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It is one of the beautiful compensations of life, that no man can sincerely try to help another without helping himself. We illustrate how the application of principles of integrative physiology at the bedside can reveal novel insights that have been largely overlooked to this day. For didactic purposes, we selected an imaginary consultant who was a ‘physiological or biochemical giant from the past’, an expert in that area who was called upon to assist our team of modern?day clinicians with an actual case.
Professor Sir Hans Krebs, the discoverer of the Krebs or tricarboxylic acid cycle, is our imaginary consultant. Before presenting the analysis of Professor Krebs, we invite the reader to stop and answer two questions.
1.?Does the severity of hyperglycaemia imply that the degree of lack of insulin actions is even more complete than in typical DKA?
The housestaff were reminded that ketoacids are synthesized normally with sustained insulin lack, so they can serve as a valuable brain fuel during starvation. The glucose concentration in plasma must always be high enough to provide a constant supply of fuel to the brain, but never rise enough in normal subjects to cause glucosuria, with loss of fuel, salt and water in the urine. Professor Krebs took great delight in adding a few succinct insights about the metabolism of glucose.
Professor Krebs stated that the first step was simply to obtain data on output by measuring the rate of excretion of glucose. To answer this question, Professor Krebs reviewed the physiology of glucose handling by the kidney.
Professor Krebs was about to continue his analysis of input when he was interrupted by the report of the chart review of usual admission blood sugar levels in young patients with diabetic ketoacidosis. The magnitude of the glucose load and the speed with which it is added to the body is a ‘clinically occult’ yet major factor that might determine the degree of hyperglycaemia when there is a deficit of insulin actions at any point in time.
While in the emergency department, the patient continued to drink, but the intake was now just water. Our professor urged them on by asking ‘Where would virtually all this extra glucose be in the body of our insulin?deficient patient?’ They responded correctly, saying that most of the glucose would be in the ECF compartment (with a smaller quantity of glucose in hepatocytes, erythrocytes and kidney cells because these organs did not need insulin to augment glucose transport). Before defining his plan for therapy, Professor Krebs summarized the major features in this case. The critical issues for therapy over the next short while would be related to defence of the ECF volume and to factors that might lead to brain swelling. The ECF volume is determined by the number of effective osmoles in her ECF compartment divided by the effective osmolality or tonicity of the ECF compartment. Professor Krebs had already been told that the clinical impression was that the ECF volume was close to its normal value of 10 litres. Professor Krebs then threw down the gauntlet and asked: ‘What should the therapy be for the excretion of one litre of urine during the initial brisk osmotic diuresis?’ He reminded them that its likely composition was 350?mmol of glucose and 50?mmol of Na+ per litre. Everyone realized that a rapid decrease of ECF volume could lead to hypoperfusion and that this should be avoided.
Suddenly, one resident recognized that the input from the GI tract had to be taken into account before a proper decision could be reached about the choice of fluid to be administered.
A bright young medical student came up with a simple answer that amazed his colleagues and brought a big smile to the friendly face of Professor Krebs. Applying this principle to the case, our young colleague knew that observing the fall (or lack of it) in plasma glucose concentration would tell them whether the supply of glucose from stomach absorption was matching the rate of glucose loss in the urine. The housestaff were brimming with confidence, having ‘absorbed’ the fruits of the teaching surrounding this case.
The look of disappointment on the countenance of their admired instructor, however, indicated that they had made a major error in logic. Physiology principle 6 restated: The volume of the ECF compartment is maintained by the number of tonomoles in that location. On mass balance, the ECF compartment had lost 300?mmol of glucose while retaining 150?mmol of Na+ and 150?mmol of Cl? (Figure 5).
The only way to lose hypertonic saline is via the urine, but this did not occur in our patient.
As understanding dawned, there was also a look of concern on the faces of the physicians taking care of this patient.
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Ia€™m a health-nut through and through, and a hard-core believer in the phrase a€?anything is possiblea€™. I finished my first marathon with great success and was instantly ready to do the next one. After college, I moved to Hilton Head South Carolina to intern at the Hilton Head Health Institute. After my gig with Camp La Jolla, I started Grad School at San Diego State and would be receiving a Dual Mastera€™s degree in Exercise Physiology and Nutrition. Being the stubborn person I am, and firmly believing that you can accomplish anything you put your mind to and you can always become the person you know you are meant to be, I did research and learned as much as I could so that I could fix myself, and eventually help others fix themselves too. It breaks my heart to look back and see all of those years, the best years, when life should be a€?easya€™ and care-free, were spent searching endlessly for answers and relief. Body Brilliance Coaching is the culmination of over a decade of education, research and personal and professional experience.A  It is a mind-changing, life-changing, body-changing method that spills all the secrets you need to drop the pounds, stomp your cravings, and step into that body youa€™ve always known you could have.
He attended Spokane Falls Community College and Eastern Washington University to receive his B.S.
Homeopathic individualized medicines versus fluoxetine for moderate to severe depression: double-blind, randomized non-inferiority trial.
In this didactic exercise, modern?day physicians seek an imaginary medical consultation with Professor Sir Hans Krebs because of an unusual finding in his area of expertise: a very severe degree of hyperglycaemia.
