What is Thermography and why should you consider it for Breast Cancer Screening?

The most frequently diagnosed cancer among women in North America is breast cancer, affecting one in every eight women. Despite treatment advances that have reduced mortality, this disease remains the second leading cause of cancer-induced death, being second to lung cancer.

Let’s face it: mammography has its limitations. An evolving breast cancer, like its surrounding breast tissue, appears white on the x-ray. This may make lesions difficult to detect in young women as well as in women with very dense breasts; in these cases a tumor may not cast a significant shadow until it is quite large. For primarily these reasons, heavy dependence is placed on the mammogram’s calcification patterns as a clinical marker for potential cancer cell development within the breast parenchyma. Unfortunately, some cancers are so aggressive that they can spread quickly before they can be detected with a routine mammogram. Despite these limitations, mammography is still viewed as the gold standard for breast cancer screening and detection. Additionally, we must consider that even the more sensitive (and much more expensive) MRI study is unable to clearly distinguish the difference between malignant/aggressive tumors and those tumors that will never harm the patient. In the end, mammography remains a pretty crude tool.

The question which begs to be asked here is: have we become so entrenched in the diagnosis of cancer that we may well be impeding the development and acceptance of better tests that can more accurately distinguish between aggressive tumors and tumors that are unlikely ever to lead to cancer? Another question to ask ourselves is: Is it not time to better support the research and the pursuit for a more diagnostic technology which can ultimately decrease the unwanted phenomenon of overtreatment and better determine tumor cancer risk? Such a screening test is completely non-invasive and exists in this country as well as all over the world. It is called Thermography. Rather than detecting anatomical changes in breast morphology, Digital Infrared Thermal Imaging (DITI), also known simply as Thermography, detects changes on a physiologic level. Let me explain. A portion of the heat that is naturally released from the body is in the form of infrared radiation. As cancer develops in the breast, cellular abnormalities occur. Physiologic changes which take place during a cancer's evolution such as increased blood flow and increased cellular activity, contribute to our released infrared heat. Such abnormal cellular changes are what Thermography detects. Similar to the 'Pap' smear, which is universally used to identify the abnormal cells that can lead to cervical cancer, the highly sophisticated camera and computerized system used in Thermography assists to differentiate benign tissue from malignant tissue due to the difference in their respective infrared signal. Get it?

Improved methods to detect and diagnose breast cancer early, when it is most curable, are required if a significant impact on morbidity and mortality from breast cancer is to be made in this country. The Cometa Wellness Center brought Thermography to the Greater Baltimore area in 2005. Our cameras are state of the art and our technicians are well educated and certified in this field. In addition to offering DITI for breast cancer screening, full body thermal imaging is also available at our Thermography Center located within The Cometa Wellness Center in our new location in Cockeysville, Maryland. A compilation of citations pertinent to thermography is available upon request. Please click on the Thermography link here or above to read more about Thermography and to receive your discount coupon.

Ariane Cometa MD, the holistic doc

The Ancient Dance between Vitamin A and Vitamin D

I would like to introduce Vitamin D and it's fat soluble nutrient partner Vitamin A. These lipid-based molecules  intricately work together as an "ancient clan" and hence, they balance and enhance each other to impact our genes, immunity, inflammation and health as a whole. With this small added knowledge, some of the readers may be sighing an "Ah Ha", as they reflect on all the powers that have been bestowed upon Vitamin D in both the medical research and the media for the past decade.  

Overwhelming evidence exists to substantiate that blood levels between 50-80 ng/ml, 25 OH D, prevents higher rates of every known pathology studied to date. Did you know that vitamin D levels have dropped in the U.S. population from 30 ng/ml between 1988-1994 to 24 ng/ml between 2001-2004? Did you know that the optimal level of vitamin D in the blood at that time and still is considered to be 32 ng/ml? You can do the math; there has been a pandemic vitamin D deficiency in the U.S. since at least 1988! Lack of sun exposure is widely accepted as the primary cause of epidemic low vitamin D status worldwide. There is a band of light known as ultraviolet-B which must be absorbed by our skin for the body to create the active form of vitamin D used by our body. As we work inside, wear protective clothing and slather sun screen on to protect ourselves from UV-linked damage and skin cancer, we block our natural ability to create essential vitamin D from sunlight!

So, if vitamin D deficiency is actually "sun deficiency" how do we explain the low vitamin D status in individuals despite their abundant sun exposure in those studies aimed at documenting the 25(OH)D status of healthy individuals who live in habitually high sun exposure? Rather than a pharmacological model (one nutrient isolated from others), we need a nutritional model that takes into account the diet and lifestyle with which we originally evolved, and the way our receptors respond to these nutrients.When our ancestral lines are considered, a genetic variability in the ability to convert vitamin D through sun exposure is a likely factor. Consider that in the U.S. alone the population has predecessors who evolved and adapted to high and low sunlight between Africa and Scandinavia, respectively . For example in a recent 2011 study, a very significant negative correlation between multiple sclerosis (MS) prevalence and available ultraviolet (UV) radiation was made. This same meta-analysis study revealed that latitude and longitude are also significant factors. Like so many MS prevalence studies, the analysis suggests a strong association between UV radiation and MS distribution, and an increase in risk for MS in those areas with a low UV light exposure in higher latitude areas. So, let's put the pieces together: high latitude areas---> low UV light exposure--->;low vitamin D conversion--->;high prevalence of multiple sclerosis. Make sense? Yes. Vitamin D is currently one of the most studied environmental risk factors for multiple sclerosis and clinically, most MS patients have low serum levels of vitamin D.

