What is Evidence-Based Medicine? Defined, evidence-based medicine is the cumulative result of a synthesis of clinical expertise, patient’s values and the best scientific evidence we have available relative to that patient’s care. Evidence-based medicine (EBM) originated in the second half of the 19th century and represents the conscientious use of the best evidence available in making reasonable decisions about patient care. Gaps Between Research and Practice in Medicine One of the biggest shortcomings of using EBM is the gap between the release of scientific studies and their adoption by the clinical community. It represents a huge knowledge gap and a barrier to the implementation of the EBM model. For example, in the case of the beneficial use of aspirin in the treatment of heart attack victims, it took almost a decade for it to become a routine practice after the EBM studies were released. Interestingly, the publication of COVID-19 articles are bypassing some of the usual publication rules and are going right into the search engines. This is to specifically reduce the gap between research and practice, an endeavor much needed in this pandemic. Classification of Evidence EBM classifies evidence based on their freedom from biases in the interpretation of the results. The levels of evidence look something like this: 1. Evidence obtained by a meta-analysis of several randomized controlled research (RCR). 2. Evidence from a sole RCR. 3. Evidence from one well designed controlled RCR. 4. Evidence from one quasi-experimental approach. 5. Research case study only. 6. Evidence from one’s clinical practice or case studies. Each level represents a strength of evidence to ponder in application to a patient’s case or to a public health situation. With EBM a provider can assess the strength of evidence with the risks/benefits of ordering tests and treatments for an individual patient or the strength of evidence for a public health recommendation. We are said to be in an age of EBM. Five Ways Evidence-Based Medicine Adds Value to the Functional Health Model 1. EBM helps functional health providers stay on top of standardized treatment protocols without reading 17 studies a day by utilizing study classification and priority. 2. Uses timely data to make decisions. This has been greatly aided by the computer age and the development and maintenance of large databases of information that providers can access for research and education. 3. It improves accountability, transparency, and worth. What this means is the patient acquires the best care for the least cost with all variables of the treatment consistent with the values of the patient. 4. Improves the quality of care. Despite the fact that Americans spend more money on healthcare than any other nation in the world, we are the sickest. 5. Improves outcomes. Functional health providers are invested in practicing medicine that works, not just seeing patients on a daily schedule and taking care of urgent ills. They want to see that a prescribed treatment has true value for a patient and that the care received has made a significant impact on that patient’s overall health and well-being. Functional health represents a fusion of EBM and alternative medicine. It has been argued that functional health practitioners are not evidence-based practitioners. That cannot be further from the truth. Functional health practitioners frequently rely on EBM for treatment decisions and novel approaches to diseases that are on the cutting edge of scientific decisions and novel approaches to diseases. #evidence-based medicine #EBM #quality control #functional health #evidence
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We are in the dark days of a novel pandemic where any glimmer of preventive hope on the horizon is appreciated in this battle. Research has recently sounded the horns of prevention in terms of taking vitamin D to fortify the body’s immune system against influenza and the novel coronavirus. According to the most recent public health outcry, the most at-risk population should be fortifying themselves with 10,000 IU of vitamin D daily in the weeks before winter and then stabilize intake at 5,000 IU per day to maintain blood levels of 40-50 ng/ml, although, admittedly, this research is controversial and needs more study. Vitamin D acts by three mechanisms – maintaining a physical barrier, increasing natural cellular immunity, and increasing adaptive immunity. Vitamin D helps keep tight gap junctions between cells. Several articles have suggested how viruses disturb junction integrity, increasing infection by the viruses and other microorganisms that can squeeze through the leaky membranes. This is a physical barrier function. Innate immunity is enhanced through the induction of antimicrobial peptides, which exhibit direct antiviral and antimicrobial activities against a spectrum of microbes, including enveloped and nonenveloped viruses, fungi, and bacteria. These peptides kill the invading pathogens by invading their cell membrane and neutralizing necessary biological activities. Cellular immunity is enhanced in part by reducing the cytokine storm induced by the innate immune system. The innate immune system generates both pro-inflammatory and anti-inflammatory cytokines in response to viral infections. Vitamin D can reduce the production of pro-inflammatory cytokines while increasing the expression of anti-inflammatory cytokines. Vitamin D supplementation also enhances the expression of genes related to antioxidation. Increased glutathione productions spare the use of vitamin C, which has antimicrobial and antioxidant capabilities. Glutathione is a peptide involved as an antioxidant, and vitamin D affects its expression. What is the Optimal Blood Level for Vitamin D in the Prevention of COVID-19? Research shows that 38 ng/L was sufficient for reducing community-acquired pneumonia, although the degree of protection increased as blood level increased with the optimal range being 40-60 ng/ml. Studies show that those at risk for influenza or COVID should take vitamin D to reduce this risk. Furthermore, randomized control trials are now recommended based upon positive clinical and observational studies on the role of vitamin D in the prevention and treatment of virus related infections. High doses of vitamin