Perlmutter Health Center

A Quarterly Health Update • Spring 2000 • Vol. 5 No. 1

David Perlmutter, MD, FACN

Quotes

"There is only one corner of the universe where you can be certain of improving, and that's your own self." -- Aldous Huxley

"A man travels the world over in search of what he needs and returns home to find it" -- George Moore

Bed Rest - More Harm than Good?

Bed rest has long been advocated as an important adjunct in the treatment of a variety of illnesses. Indeed Hippocrates stated "In every movement of the body, whenever one begins to endure pain, it will be relieved by rest". Bed rest is commonly recommended in the treatment of myocardial infarction, following various surgical procedures, for acute low back pain, to prevent early threatened abortion, and in the treatment of tuberculosis, rheumatoid arthritis, acute infectious hepatitis, and other illnesses.

But it should be remembered that bed rest is a form of medical treatment and therefore, should be scrutinized in terms of its effectiveness. Studies dating back to the 1940's have shown that bed rest offers virtually no advantage for post-operative patients following various types of surgeries and actually may increase the risk of various complications including osteoporosis, deep vein thrombosis, bed sores, and pneumonia.

In a report entitled, Bed Rest: a Potentially Harmful Treatment Needing More Careful Evaluation appearing in the October 9, 1999 issue of The Lancet, researchers evaluated the medical literature comparing bed rest to ambulation in a variety of common circumstances. Their results revealed that bed rest offered virtually no advantage over ambulation in a variety of common medical problems including acute low back pain, pulmonary tuberculosis, rheumatoid arthritis, as well as following surgical procedures such as liver biopsy, cardiac cathaterization, and lumbar puncture.

As the author stated "published results give little support for bed rest as a form of management in a wide range of settings, and suggest that it may actually delay recovery and even harm the patient. . . . Ideas about bed rest seem so entrenched that medical practice has been slow to change - even when faced with evidence of ineffectiveness. For example, a study of protocols used after spinal puncture in 1998 found that more than 80% of neurological units in the UK still insist on bed rest despite evidence from 17 years earlier that bed rest has no value. There are also reports that bed rest is still being over-prescribed after myocardial infarction and cardiac cathaterization, and for acute low back pain." Further, in specifically commenting on the use of bed rest following myocardial infarction, the author stated "the value of bed rest was questioned in 1938 because during the two months of forced bed rest more patients died of pulmonary infarction, uremia (kidney failure), and pneumonia, than of cardiac complications. Despite recommendations in 1944 for the period of bed rest to be cut to two weeks, six years later standard clinical practice still prescribed four weeks or more of bed rest. Since that time, large scale clinical trials have shown that bed rest is unnecessary, and one showed that there is significant danger associated with hospital bed rest after myocardial infarction. In current clinical practice only 12 hours of bed rest is prescribed, with ambulation in the ward by day 3." Finally, to quote from a report entitled "Abuse of rest as a therapeutic measure for patients with cardiovascular disease" appearing in the Journal of the American Medical Association, over 50 years ago, "the physician must always consider complete bed rest as a highly unphysiologic and definitely hazardous form of therapy, to be ordered only for specific indications and discontinued as early as possible."

When physicians make recommendations for a particular therapeutic intervention, it is hoped that this recommendation is made on the basis of reviewing the scientific literature supporting its effectiveness. For example, when a particular antibiotic is used in a specific infectious disease, it is generally assumed that there is scientific literature supporting the usefulness of that particular drug in treating the suspected infectious agent. Bed rest is no less a therapeutic intervention. Therefore, it to should be recommended only in the presence of a strong scientific support based on a retrospective analysis of outcome. In many instances, there is virtually no support for the recommendation of bed rest, and indeed its utilization may increase the risk of potentially dangerous complications.

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Parkinson's Disease - A Preventable Illness?

It has been estimated in the United States alone, more than one million people have Parkinson's disease, with more than 50,000 new cases being diagnosed each year. The prevalence in the over 55 population approaches 1 in 100.

Typically, Parkinson's disease is considered "idiopathic", which is to say no clear-cut cause is readily identifiable. That being said, the idea of preventing Parkinson's disease certainly does not fit with our general understanding of this illness.