Going back to the concept of evolution cited above, what about the ancient relationship between vitamins D and A? Because these fat-soluble molecules share receptors and work in balance with each other, let's talk about vitamin A and it's relationship to vitamin D. Receptors for vitamin A and vitamin D are found in every cell and share an ancient receptor in the nucleus of the cell known as retinoid X receptor (RXR).   Though vitamin A binds to its own retinoic acid receptor (RAR) and vitamin D binds to its own vitamin D receptor (VDR), they then bind to their shared retinoid X receptor, RXR. Due to the common receptor they share,these two pro-hormones are responsible for crosstalk with all the other steroid receptors on cells in the body such as the immune and endocrine system cells. Crosstalk occurs when molecules bind to the same receptor together and initiate a cascade of responses in the body. Vitamin D and A crosstalk with all the cells in our body and are much more than vitamins! Together, they have effects on every tissue in the body as they work together at the cell receptor level. Adequate levels of these two molecules are essential for our cell health, so we must get enough of them both! Most of us do not get enough vitamin A . The carotenes (e.g. beta-carotene) are our richest source of vitamin A presently consumed in the American diet. Yet carotenoids must first be be converted into vitamin A in the body to become active. Many individuals cannot make this conversion in their body for reasons that are out of the scope of this writing. Vitamin A is unjustly condoned as a toxic fat soluble vitamin and as a result is replaced with the water soluble carotenoids in our diet and most supplements. Lastly, the vitamin A rich foods such as whole milk, butter, eggs and liver are often avoided for poorly substantiated "fat conscious" health reasons. Vitamin D is found in many foods, including fish, eggs, fortified milk, and cod liver oil. Although the sun also helps the body produce vitamin D in as little as 10 minutes of sunlight exposure daily, this is dependent on geographic location and time of year.

As many of you know, The Cometa Wellness Center has it's own Holistic Pharmacy. This pharmacy was created to provide only the most advanced, safest and well tested supplements to our community. We are able to do this because I have studied not just the research on the various herbs and nutriceuticals which we offer, but the companies which sell us our supplements that we provide to you as the consumer. From the inception of my medical education in 1988, I have always intergrated my convention medical training with my continuing research in the field of medical herbs and nutriceuticals to provide my patients and The Cometa Wellness Center community with the benefits of this integrated approach aimed to augment the health of the whole person, mind, body and soul.


With a Masters in Biology, I have always been intrigued and have loved the study of Molecular Biology as it applies to medicine. I have never "followed the pack" so to speak in medicine, and pride myself on the work I have done with doctors and other medical experts to provide what I consider to be the most current medical approach for the patient. Honestly, this has often put be ahead of my conventional medical community of doctors, when it comes to medical treatment plans that are safe, effective and natural.

Recommendations for Vitamin A and Vitamin D supplementation are dependent on current circulating vitamin D levels and are assuming a vitamin D level  below or in proximity to 32 ng/ml.

I recommend:

Vitamin D3 5000 IU daily with a meal and a minimum of Vitamin A as Retinyl Palmitate 6000IU in your multivitamin daily.

We also carry Vitamin D3 Complete Daily Balance with A and K2. This product by Allergy Research Group has your Vitamin A and D together with: Vitamin D3 (as Cholecalciferol) 2000 IU and Vitamin A (as Retinyl Palmitate) 3000 IU per capsule. I recommend 2 daily.

Ariane Cometa MD, the holistic doc

The Vitamin D Controversy

The Cometa Wellness Center

For the last decade,Vitamin D has become appreciated for how vitally important it is to optimum health. Since its discovery, vitamin D has been known primarily for its role in bone health. However, as a result of major advances in research this perspective has changed. In fact, in 2010, the 'sunshine' vitamin was justifiably called 'the nutrient of the decade'. While it is true to say that the classic function of vitamin D is to control calcium metabolism, we now know that the importance of vitamin D spreads far wider than just bone health. Serum 25-hydroxyvitamin D [25(OH)D] is the major circulating form of vitamin D and a standard indicator of vitamin D status. Emerging evidence in the literature suggests a high prevalence of suboptimal vitamin D globally, as defined by serum 25(OH)D levels of less than 32 ng/ml, as well as an association between lower serum levels and higher morbidity and mortality from cancer and many other diseases.

On November 30, 2010, in both the New York Times article, "Report Questions Need for 2 Diet Supplements" and in the Wall Street Journal articles, “Triple That vitamin D Intake, Panel Prescribes",  and "Can Too Much Vitamin D be Hazardous to Your Health?", the public heard conflicting messages about the varied benefits of vitamin D. Due to the vast amount of information in this blog, I have chosen to focus on the Vitamin D Controversy in this posting. There will be an informative blog to follow, which will detail the best approach toward vitamin D dosage.

In a 'claim' to help clarify the correct amount of vitamin D the U.S. population should supplement with daily, the United States and Canadian governments asked the Institute of Medicine (IOM) to assess the current data on health outcomes associated with calcium and vitamin D, as well as updating the nutrient reference values, known as Dietary Reference Intakes (DRIs). Ironically, in this report, the IOM finds that the evidence supports a role for vitamin D and calcium in bone health but not in other health conditions! Further, IOM states that emerging evidence indicates that too much Vitamin D may be harmful. Before we take what the IOM has declared the new guidelines I would like to quote Linus Pauling. Dr. Linus Pauling (February 28, 1901 – August 19, 1994), often referred to as the "Father of Vitamin C", is the only person ever to receive two unshared Nobel Prizes — for Chemistry (1954) and for Peace (1962) and  has watched this country's policy in medicine for a long time.

Linus Pauling wrote:
Government vitamin recommendations are set to the minimum necessary to keep a prisoner alive without showing any overt symptoms. The government must protect itself against lawsuits. Vitamins for optimum health are always higher than the government recommendation. Optimum health and life extension is not in the best interest of government obliged to pay social security and medical costs for a large portion of the population.

An important fact about the outcome of this IOM analysis is that most of the results have been left out of the media. First, let me make clear the fact that the IOM panel's recommendation was narrowly confined to the amount of vitamin D needed to maintain bone health. Their recommendations are not made with the intention of preventing any other ailments that might be related to one’s vitamin D intake. Why? Because the studies they used in their final analysis linking low levels of vitamin D to bad health outcomes are based on statistical correlations alone; they fall short of establishing causality. What this means is that the IOM panel only considered modifying dietary recommendations on the basis of a clear cause-and-effect relationship between the nutrient and disease. The report states:

A relationship between cancer incidence and vitamin D (or calcium) nutrition is not adequately and causally demonstrated at present; indeed, for some cancers, there appears to be an increase in incidence associated with … higher vitamin D intake.

