The Cometa Wellness Center

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

2012-01-22T14:36:00.000-05:00

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

2011-07-24T11:19:00.000-04:00

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

2011-01-14T14:36:00.002-05:00

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

2010-11-21T18:41:00.005-05:00

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

2010-09-26T11:45:00.000-04:00

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

2010-09-06T00:09:00.000-04:00

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

2010-08-01T17:21:00.009-04:00

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

Treat Irritable Bowel Syndrome Naturally and Effectively

2010-06-23T21:58:00.000-04:00

The Cometa Wellness Center

"No one knows exactly what causes irritable bowel syndrome". This is a very common statement made by the medical profession. This is why I have always recommended that my patients follow the old adage...

"View the forest not the trees"

In this vein, the most important thing to remember when it comes to your digestion is that it is responsible for digesting your food! As simple as this may sound, it is easy to lose this awareness, and become a victim of our diet.

Have you ever wondered why or how medicine can describe symptoms, give the symptoms a name (i.e. the "diagnosis"), bill for the symptoms by 'name' (i.e. the diagnosis) but cannot give the patient a clear etiology for these symptoms or even an effective treatment program? In my opinion, a prescription is often not an effective treatment plan. A perfect example of this 'phenomena' is the diagnosis, Irritable Bowel Syndrome. There are many 'diagnoses' in this category such as Chronic Fatigue Syndrome and Fibromyalgia. My 'favorite' etiology in medicine for a patient's symptoms is "Idiopathic". This is a fancy term for "we do not know" and yet can still be used and billed for through insurance companies. Even when medicine does not know the cause of a problem, it must come up with a fancy name for it! I think part of the reason for WHY medicine needs to do this is the system-based or specialized practice of medicine which now exists and breaks the patient into many parts. The specialization of medicine has made it very difficult for a person to be viewed by the doctor as a WHOLE person. Hence, discovering the cause of a patients symptoms is often left for 'the other' specialty referral and the patient may go from doctor to doctor with a few potential diagnoses attached to their symptoms and no clear plan of action! Does this sound familiar? I bet it does.

What is IBS?

Irritable bowel syndrome (IBS) is one of the most common disorders that presents to the doctor's office. This is most likely because the symptoms of IBS are so easily triggered. The symptoms of irritable bowel syndrome can vary widely from person to person and often resemble those of other diseases. Among the most common are:
~Abdominal pain or cramping.
~A bloated feeling.
~Gas (flatulence).
~Diarrhea or constipation - sometimes alternating bouts of constipation and diarrhea.

The Whole Person Approach to IBS

Food Intolerance

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 who implement natural medicine. One very common type of food intolerance is "food allergy". 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. Most doctors do not believe that what a person puts in their mouth has any impact on their GI health. How many people have been told that their GI symptoms are UNRELATED to food?! I would like to review what we know about food allergy and how it impacts GI health.

Pivotal to food allergy is a breakdown in immune system messaging that occurs when the body has lost tolerance to certain food proteins (i.e. hypersensitivity). Food allergy occurs when ingested proteins from food act as "antigens". Antigens are protein substances which are regarded as foreign by the immune system and hence, stimulate an immune response (i.e. make antibodies). We know that daily dietary challenge to food protein 'antigens' is a set up for both local gut micro-inflammation as well as systemic inflammation. What results is called 'gut permeability'. Many people have heard the well known term "Leaky Gut Syndrome". How does such permeability or Leaky Gut occur, you ask? The answer lies in the integrity of our gastrointestinal lining, aka Gut Integrity.

Gut Integrity

Gut mucosal integrity is essential for both competent digestion and the correct absorption of nutrients. Normally, 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. Our gut mucosa is the largest body surface area in contact with our external environment! I guess it is understandable then, that the majority of the cells which constitute OUR IMMUNE system reside in the gut. The Gut Associated Lymphoid Tissues, also called "GALT", is the term applied to the immune system of the GI tract. The GALT system is a tightly regulated mucosal immune response protecting us from untoward micro-inflammation. When food allergy occurs, the GALT system has become compromised and complexes of antibodies form with food protein (i.e. antigen). These complexes become a constant challenge for the intolerant person. Such insult leads to a hypersensitive state and the likelihood of subsequent inflammation which leads to structural changes in gut mucosal integrity. Food allergies are implicated in many disease states, but by far the most well known example is Celiac disease.

