objective outcomes should be more heavily relied on for optimal asthma care.”

However an accompanying editorial in the same journal questions the authors interpretation.

In it, Daniel Moerman, Ph.D. asks: “Are patients wrong if they report improvement even if there is no evidence for this?” He argues that it is after all subjective symptoms such as wheezing, rather than reduced FEV1 that brings patients to seek medical attention in the first place.

Hence the question, What is the more important outcome in medicine: The objective or the subjective, the doctor’s or the patient’s perception?

All medical procedures whether active or placebo, he argues, are meaningful insofar that they represent something. These meanings create expectations that can dramatically modify the effectiveness of even the most powerful proven treatments. He gives an example of a recent experiment that showed the effects of an opioid drug were either doubled or extinguished by manipulating subject expectations and that  MRI scans showed brain mechanisms differed as a function of these expectations.

Moerman asks: “Do we need to control for all meaning in order to show that a treatment is specifically effective?” Maybe, he suggests, it is sufficient simply to show that a treatment yields significant improvement for the patients, has reasonable cost, and has no negative effects.

What do you think? Is perception reality?  We’d love to know.

Worming our way towards a Cure for M.S.?

Hot on the heels of our recent fecal transplant posting, SRxA’s Word on Health brings you news that might once again trigger your yuck factor.

According to an article in last week’s Wall Street Journal, help may be at hand, or maybe we should say “stomach” for people with multiple sclerosis – as the help is courtesy of  none other than parasitic worms.

Early safety studies conducted in the US suggest that the eggs of pig whipworms have anti-inflammatory properties that can reduce the size of brain lesions in MS patients. A similar trial is now under way in Denmark. And in Britain, academics at the University of Nottingham are studying the potential health benefits of hookworms.

If these trials prove successful, treatment with parasitic worms, or more correctly, helminthic therapy, could provide a simple, cheap, and controllable treatment for the debilitating condition, which affects 2.5 million people world-wide.

Multiple sclerosis is an inflammatory disease of the brain and spinal cord, in which an overactive immune system attacks the nerve fibers responsible for sending signals to the rest of the body. Its symptoms include impaired vision, muscle weakness and spasm, fatigue, memory loss and depression. Although a number of medications can slow the disease’s progression, many of them have unpleasant side effects including hair loss, muscle aches, sleeplessness and flu-like symptoms.

Interest in helminthic therapy surged in 2007 with the publication of an Argentina study which showed that the progression of multiple sclerosis was much slower in patients who carried parasitic worms in their intestines than in those who didn’t. Another recently published study in the Multiple Sclerosis Journal suggested that pig whipworm is effective in treating MS symptoms.

“The results are quite promising,” says John Fleming, a professor of neurology at the University of Wisconsin School of Medicine and Public Health, who led the study.

Five patients took part in the Phase 1 trial. All were newly diagnosed with relapsing-remitting MS, a form of the disease in which new symptoms can appear and old ones resurface or worsen. Whipworm eggs were taken from disease-free pigs and grown in a clean laboratory environment. Every two weeks over the course of three months, the patients in the study drank 2,500 of the eggs mixed into a sports drink. The eggs hatched in the patient’s intestines and were killed by the immune system after about a week.  Patients who took part said the liquid was salty but didn’t taste or smell unpleasant.

During the study, patients underwent MRI scans, which tracked the number of new brain lesions that developed before, during and after they ingested the worm eggs.

“What makes us optimistic is that brain lesions in four out of the five patients decreased over the course of the study and then rebounded after it finished,” says Dr. Fleming. While the pattern shown by the MRIs is encouraging, he adds, larger and longer studies will be needed before any definite conclusions are possible.

Researchers say the Wisconsin study’s findings could mean that the immune system’s over-response to the brain tissue was lessened by anti-inflammatory effects from the worms, and this could offer an alternative approach to treating MS.

