Remedies for Restless Legs

Restless legs syndrome (RLS) is a neurological disorder that causes a person to periodically move their legs in response to an uncomfortable or unpleasant sensation in the legs.  In the United States, 5-15% of the population suffers from RLS.  Older people are generally more affected than younger people and the condition commonly occurs during the later stages of pregnancy. Typically, symptoms occur primarily during periods of inactivity and are usually worse in the evening or at night.  As a result, RLS frequently interferes with sleep, resulting in chronic sleep deprivation and an eventual reduction in quality of life.  In fact, if you have ever shared a bed with a person with RLS, you know that it is nothing to laugh about.  The reality is that many couples eventually sleep apart.   

A number of factors may be responsible for RLS.  Generally, iron deficiency is recognized as a reversible cause of RLS.  Additionally, vascular illnesses, diabetic peripheral neuropathy, kidney disease, reactive hypoglycemia, stress, alcohol, caffeine, nicotine and food sensitivities may also contribute. 

Pharmaceutical treatment may be utilized, including benzodiazepines and dopamine agonists, such as pergolide mesylate and ropinirole hydrochloride).  Thankfully, dietary modification and appropriate nutritional supplementation are all that is needed to successfully treat RLS in many cases. 

Nutritional Supplements:

Iron:
Approximately 25% of patients with RLS are iron deficient. In fact, research has shown that the uncomfortable sensations linked with RLS may be due to an imbalance in the brain of ferritin (a protein found inside cells that stores iron for later use).  The amount of ferritin in your blood is directly related to the amount of iron stored in your body.  As a result, testing the amount of ferritin in your blood is a routine test used by qualified naturopathic doctors to diagnose certain conditions, including iron deficiency anemia.   Iron is also necessary for the formation of dopa and dopamine from tyrosine.  Studies have shown that patients with RLS respond to treatment with dopamine agonists, suggesting that RLS forms as a result of reduced dopaminergic activity in the brain.  Therefore, the more severe the iron deficiency, the more severe the RLS symptoms. 

Iron deficiency can cause a number of problems other than RLS.  Although anemia is the most well known consequence of iron deficiency, having low iron can cause many other symptoms, even in the absence of clinical anemia.  These include fatigue, impaired mental concentration, lassitude, muscle fatigability, decreased aerobic capacity, mood disturbance, menorrhagia (heavy menstrual flow), hair loss, impaired immune function, intolerance to the cold and impaired capacity to regulate body temperature, abnormalities of the tongue, digestive disturbances and angular stomatitis (irritation and fissuring in the corners of the lips).

Common causes of iron deficiency include excessive menstrual flow, gastrointestinal blood loss (due to the use of NSAIDS or gastrointestinal disease), regular consumption of foods and beverages that inhibit iron absorption (tea, coffee, soy), insufficient intake of iron in the diet, and malabsorption (due to achlorhydria, Celiac disease, etc.)

Although iron may appear as the wonder supplement for treating RLS, iron supplementation in non-iron deficient individuals should be avoided, as it may increase the risk of cardiovascular disease and other chronic illnesses and can be very harmful in people with hereditary hemochromatosis.  Therefore, be sure to have your ferritin levels tested by a qualified naturopathic physician before beginning any iron supplementation. 

Magnesium:
One of the signs of magnesium deficiency is central nervous and neuromuscular irritability, which could be a factor in the development of RLS.  Inadequate magnesium intake is common in Western society due to a number of factors, including stress, alcohol consumption, caffeine intake, and pregnancy.

Folic Acid:
Severe folic acid deficiency can cause various neuropsychiatric symptoms, such as RLS, stocking-type tactile hypoesthesia (decreased sensation), depression, and decreased vibratory sense in the knees.  Folic acid deficiency is typically caused by malabsorption or inadequate dietary intake.  Fortunately, symptoms of folic acid deficiency can be reversed through folic acid supplementation.