New research, however, is revealing that certain lifestyle factors may considerably increase the risk of Parkinson's disease. In two fascinating reports in the January 1999 issue of Movement Disorders, the relationship of increased risk of Parkinson's disease to both occupational exposure to pesticides as well as intake of animal fats, was described. In the first report, dietary data from 103 patients with the disease were compared to a similar number of controls. Those individuals having the highest consumption of animal fat were at a 300% increased risk for developing Parkinson's disease. Interestingly, there was a lower risk of Parkinson's disease in those individuals eating foods high in niacin.

There was also confirmation of the long-held belief that occupational exposure to agricultural work and pesticide exposure, significantly increases the risk of Parkinson's disease.

Why high-fat diets may increase the risk of Parkinson's disease is not clear. Nevertheless, there may be a relationship between these two studies in that consuming foods high on the food chain (animals) does increase an individual's consumption of fat soluble pesticides which are now ubiquitous in our environment. In the mid-1980's research demonstrated that a particular toxin could immediately cause Parkinson's disease. This has formed the foundation for a school of research exploring how a toxic insult can damage a particular part of the brain and create a disease like Parkinson's.

The take-home message from these two reports is simply that Parkinson's should not be considered to be a disease that develops "out of the blue". There are very important modifiable factors, which can significantly increase the risk of this debilitating problem.

To learn more about the health risks of pesticides I recommend reading Our Stolen Future by Theo Coburn, Dianne Dumanowski, and John Peterson Myers, with a foreword by Vice President Al Gore (ISBN 0-452-27414-1). The health benefits of a vegetarian diet are eloquently described in Dr. Neal Barnard's book, The Power of Your Plate (ISBN 0-913990-69-8).

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Essential Fatty Acids and Heart Disease

Over the past decade, the usefulness of essential fatty acid supplementation in cardiovascular disease has received a lot of attention and while mainstream medicine emphasizes cholesterol lowering drugs and perhaps aspirin, the data confirming the usefulness of essential fatty acid supplements is no less powerful. In an article appearing in The Lancet (August 7, 1999) Italian researchers demonstrated a powerful protective effect of Omega 3 essential fatty acids derived from fish with respect to cardiovascular risk. Their justification for this study was the observation that Eskimo populations, despite consuming high fat diets, have very low rates of cardiovascular disease, likely because of the fact that their diets are rich in fish oils.

During the two-year period from 1993 to 1995, over 11,000 patients, having survived a recent myocardial infarction, were randomly assigned to either receive omega 3 essential fatty acids (one gram each day), vitamin E, or no supplementation whatsoever. The findings of the study revealed a profound lowering of the risk of either second myocardial infarction, death, or stroke, in the group receiving the essential fatty acid supplements by as high as 20%.

The authors speculate that the beneficial effects of the omega 3 essential fatty acids likely is derived from the fact that they helped reduce the production of inflammatory chemicals, reduce oxidation of cholesterol, improve the function of cells lining the arteries, and may have a role in the gene expression of certain "adhesion molecules", which may be involved in increasing risk for coronary events.

Essential fatty acid supplementation represents a powerful tool in reducing risk of vascular events including myocardial infarction and stroke. Common essential fatty supplements include flax seed oil and fish derived oils containing EPA and DHA. These nutritional supplements are easily obtained from health food stores. It is important to take a good quality vitamin E (d-alpha-tocopherol) along with these essential fatty acid supplements to keep them from becoming oxidized and thus rendered effective. Further, essential fatty acids should always remain refrigerated, again, to reduce their risk for becoming oxidized.

Perhaps the most authoritative text available to learn about the health-giving properties of essential fatty acids is the book, Fats and Oils - The Complete Guide to Fats and Oils in Health and Nutrition by Udo Erasmus (ISBN 0-920470-16-5)

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Hyperbaric Oxygen and Cerebral Palsy

The term "cerebral palsy" is not a specific diagnosis, but is now generally applied to children who experience some form of brain trauma either at the time of birth or shortly before. Typically, these children manifest some degree of cognitive impairment as well as physical impairment, often with weakness and spasticity of arms and legs.

Typically treatment therapies for children with cerebral palsy have been directed at the physical manifestations of the underlying problem. That is, most efforts are geared to increase range of motion, reduce spasticity, and increase strength, along with specific therapies designed to enhance skills of communication and academic performance.

Evidence from around the globe is now accumulating providing strong support for the use of hyperbaric oxygen therapy (HBOT) as an approach to the actual underlying problem in children with cerebral palsy - a technique which actually targets the abnormalities of brain function.