According to their analysis, the role of vitamin D in relationships to falls and physical performance, cancer, cardiovascular disease, autoimmune disorders, and immune functioning remains unresolved. These potential roles of vitamin D are currently best described as hypotheses of emerging interest, and the conflicting nature of available evidence cannot be used to establish health benefits with any level of confidence. The fact is that there ARE THOUSANDS of medical research articles which absolutely substantiate a correlation between low Vitamin D levels and higher incidence of all of the diseases they state above "are not adequately and causally demonstrated at present". Yet, The Institute of Medicine, an arm of the National Academy of Sciences that sets governmental nutrient levels, states that there wasn't enough evidence to prove that low vitamin D causes such chronic diseases and worse, it based its new recommendations on the levels needed to maintain strong bones alone. Hence, we are all now informed that we should all take the same amount of D to protect ourselves for everything from Rickets to heart disease and cancer based on the new recommendations for strong bones? I don't think so!

Just review the medical literature over the past ten years and you will find that there are thousands of research studies to substantiate an inverse relationship between all the diseases studied and vitamin D levels. What this means is that in these studies, there exists the very real and strong fact that the lower the vitamin D level is in a person's blood, the HIGHER the incidence of that disease. The way I see it, the problem with the IOM conclusions lies in what one considers hypotheses of emerging interest, and the conflicting nature of available evidence  which cannot be used to establish health benefits with any level of confidence. How can this be if all the research studies demonstrate over and over again, that the lower the level of vitamin D in the blood, the higher the incidence of disease in that population? The answer to this question is that this inverse relationship is between low level of vitamin D in the blood and higher incidence of illness and death from disease is based on epidemiological studies that look at the level of vitamin D in the blood of these people and their likelihood of getting the disease. These epidemiological studies are retrospective and are certainly good enough for me and most of my patients. Yet, Catherine Ross, the committee chair, states We couldn’t find solid evidence that consuming more of either nutrient [calcium or vitamin D] would protect the public from chronic diseases. How much evidence do they need, when you have 1000's of articles demonstrating that the higher the D levels in the blood, the lower the incidence of disease? Did it ever dawn on anyone here that the double blind placebo controlled study described above may not be the best gold standard for testing the effectiveness of everything or anything? Why are the epidemiological (retrospective) studies done for the last decade not just as useful or maybe even better? Isn't it sensible to consider that when it comes to the global analysis of impact something has on our population, that we cannot double blind control study it? Where is the fallacy in studying the relationship between serum levels in a global patient population and  incidence of disease found? AND don't say that the problem lies in "bias potential", as we all know that bias appears all over in ALL studies. "Bias" is a result of human nature and human potential to recreate the wheel, ill intentioned or not.

The report's authors left themselves an out with their conclusion when they state there is not sufficient evidence to establish a relationship between vitamin D and health outcomes other than bone health does not mean that future research will not reveal a compelling relationship between vitamin D and another health outcome. I concur and quote Dr. Pocinki, an internist in Washington D.C., in his commentary to the Wall Street Journal article posted in response to the new IOM recommendations,

I supplement patients who are deficient and they feel better. They come in and say, 'I've been much less achy and stiff or my mood's been better since I've been taking the vitamin D. Do we have the data to prove this conclusively? No. We don't have evidence for much of what we do in medicine, but if you wait for the evidence, you may be depriving your patients of beneficial treatments."  This last statement concurs with what Linus Pauling states; Vitamins for optimum health are always higher than the government recommendation.

To review the results of this study, it clearly defines a range between 600-4000IU daily, not 600IU, for Vitamin D intake, from their limited research analysis. Yet, Patsy Brannon, a professor of nutritional sciences at Cornell University and a member of the IOM panel, said the panel found such a wide range of blood levels considered optimal in various studies that it could not settle on a single threshold level. She states I think the confusion is understandable. The committee is very concerned about the lack of evidence-based consensus guidelines for interpreting blood levels for vitamin D. We strongly recommend that these be developed.  I ask you, 'Where is the value of recommending a SINGLE threshold for the wide range of Vitamin D blood levels, when for over the last 10 years it has become apparent that in virtually all disease states studied, the lower the blood vitamin D levels, the higher the incidence of disease? Should we not be insuring that we have an adequate amount of vitamin D circulating our blood to protect us from disease rather than focusing on HOW much to take to get that insurance?' This is why I follow the blood serum levels of Vitamin D circulating (serum 25-hydroxyvitamin D [25(OH)D]) in my patient's blood and then match that need with the correct amount of Vitamin D3 taken by the person each day. For most of my patients, to attain and maintain a vitamin D level in their blood between 50-80 ng/ml, they require Vitamin D3 5000IU daily.

The panel dismissed concerns that many Americans and Canadians are vitamin D deficient, noting that there is no scientifically validated level that's considered optimum. Even so, the panel concluded that for 97% of the population, a blood level of 20 nanograms of vitamin D per milliliter is sufficient. WHAT? How can this be true? I will tell you HOW...it is because to admit otherwise, would mean that this country's medical experts have not acknowledged a national vitamin D deficiency AND admitting that could arouse angry concern and consequences that this government is not prepared to be accountable for. To acknowledget that our standard vitamin D reference ranges have been this wrong for this long would mean that more than half of the U.S. population are considered deficient in vitamin D and again, I quote Linus Pauling, such an admission is not in the best interest of government obliged to pay social security and medical costs for a large portion of the population. Studies in bone health alone have shown that at levels below 30 ng/ml, the body seeks calcium for everyday needs by leaching it from bones; i.e. precipitates Osteoporosis.

Vitamin D is more than a vitamin, as it modulates our physiology from a standpoint of much greater significance than a mere vitamin. We now know that Vitamin D is much more than the sunshine vitamin, because it is responsible for regulating more than 2000 genes, and as a result, vitamin D is now known as a cell modulator and hormone. Michael Holick, a professor of medicine at Boston University School of Medicine states that despite the paucity of randomized-controlled trials (these are the "gold standard" studies that look at outcome when a controlled amount of vitamin D is given to one population and placebo is given to the other and these studies are very different from the epidemiological studies that documents vitamin D's value), the long list of chronic diseases associated with vitamin D does make sense, given that it is actually a hormone that affects virtually every organ in the human body and regulates as many as 2,000 genes. Dr. Holick is the man who discovered the active form of vitamin D 40 years ago and is well versed and experienced as a proponent of vitamin D in high doses for this reason. There is no downside to increasing your vitamin D intake, and there are more studies coming out almost on a weekly basis, he said.