Reactive Hypoglycemia, Stress, Alcohol, Caffeine, Nicotine, Food Sensitivities: 

All of these factors have been implemented in the development of RLS.   Therefore, in patients with reactive hypoglycemia (low blood sugar that occurs 1-3 hours after eating), it would be advisable to seek guidance on how to improve blood glucose control, as this has been shown to improve RLS in this population.  Furthermore, caffeine and nicotine are nervous-system stimulants and avoidance of these has been shown to eliminate RLS.  Therefore, it would be recommended to eliminate these substances for a trial period and see if symptoms resolve.  Additionally, alcohol consumption may cause a deficiency in nutrients linked with RLS, so I would advise avoiding alcohol for a certain period of time as well, and seeing whether symptoms resolve.  Lastly, food sensitivities can cause a vast number of problems in the body, other than just RLS, so it is very important to seek professional guidance from a trained naturopathic doctor in the proper detection and management of any food sensitivities one may have. 

Recommendation for Treatment:

The factors listed above are merely suggestions in the treatment of restless leg syndrome and are by no means an exhaustive list.  As each person’s case is unique from the next, please see your licensed naturopathic physician for a thorough assessment to ensure that your RLS is not the result of a more serious condition.  This will also help you to receive the most appropriate treatment. 

Sugar Takes the Pain Away

Chronic pain affects a large percentage of the population and must be taken seriously.  In addition to the pain itself, chronic pain can lead to a number of other conditions, including weight gain, insomnia, anxiety, and depression.

A New Zealand physician, Dr. John Lyftogt, has developed a revolutionary technique in the treatment of chronic pain, known as Neural Prolotherapy.

Types of Pain:

Neuroscientists have identified two types of pain: Nociceptive and Neuropathic. Nociceptive pain is characterized as being localized, proportional to the injury, and goes away on its own or with the use of pain medication.  Neuropathic pain, in contrast, is characterized as being diffuse, disproportional to the injury, feels deep, and does not go away. This type of pain may be one of the reasons why NSAIDS are not effective in many painful conditions.

Dr. Lyftogt discovered that injections of 5% dextrose under the skin along the length of a nerve caused an improvement in local swelling, a reduction in pain, and an improvement in function. Through his research, Dr. Lyftogt has shown that dextrose selectively blocks neuropathic pain, making it an ideal treatment for this particular type of chronic pain. 

What Causes Neuropathic Pain?

Neuropathic pain results from a condition known as Neurogenic Inflammation.  Ligaments, tendons, and joints are innervated by TRPV-1 sensitive C pain fibers.  The main role of these fibers is to ensure that every cell is functioning properly.  In a healthy state, these nociceptors are silent and do not produce pain. However, when the body is injured, these nerve cells initiate a repair response in order to restore normal function to the body part.  They do this by activating their TRPV-1 receptor, which release two neuropeptides: Substance P and Calcitonin Gene Related Peptide (CGRP).

Substance P causes pain, which tells the brain to decrease function in the area affected.  CGRP causes cells to become engorged with calcium, which may lead to calcium deposits in areas of chronic inflammation.  Together, substance P and CGRP cause dilation and leakage of blood vessels, which creates redness and swelling in the injured area.

http://drreeves.com/Treatment-Variations/Neural-Prolotherapy

Subcutaneous nerves also have their own nerve supply.  These small nerves are known as Nervi Nervorum (NN) and can also cause pain and inflammation when injured. In addition, nerves pass through a number of small holes in fascia.  Injury to the fascia can cause these holes to decrease in size and squeeze the nerves passing through. This injures the nerves and when nerves are injured they swell. Swollen nerves then get trapped in these holes, resulting in a Chronic Constriction Injury (CCI).  CCI’s further inhibit the healing of nerves by blocking the flow of Nerve Growth Factor (NGF), which is necessary for nerve health and repair,.  Furthermore, the injured, swollen nerves activate their TRPV1 receptors, thus producing pain and inflammation. 

All of these processes work together to cause Neurogenic Inflammation and can result in pain, swelling and leakiness of blood vessels.  “Hilton’s Law” states that the nerve supplying a joint also supplies the muscles that move the joint and the skin that surrounds the joint.  This suggests that irritation to a nerve supplying the skin over a joint may cause pain and dysfunction in that joint as well as in the muscles surrounding that joint.

Therefore, as long as the TRPV-1 receptors remain activated, Neurogenic Inflammation will continue, inhibiting healing of the nerve.  Eventually, tissues begin to degenerate, resulting in even greater loss of function in that area.  Thankfully, research has shown that dextrose blocks TRPV-1 receptors, thereby blocking the release of CGRP and SP.  This leads to a reduction in Neurogenic Inflammation and the promotion of nerve health. The end result is decreased pain, improved nerve health, and return of function to muscles and joints. 