To illustrate the utility, simplicity, and cost?effectiveness of this approach, we restricted that consultant's database to medical literature prior to the onset of the Second World War. He was asked to explain why the blood sugar was so high in a young female patient with type I diabetes mellitus (DM).
First, does the severity of hyperglycaemia imply that the degree of lack of insulin actions is more complete or longer in duration than in patients with more typical values in diabetic ketoacidosis (DKA)? A deficiency of insulin gives ‘metabolic permission’ to have an increased rate of production of glucose and a lower rate of glucose removal by metabolism, thereby leading to an elevated blood sugar level. With insulin deficiency, removal of glucose by oxidation is low, because fat?derived fuels are being oxidized. He suggested that all the hospital charts in this patient group over the past several years be examined for blood sugar levels. The professor knew from his reading that 50–60?g or close to 300?mmol of glucose are typically excreted per litre of urine during a glucose?induced osmotic diuresis.1 This quantity of glucose is equal to the amount of glucose in half a litre of apple juice. She reported that the results from the second blood sample drawn 100?min after admission were available. A review of all the patient charts with the diagnosis of severe hyperglycaemia or DKA over the past two years had confirmed the impression that this degree of hyperglycaemia is distinctly unusual (Figure 3). Each solid dot represents an individual patient (n=36) who was admitted because of diabetic ketoacidosis over a 2?year period.
He announced that his grasp of the physiology of glucose absorption in the GI tract was incomplete and proceeded to consult with a colleague, the eminent GI physiologist, Horace Davenport.
For this glucose entry, one needs both the ingestion of glucose?containing fluids and delivery of this solution to the absorptive surface of the intestinal tract. Professor Davenport advanced the hypothesis that their patient may have accumulated a large quantity of glucose (apple juice) in her stomach or in the lumen of the intestinal tract if the latter were dilated due to slow motility. Professor Krebs then asked the physicians on rounds, ‘In what way might this degree of hyperglycaemia “help” our patient?’ We invite the reader to pause and answer this question. It was their impression that such a high blood sugar value was obviously detrimental, although admittedly, they were relying on clinical impressions and statistical associations rather than having a pathophysiologic basis for their view. For simplicity, he said, assume her ECF volume is normally 10?l, because she weighs 50?kg and her ECF volume is 20% of body weight. From his metabolic analysis, he concluded that the patient was clearly suffering from a deficiency of insulin that was sufficient to permit hyperglycaemia, but not severe or prolonged enough to cause a clinically important degree of ketoacidosis.
Professor Krebs might have called these osmoles tonomoles to emphasize how they differed from compounds such as urea that cross the ECF:ICF interface, have an equal concentration in both of these compartments, and do not influence compartment volumes. Assuming this to be true for the moment, he needed to know one other fact, the plasma Na+ concentration. Moreover, glucose was ‘protecting’ the ECF volume in this patient by causing the retention of 2?l of water in this compartment. For example, as long as there was absorption of fluid from the GI tract with a composition that matched urine output (in terms of volume and number of tonomoles), the ECF volume would be maintained without giving an infusion of saline (Figure 5, left panel). This principle was utilized to examine events in the first 100?min after admission (Figure 5).
The events in the first 100?min in hospital are depicted in the left portion of the figure.
A positive balance of 100?mmol of Na+ should raise the ECF osmolality and draw water out of the ICF compartment. Therefore, the total number of tonomoles in the ECF compartment was largely unchanged, so there should be no shift of water across the ECF:ICF interface. Nevertheless, because the plasma tonicity (glucose and Na+ concentrations) would only be known in retrospect, the initial intravenous fluid therapy was isotonic saline at a rate equal to the urine volume for the first 100?min. Water can be added to the ECF compartment as an isotonic but Na+?poor solution or as a hypotonic fluid (Figure 6). Ubiratan Cardinalli Adler, UNIFESP (Federal University of SA?o Paulo, Brazil), Av Rouxinol, 1041 cj. Although Professor Krebs is restricted to data prior to World War II, this does not prevent him from making novel discoveries.
Despite a total lack of information about molecular biology, or direct experience with problem?based learning or evidence?based medicine, this expert still had at least three advantages. Our objective is to illustrate that it is very efficient to begin the clinical analysis with an applica tion of basic principles of integrative physiology. The modern attending staff mentioned that this degree of hyperglycaemia was extremely rare in their experience at a pediatric tertiary care hospital. The H+ are buffered primarily with HCO3? (equation 1).2 This leads to an increase in the anion gap by an amount equal to the fall in bicarbonate concentration in plasma (Figure 1).
The H+ so produced react with HCO3? in the ECF compartment (rectangle) producing CO2 that is blown off via the lungs. From this interaction was born the fifth physiological principle which is expanded upon below.
He thanked the house officer who told him that there was no evidence of a major decline in her ECF volume on physical examination on admission.
The most decisive findings were the combination of a very severe degree of hyperglycaemia and a large glucose?induced osmotic diuresis.
In this patient, the tonomoles in the ECF compartment are Na+ plus its attendant anions as well as glucose.