I leave you with a quote from CLS, who wrote on November 30, 2010, as a comment in the Wall Street Journal, in response to the new IOM recommendations:

600 i.u. of vitamin D daily? You mean the same amount one makes in 40 seconds (seconds) of high angle sun exposure? The human body makes at least 10,000 i.u. daily, in 15 -20 minutes of direct sun exposure, in a bathing suit, or, for novelty’s sake, in the last 100,000 years of evolution when we had no clothes. 600i.u. for an NFL player and my petite girlfriend? Sounds like the review board couldn’t wait to find an exit. I’ll stick to the overwhelming evidence that (blood levels between) 50-80 ng/ml, 25 OH D, prevents higher rates of every known pathology. I have read the research (more than 5000 medical abstracts, reports etc) and nothing in medical history has been more obvious: Vitamin D deficiency is ubiquitous and at the root of many, if not all early onset chronic diseases, acute infections, autoimmune dysfunction etc etc etc. Here’s an easy way to see who’s right:

I’ll maintain my vitamin D health in the 50-80 ng/ml range. Others may follow the new recommendations. Let’s see who gets sick the most and dies first?

So the Institute of Medicine admits that their previous vitamin D level recommendation was off by 300%. Why should Americans believe this panel of ‘experts’ once again?

Ariane Cometa MD, the holistic doc

Treat GERD Naturally and Effectively

The Cometa Wellness Center

Natural Approach towards GERD for disease cure, not symptom suppression!

The most important thing to remember when it comes to your digestion is that it is responsible for digesting your food! Gut mucosal integrity is essential for both competent digestion and the correct absorption of nutrients. Factors such as digestive enzymes, mucus, bacterial flora, and low pH (yes! an acidic environment!), are integral to mucosal integrity, health and function. Proton-pump inhibitors (i.e. the stomach acid-inhibitors such as Nexium, etc), NSAIDs (e.g. Motrin), steroids, antibiotics and poor dietary habits are examples of culprits that breakdown the first line defense against hypersensitivity to food proteins, as well as the aid we need in digestion and nutrient absorption.

Integral to most of the GI support programs I have successfully implemented in my medical practice, is the recognition and treatment of food intolerance. The loss of food tolerance leads to hypersensitivity. Such food hypersensitivity can lead to an array of gastrointestinal disorders. The many causes of food intolerance are still a quandary to conventional medicine. This is not the case for those of us that implement natural medicine. One very common type of food intolerance is food allergy and/or sensitivity. Whether it be GERD, IBS, Colitis, Gastritis, Peptic Ulcer Disease (PUD), or any combination of the above, the identification of food sensitivity and/or food allergy in that patient is imperative. Food allergy and sensitivity testing is available at The Cometa Wellness Center. Stayed tuned for the next blog to learn more about food intolerance and the difference between food sensitivity and food allergy.


 Always remember when it comes to food and you...View the forest, not the trees, because you are what you eat!

Correct nutritional and herbal support can enhance your Gut Integrity and Digestion/Nutrient Absorption

Glutamine

Glutamine is a critical nutrient for the health and function of the gut mucosa and its residing immune cells. Glutamine is the most abundant amino acid in our blood stream. It has been studied in the field of nutritional support for years. Although classified as a non-essential amino acid, it is considered a conditionally essential amino acid when a person is under "catabolic" stress such as in the critically ill patient. Glutamine is considered an essential amino acid under catabolic stress (i.e. body breakdown) because the body mobilizes glutamine from muscle tissue to provide substrate for more needed energy. Glutamine is the main fuel for enterocytes (i.e. cells of the colon) and it plays an important role in the structure and function of the GI tract. Supplementation with glutamine has been proven through many studies now to lower morbidity and mortality in the critically ill patient through its importance as an important dietary nutrient. It provides respiratory fuel for the immune cells, liver cells and intestinal mucosal cells, and is key to the nitrogen balance required by these systems when protein metabolism must be "amped up". In my medical practice the nutritional support provided by the addition of the amino acid glutamine is integral to a successful GI support program. The relevance of glutamine enriched diets for required nutritional support in disease is well supported in the literature. Glutamine is available in the supplement Glutagenics and GI Integrity below.

Gamma-oryzanol

To best explain how we naturally treat GERD and other GI tract dysfunction, it is helpful to explain bowel function itself. Gastrin is a hormone that stimulates secretion of gastric acid (HCl) by the parietal cells of the stomach and aids in gastric (stomach) motility. It's release is stimulated by G cells in the stomach, duodenum, and the pancreas. A product which reduce gastric secretion and is shown to prevent ulcers since 1978 is known as Gamma-oryzanol. Extracted from rice bran oil and other grain oils such as corn and barley, the active constituents of gamma-oryzanol (ferulic acid compounds) are also present in many foods, including oats, berries, citrus fruits, tomatoes, olives, and vegetables. Luckily gamma-oryzanol is also available in the natural supplement cited in the Treat GERD Naturally Package, Heartburn Essentials. Similar to how strontium is able to reduce the activity of osteoclasts from excessive bone breakdown, (rather than "poisoning" osteoclasts as the Fosemax-like drugs do) gamma-oryzanol reduces Gastrin production but does not totally suppress this important hormone Gastrin.

DGL

Deglycyrhizinated licorice, also known as DGL, is a well know GI supportive herbal preparation. DGL, is a licorice preparation that has been modified in such a way that the 'hypertensive' effects of Glycyrrhizin have been removed and the agents that sooth and heal the mucous membranes have been enhanced. Known, to enhance the positive effects of Goblet cells lining the stomach, DGL helps both heal the stomach and small intestine from ulcers as well as heal the esophagus and stomach from inflammation (esophagitis and gastritis, respectively). DGL is also very effective at healing mouth mucosal ulcers. DGL is used in my practice to both heal as well as PROTECT the GI mucosal tissues from insult. It is in both the Heartburn Essentials as a capsule preparation to be taken with meals or as a powder preparation in the product Glutagenics.

N-Acetyl- D-Glucosamine

Just like glucosamine sulfate is used for joint support, N-Acetyl- D-Glucosamine is a naturally occurring amino sugar integral to GI support. N-acetyl-d-glucosamine (NAG) is incorporated into glycosaminoglycans and is a major structural component for intestinal mucous secretions. This mucous is both protective as well as necessary to propel digested food through the GI tract. Supplementation with NAG helps maintain normal glycosaminoglycan synthesis and intestinal mucous production. In patients with GI integrity breakdown such as GERD and IBS, conversion from glucosamine into NAG is less effective. That's why for the GI tract, NAG supplementation is usually preferred over glucosamine sulfate. N-Acetyl-D-Glucosamine is available with glutamine and other gut enhancing nutrients in the formulated supplement GI Integrity.