Factors such as low stomach pH (i.e. an acidic environment in the stomach), digestive enzymes, mucus and bacterial flora are integral to mucosal integrity, health and function. Proton-pump inhibitors (e.g. Nexium, etc), NSAIDs (e.g. Motrin), steroids, antibiotics and poor dietary habits all interfere with:

1) our first line defense against hypersensitivity to food proteins.
2) the aid we need for digestion and nutrient absorption.

Stress Response and IBS

Most people with IBS, find that their signs and symptoms are worse or more frequent during stressful events. Even events that are not considered very stressful, such as a change in your daily routine or family arguments can bring on IBS symptoms. Hormonal changes can also cause a stress response in women with IBS. Many women find that IBS symptoms are worse during or around their menstrual periods.

Stay tuned to The Cometa Wellness Center blog with drcometablog.com to learn how to Treat IBS Naturally and Effectively through support for enhanced gut integrity and digestion/nutrient absorption.

Food Allergy 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 test available at the Center. Call the Center at 410-296-6100 if you would like to be tested for Food Allergy.

Doctor's message.... So always remember when it comes to food and you:
View the forest, not the trees, because you are what you eat!

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

Are you tired and can't fix the problem?

2010-03-29T13:55:00.001-04:00

The Cometa Wellness Center The power of natural medicine in treating all disease is magical. Yet, it can still be a challenge for the individual with fatigue to find a cure even with all of the various natural medicine options available. Part of this challenge comes from the fact that the mitochondria has not been understood or addressed by those suffering from fatigue and trying to treat this disabling condition.

The evolution of the mitochondria is fascinating and debated to this day. The most accurate and well supported theory for the origins of the organelle we call, the mitochondria, is The Endosymbiotic Theory. This theory was first postulated by former Boston University Biologist Lynn Margulis in the 1967 and officially in her 1981 book "Symbiosis in Cell Evolution". Although now accepted as a well-supported theory, both she and the theory were ridiculed by mainstream biologists for a number of years. Thanks to her persistence, and the large volumes of data to support the hypotheses postulated by her and other scientists over the last 30 years, biology can now offer a plausible explanation for the evolution of the mitochondria. Margulis' original hypothesis proposed that aerobic bacteria (those that require oxygen) were ingested by anaerobic bacteria (poisoned by oxygen), to provide both with survival advantages. Each would have performed mutually beneficial functions in their symbiotic relationship; the aerobic bacteria handling the toxic oxygen for the anaerobic bacteria, and the anaerobic bacteria ingesting food and protecting the aerobic "symbiote". Endosymbiosis is the term used when a cell is engulfed by another cell, and is not digested but instead lives together with its host in a mutually beneficial relationship, or symbiosis.

The end result of such endosymbiosis is The Cell, as we know it today and which contains a double-membrane bound organelle called the mitochondria. In The Endosymbiotic Theory, the inner lipid bilayer would have been the engulfed aerobic bacterial cell's plasma membrane, and the outer lipid bilayer came from the anaerobic bacterial cell that engulfed it. Hence, mitochondria are the evolutionary result of endocytosis (ingestion) of aerobic bacteria by anaerobic bacteria. Interestingly, Chloroplasts are the result of endocytosis of photosynthetic bacteria, and are to plants what the mitochondria are to us humans.

So, why is the evolution of the mitochondria so important to us when we want to treat fatigue? The mitochondria IS the organelle in the cell that provides us with our cellular energy. It is literally the cells internal battery from which all our oxygen-dependent energy must come. Among other jobs, the mitochondria is responsible for making adenosine triphosphate, ATP. ATP production is oxygen dependent, and is the energy our mitochondrial battery makes. Without ATP, we die. For example, when rigor mortis sets into the human being after death, it is because ATP production has ceased and the muscles freeze up in the position that they last had their life preserving ATP before cell death. Cool huh? The importance of supporting the restoration of mitochondrial health to our cells is integral to cell health and energy when we want to address FATIGUE.