If its volume is 10?l in both the normal (left) and hyperglycaemic (right) states, its composition changed—it lost 340?mOsm of electrolytes (170?mmol Na++170?mmol Cl?) while gaining 650?mOsm of glucose.
In the first 100?min since admission, they had given the patient 1l of isotonic saline to match the urine output of 1l. It was clear to them that 1l of output might represent the loss of 1l of ECF volume and that the litre of isotonic fluid that they gave should maintain the normal ECF volume.
In that period, there was no appreciable change in the plasma glucose or Na+ concentrations, implying that glucose disposal by osmotic diuresis was being matched by glucose and water entry from the GI tract. Because of the absence of a fall in glycaemia or a rise in natremia when 1 litre of urine is excreted, a similar quantity of glucose (350?mmol) was absorbed from the GI tract. They stated that one litre of intravenous fluid was given and 1l of urine was excreted so there was water balance.
Therapy will then be dictated by the changes in the plasma glucose concentration and the physical examination.
Because the tonicity of plasma fell while there was an apparent total tonomole balance, it is likely that there was an addition of hypotonic fluid.
First, he illustrates how an occult factor, rapid absorption of glucose from the intestinal tract, was a critical feature in explaining the basis of the severe degree of hyperglycaemia without obvious ketoacidosis in a 16?year?old patient with type 1 diabetes mellitus in poor control. The net result is the replacement of HCO3? with ketoacid anions (KA?) in the plasma raising the plasma anion gap. This pool size of 75?mmol is close to 5% of the daily throughput (intake and disposal) of approximately 270?g (1500?mmol) of glucose. Moreover, he knew that it would be very difficult indeed to sustain a very high input of glucose, even though it is common for these patients to consume a large volume of glucose in sweetened beverages.
For comparison, a normal diet will supply an average of 18?g or 100?mmol of glucose per 100?min. This history is common in patients with DKA, yet this severe degree of hyperglycaemia is rare (Figure 3). He issued a caution—the composition of the fluid in the stomach would undergo a change because of this ongoing intake of water without sugar. That the required input of glucose was so big meant that it had to arise from an exogenous source. They had assumed that this would result in neutral water balance (1l in, 1l out) and the replacement of close to 300?mmol of glucose lost in the urine by 300?mmol of electrolytes as isotonic saline. The challenge then was to replace only those ECF losses that were not being replaced by entry from the GI tract. Therefore intravenous saline was not needed to avoid a change in the ECF compartment volume and composition (to be absolutely correct, 50?mmol of NaCl should have been given). This provided clear evidence that glucose absorption from the GI tract had slowed markedly.
The modern medical student, although impressed with this logic, stated that he had read a number of papers suggesting a relationship between changes in glucose concentration and the plasma Na+ concentration (references 5 and 6 were not available to Professor Krebs).
One should replace the urine volume with isotonic saline only if there is a suitable fall in glycaemia. Since the intravenous fluid was isotonic saline, the source of the hypotonic input was likely to be from the GI tract. There is a need for large-scale longitudinal data on treatment utilization and outcomes, stress, emotion, and pain. Second, by examining simple principles of renal and gastrointestinal physiology in a quantitative fashion, Professor Krebs speculates as to how cerebral oedema might occur before therapy in a patient with a severe degree of hyperglycaemia. Second, he had the confidence to rely on deductive reasoning to propose a hypothesis that he could test with a quantitative analysis.
KA? are retained in the body because they (with Na+) are filtered (solid lines) and largely reabsorbed (dashed lines) in the proximal convoluted tubule (PCT) of the kidney.
Given these numbers, a mismatch between intake and output could easily cause large changes in plasma glucose levels, especially if the ability to remove glucose by metabolism was compromised.

He also emphasized that this degree of polyuria required that the effective blood volume be close to normal (i.e. Nevertheless, there was no direct way to monitor stomach contents or the rate of stomach emptying.
In quantitative terms, the glucose content in the ECF compartment had decreased by close to 300?mmol, an amount easily excreted by the kidney and representing 1l of ‘glucose?containing ECF’.
Professor Krebs patiently pointed out that these calculations were based on adding hypertonic glucose to the body, a situation different from that of our patient. The expected values are that the rise in natraemia should be close to half the decline in glycaemia to maintain a constant plasma tonicity and thereby avoid inducing ICF volume expansion and as a result, brain cell swelling.
At this point, the admitting physician reminded everyone that the patient had continued drinking large volumes of water instead of fruit juice since coming to the hospital. But after working eight years at Sacred Heart Medical Center, he decided there must be more to healthcare than just the linear allopathic approach.
We hope that readers and educators will appreciate the value of applying principles of integrative physiology in a quantitative fashion at the bedside. Third, because he was well?versed in integrative physiology, he had an advantage over modern counterparts whose knowledge is much greater in depth, but unfortunately, less developed in breadth.
This rise in tonicity would obligate the movement of close to 2?l of water (10% of the ICF volume of 20?l) to the ECF compartment and ultimately to the urine in this patient. Replacement of ECF volume with 1l of isotonic saline would prevent any haemodynamic insult.