Treat GERD Naturally Supplement Program


The following program has historically been implemented with the greatest long term success, when accompanied by "health-full" whole food choices and at times, the temporary elimination of sensitive and/or allergic foods. Remember, stayed tuned for our next blog at drcometablog.com to learn more about the difference between these potential food intolerances in your life that may cause discomfort and disease. One does not need to be a patient with Dr. Cometa to take advantage of this very useful testing available at the Center. Call the Center at 410-296-6100 if you would like to be tested. 

1. Heartburn Essentials
Take 2 capsules three times a day with each meal

2. GI Integrity 
Take 2 after breakfast and 2 after lunch

3. Glutagenics
Take 1 teaspoon in the PM after dinner and in AM upon arising as necessary for extra support and protection

For a fair trial, this strong GI Support program should be followed for 2 months with careful eating. Supplements never replace common sense! The process of food reintroduction and GI support supplement reduction must be done slowly and very carefully. Please do not rush off the supplements before you slowly and methodically reintroduce and test allergic foods back into the diet. For help with temporary food elimination and reintroduction as well as general nutrition, do not forget...The Cometa Wellness Center has a fabulous new Certified Nutritionist, Ana Goldseker, CNC. Ana Goldseker's philosophy and knowledge of nutrition is completely "wholistic", and has been a great asset to the Center.

Ariane Cometa, holistic doc
The Cometa Wellness Center Pharmacy

The IBS and GERD connection

The Cometa Wellness Center

Gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) are very common disorders in the general population. Symptoms of IBS are commonly encountered in GERD patients, and symptoms of GERD are not uncommon in IBS patients. "GERD and IBS may be two distinct manifestations of a similar underlying pathophysiologic process that can affect different levels of the gastrointestinal tract. ...the reason for the overlap observed between GERD and IBS remains to be elucidated..." I quote these words because I read them over and over again in the medical literature. The "overlap" observed between disease states in the human body will always be illusive in the medical paradigm where the body is broken down into parts! The specialization of medicine has made it very difficult for a person to be viewed by the doctor as a WHOLE person.  I quote the old adage...

                                        'View the forest not the trees'

The most important thing to remember when it comes to your digestion is that it is responsible for digesting your food! Gut mucosal integrity is essential for both competent digestion and the correct absorption of nutrients. Factors such as digestive enzymes, mucus, bacterial flora, and low pH (yes! an acidic environment!), are integral to mucosal integrity, health and function. Proton-pump inhibitors (i.e. the stomach acid-inhibitors such as Nexium, etc), NSAIDs (e.g. Motrin), steroids, antibiotics and poor dietary habits are examples of culprits that breakdown the first line defense against hypersensitivity to food proteins, as well as the aid we need in digestion and nutrient absorption.

What the current medical literature DOES NOT tell us about GERD

For those whom suffer from GERD, you should know there are no studies to document that GERD is an 'excess acid production' problem. The acid is simply stagnant with the food in your stomach (i.e. a delayed gastric emptying rate) and moving up into the esophagus rather than down from the stomach into the small intestine in a timely fashion. This is due to a breakdown in the functional gut mucosal integrity cited above. The fundamental abnormality in gastroesophageal reflux disease is exposure of the esophagus to acidic gastric contents, resulting in injury and/or symptoms.

As we understand GERD, there are now 2 known types of this disease. The most well established type is erosive esophagitis, (EE) where there is inflammation and the potential for Barrett's esophagus (i.e. esophageal cancer potential). This disease is correlated with regurgitant esophageal acid exposure, NOT excessive stomach acid production! There is also a second type of GERD, known as non-erosive reflux disease (NERD). This version of GERD is actually more predominant and accounts for over 50% of gastroesophageal reflux. Patients with NERD have typical reflux symptoms caused by the esophageal reflux of gastric contents but have no visible esophageal mucosal injury. This is in contrast to patients with erosive esophagitis and Barrett's esophagus, who have obvious esophageal mucosal injury on endoscopy.

IBS and GERD

It is the more common nonerosive gastroesophageal reflux disease (NERD), which frequently has features of irritable bowel syndrome (IBS). Irritable bowel symptoms are hence often associated with reflux symptoms, but not necessarily with acid exposure. Recent studies have demonstrated that GERD patients who also suffer from IBS-like symptoms perceive their GERD-related symptoms as more severe and are less likely to respond to anti-reflux treatment, as compared with those without IBS. The presence of both IBS and GERD in a patient is considered a likely explanation for "the failure" of proton pump inhibitors to treat GERD.

Although acid reflux gives rise to similar symptoms in both NERD and EE patients, the underlying mechanism of acid injury may be different. A breakdown in the mucosal integrity of the esophagus predominates in NERD and resembles the gut permeability disorder we reviewed in the June 23, 2010 blog, "Treat IBS Naturally and Effectively". Remember from this review that there are tight junctions between the cells that line the gut mucosa. These tightly adhered cells form the primary barrier between the external environment (e.g. our food) and the internal environment of our body. We now know from clinical research that "dilated intercellular spaces may be responsible for the enhanced perception of proximal acid reflux and that these dilated intercellular spaces are a feature of NERD patients, irrespective of esophageal acid exposure". These mucosal changes are considered an objective, structural marker of reflux symptoms. Through the food allergy response described under Food Intolerance in the June 23, 2010 blog, the food intolerant person slowly looses the tightly regulated mucosal immune response that protects them from untoward micro-inflammation. This leads to structural changes in gut mucosal integrity. This sounds an awful lot like the "dilated intercellular spaces" described in the medical literature that are now considered a structural marker of reflux, but NOT always related to esophageal acid exposure. The presence of IBS features in a large proportion of NERD patients reflects a high prevalence of visceral (i.e. gut) hypersensitivity that may aggravate acid reflux symptoms. Do you think there is a connection between food sensitivity/allergy, IBS and GERD pathophysiology? Of course!

Those nasty Proton-Pump Inhibitors!

GERD patients with a poor response to acid suppression treatment are seen a lot. Even double proton pump inhibitor dosing does not relieve symptoms in many patients with GERD. The literature clearly states that current definitions of acid reflux require review and the precise role of acid in NERD (type 2 GERD) needs further clarification.

