Radiation Induced Xerostomia (Dry Mouth)

Acupuncture Can Help

Radiation induced xerostomia is a common side effect 
experienced from radiation therapy to the head and neck region.   

Radiation treatments are often given as a therapy for cancers involving the oral cavity, pharynx, larynx, paranasal sinuses, nasal cavity and salivary glands. 

Patients who receive radiation to the head and neck may experience redness, irritation, and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing; changes in taste; or nausea. (1)

Why is dry mouth a problem?
Besides causing the aggravating symptoms mentioned above, dry mouth also increases a person's risk of gingivitis, tooth  decay and mouth infections such as thrush. (2) Irritation to the mouth and thick saliva contribute to difficulty eating which often affects proper nutrition and dietary intake needed to maintain good quality health and healing.

Treatment
Acupuncture is a viable option for prevention and treatment of radiation induced xerostomia. There are several studies showing support for the use of acupuncture to help stimulate the salivary glands in the production of saliva (see below). Most recently however, MD Anderson Cancer Institute along with Fudan University in Shanghai Cancer Center completed a study using acupuncture as a preventative therapy for dry mouth finding there is benefit in using it before symptoms present themselves from radiation therapy.

86 patients with nasopharyngeal carcinoma were treated in the study. Forty patients were randomized to acupuncture and 46 to the standard of care. Those in the treatment arm received acupuncture therapy three times per week during the seven-week course of radiotherapy. Patients were evaluated before radiotherapy, weekly during radiotherapy, and then again one and six months later. The results were based on data derived from two self-report questionnaires and measuring actual saliva flow. Patients completed the Xerostomia Questionnaire (XQ), an eight-item survey which assessed symptoms consistent with the condition.  XQ scores under 30 corresponded to mild or no symptoms of xerostomia. (3) 

The largest group differences in XQ scores were seen by the end of radiotherapy, but the differences persisted over time.  By one month after the end of radiotherapy, 54.3 percent of the acupuncture group reported XQ scores greater than 30, compared to the control group at 86.1 percent. By six months after radiotherapy, the numbers dropped to 24.1 percent in the acupuncture group and 63.6 percent of the control group still reporting symptoms of xerostomia.  Saliva flow rates were also greater in the acupuncture group, starting at three weeks into radiotherapy and persisting through the one and six month follow-up. (3) 

The second measure, MD Anderson Symptom Inventory Head and Neck (MDASI-HN), ranked the severity of cancer-related symptoms, other than xerostomia, and their interference with quality of life. The team also measured saliva flow rates using standardized sialometry collection techniques. (3)

Watch this video discussing how acupuncture works in xerostomia.
http://www3.mdanderson.org/streams/CompactVideoPlayer2.cfm?xml=cfg/Acupuncture-Study-2011--cfg

Supporting research on acupuncture and xerostomia:
1. http://www.ncbi.nlm.nih.gov/pubmed/22072272
2. http://www.ncbi.nlm.nih.gov/pubmed/18532895
3. http://www.ncbi.nlm.nih.gov/pubmed/11920486
4. http://www.ncbi.nlm.nih.gov/pubmed/10673783

For additional tips to support dry mouth go to:
http://www.mayoclinic.com/health/dry-mouth/AN02112

References:
1. http://www.cancer.gov/cancertopics/factsheet/Sites-Types/head-and-neck
2. http://www.webmd.com/oral-health/guide/dental-health-dry-mouth
3. http://www.mdanderson.org/newsroom/news-releases/2011/ut-md-anderson-study-finds-acupuncture-can-prevent-radiation-induced-chronic-dry-mouth.html

Image courtesy of http://www.intelligentdental.com/wp-content/uploads/2011/10/dry-tongue.jpg

Beneficial Estrogen Metabolism in Breast Cancer

The Benefits of Diindolylmethane 
(DIM)

Diindolylmethane is formed in the body through digestion of plant substances contained in “cruciferous” vegetables such as cabbage, Brussels sprouts, cauliflower, and broccoli. Scientists think these vegetables may help to protect the body against cancer because they contain diindolylmethane and a related chemical called indole-3-carbinol. (1)

AFFECTS IN THE BODY

DIM has the biological properties listed in the chart below. Because of its various potential anticancer properties, including estrogen metabolism, the National Cancer Institute of the United States has begun clinical trials of DIM as a therapeutic for numerous forms of cancer including breast cancer. (2) 