He stated firmly, ‘Never apply data from one set of conditions to a second setting where the conditions are not identical’.
Randomized long-term trial of camel milk as an adjunct to insulin therapy in type-1 diabetes. Third, the plasma test for acetone, a metabolic derivative of one of the so?called ketoacids (acetoacetate), was only minimally positive in both the urine and the plasma.
These numbers highlight the large renal capacity to eliminate glucose when the GFR is maintained (Table 1). This in turn was due in part to the glucose and water retained in the body, re?expanding the ECF volume.
Professor Krebs recognized, but for the moment chose to ignore this water shift for simplicity. We again ask the reader to pause and make their own decision before moving to the next paragraph.
He received his Doctorate of Naturopathic Medicine (ND) from the National College of Naturopathic Medicine in 2004. This was not typical of diabetic ketoacidosis (DKA) and, at least from the perspective of fat metabolism, was not consistent with a very severe sustained lack of insulin. Excessive input, he proclaimed, must be the major culprit to explain the unusual degree of hyperglycaemia in view of the very high renal elimination of glucose.
He further cautioned that this severe degree of hyperglycaemia would resolve when the input of glucose decreased, but that the rate of stomach emptying as well as the concentration of glucose in the fluid retained in the stomach were important yet unknown variables.
Thereafter he turned his attention to the degree of hyperglycaemia to see if this might imply a severe lack of insulin.
While glucose entry into the body pool can be from endogenous or exogenous sources, he had dismissed the former as a serious possibility with an elegant quantitative analysis (Appendix 1). Patients are recruited from web sites for patient advocacy and health enhancement programs.
Professor Krebs was sure that our team of physicians would agree that exogenous glucose and not endogenous production was the cause of hyperglycaemia and shifted his focus to events in the gastrointestinal (GI) tract.
Therefore this long-term study was undertaken to assess the efficacy, safety and acceptability of camel milk as an adjunct to insulin therapy in type 1 diabetic patients. Methods: In this 2-year randomized clinical parallel design study, 24 patients with type 1 diabetes were enrolled and divided in 2 groups. Group I (n=12) received usual care (ie, diet, exercise, and insulin), and group II (n=12) received 500 mL camel milk in addition to diet, exercise, and insulin. His fundamental belief is in the integration of well-studied natural medicine with western allopathic medicine. Previous studies have found that between 30% and 60% of pediatric neurology patients have used CAM at some point in their lives. Whereas, the effect of vitamin C on conventional photodynamic therapy (PDT) of tumor cells has been documented, the mechanism of vitamin C induced increase in tumor cell response to PDT is unclear. In this report we demonstrate the presence of vitamin C during photo-oxidation of MC540 significantly increases its apoptotic activity in tumor cells.
Interestingly, we observed that the presence of vitamin C during photo-oxidation of MC540 only and not its addition to a prior photo-exposed mixture to MC540 is critical for its enhanced sensitivity. These findings provide impetus to the approach in developing ROS generating small molecule compounds with potent apoptosis inducing activity.
These data could have implications in the use of vitamin C in photo-sensitizer-mediated reactions with the view to favorably tailoring the cancer cell milieu for efficient apoptotic execution. Many patients are still not discussing their CAM use with their doctors and are using CAM alongside their conventional medicines, thereby increasing the likelihood for potential interactions.
One limitation of this study is that our ability to determine between-site differences is limited by the difference in sample size.
Electrodermal measures as clinical markers: Jing-point electrical impedance in adolescent women with chronic pelvic pain. Consequently, skin electrical measures at Jing points are commonly obtained and interpreted for diagnostic purposes.
Denise Adams, University of Alberta, 1047 RTF Building, University of Alberta, Edmonton, AB, T6G 2E1, Canada. The objective of this study is to determine whether electrodermal measures at Jing-points are associated with clinical outcomes in adolescents with chronic pelvic pain in a randomized, sham-controlled acupuncture trial.
Methods: We recruited 18 adolescent women aged 13 to 22 years of age suffering from chronic pelvic pain and laparoscopically diagnosed with Stage I-III endometriosis. Using a Hibiki-7 device, normalized electrical impedance values were obtained at all 24 Jing-points for each treatment session. Phase II: CAM research networks in Canada and the US will notify CAM providers of this study, so they may alert patients. Left-right asymmetry and measures for statistical dispersion (standard deviation and Gini coefficient) of Jing-point impedance values were calculated. Parents or legal guardians may self-identify and reply on behalf of patients under 18 year of age if they meet the criteria for Phase I. With a generalized estimating equation method, we evaluated the association between the electrodermal-derived measures and clinical outcomes while accounting for treatment designation and time. Phase III: The methods for phase II were utilized but CAM associations and training organizations were substituted for CAM research networks. The majority of the cases involved the use of Traditional Chinese Medicine to improve quality of life.
Preliminary analyses indicate that, over time, subjects in the active acupuncture arm were more likely to have reduced left-right asymmetry and statistical dispersion of Jing-point measures compared to subjects in the sham-control arm.