Yes, proton-pump inhibitors may wipe out GERD symptoms, by taking away the acid production naturally found in the stomach. Yes, they also reduce esophageal exposure to acid and consequently reduce the incidence of Barrett's esophagus. But, would it not be better to keep Mother Nature's plan, and allow the acid to reside in the stomach? Would it not make more sense to help the acid do its job in a timely fashion, by facilitating digestion and the normal propulsive forward motion of food through the digestive tract? Let's look at what we do when we inhibit stomach acid production. By inhibiting acid production, we are:

• 1. Inhibiting the first line defense our body has to kill pathologic bacteria that has entered the stomach from the mouth.
• 2. Inhibiting the production of enzymes that are low-pH (acid) dependent in the stomach and small intestine.
• 3. Inhibiting the essential breakdown of food in the stomach before it continues into the small intestine.
• 4. Likely reducing the ability of the lower esophageal sphincter (thought to be acid sensitive for its closure) to close and hence increasing reflux!

Note, that by taking Nexium-like drugs, one is not only is often UNABLE to address NERD, BUT is also breaking down the first line defense to disease in the gut! Does any of this sound like a good idea? NO!

Natural Approach towards GERD for disease cure, not symptom suppression!

Integral to most of the GI support programs I have successfully implemented in my medical practice, is the recognition and treatment of food intolerance. The loss of food tolerance leads to hypersensitivity. Such food hypersensitivity can lead to an array of gastrointestinal disorders. The many causes of food intolerance are still a quandary to conventional medicine. This is not the case for those of us that implement natural medicine. One very common type of food intolerance is food allergy and/or sensitivity. Whether it be GERD, IBS, Colitis, Gastritis, Peptic Ulcer Disease (PUD), or any combination of the above, the identification of food allergy in that patient is imperative. Food allergy and sensitivity testing is available at The Cometa Wellness Center. One does not need to be a patient with Dr. Cometa to take advantage of this very useful testing available at the Center. Call the Center at 410-296-6100 if you would like to be tested.
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Stay tuned to The Cometa Wellness Center blog with drcometablog.com to learn how correct nutritional and herbal support can enhance your Gut Integrity and Digestion/Nutrient Absorption.

Ariane Cometa MD, the holistic doc
The Cometa Wellness Center Pharmacy

The Connection between Osteoporosis and Atherosclerosis: Calcified Bones NOT Arteries

The Cometa Wellness Center
Have you ever wondered why so many aging people have calcified plaque in their arteries and yet walk around with brittle bones that are markedly depleted of calcium? Vitamin K2 is the link between these diseases. Vitamin K2 will be discussed shortly.

                                      Healthy Bone Turn-over

Bone is a dynamic, living tissue that is continuously remodeled. As old bone is resorbed by osteoclasts (cells that break bone down), the "old and stressed" bone is replaced with healthy new bone by osteoblasts (new bone cells). DO WE WANT TO INHIBIT RESORPTION? Of course not. Say "NO!" to Fosemax! Why? I will tell you why.

Bisphosphonate drugs (e.g. Fosemax and Actonel) increase the Bone Mineral Density (BMD) of the bones at the expense of our bone quality. Such drugs reduce the activity of osteoclasts through cell death. These drugs act as an osteoclast poison. This is how the drugs slow resorption of bone. In addition, they do not increase the activity of osteoblasts (new bone cell growth). As a result, these drugs maintain "older" bone with poorer architectural quality. As old bone is NOT torn down and the osteoblasts continue to build new bone, the bone is more brittle, therefore the QUALITY of the bone will naturally be diminished and weaker.

 Medical research documents that WE WANT Bone Quality, not just Quantity:
1. JAMA Commentary article, March 26, 2008; "In an effort to prevent fractures, do we pay too much attention to BMD (quantity) at the exclusion of what improves the vitality or quality of bones?"

2. JAMA 1998 article; "The antifracture benefit of bisphosphonates in women with low bone mass but without prevalent fracture must be judged to be small".

3. NIH in 2001 defines bone strength as a combination of BMD and "bone quality". "Bone quality is a vague entity and BMD is widely over emphasized".

Bisphosphonates may increase BMD, but at what expense? The answer is in the value of Vitamin K2 and Strontium. Let's start with Vitamin K2.

                                               The Vitamin K's

•  1929, Danish Nutritionist discovers Vitamin K1
• "K" for koagulationsvitamin
• "The clotting vitamin".
• In the 1970's, the discovery of many non-clotting Vitamin K2 dependent proteins were found ubiquitously in the body, including the bones and the vessels.

                                                  Vitamin K2
                                      How is Vitamin K2 different?

•  Menatetrenone is Vitamin K2, not Vitamin K1.
• Vitamin K2 is deficient in the American diet, with only tiny quantities available in goose liver, butter and egg yolks.
• Vitamin K1 conversion to Vitamin K2 does occur minimally in our bodies. Plus, this conversion slows down with age.
• Vitamin K2 is a GREAT bone builder.
• Clinical trials have shown that Vitamin K2 provides bone protection beyond the BMD numbers.

There are many Vitamin K2 dependent proteins. Vitamin K2 activates important proteins in the body. Osteocalcin is one of these very important proteins. This protein binds calcium (once activated by Vitamin K2). Calcium from all over the body is then transported from the bloodstream into the bone matrix. Sounds pretty important to me! Vitamin K2 is nature's calcium chelator!

Over the last decade, randomized, controlled human, animal and in-vitro studies have consistently demonstrated that K2 supplementation protects bone health.

• Deposits bone into the bone matrix.
• Prevents prostaglandin E2 (PGE2) mediated calcium loss AND PGE2 production.
• Reduces osteoclast (cells that break bone down) formation from stem cells (but does not poison osteoclasts).
• Promotes osteoblast (new bone cells) maturation and activity through effects on gene expression.

                                BMD does not equal Bone Quality

• Vitamin K2 increases strength, improves the structure and boosts the mineral content of bone.
•  It does this while it maintains or improves BMD.
• Women's risk of fracture slashed with Vitamin K2 is comparable to bisphosphonates.