D seem to be well tolerated with doses of 60,000 IU/d found in the literature to treat asthma, rheumatoid arthritis, rickets, and tuberculosis in the 1930s and 40s. High doses of vitamin D over prolonged periods can damage the kidneys; however, we are talking about high doses for a short time. The tolerable upper limit for vitamin D is 4,000 IU/day. Research shows that doses of 25,000 IU have not caused severe side-effects. Everyone is different, and we err on the side of caution. Obviously, the research on COVID is challenging the tolerable upper limit in its recommendations suggesting that supplementation could improve the outcome of the clinical COVID 19 condition. Improvement of Clinical Outcomes of COVID-19 with Supplementation Recent research results have shown that having a favorable clinical outcome rather than a critical outcome was increased approximately 19.61 times with a high vitamin D level. Vitamin D status was found to be significantly associated with clinical outcomes. Of 212 cases of COVID 19, 23.1 % were identified as mild, 27.8 % were ordinary, and 26.4 % were severe, and 22. % were critical. Mean serum vitamin D level was 23.8 ng/ml with < 20 being defined as deficient. Using multinomial logistic regression, a distinct relationship was found between the level of vitamin D and the severity of clinical outcomes between all levels of severity compared to levels of vitamin D. As for the link with immune function, one systematic review and one met-analysis of data from 11,321 people published in the British Medical Journal found that people who took weekly or daily supplements of vitamin D were less likely to develop respiratory tract infections than those who didn't. There is despite a conflicting review in the same journal that said there was no relationship. Then, another review published in the same journal issue stated that according to the Royal Society there is a biologically plausible reason to suspect vitamin D deficiency to be involved in immune dysregulation. Clearly we see a confusion in study results. In the midst of all this mud, Dr. Fauci himself states he takes two vitamins to ward off COVID, vitamin D and vitamin C. Public Health Call to Action Research is showing that vitamin D deficiency is common and may contribute to increased risk of respiratory infection, particularly COVID-19. It is advised by some groups that the following be urgently supplemented with 800-1,000 IU of vitamin D to enhance their resistance to COVID-19:
While there is a slight discrepancy between the amounts of vitamin D being recommended, the fact that supplementation is being recommended should not be taken lightly. Every nursing home resident should have it in their care plan to increase vitamin D intake to 1,000-10,000 IU per day, depending on their blood levels. Deficient individuals may need to supplement with 10,000 IU 5 days per week for six weeks and then drop down to 5,000 IU per day until optimal blood levels are reached, and then maintenance may be set at 1,000 IU/d. Others who have higher blood levels of vitamin D may only need 800 IU per day. The best thing to do is get your blood level for vitamin D measured and then consult with your health care provider for repletion and maintenance dosing recommendations. #COVID-19 #vitaminD #coronavirus #vitamins #vitamin D deficiency These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease. Berberine is a chemical found in several plants including the European barberry, goldenseal, goldthread, Oregon grape, philodendron, and tree turmeric and belongs to a class of compounds called alkaloids. It is said to have powerful effects similar to that of a pharmacological nature and has been used for centuries in Chinese medicine. It is just now coming of age in modern nutritional medicine in the treatment of diseases such as diabetes. How Does Berberine Work? Berberine is known to stimulate insulin secretion and to activate AMPK, an enzyme known to regulate cellular energy metabolism. Its primary actions are to:
Effectiveness of Berberine in Diabetic Patients: Berberine has been found to act in a similar manner as the commonly used diabetes drug Metformin. It is not clear whether metformin and berberine undertake all actions via the same mechanisms, or some via similar and other different mechanisms. While the severe adverse gastrointestinal side-effects that interfere with metformin compliance are generally absent in berberine treatment, treatment with both berberine and metformin (or other oral hypoglycemics) has been found to be superior in controlling glucose than either treatment alone. Dosage and treatment duration may vary with the patient’s age. Data suggests that berberine therapy becomes unremarkable in treatments lasting more than 90 days or in amounts greater than 2 grams. Further clinical studies of longer duration are needed in this area. The most effective dose is 500 mg three times a day. Because most anti-diabetic drugs cannot be used in patients with hepatic dysfunction, renal disease, and heart disease, this makes pharmacological therapy of type 2 diabetes complicated and the use of other nutraceuticals such as berberine more desirable. Current studies have reported the significance of berberine against oxidative stress and inflammation in cells, elaborating its vital role in diabetes mellitus. Generally, a decrease in blood glucose level by 20–40% is reported in fasting patients treated with berberine alone, this effect resembles that of rosiglitazone and metformin treatment. Application: Preliminary research from both animal and human studies indicate that berberine therapy in dosages of 500 mg three times per day may be an advantageous treatment for diabetes type 2 either alone or in conjunction with other hypoglycemics for optimal blood sugar control with minimal adverse side-effects. The mechanisms of action of berberine mirror those of the common anti-diabetic drug metformin without the severe diarrhea side-effects that adversely affect medication compliance. Further long-term studies are needed on human subjects to identify exact mechanisms of action and duration of treatment best utilized for long term blood sugar control of diabetes. #berberine #AMPK #diabetes #blood sugar #type 2 diabetes #metformin These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease. Many