Further analyses with multivariable models will be performed to assess whether this difference is statistically significant for each electrodermal measure. The chiropractic care of children with otitis media: a systematic review of the literature utilizing whole systems research evaluation and meta-synthesis. Joel Alcantara, International Chiropractic Pediatric Association, 327 N Middletown Rd, Media, PA 19063. Key words were otitis media and related words (ie, acute otitis media, otitis media with effusion, ear infections, etc) AND chiropractic. A narrative review of the literature was performed and augmented with a meta-synthesis of the literature with a focus on chiropractic management and the application of a whole systems research (WSR) evaluation. Results: Our systematic review revealed 20 articles consisting of 6 case reports, 5 case series, 1 retrospective cohort, 2 prospective cohorts, 2 reviews of the literature, 2 commentaries, 1 survey study and 1 prospective, parallel-group, observer-blinded, randomized feasibility study.
Due to the lack of higher-level research design, a meta-analysis of the literature was not possible.
This included the use of otoscopy and tympanogram to provide objective pretreatment and comparative outcome measures. Eighty-nine percent of respondents reported treating pediatric patients; patients under the age of 17 made up 12% of chiropractic and 20% of both naturopathic and osteopathic patients.
Activator, Gonstead, Toftness, Chiropractic Biophysics, and Diversified Techniques were utilized with an emphasis on the upper cervical spine (the C1 or C2 vertebral bodies).
Approximately two-thirds of both osteopaths and naturopaths disagree or strongly disagree that immunizations are safe compared to one-third of chiropractors.
One paper described utilization of cranial technique, 2 papers described a dietary intervention, and 2 papers utilized soft-tissue massage to augment spinal manipulative therapy. Fifteen studies were amenable to the WSR evaluation resulting in a score of 7.06 from a maximum of 11. The immunizations of most concern to the 3 professions included MMR, varicella, influenza, DPTP, and hepatitis.
The most common reasons for concern were related to safety, including that vaccines may contain dangerous ingredients, may produce side effects, and may be linked to future problems such as neurological damage.
Conclusion: This systematic review highlights the need for more higher-level research designs in addition to incorporating new methodologies (ie, whole systems research) reflective of the holistic and vitalistic clinical and theoretical framework of chiropractic. The chiropractic care of children with enuresis: a systematic review of the literature utilizing whole systems research evaluation. Significantly more naturopaths advised parents against vaccinations (27%), compared to 10% of chiropractors, and 12% of osteopaths (P=.0002). Joel Alcantara, International Chiropractic Pediatric Association, 327 North Middletown Rd, Media, PA 19063. There was no significant difference between groups for those advising parents in favor of vaccinations (15% C, 14% N, 6% O) (P=.1143).
Key words were enuresis, nocturnal enuresis, bedwetting as well as related words AND chiropractic. A narrative review of the literature was performed and augmented with an evaluation using WSR evaluation. Results: Our systematic review revealed 7 articles meeting the eligibility criteria for review. Four of the 7 papers involve case reports describing the care of children aged 8 to 14 years with primary complaints of nocturnal enuresis. Spinal manipulative therapy involved the use of Toggle recoil, Sacro-Occipital Technique, Activator Methods, Gonstead Technique, and Diversified Technique to address primarily segmental dysfunctions in the lumbosacral spine.
We conducted a systematic review to assess the nature and severity of adverse events associated with pediatric acupuncture.
A large prospective cohort study (N=171) demonstrated improvement in wet nights per week from baseline following 2 weeks of care. In a randomized clinical trial, within-group comparison of pretreatment and comparative rates of enuresis subjects demonstrated an improvement. However, the study was fraught with research design issues such as randomization and biostatistics. Six of the 7 studies were amenable to WSR evaluation and resulted in a scoring of 7.33 from a maximum possible score of 11 points.
One reviewer screened all articles, while the second reviewed all excluded articles to ensure that no article was inappropriately excluded. Full articles of potentially relevant references were retrieved and assessed by two independent reviewers. The use of Whole Systems Research provides promise in contributing to evidence-based practice and reflects the holistic and vitalistic chiropractic approach to patient care.
Results: Seven thousand, two hundred sixty-two potentially relevant articles were identified. Eleven of these studies included adults as the majority of patients; for these studies the age of the patient experiencing the adverse event was never reported.
Most of the adverse events that have been identified in children were mild and included pain, bruising, and worsening of symptoms.
The few adverse events rated as moderate or serious included one pneumothorax, 2 infections, and 2 cases of complications from needles left in the body. Methods: This study was approved by the Institutional Review Board of Life University (Atlanta, Georgia). A 26-item questionnaire was sent to 9000 subscribers of an online newsletter from Midwifery Today Magazine.
The first domain identified demographics (midwife credentials, age, years in practice, and place of practice). The second domain queried participants regarding their formal and postgraduate training on the subject of chiropractic.
The third domain attempted to identify their experience (ie, positive or negative experience) with chiropractic personally and professionally as it pertains to pregnancy and infant care. The fourth domain asked their opinion about the safety of chiropractic care for pregnant and pediatric patients.