                              Bridging the vessels and the bones

Have you ever wondered why so many aging people have calcified plaque in their arteries and yet walk around with brittle bones that are markedly depleted of calcium? Vitamin K2 is the link between these diseases. Vitamin K2 deficiency is an epidemic in the country as is Vitamin D deficiency. Vitamin K2 availablity decreases with aging. As a result... osteocalcin is not able to bind calcium and transport it to the bone matrix. This is one reason why calcium accumulates in the arterial wall. But there is more to the story....read on!

                                       From Bones to Vessels

In Vitamin K2 deficiency, not also is the important Vitamin K-dependent protein, osteocalcin, underactive, BUT so is another important Vitamin K2 protein called Matrix G1a protein. This essential K2 dependent protein is an inhibitor of arterial calcification. So, in addition to ineffective transport of calcium into the bone matrix, we cannot prevent or inhibit arterial calcification. Youch! What do we end up with?

                                          Calcified Vessels!

 Increasing evidence reveals that the Vitamin K-dependent calcification process is ubiquitous. Therefore in Vitamin K deficiency... we literally ossify the plaque of our arterial wall rather than our bone matrix!

                              How do we find Vitamin K2?

Vitamin K2 is rich in the Japanese diet. Natto is a traditional Japanese food. It is a fermented soy condiment. Vitamin K2 is extracted from Natto and is purified of all it's soy content and grown through fermentation with the probiotic Bacillus, natto. It is very biologically active. Natto is the richest known food source for Vitamin K2. Eastern regions of Japan eat a lot more Natto. Research has demonstrated that these women, who eat more Natto, have far fewer fractures than their western neighbors. Pure Natto resources can be found in Japanese groceries. Since Natto is not available in your local grocery store, and we do not live in Japan, let's talk about Vitamin K2 supplementation.

                                        Vitamin K2 Dosage

• Vitamin K2 30-45 mg daily in divided doses with meals.
• Pure Natto resources found in Japanese groceries.

There are many reasons to address this problem naturally. The most important reason is that by naturally correcting your bone metabolism issue, you have corrected the problem. Of course the correct diet and weight bearing activity program are integral to the bone health program recommended below.

Let Nature and Lifestyle improve Bone strength. Nature addresses the age-related decline in bone formation.
                                                             
                                              Lifestyle

• A diet high in lots of fresh vegetables and lean meats is great for bone formation.
• The diet should be low in sugar, soda, caffeine and NO SMOKING. These ALL leach out important nutrients or worse, poison the bone cells (osteoblasts).
• Exercise: Power walking and using light 2 pound weights in the hands when you walk can be very helpful. Try to do this 30 minutes, 3-5 times a week. Exercise helps us with Proprioception, which helps with balance, coordination, mobility and strength.

                               Natural supplements for Bone Health
                                 You must not be on Coumadin to follow this program.
          Available at The Cometa Wellness Center Pharmacy

• Peak K2, 15 mg/capsule. Take 1 capsule twice daily with meals
• Vitamin D3 such as Vitamin D3 1000 IU or 5000 IU. Take 1 capsule daily with a meal.
• Well-balanced Bone mineral supplement such as Osteosheath, 2 capsules twice daily with meals.
• Treatment can be safely started while on your Osteoporosis medication.

Also, for those of you who have Osteoporosis, please add Strontium. We will review the value of Strontium and Vitamin D3 in the reversal of Osteoporosis in upcoming blogs.

• Strontium, take 2 in the AM 1 hour before all medication, supplements and food.

Doctor's message:

I have been 100% successful in reversing early bone loss AND Osteoporosis with the above recommendations. Please consider how important your bone health is for longevity and quality of life as we age, and keep those bones "truckin".

Ariane Cometa MD, the holistic doc

Manage IBS Naturally and Effectively

The Cometa Wellness Center

We reviewed the "whole person" approach towards Irritable Bowel Syndrome (IBS) in the June 23, 2010 blog. The effect that food intolerance has on our gut integrity was described. The present blog outlines how to best manage IBS Naturally and Effectively.

How do we manage IBS Naturally and Effectively?

 Food Allergy Testing

Please refer to the June 23, 2010 blog Treat Irritable Bowel Syndrome Naturally and Effectively for a complete explanation of this important test that so many people with IBS need to know about! It is available at The Cometa Wellness Center. One does not need to be a patient with Dr. Cometa to take advantage of this very useful test available at the Center. Call the Center at (410) 296-6100 if you would like to be tested for Food Allergy.

Natural Supplementation to Enhance Gut Integrity and Aid Digestion/Nutrient Absorption

There are many herbs and nutriceuticals (i.e. vitamins, minerals, amino acids, etc.) to consider for GI integrity and health function. Below I will describe what I consider to be some very important key players in the management of IBS. Remember, in the world of natural medicine, we always use the symptoms (i.e. irritable bowel symptoms) to help direct our program and this means addressing symptom origins!

Glutamine

Glutamine is a critical nutrient for the health and function of the gut mucosa and its immune cells. Glutamine is the most abundant amino acid in our blood stream. Its nutritional value has been studied for years. Although classified as a non-essential amino acid, it is considered a conditionally essential amino acid when a person is under "catabolic" stress such as in the critically ill patient. Glutamine is considered an essential amino acid under catabolic stress (i.e. body breakdown) because the body mobilizes glutamine from muscle tissue to provide a substrate for more needed energy. Glutamine is the main fuel for enterocytes (i.e. cells of the colon) and it plays an important role in the structure and function of the GI tract. Supplementation with glutamine has been proven through many studies to lower morbidity and mortality in the critically ill patient through its value as an important dietary nutrient. It provides respiratory fuel for the immune cells, liver cells and intestinal mucosal cells, and it is key to the nitrogen balance required by these systems when protein metabolism must be "amped up". In my medical practice, the nutritional support provided by the addition of the amino acid glutamine is integral to a successful GI support program. The relevance of glutamine enriched diets for required nutritional support in disease is well supported in the literature. Glutamine can also be found as an individual supplement or in a combination formula. I prefer to use Glutamine and all other GI support supplements in a formula, because together, they work synergistically to enhance each other's effectiveness.