The use of hyperbaric oxygen therapy in cerebral palsy offers an exciting new therapeutic approach for the treatment of cerebral palsy. In actuality however, hyperbaric oxygen therapy itself is not a new technique. It has been utilized for decades for the treatment of injuries related to underwater diving, and in addition has found great utility in the treatment of poorly healing wounds, burns, various bone disorders, complications of radiation therapy, circulatory problems, carbon monoxide poisoning, multiple sclerosis, head injury, and stroke. Hyperbaric oxygen therapy is approved by the FDA as well as the AMA and acts by enhancing tissue levels of life-giving oxygen.

Normally, oxygen is almost exclusively carried by red blood cells. During hyperbaric oxygen therapy, there is a substantial increase in the amount of oxygen carried in all body fluids, including plasma, cerebrospinal fluid, lymph and intracellular fluids. This allows increased oxygen levels in areas of tissue damage or injury. Increasing oxygen levels promotes growth of blood vessels and increases the metabolic activity of previously marginally functioning cells, including brain neurons. Patients receiving hyperbaric oxygen therapy enter a monoplace (one-person) clear acrylic chamber where they breathe 100% oxygen delivered to the chamber under increased atmospheric pressure.

Typically, treatments last one to two hours during which time patients relax, watch television, or sleep, while they are carefully monitored by highly trained technicians. Most chambers are large enough to comfortably treat both an adult and a child. The effectiveness of hyperbaric oxygen therapy in children with cerebral palsy is likely a manifestation of enhanced function of previously damaged neurons. These neurons have been called "idling neurons" in that while they are still alive, they have been damaged to the extent that their function is compromised. The concept of enhancing the function of these idling neurons has been extensively described in stroke patients as we have reported in previous issues of the Perlmutter Letter. Canadian researchers have been vigorously exploring the utility of HBO in cerebral palsy. Dr. Pierre Marois and his team of researchers from McGill University in Montreal have recently studied 25 children with cerebral palsy, aged 4 to 7 years, treated with hyperbaric oxygen therapy on a daily basis for 20 days at McGill University. Another 15 children were treated twice a day for 10 days. Both groups thus received a total of 20 treatment sessions. The results of their post-treatment evaluation were truly remarkable. According to Dr. Marois "…the results are really incredible! 23 of the 25 children have great results. Twenty-three have amelioration with their spasticity and may have amelioration with speech and cognitive function".

Further, their published results reveal "the clinical observations do list numerous functional changes, definite improvements, a large amount in the level of arousal/response to communication." From statistical analysis of the objective estimations we confirm these change, more particularly on the level of motor functioning like walking and the quality of sitting position, similarly on the level of spasticity. These results are suprising considering the small number of treatments given (20), and of extreme importance because its (a question of) the first study documenting objectively the prospects of beneficial effects of HBO in the treatment of children suffering from cerebral palsy.

While it is important to recognize that hyperbaric oxygen therapy clearly represents an important tool in the treatment of children with cerebral palsy, it should be viewed as an adjunctive form of therapy to be used in conjunction with other established treatment protocols including physical therapy, occupational therapy, speech therapy, as well as pharmaceutical therapy designed to reduce spasticity. The use of HBO in children with cerebral palsy is now gaining a strong foothold in the United States and there is no doubt that because of its profound effectiveness, its utilization will become much more widespread.

Public awareness of the use of hyperbaric oxygen therapy in children with cerebral palsy in North America can be credited in large part to the work done by Mothers United for Moral Support (MUMS). This worldwide organization, founded by Julie Gordon, a mother of a child with cerebral palsy, seeks to unite parents of children with cerebral palsy and other needs and to share information concerning various therapeutic options.They can by contacted at telephone 920-336-5333. E-Mail can be directed to the MUMS National Parent - to - Parent network by contacting MUMs@netnet.net.

We are proud to report that the Perlmutter Hyperbaric Center has become a world leader on the use of hyperbaric oxygen therapy in cerebral palsy and other neurological disorders. To receive more information about hyperbaric oxygen therapy in the treatment of cerebral palsy, contact The Perlmutter Hyperbaric Center at 239-434-9699 and visit our web site at www.perlhealth.com.

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New Study Shows Garlic Helpful in Reducing Cholesterol

It is now certainly common knowledge that elevated serum cholesterol represents an important and modifiable risk factor for the development of cardiovascular as well as cerebrovascular disease. Attention to cholesterol through dietary modification, the use of nutritional supplementations, behavioral changes, and drug intervention is likely responsible for a significant decrease in incidents and mortality from these forms of vascular disease.