The fifth domain surveyed their knowledge regarding the scope of practice of chiropractic for pregnant and pediatric patients. The respondent ranged in age from 41 to 50 years with practice experience ranging from 6 to 10 years. With respect to their training on chiropractic, 31% (n=57) reported receiving formal education (ie, during midwifery education) on the subject of chiropractic. Fifty-five of the 157 who did not indicated receiving some education on chiropractic through continuing education seminars. With respect to the midwife responders’ experience with chiropractic, 95% (n=176) admitted to making a professional referral to a chiropractor with 73% (n=137) having referred an infant to a chiropractor. Ninety-two percent (n=171) reported being chiropractic patients with another 58% (n=124) presenting their child for chiropractic care. Over 90% indicated experiencing a positive experience as patients and with their child’s care.
All of the respondents perceived chiropractic was safe for pregnant patients, while only 97% considered chiropractic safe for children. An overwhelming majority of the responders (98%) indicated that chiropractors work with birth professionals, while 92% indicated that they were knowledgeable about the role of chiropractic in prenatal care. Lastly, 75% indicated interest in learning more about chiropractic, with 86% wanting more evidence-based practice chiropractic. From the 809 articles reviewed, 18 articles met the full inclusion criteria and proceeded to data extraction. Identified adverse events include local pain or soreness, swelling, mild fevers, and skin rashes. Thus far, the majority of adverse events reported have been mild with few moderate or serious adverse events occurring in pediatric patients.
Total weight and body composition changes in response to weight reduction diets of varied protein content in midlife women.

Age-related changes in body composition for women include loss of lean mass and gains in total weight, fat mass and central fat deposition.
There is growing evidence that diets with low-to-moderate carbohydrate and fat content and increased levels of high-quality protein are effective for weight loss. Greater subjective satiety is reported by subjects following test meals containing whey protein compared to other protein sources.
The beneficial effects of whey protein on satiety, thermogenesis, and lean body mass protection suggest that whey may be a preferred protein source for weight loss treatment. The specific aims of this study are to assess weight loss in subjects receiving energy-reduced dietary regimens and to evaluate parameters of weight and body mass change between the 3 treatment groups. Study Design: We are conducting a randomized, controlled pilot feeding study to evaluate the effect of different dietary protein sources on weight loss.
Endpoint measures include body weight and body composition data obtained at baseline and at 8 weeks for dietary treatment.
The HP diet and the WP diet produced greater total fat loss and less total lean tissue loss than the CD. Conclusions: Preliminary data shows that across treatment groups, the high-protein diets conserved lean tissue and promoted reduction of fat tissue. Trials investigating TCM must be conducted with increased methodological rigor to be of value in evaluations. The single included study suggesting that acupuncture may be safe and efficacious in CFS is limited in applicability by the use of sham acupuncture as the control. Integration and interface between naturopaths and conventional rural care: empirical findings from a grass-roots research project. The worsening epidemic of DM in the United States, along with the increasing prevalence of obesity, insulin resistance, and IGT, render the identification of promising interventions for these states a matter of some urgency. Jon Adams, University of Queensland, School of Population Health ,University of Qld, Herston, Queensland, 4006, Australia.
While lifestyle interventions based on dietary pattern and physical activity can delay or prevent the onset of diabetes and reduce cardiovascular risk, adherence at the population level is severely limiting.
Pharmacotherapy offers promise for diabetes prevention, but with associated high costs, unacceptability to many patients, and potential toxicity. In this context, the potential role of chromium (Cr), an insulin cofactor, in IGT is of great interest. Proposed, therefore, is a randomized, double-blind, placebo-controlled pilot trial conducted at the Yale Prevention Research Center to investigate the effects of daily Cr for 6 months at 2 dose levels on serum measures of glucose tolerance and on endothelial function in adults with IGT, IFG, and IR. The study is powered to detect a clinically meaningful effect of Cr supplementation at either dose on glucose control, and to compare the two doses for equivalence. The study will investigate effects of Cr on both measures of glucose tolerance (glucose, insulin, OGTT) and brachial artery endothelial function, thus combining serum measures with a physiologic test of Cr effects on the vasculature. The proposed study will generate much needed data regarding the efficacy of Cr in those at risk for type 2 diabetes and offers the promise of guiding practice, as well as directing future study. By contributing to knowledge related to potential diabetes prevention strategies, this study addresses one of the more pressing public health issues in the United States today. Risk to human subjects in this study is a minor increment over minimal due to the administration of nitroglycerin as a control in BARS testing.
Secondary outcomes: (4) It will show improved well-being, as measured by elevated melatonin and DHEA.
Unlike many relaxation therapies, energy healing requires no participation by the patient, a feature that makes it particularly attractive in the hospital setting, where patients are often anxious, depressed, in pain, or sedated. Despite the increasing use of energy healing, few studies have looked at its benefits and even fewer at its underlying mechanisms of action.
In this pilot study, we examined the effects of an energy healing modality known as Reiki on the autonomic nervous system (ANS) and the hypothalamus-pituitary-adrenal (HPA) axis, both of which participate in the stress response and stress-induced pain and disease progression. Subjects rested for 10 min before baseline heart rate and blood pressure were measured and blood was drawn to determine cortisol, ACTH, and DHEA levels, using commercial immunoassay kits. Subjects then received a 30- to 45-min Reiki or Pretend Reiki session followed immediately by post-session heart rate and blood pressure measurements and at 2h by blood draws.