Biological activities of 3,3'-diindolylmethane

HEALTHY ESTROGEN METABOLISM
The standard explanation for the association of cumulative, excessive estrogen exposure and breast cancer risk is that estrogen and perhaps progesterone affect the rate of cell division; and thus manifest their effect on the risk of breast cancer by causing proliferation of breast epithelial cells. Proliferating cells are susceptible to genetic errors during DNA replication which, if uncorrected, can ultimately lead  to a malignant phenotype. (3) Oxidative metabolites of estrogens have been implicated in the development of breast cancer, thus addressing estrogen metabolism can be a method of prevention.

According to National Cancer Institute: “Diindolylmethane promotes beneficial estrogen metabolism in both sexes by reducing the levels of 16-hydroxy estrogen metabolites (“bad estrogens”) and increasing the formation of 2-hydroxy estrogen metabolites (“good estrogens”), resulting in increased antioxidant activity.”

SUPPORTING EVIDENCE
DIM supplementation has been shown to alter estrogen urinary metabolites in women. In a prospective placebo-controlled pilot study 19 post-menopausal women with a history of early stage breast cancer were randomized to receive 108mg DIM or placebo for thirty days. Urinary metabolite analysis was conducted for 2-hydroxyestrone (2OHE-1), 16-alpha hydroxyestrone (16alpha=OHE-1), DIM, estrone (E1), estradiol (E2), estriol (E3), 6beta-hydroxycortisol (6betaOHC) and cortisol. The treatment group demonstrated significant increases in levels of 2-OHE1 (P=0.020), DIM (P=0.045), and cortisol (P=0.039) and a non-significant increase in the 2-OHE1/16alpha-OHE1 ratio from 1.46 to 2.14 (P=0.059). The results of this study demonstrate that DIM supplementation increases 2-hydroxylation of urinary estrogen metabolites. But whether this translates to reduced cancer risk has not been confirmed. (4)

Evidence continues to build supporting the use of DIM and its potential as a therapeutic agent in breast cancer prevention and possible treatment. The standard recommended dosage of bioavailable DIM for women is 100-200 mg of DIM daily. Men typically need a higher dose than women, such as 200-400 mg per day.

A review of active clinical trials involving DIM:
http://clinicaltrials.gov/ct/search?term=diindolylmethane

Additional reading on Healthy Estrogen Metabolism and DIM:
http://www.dimfaq.com/

References:

1. http://www.webmd.com/vitamins-supplements/ingredientmono-1049-DIINDOLYLMETHANE.aspxactiveIngredientId=1049&activeIngredientName=DIINDOLYLMETHANE
2. http://en.wikipedia.org/wiki/3%2C3%27-Diindolylmethane
3. Afr J Reprod Health. 2006 Apr;10(1):13-25.
4. Nutr Cancer. 2004;50(2):161-7.
Image courtesy of http://bonnieplants.com/wp-content/uploads/2011/10/brussels-sprouts-growing-lo.jpg

FLAXSEED USE IN BREAST CANCER

Current Research

Flaxseed, also known as linseed, is prominently known for its high content of omega-3 fatty acids, fiber and lignans. It is mainly because of the lignans however, that the seed has gained popularity and become a food of interest in breast cancer research.

According to a study published in 2011 in The Journal of Nutrition the phytoestrogen lignans are naturally occurring compounds with structural similarity to endogenous estrogens. Lignans are widely available in whole grains, seeds, nuts, legumes, fruit, and vegetables, with the highest concentration in flaxseed and bakery products containing flaxseed.

In human and experimental studies, high lignan intakes (from flaxseed) affect endocrine and growth factor pathways through a number of mechanisms, including modification of steroid hormone metabolism, modification of insulin-like growth factor and epidermal growth factor, and inhibition of aromatase and 17β-hydroxysteroid dehydrogenase. Lignans inhibit cell proliferation in both ER+ and ER− cell lines, reduce tumor growth and metastasis in a number of animal models, and work synergistically with Tamoxifen to reduce tumor growth. 