The theory behind helmintic therapy is known as “the hygiene hypothesis.” This argues that developed countries such as the U.S., Europe and Japan have higher incidences of allergies and autoimmune diseases because the population has little or no exposure to parasites or infections. In developing countries, where people are exposed to low-level infections or infestations, the rates of such diseases are much lower.  Essentially, the proponents of this therapy argue, our immune system is created to be in balance with the worm’s influence on us.  Naturally, our body wants to fight the foreign nematode invaders, but the worms don’t like that and they’ve actually evolved to suppress our immune response to their presence.  That means that without them our immune system over-reacts to things that in its ancestral setting it would have ignored

We spoke to a friend of ours who has MS and asked, would you intentionally swallow worms if it would help control your disease? After some initial hesitation, she gave the idea the thumbs up.  “Although it sounds gross, it’s probably no worse than injecting myself every day with chemicals that I really know nothing about and which leave me looking like a pin cushion” she told us.

What about you?

Patients Don’t Pooh-Pooh Fecal Transplants

Let’s start this blog with the disclaimer that what you’re about to read has a high “yuck” factor…unless it seems you’re a patient or a parent of a patient with ulcerative colitis.

A new study just published in the journal Inflammatory Bowel Disease examined the social and ethical issues associated “fecal microbiota transplantation” (FMT).

Yes, FMT is just what you’re thinking it is!  Also known as fecal bacteriotherapy, it is a provocative treatment performed in an attempt to calm a troubled bowel by reintroducing the vast diversity of collaborative bowel inhabitants after the usual mix has been disturbed. More than 1,000 different strains of bacteria co-exist peacefully in the typical healthy bowel. But when the delicate balance is altered, by antibiotics or other causes, a few strains can become dominant, leading to severe diarrhea, inflammation and tissue damage.

Although transplants of fecal matter have been used sporadically to treat gastrointestinal disease for more than 50 years, more recently, the approach has produced lasting remissions for a small number of patients with ulcerative colitis.

The first fecal transplants date back to 1958, when they were used to treat life-threatening bowel infections. They did this by collecting fecal matter from a healthy donor and injecting it into the patient’s colon.

Then in 2003, an Australian team published a report on successful treatment of six patients with longstanding ulcerative colitis with this approach.

And although you may be feeling a little squeamish by now, it seems that patients with severe inflammatory bowel disease develop a high tolerance for therapies that others might consider unorthodox. According to study author David Rubin, MD, Associate Professor of Medicine at the University of Chicago, “Once patients get past the yuck factor they find the concept appealing.”

Like an organ transplant, fecal microbiota transplantation begins with finding a donor, often a family member. The treatment team collects a fresh stool sample of at least 200 – 300 grams (7-10 ounces). The sample is mixed with salt water in a blender and filtered to remove particulate matter. It can be administered to the recipient through a colonoscope, as an enema, or, when the inflamed region is higher in the colon, through a nasogastric tube.

The researchers organized six focus groups with patients or parents of children with ulcerative colitis to explore the attitudes and concerns raised by this approach.

They found that:

• 21:22 patients or parents of patients were interested in trying FMT for themselves or their child
• Most wished it were already available
• They viewed the treatment as more ‘natural’ than using drugs to control the disease, and easier and safer than currently available therapies
• Many compared it to probiotics, a popular alternative therapy among patients with colitis.

The major concerns were focused on how donors would be selected and screened. Patients wanted healthy donors, usually family members, and asked that even their diet and medications be considered. A donor who had eaten peanuts recently, for example could be hazardous for a recipient with peanut allergies.

The “yuck” factor came up in the focus group discussions of bacterial delivery. Patients and parent were comfortable with the idea of a “spray” colonoscopy or delivery via enemas, but were disturbed by the idea of using a nasogastric tube for the transfer of fecal bacteria.

“What our study ultimately tells us is that patients are not only tolerant of this therapy but are eager for it to become available,” Rubin said. “A few have already tried this strategy at home, using ‘protocols’ they found on the internet and tools available at any drug store.”

The team plans to begin offering FMT this fall.

Would you sign up for a poop transplant or consider being a donor?