Difference Between Prolotherapy and Neural Prolotherapy:

Traditional prolotherapy involves a different solution with deeper injections, targeting connective tissue, such as ligaments and tendons.   Neural prolotherapy uses 5% dextrose only, involves shallow injections and targets nerve pathways.

The Procedure:

The procedure involves a series of injections just under the skin along the length of a nerve.  Your qualified naturopathic physician will use a very small needle to inject 5% dextrose along certain areas.  The injections themselves can be painful, but relief of the original pain and discomfort is usually seen within moments after the treatment.

Treatment usually involves 6-8 weekly sessions.  Additional sessions may be needed if the patient has had surgery, significant underlying medical illness (history of cancer, autoimmune disease, diabetes) and/or moderate to severe whiplash injuries with widespread pain.  Physical activity is not restricted post-injection and most patients are able to return to their normal activity level within a day or two. 

Side Effects:

Patients often experience a slight “bee sting” sensation and mild itching in the injection site. This is normal and will resolve within a few hours.  Mild bruising may also occur over the treated areas and is nothing to be concerned about.

The majority of patients tolerate the treatment well, with the occasional exception of someone who is needle phobic or quite pain sensitive.  In these cases, another treatment method might be preferable.

If you or someone you know is suffering from chronic pain, please see a qualified naturopathic physician who can consider whether neural prolotherapy would be the right treatment for you.

Macular Degeneration





Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is the number one cause of progressive vision loss and blindness in developed countries.  Of Americans over age 65, at least 10% have some loss of vision due to AMD and as many as 30% of Americans over the age of 75 are affected.  

My grandmother, her two sisters, and now my uncle have all had their struggle with this terrible, yet preventable illness.  Thankfully, although I may be carrying this disease in my genetics, I do not necessarily have to suffer from it.  In this case, a healthy diet may mean a healthy gene expression. 

AMD comes in two forms: Non-exudative AMD (also known as dry or atrophic AMD) and exudative AMD (also known as wet AMD).  Greater than 90% of people with AMD have dry AMD, which slowly progresses over a number of decades. Wet AMD, in contrast, is associated with neovascularization, retinal edema, and hemorrhage, and results in rapid vision loss, frequently over a number of months.

Pathophysiology:

Retinal pigment epithelial cell degeneration is the description of age-related macular degeneration.  This degeneration results in a loss of the associated rods and cones.   Doctors still do not clearly understand the etiology of AMD, but it seems to include the accumulation of lipofuscin (a brownish pigment that remains after damaged blood cells have been broken down and absorbed) within retinal cells.  The accumulation of lipofuscin occurs as a result of oxygen-induced free radical damage or ultraviolet light damage to cell membranes. 

Risk:

The risk for developing AMD is partially determined by genetics, but because new scientific research has demonstrated a relationship between food and gene expression, I believe that having a genetic predisposition to AMD does not necessarily mean you will develop it. Currently, there is no known effective Western medical treatment for dry AMD. Wet AMD may be treated using medications that inhibit angiogenesis and laser photocoagulation. 

What a person with AMD might see

Observational studies have demonstrated that high consumption of cholesterol, total fat, saturated fat, and linoleic acid have each been associated with an increased risk of AMD.  The relationship between amount of linoleic acid (an essential fatty acid) and AMD may be the result of the use of linoleic acid (which is converted to toxic peroxides at high temperatures) for cooking.  Many vegetable oils contain this compound.  

In contrast, high intake of fish, and moderate wine consumption have been associated with a decreased risk of AMD, and foods rich in the carotenoids, lutein and zeaxanthin may aid in the prevention of AMD or slowing its progress.

Nutritional Supplementation:

As we age, our nutritional status tends to decline due to a combination of factors.  Firstly, gastrointestinal absorption naturally becomes less efficient with advancing age, which results in reduced cellular uptake of nutrients.  If we combine a poor diet with this naturally decline in a physiological process, we increase our chances of nutritional deficiency.  Furthermore, suboptimal nutritional status may be especially detrimental to the special sense organs involved in smell, taste, hearing and vision. 

Lutein and Zeaxanthin:

Lutein and zeaxanthin are dietary carotenoids.  They are found in higher concentrations in the macular region of the retina than in plasma and other tissues.  Macular pigment is primarily composed of these two carotenoids.  The most important role of lutein and zeaxanthin is to filter the phototoxic blue-light  portion of the sun's rays, thereby providing a protective effect on the macula. 