of us brush off common aches and pains treating them with ibuprofen and hoping the bothersome things will go away, but such practices are becoming costlier not only financially, but health-wise as well. It is not uncommon to hear stories of someone with diabetes putting off care for an infected toe because of lack of insurance and several weeks down the road the toe needs to be amputated. Culinary medicine does not have a single philosophy as it is not dietetics or functional medicine, nor is it culinary arts or food science. It is, rather, a new evidence-based field in medicine that blends the art of food and cooking with the science of medicine. Culinary medicine is all about making evidence based decisions about the food we choose to eat and how we eat it so that we can prevent and treat disease while restoring optimal well-being. As food is condition specific, the theory goes, different clinical conditions require different foods, beverages and manners of cooking as well as types of herbs used in seasoning such foods. Although special attention is paid to using the foods that the patient regularly eats or drinks, modifications are by nature necessary but designed to empower the patient to care for herself or himself safely, effectively, and happily with food and beverage as a primary care technique. Special attention is paid to how food works in the body and how such foods can be made pleasurable to the patient so that cooking and eating are both a healthy and enjoyable experience. According to one study, culinary medicine started trending in response to five factors:
Preliminary research regarding culinary medicine is encouraging. A longitudinal study among 627 medical students showed hands-on cooking and nutrition education vs. traditional education improved diet, attitudes, and competencies. Results from a small randomized controlled trial of patients with type 2 diabetes showed improvement in HbA1c, blood pressure, and cholesterol after following a Mediterranean diet cooking and nutrition curriculum provided by a medical school-based teaching kitchen. Culinary medicine is an evidence based approach to food and lifestyle intervention. It encourages us to think of food as medicine, nutrition with cooking and necessity with creativity. The growing body of research supports the idea of food as medicine as more and more programs make successful groundbreaking efforts at making food a critical part of patients’ medical care. Some doctor’s in communities are writing prescriptions for fresh vegetables and produce and vendors respond to the prescriptions with discounts on their products. Culinary medicine can be a beautiful community health initiative that the entire family can be involved in at all stages of the wellness/disease spectrum. #culinary medicine #MNT #medical nutrition therapy #wellness Thyroid supplements are generally taken by those who think they have sluggish thyroids, they are gaining weight for no reason or they have self-diagnosed themselves with hypothyroidism. The supplement market is eager to meet the needs of desperate consumers armed with only a handful of internet articles and a plethora of misinformation. Here we will discuss the most common thyroid supplements and what they are designed to do and why a patient should not take these supplements without a doctor’s recommendation or upon a dietitian's recommendation. Iodine is needed for the production of the thyroid hormone. Before the 1920’s iodine deficiency was a common problem, especially in the so-called “goiter” states where soil was especially depleted. However, the U.S. implemented a salt fortification program adding iodine to salt and thus forming iodized salt. Iodine deficiency dropped. Today, iodine deficiency in the United States is not the primary cause of hypothyroidism, but rather an autoimmune condition called Hashimoto’s is the cause of 80% of the nearly 20 million Americans who currently are hypothyroid. In Hashimoto’s Disease (HD), iodine is often avoided. So, if someone with Hashimotos hypothyroidism supplements with iodine, the situation could be made worse as it may accelerate thyroid cell destruction. Research has shown that high doses of iodine can trigger Hashimoto’s in people who are genetically predisposed to Hashimoto’s and may perhaps have certain “vulnerabilities” like a selenium deficiency. Selenium protects the thyroid from oxidative damage and without selenium a high iodine intake can destroy the thyroid. Iodine and selenium need to be in balance and selenium is the next most important hormone for thyroid health aside from iodine. Taking selenium just because one thinks their thyroid is “sluggish” may not help the problem, but cover up a more serious one that need pharmacological and/or surgical intervention. Oftentimes we see patients struggle with self-perceived thyroid problems by supplementing with nutrients the thyroid needs, but giving selenium may hide an undiagnosed tumor, goiter or the synergy of nutrients needed to get the thyroid healed if it is truly sick. Both excessively high and excessively low selenium levels have proven damaging to the thyroid gland. L-Tyrosine Most people have enough L-tyrosine in your body but occasionally a supplement is recommended if you have hypothyroidism. Be careful not to supplement on your own as too high of an L-tyrosine level can aggravate high blood pressure, manic symptoms and may interact with other medications. Coleus Forskohlii This herb enhances the uptake of iodine into the cells and promotes the production of T3 and T4. Again the problem with this herb is the same as with supplementation with iodine. Ashwagandha As a member of the nightshade family, those individuals with autoimmune conditions are to avoid products from this family. Grave’s Disease and Hashimoto’s Disease are both diseases of the autoimmune system and as such call for avoidance of this otherwise very beneficial herb. Supplements should only be taken after consultation with a health professional. Seemingly wonderful products can be harmful if taken for the wrong reason or the wrong condition. Not all supplements are safe. Supplements should be recommended by a Registered Dietitian after a complete medical nutritional assessment is done. |
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