When asked whether they thought they were in the Reiki or Pretend Reiki group, about 70% of the participants reported that they believed that they had received a true Reiki session. This suggests that the beneficial effects of Reiki on physiology, as compared to the Pretend Reiki, cannot be explained solely by the placebo effect. Issac Amponsah, Faculty of Pharmacy Kwame Nkrumah University of SC, Knust, Kumasi, 233, Ghana. Effects of ultra-low dilutions of sabal serrulata on human prostate cancer growth: mechanistic studies. Hakima Amri, Georgetown University, Basic Science Bldg, 3900 Reservoir Rd NW, Washington, DC 20007. Finally, serum protein differential expression was carried out using 2-dimensional gel electrophoresis followed by mass spectrometry analysis. Effect of mind-body medicine skills on elements of emotional intelligence in medical students. Yet studies have reported that traits such as altruism and empathy tend to decline throughout medical school training. In an effort to foster medical student self-awareness and mindfulness, which may improve their EI, Georgetown University School of Medicine (GUSOM) offers an experiential course to undergraduate medical students in mind-body medicine skills. The purpose is to expose students to a variety of mind-body approaches including meditation, imagery, as well as group sharing and listening generously for self-awareness and reflection.
The aim of this study was to assess the impact of the Mind Body Medicine Skills (MBS) course on perceived stress, mindfulness, and elements of EI including intrapersonal capacities (attention to feelings, mood repair, clarity of feelings) and interpersonal capacities (perspective-taking, empathetic concern, and personal distress in response to distress in others). The intervention group (n=30) was comprised of first year medical students who self-selected to participate in this elective. The control group (n=36) included students from the first year class who completed the surveys but did not take the MBS course. Four questionnaires were completed at the start and end of the spring semester by all study participants: the Perceived Stress Scale (PSS), the Mindful Attention Awareness Scale (MAAS), and a survey of EI developed by Stratton et al (2005) comprised of the Trait Meta-Mood Scale and the Interpersonal Reactivity Index.
ANCOVA was used to compare the MBS and the control groups at the end of the semester, controlling for beginning scores. Patient perspectives of integrative and primary care management of back and neck paina€”qualitative findings from a randomized clinical trial. These conditions are additionally some of the most common reasons why patients use complementary therapies, often without dialogue with conventional care providers.
The focus groups were conducted separately for those in the integrative vs the conventional treatment groups. The interview data were transcribed ad verbatim and analyzed utilizing inductive content analysis technique. Eliane Angst, UCLA Center for Excellence in Pancreatic Diseases, 675 Charles E Young Drive South, Los Angeles, CA 90095. A significant reduction in cell numbers was seen with quercetin concentrations of ~30 AµM and a maximum effect at ~75 AµM.
In MIA PaCa-2 cells a ~65% reduction in cell number was seen with 75 AµM of quercetin after 48 hours.
Starved BxPC-3 cells treated with 75 AµM quercetin showed a ~95% reduction in cell number after 48 hours.
Conclusion: These results suggest that quercetin has a potent growth-inhibitory effect in pancreatic cancer cells in vitro. Additional experiments to investigate the underlying mechanism of growth inhibition and animal studies are underway. Flovanoids may reveal to be potent anticancer drugs found in our daily food, leading to specific diet recommendations.
These can be taken together to qualify as an academic minor in many of the conventional MA or PhD programs, often forming the basis of a thesis or dissertation required for the terminal degree.
In the fall of 2009, the university will launch a doctorate of nursing practice with a focus in integrative health and healing. Georgetown University developed a concentration of CAM within its Masters in Physiology program in 2003. We address the multicultural perspective, comparing data collected in Canada and Europe to those in the United States. The reason for this is that results on the health-promoting effects of spirituality and religiosity cannot easily be transferred from the United States to countries with different cultural and religious backgrounds.
Thus, one has to recognize different concepts of spirituality, different attitudes towards its utilization, and objections against the implementation of it in a particular medical system. In Germany, 3 colleagues have founded the Transdisciplinary Working Group on Spirituality and Health, and in Canada the Canadian Research Network on Spirituality and Health has been active for a couple of years.
Data and approaches from these different networks will be combined into this symposium.Dr BA?ssing is an associate professor at the University of Witten, Herdeckea€™s Faculty of Medicine, where he directs the research group Spirituality and Health. The effect of a€?acupuncture for losing weighta€? on the level of blood sugar: a survey on the mechanism. Hoda Azizi, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Beijing, Beijing, 100029, China. Material and Methods: In this clinical trial study, 66 patients were included in case and control groups.
Blood sugar was examined just before inserting needles and immediately after withdrawal of needles.
Conclusion: Our results suggest that the mechanism of acupuncture in losing weight is significantly related to making an increase in BS. John Balletto, Center for Muscular Therapy, Inc, 545 Pawtucket Avenue, Mailbox 304, Pawtucket, RI 02860-6046. As with business startups that begin informally and successfully mature into larger enterprises, growth brings new organizational challenges, together with greater visibility and opportunity.