Garlic certainly represents one of the most commonly recommended nutritional supplements to help lower cholesterol and thus likely lessen the incidence of cardio and cerebrovascular disease. In an attempt to fully quantitate garlic's ability to lower cholesterol, researchers recently performed a double-blind study evaluating the effectiveness of aged garlic extract (Kyolic® garlic) compared to placebo in lowering serum cholesterol. The study group was comprised of 41 men with moderate elevations of cholesterol (220 - 290). After a four-week baseline period during which the subjects adhered to the National Cholesterol Education Program, Step One Diet, they were started on either 7.2 grams of Kyolic® garlic or an equivalent amount of placebo as a dietary supplement for a six month period of time. Serum cholesterol levels as well as blood pressures were followed during the entire study period.

The remarkable findings of this study, published in a recent issue of the American Journal of Clinical Neurology, revealed a reduction of total cholesterol of approximately 7% in the group receiving Kyolic® garlic. LDL (bad cholesterol) was reduced by 4.6% in the treated group compared to those receiving placebo. Further, another statistically significant finding was a 5.5% decrease in systolic blood pressure with a modest reduction of diastolic pressure in the group receiving the garlic extract. The authors concluded "our results show that aged garlic extract (Kyolic® garlic) is a safe supplement over extended periods of time and that it does not alter blood counts or change blood chemistry or thyroid function. Furthermore, our double-blind crossover study showed that garlic supplementation can produce significant reductions in total as well LDL cholesterol, but did not change HDL cholesterol and triaicylglycerol concentrations. In addition, blood pressure is beneficially affected by garlic administration."

Aged Garlic Extract (Kyolic® garlic) is by far the most widely studied garlic preparation available. Its beneficial effects on cholesterol as well as blood pressure are the reasons we utilize Kyolic® garlic exclusively at the Perlmutter Health Center.

For more information about Kyolic® garlic, contact Wakunaga of America at (800) 421-2998, or online at www.kyolic.com.

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Book Review

BrainRecovery.com - Powerful Therapy for Challenging Brain Disorders by David Perlmutter, MD, FACN
Perlmutter Health Center - Publisher, ISBN 0-9635874-1-2.

I am writing this foreword not because I am a neurologist capable of evaluating the entire book's contents, but because I am someone who has chosen to have my family members and patients cared for by Doctor David Perlmutter. I deeply respect his open-mindedness and expertise as a physician. He combines the skills of a well trained traditional medical practitioner and caring physician with the wisdom of one who goes beyond the limitations of today's so called medical education and the closed minded medicine I see it practiced today.

As one who has been working for over twenty years to enlighten medical minds to treat the whole person and integrate their care I see David as a leader in his field. He is willing to explore new therapeutic modalities - skillfully and compassionately guiding his patients through challenging medical problems. His book is an excellent resource based upon his extensive experience and expertise in areas others are often slow to accept because of their training and limited information.

On a personal level I know the struggles I have gone through to receive therapies that David now makes available to patients through his practice and consultations. He and his book are true guides for those who seek healing. The information contained needs to be available to everyone so true integrative therapy can become the normal method of treatment in the field of neurology.

Bernie Siegel, M.D.

I have just finished reading Dr. David Perlmutter's book, BrainRecovery.com - Powerful Therapy for Challenging Brain Disorders, and have sat in awe of both what is happening in neurology and the manner in which Dr. Perlmutter tells the story. In my education thirty years ago, I learned that brain injury was irreversible and that disorders such as Parkinson's and Alzheimer's were inherited. What I learn from both the scholarship and clinical expertise of Dr. Perlmutter in his book is that both of these concepts are wrong. The brain, to some extent, can be healed and these neurological diseases are not predetermined and unmodifiable.

What a tremendous sense of empowerment for the individual who is either at risk or who has early stage neurodegenerative disease to know that there is something that can be done.

I applaud Dr. Perlmutter for making this breakthrough information available not only to the medical community, but more importantly, to the many people who need to learn of it. It was only in the early 1990's that the concepts of brain plasticity and brain healing started to be better understood by the biomedical community. It might be another ten years before it is widely understood and in general medical practice by the average physician. Dr. Perlmutter's book gives the reader at least a ten-year head start in accessing this revolutionary information for their own health and those for whom this information can be vitally important.

Jeffrey Bland, Ph.D.
President, Institute for Functional Medicine
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