N-Acetyl-D-Glucosamine

Just as glucosamine sulfate is used for joint support, N-Acetyl-D-Glucosamine is a naturally occurring amino sugar integral to GI support. N-acetyl-d-glucosamine (NAG) is incorporated into glycosaminoglycans and is a major structural component for intestinal mucous secretions. This mucous is both protective as well as necessary to propel digested food through the GI tract. Supplementation with NAG helps maintain normal glycosaminoglycan synthesis and intestinal mucous production. In patients with GI integrity breakdown such as GERD and IBS, conversion from glucosamine into NAG is less efficient. That's why for the GI tract, NAG supplementation is usually preferred over glucosamine sulfate. N-Acetyl-D-Glucosamine is available with glutamine and other gut enhancing nutrients in the formulated supplements through our Holistic Pharmacy.

Digestive Enzymes

Digestive enzymes assist the digestive tract from the acidic stomach environment to the alkaline environment of the small intestine. They are responsible for preparing the food for the colon, where the microflora of our "good bacteria" take over the work to complete nutrient absorption. Depending upon your digestive needs there are many types of enzymes to choice from. Apple Cider vinegar is a nice and wholesome way to restore the natural pH in your stomach. pH balance is integral to your digestion. Apple cider vinegar stimulates your own digestive enzymes. See the GI Integrity package below regarding which enzyme preparation is best for you. If you are not sure which enzyme preparation is best for you, Digestion GB is an excellent formula and my favorite!

Prebiotics and Probiotics

The role in colonic health for both probiotics and prebiotics has been a topic of clinical research for years. According to the currently adopted definition by FAO/WHO, probiotics are: "Live microorganisms which, when administered in adequate amounts, confer a health benefit on the host." A prebiotic is "a selectively fermented ingredient that allows specific changes, both in the composition and/or activity in the gastrointestinal microflora and confers benefits upon host well-being and health." Both affect the composition of the microflora, and hence the health of the colon. Butyrate (aka buyric acid) is a prebiotic. It undergoes fermentation in the colon and gives rise to short-chain fatty acids (SCFA). SCFA are the major source of energy for colon cells (enterocytes). Butyrate is a specific SCFA that is known to enhance the growth of lactobacillus and bifidobacterium (i.e. the good bacteria in the colon). As a "food" for colonic cells, butyric acid has historically helped my patients recover from both IBS as well as Inflammatory Bowel Disease (IBD). Probiotics (e.g. lactobacillus and bifidobacterium), like the prebiotics, help balance the microflora of the intestines. Unbalanced microflora is one of the reasons a person experiences gas with the associated symptoms of abdominal pain, cramping and bloating in IBS. Probiotics developed in the United Kingdom and provided by the company Pharmax are the only probiotics carried at The Cometa Wellness Center. They have been proven effective, not just over the test of time, but through clinical research, Pharmax makes superior and highly bioavailable bacterial probiotic strains.

Carminatives

Carminative herbs sooth cramps of the digestive tract. Many times cramps are accompanied by flatulence (i.e. gas). Carminative herbs assist in the expulsion of gas from the stomach and intestines. They ease griping pain in the GI tract associated with eating. Herbs that comfort the intestine through their carminative properties also facilitate digestion as they help to relieve gas. I prefer the combination of peppermint, rosemary, and thyme extracts in an enteric-coated soft gel which releases into the intestines, not the stomach. Mentharil, formulated by the company Integrative Therapeutics, makes an excellent formula and with the release of these therapeutic herbs into the intestines, the antispasmodic and soothing benefits are maximized.

Serotonin, Stress and IBS

Irritable bowel syndrome is a complex disorder associated with altered gastrointestinal motility, secretion and sensation. Serotonin is an important signaling molecule in the gut as well as our mental health. The stress in our life is major contibutor to IBS in many people. I bet you did not know that most of the body's serotonin is present in the cells of the gut! WOW! Serotonin binds to three types of cells in the GI tract: the enterocytes (colon cells), the smooth muscles that line the intestine and the enteric neurons (nerve cells). We know that in IBS, altered serotonin signaling involves both the intestinal and extra intestinal systems. Tegaserod, is a medication which acts like serotonin. It is used in constipation predominant IBS. Tryptophan is an essential amino acid and is easily converted into serotonin in our body (i.e. it is a serotonin precursor). Thus, taking Tryptophan can naturally increase serotonin levels in the body which in turn may reduce the stress response in our lives as well as IBS symptoms. Tryptophan has been an excellent natural solution for many of my patients with IBS and who feel "stressed out". This is especially true in the individual who has an IBS picture which involves more constipation or has alternating bouts of constipation with diarrhea.

G.I. Support Supplements in Summary
(each product can be investigated by clicking on the name of the supplement)

1. GI Integrity contains the essential nutrients Glutamine and N-acetyl-Glucosamine as well as other gut mucosal integrity support. Take 2 after breakfast and 2 after lunch and/or 2 after dinner.
2. The digestive enzyme formula Digestion GB  Take 1-2 capsules with each meal.
For other enzyme selections, visit our Holistic Pharmacy and browse through the others available.
                      Dosage for all enzymes: Take 1-2 capsules with each meal.
3. The Probiotic preparation I like by Pharmax is HLC High Potency Capsules. Take 1 with meals and/or 1-2 before bed.
For other Probiotic selections, visit our Holistic Pharmacy and brows through the others available.
4. Tryptophan 500 mg  is very uselful if IBS is predominated by comstipation.Take 3 capsules before bed and consider three in the AM upon awakening.
5. For gas abd bloating use the carminativepreparation, Mentharil  Take as needed and as directed on the bottle.
6. For the IBS patient who is also predisposed to bowel inflammation such as Diverticulitis or Colitis, please consider the Prebiotic preparation ButyrEn 500 mg. This Butyrate preparation is best taken 2 tablets with each meal.


Visit our website to view the G.I. Integrity Support Package.


Doctor's message
A wholesome diet optimizes our digestion and a healthy GI tract. Remember, with IBS, the recognition and treatment of food intolerance is imperative. The temporary elimination and gradual reintroduction of foods that we are allergic to or simply do not tolerate is essential if we want to maximize gut mucosal integrity with our diet. A strong supplement program which will Enhance Gut Integrity and Aid Digestion/Nutrient Absorption also needs to be considered. Do not forget to reduce stressors in your life and when needed, modify the stress response with helpful tools like meditation, yoga, walking and the very beneficial amino acid, Tryptophan.

For those of you who suffer with IBS, I hope that you find the healthful tips outlined in this August and last Junes blog @ drcometablog.com helpful and informative.

Ariane Cometa MD, the holistic doc