Several, but not all, epidemiologic studies report reduced risks of breast cancer associated with higher exposure to dietary lignans, expressed as either dietary intakes or as plasma, serum, or urinary lignan concentrations. The protective effect of lignans may also be stronger in specific subgroups of women with breast cancer; lower risks have been reported to be limited to premenopausal women, women with specific CYP17 genotypes, and recently for ER− breast cancer (1).

Several studies have found that higher lignan intakes were associated with lower risks of breast cancer with more favorable prognostic characteristics, lower tumor biomarkers and inhibition of the growth and metastasis of human breast cancer (2). 

All this said, Ruth Patterson, PhD who wrote an article entitled: Flaxseed and Breast Cancer: What Should We Tell Our Patients? in the Journal of Clinical Oncology states, "the prudent clinician should be wary of recommending high doses of any dietary compound solely on the basis of laboratory and observational epidemiologic studies". She based this opinion on the fact that in humans, lignans are metabolized by the gut microflora into enterolignans; enterolactone is the main metabolite. Therefore, enterolactone concentrations in serum, plasma, and urine have been used as biomarkers of dietary lignans. Studies indicate that women with higher levels of serum enterolactone have approximate 40% reduced risk of overall mortality and distant disease. 

However positive this seems, there happen to be several variables that must be considered when using enterolactones as a secure indicator Patterson states: "Serum enterolactone concentrations are an imperfect measure of dietary intake because they reflect (in unknown proportions) dietary intake of lignans, other dietary and environmental exposures, and host characteristics" (3). Thus the take home message is baseline levels of enterolactones obtained from our daily diet may be supportive for breast cancer risk reduction but supplementing with higher quantities may or may not achieve this outcome.

Continued research is warranted to support supplemental flaxseed intake for breast cancer prevention and support. I recommend the use of flaxseed to be a part of a balanced diet using 1-2 tablespoon daily and only 1 tablespoon daily as an upper limit in ER+ patients.

Additional reading from leading cancer institutes:

Dana-Farber Cancer Institute 

http://www.dana-farber.org/Health-Library/Phytoestrogen-s-Role-in-Estrogen-Positive-Breast-Cancer-Patients.aspx

Memorial Sloan-Kettering Cancer Center

http://www.mskcc.org/cancer-care/herb/flaxseed

American Institute for Cancer Research

http://www.aicr.org/assets/docs/pdf/education/FlaxseedBreastCancer.pdf

References

1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237232/

2. http://www.mskcc.org/cancer-care/herb/flaxseed

3. http://jco.ascopubs.org/content/29/28/3723

Image courtesy of: http://www.wikihow.com/Prepare-Flax-Seeds

ACNE

TAKE BACK YOUR SKIN

Acne is a disease of Western civilization affecting approximately 50 million individuals in the United States. Skin is our largest organ and the biggest organ of detoxification. It functions to protect us from microorganisms, repel chemicals, prevent excess water loss and guard against UV radiation. It also helps us regulate temperature, produce vitamin D and acts as a sensory organ. The skin has 3 layers including the epidermis, dermis and hypodermis. Our epidermis contains 3 types of cells including basal, squamous and melanocytes. The dermis contains sweat glands, blood vessels, sebaceous (oil) glands, nerve endings and is where vitamin D is synthesized. The hypodermis or subcutaneous layer contains fat cells.

In Naturopathic medicine we look to several different areas to address the cause of acne including bacteria, sebum and terrain.

Bacteria
In acne patients normal flora, Propionibacterium acnes, generates components that cause inflammation and irritate the skin. White blood cells are drawn to the area and which weaken the walls leading to rupture. Pustules and cysts can form from foreign body reaction.

Sebum
Propionibacterium acne proliferates in sebum, altering the epithelial lining which forms plugs called comedones. Sebum in acne patients tends to be of poor quality from consumption of poor quality, heat damaged food such as trans fats and high omega 6/omega 3 ratio. Bacteria living off this poor quality sebum generate byproducts leading to acne.

Terrain
This encompasses a wide variety of internal and external factors including genetics, diet and environmental toxins. An imbalance in gut flora (dysbiosis), high simple carbohydrate diet, poor quality fats and proteins, food allergies and weak digestion can all contribute to the occurrence of acne.

Taking back your skin!
Skin health is very much in your hands. Here are some suggestions to help balance your digestion to promote a healthy terrain and sebum.