The maturation of massage as a healthcare profession increases the need for a process to formalize the synthesis of massage therapy knowledge from clinical experience and research—to collect what we know and to make such baseline knowledge widely available to practitioners, consumers, and other healthcare stakeholders. The present paper lays out the motivations and framework for creating massage therapy guidelines that are informed both by research and by clinical experience. It also acts as a report to the massage therapy profession and to other stakeholders about the work of the Best Practices Committee of the Massage Therapy Foundation since 2006. And it has the additional goal of providing a healthcare literature basis for future academic discussions of massage. The discussion here is based on a definition from the Institute of Medicine and on research into the nature of expertise. Topics addressed include guideline creation, credentialing of complementary and alternative medicine practitioners, definition of competence, and the increasing role of technology (that is, informatics) in managing training and task-necessary competencies. The roles of transparency and a wide and open peer review are emphasized as essential to the usability and credibility of guidelines.
Health Canada issues consumer advisories regarding the safety of marketed health products, yet the criteria for issuing advisories have not been evaluated for consistency or objectivity. The Causality Algorithm used by Health Canada was used to rate degree of association between the adverse events (AEs) and the products. The Severity of Adverse Events Scale, developed by the National Cancer Institute, was used to determine the severity of the AEs. Most NHP AWRs were issued based on potential AEs from contamination and adulteration, whereas most of the AWRs for therapeutic drugs were issued due to actual AEs. Of the 6 NHP AWRs issued for actual AEs, 3 (50%) were unassessable for severity, whereas of the 28 AWRs issued for actual therapeutic drug AEs, 1 (3%) was unassessable for severity. The origin of reports for NHPs tended to be from foreign sources or Health Canada, whereas reports for therapeutic drugs were mostly issued by Health Canada in conjunction with drug manufacturers. The potential of a mistletoe (Viscum album L) extract to alleviate adverse effects of cancer chemotherapy: an in vitro study.
Stephan Baumgartner, University of Bern, Institute of Complementary Medicine KIKOM, Inselspital, Bern, BE, 3010, Switzerland. We investigated the effect of a mistletoe extract on PBMC with and without concomitant treatment with cyclophosphamide and compared viability and replication of normal PBMC with that of a T-cell leukemia cell line.
The results motivate further preclinical and clinical investigations of mistletoe extracts as an adjuvant medication in cancer therapy to alleviate side effects of conventional therapy.
Stephan Baumgartner, Institute of Complementary Medicine KIKOM, University of Bern, Inselspital, Imhoof-Pavillon, Bern, BE, 3010, Switzerland.
We investigated the potential of a commonly used plant pathogen–system, Arabidopsis thaliana infected with the virulent bacteria Pseudomonas syringae (pv tomato strain DC3000), regarding its response towards a homeopathic treatment. Compared to Bion (a common SAR inducer used as positive control), the magnitude of the treatment effect of Biplantol was about 50%. None of the other tested preparations yielded significant effects in the overall evaluation.
The purpose of this study was to determine remedy effects on a common quantitative measure of complexity, the correlation dimension (D2), of human sleep electroencephalography (EEG). High Hostile subjects increased complexity at C3 and Pz, but decreased complexity at O2 during stage 3 sleep on CC. In the high Anxiety-Sensitive subjects, CC caused significant increases in complexity at Pz and O1 during stage 3 sleep and at C3, C4, and Pz during stage 4 sleep. CC increased complexity significantly at Cz, C4, and O2 during REM sleep in only the high Anxiety-Sensitive subjects.
The purpose of the present study was to determine whether or not the objective measure of polysomnographically-recorded all-night sleep recordings can distinguish verum homeopathic remedies from placebo in human subjects. NV produced more marked effects on increased shifts in sleep stages, with a growth in effects from night 22 to 23. This study examined the effects of olfactory administration of a polycrest homeopathic remedy Sulphur on heart rate variability (HRV). The Sulphur was given at dilution factors used for preparing 6c, 12c, and 30c potencies (1 potency per session, with potency order randomized), but for each potency, the test solutions were succussed to different degrees (stirred without shaking, 10, 20, or 100 succussions). Homeopathic remedies increase spectral electroencephalographic power during sleep in healthy young adults. The purpose of the present study was to assess the effects of verum vs placebo homeopathic remedies on spectral qEEG measures of polysomnographically-recorded all-night sleep recordings.
Evaluating a nonlinear dynamical model for human flourishing: Relationship of PANAS positive-to-negative-affect ratio and global health and well-being. The purpose of the present study was to compare global physical health (GPH) and well-being ratings of young adults whose P:N mood ratios fell above vs below the Losada line. Despite higher (MCSD) scores in PF, a small sex and age difference between groups, ANCOVAs controlling for MCSD, sex, and age still showed statistical significance of the above PF vs PL group differences. Gurjeet Birdee, Osher Research Center Harvard Medical School, 401 Park Drive, Suite 22-A West, Boston, MA 02215. We identified the prevalence of CAM modalities used and the characteristics of users among the pediatric population.

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