Due to the fact that AMD may be the result of oxidative damage, supplementation with antioxidants may slow its progression.  In addition, certain nutrients such as lutein, zinc, and taurine play a crucial role in metabolic functions of retinal tissues.  As a result, increasing consumption of these nutrients might enhance the function of retinal cells that are still living, thereby improving vision as well as aiding in the prevention of retinal degeneration.  The concentration of lutein and zeaxanthin in the macula is partially dependent on their dietary intake, which is why supplementation can be so important. 

Fish Oil:

Docosahexaenoic acid (DHA) is a fatty acid present in fish oil, and has been linked with improvement in AMD patients. 

Zinc:

Research has shown than zinc supplementation has been beneficial in the treatment of AMD.  Zinc plays a crucial role in visual function. Higher concentrations of zinc are found in the eye than in most other bodily tissues, and its effects on vision happen in a few important ways. Firstly, zinc is a cofactor for enzymes involved in visual function. Secondly, zinc helps to stabilize cell membranes and has anti-oxidant properties. 

Research has shown that avoiding zinc deficiency in some elderly individuals may require higher consumption of zinc than the Recommended Dietary Allowance.  Furthermore, such persons may have a greater susceptibility to the negative effects of deficient zinc intake than others in that population.  With regards to patients with AMD, their mean serum concentration of zinc was found to be significantly lower than that of an age-matched control group. 

Caution: Supplementation of zinc may interfere with copper absorption, thereby causing copper deficiency. Therefore, co-administration of copper is necessary. 

B Vitamins:

Atherosclerosis is thought to be an important contributing factor in the pathogenesis of AMD.  One crucial risk factor in the development of atherosclerosis is hyperhomocysteinemia.  Furthermore, observational studies have demonstrated a positive relationship between the levels of homocysteine in the blood and the risk of developing AMD.  Folic acid, vitamin B6 and vitamin B12, taken together as supplementation, has been shown to reduce homocysteine levels.            

Glutathione:

Glutathione is a very important antioxidant and is found in ocular tissues, including the retina.  Based on the report of one practitioner, a series of intravenous glutathione treatments has been shown to improve both dry and wet AMD.

Melatonin:

There may be a few explanations as to why melatonin could help with the treatment or prevention of AMD.  Firstly, levels of melatonin decline with age, which may play a role in the pathogenesis of AMD.  Secondly, melatonin has a large role in regulating the mount of light that reaches photoreceptors of the eye through its regulation of eye pigmentation.  Lastly melatonin’s role as an antioxidant may help to protect the epithelial cells of retinal pigment from oxidative damage.  

Ginkgo Biloba Extract:
Ginkgo plays a role in the prevention of free radical-induced damage and also enhances blood flow.  

Taurine:

The retina contains high concentrations of taurine, with most of it located in the photoreceptor cell layer.  The functions of taurine appear to be its action as a cellular buffer, thereby protecting cells from the detrimental effects of toxins, ultraviolet light and osmotic changes.  Although humans are capable of synthesizing taurine from cysteine, adequate amounts of taurine are partially dependent on dietary intake.

Anthocyanosides:

Anthocyanosides are a group of flavonoids and are the main component of bilberry, an herbal supplement. Anthocyanosides are also present in blueberries, as well as some other fruits and vegetables.  Anthocyanosides act as antioxidants and experts believe that also act as biochemical amplifiers in retinal photoconduction.  Research has shown that supplementation with anythocyanosides to healthy volunteers has resulted in improved markers of visual function, such as macular sensitivity and dark adaptation.  Furthermore, patients with diabetic retinopathy demonstrated reduction in the degree of hemorrhage in retinal vessels as well as improved capillary integrity.    

Selenium:

Selenium is an antioxidant that is found in large concentrations in the retina.  Therefore, it is thought that its antioxidant action may help to prevent oxidative damage that leads to AMD.

As Naturopathic Doctors, we strive to treat each patient as an individual.  Therefore, it will be necessary to consult with your licensed Naturopathic Physician for proper administration of these supplements, as well as for proper diet and nutrition counseling. 

Other Considerations:
Ozone Therapy- Major Auto Hemo Therapy (MAH)