• Avoid high glycemic carbohydrates (see link for further description of these foods). http://whfoods.org/genpage.php?tname=faq&dbid=32
• Eliminate trans fatty acids
• Eat a diet high in omega 3 fatty acids. We tend to get enough omega 6 in our diet and the balance of 6:3 is generally too great. (See link for omega 3 foods) http://www.whfoods.com/genpage.php?tname=nutrient&dbid=84
• Add fermented foods to your diet for the natural probiotics such as sauerkraut, kimchi, kombucha, miso, kefir and tempeh. 

Adding a probiotic, fish oil and certain vitamins, minerals and botanicals through nutritional supplementation can also be an effective method to restore gut health, reduce inflammation, support nutrition and healthy skin.

Detoxification 
Further internal healing of the digestive tract and skin can be achieved by eating an anti-inflammatory diet, cleansing, colonics, sauna and dry skin brushing. Talk with your naturopath to assist you in making a comprehensive plan to promote skin health.


Images courtesy of: Beautiful Young Woman With Clean Skin Of The Face" by posterize

INFLUENZA

                      ' Tis the Season

                                                                       

The season has changed and autumn is upon us. This of course means change in temperature to cooler and more windy, damp weather. It also means it is time to think about protecting ourselves from the seasonal pathogen of influenza.

Western medicine and Naturopathic/Chinese Medicine acknowledge influenza as a seasonal illness but address it in very different ways.

Western Medicine

According to the Center for Disease Control, flu season lasts from October to May with every flu season being a bit different and affecting people in a variety of ways. We know in both Western and Naturpathic/Chinese Medicine that those who are more vulnerable must take extra precaution to prevent illness so not to have serious outcomes from the influenza virus.

Western Medicine recommends the flu vaccine as one of the priority measures of prevention. Take a look at the CDC website for recommendations about who should receive the vaccine, how the vaccine works and when it is recommended to get a vaccine.

http://www.cdc.gov/flu/protect/keyfacts.htm

Chinese Medicine and Naturopathic Medicine

Traditional Chinese Medicine (TCM) and Naturopathic Medicine focus on understanding the patient's underlying constitution and the type of influenza virus and pattern of symptoms. For example a common pattern in TCM manifests as a serious wind-heat or wind-cold pattern, mixed with dampness or food stagnation while the less severe type manifests as a milder wind-heat or wind-cold pattern, and the viral pneumonia type exhibits as heat obstruction of the Lung.

For further explanation of Chinese Medicine patterns and diagnosis, see:

http://drrademacher.blogspot.com/2013/08/chinese-medicine.html

The holistic medicine practitioner must consider the lifestyle and constitution of the patient such as stressful lifestyle, poor dietary habits, inadequate sleep, low immunity or chronic illness that may not allow the person to protect themselves from these climactic factors and seasonal pathogens. Naturopathic Medicine places great importance on supporting the body’s vitality by supporting optimal health with the previous mentioned factors.

Here are some recommendations to prevent acquiring the seasonal flu:

• Cover coughs and sneezes
• Wash hands often
• Stay home when sick
• Clean surfaces and objects in your environment
• Consider taking supportive supplements/herbs for your immune system and at first onset of symptoms. Ask your naturopath or Chinese medicine practitioner for recommendations.
• Acupuncture
• Hydrotherapy
• Lifestyle Modifications: adequate sleep/rest, whole foods diet, stress reduction, regular exercise.

Image courtesy of: http://www.freedigitalphotos.net/images/agree-terms.php?id=100111172. Sick Woman Covered With Blanket At Home" by marin.

Chinese Medicine

The Philosophy Behind the Treatment

Part 2 of 2

Pattern recognition

Pattern recognition in Chinese Medicine is utilized to identify the area/s in the body that have become out of balance. Utilizing the information gathered from assessment with the patients history, pulse and tongue diagnosis, as well as the appearance, smell and sound of the patient, the practitioner uses this data to establish recognition of patterns that are present. These patterns are well understood in Chinese diagnostics and can render a concise treatment plan using acupuncture, lifestyle modification, diet, massage and herbal formulas. 

There are multiple methods and theories of pattern recognition. Listed below are these methods and an explanation to begin to understand how a practitioner reaches a diagnosis and treatment plan.

The 8 Principles

Identification of Patterns According to the Eight Principles/Patterns

• Interior/Exterior: Interior/Exterior indicates the location of the disharmony, not the cause. For example: Diseases caused by an exterior pathogen (ie coldness) may begin in the exterior (the meridians), but in time they may affect the interior (such as the internal organs).
• Hot/Cold: Describes the basic nature of the imbalance. Either slow or accelerated metabolic activity.
• Excess/Deficiency: Excess conditions produce signs like: acute disease, restlessness, irritability, severe pain. Deficient conditions produce signs like: chronic disease, listlessness, lying curled up weak respiration, dull, lingering pain.
• Yin/Yang: Interior, empty, cold is Yin. Exterior, full, heat is Yang. (1)

The 8 Principles are four sets of polar categories that distinguish between and interpret data gathered by examination. They determine the relative nature, quality, and location of the Qi, Moisture, and Blood in the body as a whole and within each of the 12 Organ Networks. (See previous article Part 1 on Chinese Medicine Philosophy.) (2) 
http://drrademacher.blogspot.com/2013/08/chinese-medicine.html

The 5 Climates

The five climates correspond to the cycle of the seasons. These include Wind, Heat, Cold, Dampness and Dryness.

• Wind: its nature is movement and is associated with spring which is a time of sudden change in the environment. It corresponds to the wood phase.
• Heat: its nature is to accelerate metabolic activity, dilate blood vessels and activate circulation. Summer is dominated by heat and corresponds to the fire phase.
• Dampness: its nature is to sink and accumulate like a stagnant swamp. It is characterized by a buildup of fluids or excess sections. Late summer is dominated by dampness and corresponds to the earth phase.
• Dryness: its nature is to wither and shrivel. Dryness damages fluids and is manifested by symptoms of dehydration. Dryness dominates autumn, the season associated with the metal phase.
• Cold: its nature is to slow things down by chilling them. Cold depresses metabolism and retards circulation. Winter is dominated by cold and corresponds to the water phase. (2)

The 5 Phases
The Five Phases, or Five Elements, are aspects of Qi. They include Wood, Fire, Earth, Metal, and Water. These five phases or elements have a function of  generating each other as well as restraining each other. Its like a system of checks and balances. For instance, wood element generates fire providing fuel for combustion, yet inhibits earth element by covering it with trees, thus preventing erosion. These examples in nature are quite literal yet symbolically can also be seen in the body with similar functions. 

Each organ is associated with a phase/element and thus the organ network is in tune with the cycles of generation and restraint. A regular rhythm of qi coursing in the body is the underlying movement of the 5 phases, thus when out of balance it must be noted which phase/element and organ (see diagram to the right) is affected and which is the root of disharmony and hindered flow of qi. It is this association along with identifying the 5 climates and 8 principles that leads the practitioner to identify the pattern of disease.

Using the Philosophy to Prescribe a Treatment

The above is truly a vast amount of complex information that when utilized can enlighten the practitioner to the underlying cause of illness in the patient. The Chinese practitioner reflects on information gained in history taking, pulse and tongue diagnosis as well as other observations in appearance, smell and sound of the patient. From this, one can devise a treatment using one or a combination of Chinese therapies. 

Applying the patients full scope of information in association to the levels of the body allows the practitioner to begin to develop an understanding of where an imbalance lies in the system. This imbalance may be superficial in the meridian level, there could be deficiency of blood or tissue injury, or possibly damage at the deep layer of the organs. Once the practitioner identifies the level of disease and climate features, the meridians, tissues and organs that need focused attention and principles that must to be applied, a treatment plan is devised to restore proper functioning of the system.

Suggested Reading on this topic:

The Web Has No Weaver: Understanding Chinese Medicine by Ted Kaptchuk

Between Heaven and Earth: A Guide to Chinese Medicine by Harriet Beinfield

Resources

1. http://www.sacredlotus.com/diagnosis/patterns_qi_blood_fluids.cfm
2. Between Heaven and Earth by Harriet Beinfield and Efrem Korngold. Chapter 5, pg 61-92.

Images courtesy of: 
http://www.traditionalchinesehealing.com/wp-content/uploads/2013/05/Pulse-Reading.jpg
http://www.soundsourcery.com/tjm/images/FiveElement.gif