Thermogenesis was described in the March 6, 2010 blog. Thermogenesis is the term used to describe how our body produces cellular energy in the form of heat. Remember, that as we raise our metabolic rate through thermogenesis, we are literally burning our stored fat for daily fuel. Now, guess where thermogenesis takes place in our body. That's right; thermogenesis takes place in the mitochondria! So just imagine that while you are burning calories and losing fat and inches, you can create more energy, by making ATP at the same time. Sounds too good to be true but it is not. Yet, it does require a healthy lifestyle, because your cells are smarter than you are! You may be able to fool yourself, but you cannot fool your cells!

When addressing fatigue, let's begin with a very basic addition to our diet. This is the five carbon sugar, D-Ribose. If I was to make ONE addition to the diet and it was to come as a dietary supplement, it would be a canister of D-ribose powder. Let me explain why. D-ribose is a naturally occurring five-carbon sugar found in all living cells. The body naturally converts glucose into D-ribose. D-ribose is vital for the mitochondria to keep our cells supplied with energy because the mitochondria uses D-ribose to generate our ATP. D-ribose is essential for all the pathways of energy metabolism. Chronic fatigue syndrome (CFS) and fibromyalgia (FMS) are both associated with decreased mitochondrial function and declining tissue levels of adenosine triphosphate (ATP). Supplementing the diet with additional D-ribose can increase the rate at which ATP is generated as it is constantly being broken down and "recreated". Why is this? One of the problems faced when the body's D-ribose stores have been depleted, is that our tissues are unable to produce the essential nutrient, D-ribose quick enough to restore depleted energy stores. Cellular energy depletion is considered a major contributor to both fatigue and muscle pain. Without supplemental D-ribose, energy depletion becomes more severe and creates a vicious cycle between an increase in cellular energy demand and the diminished reserves. This is because energy is used faster than fuel such as D-ribose is made available to renew it.

In 2006, an open-label uncontrolled pilot study was done to evaluate the effect of D-ribose on symptoms in forty-one patients with CFS and FMS. Well over half of these patients experienced significant improvement while using D-ribose, with a 45% average increase in their energy. The form of D-ribose we carry at The Cometa Wellness Center is the same used by Teitelbaum MD in this 2006 pilot study. Corvalen contains pure D-RIBOSE, a safe and clinically-proven ingredient that accelerates the natural way our bodies produce energy. Taking Covalent every day helps the body restore lost energy quickly and reduces muscle stiffness, soreness and fatigue.

Do you need D-ribose? Corvalen, as all well made D-ribose is safe and associated with no remarkable side effects when dosed correctly. Quite frankly, everybody benefits from D-ribose to support mitochondrial health and essential ATP energy production. Check out Corvalen today at the Cometa Wellness Center Holistic Pharmacy. It even tastes good!

Ariane Cometa MD, the holistic doc
The Cometa Wellness Center

Burn Stored Fat through Thermogenesis

2010-03-06T12:48:00.001-05:00

The Cometa Wellness Center

There are many facets to an effective weight-loss program. Losing weight is all about changing the composition of the body. When someone tells you, "you look like you've lost weight", they are not looking at what you weigh on the scale; they are looking at you. This is a very important principle to remember when embarking on any effective weight loss program. The goal is to burn stored fat in our body as fuel, AND to build lean body mass. As we effectively replace fat mass with lean body mass, our body changes, but the amount of actual weight we lose will vary and the process of pounds lost can be slow. This is why the scale is not your friend, but your foe when you want to "lose weight".

Any effective and positive change that we make in our body towards healthy weight loss must start with a shift in the internal process of Thermogenesis. Thermogenesis is the term used to describe how our body produces cellular energy in the form of heat. The best source of the cellular energy for heat conversion is our fat cells. The ultimate goal in weight loss is to increase our metabolic rate through thermogenesis. As we raise our metabolic rate through thermogenesis, we are literally burning our stored fat for daily fuel.

I can’t count the number of people whom I have heard recite the same words: "I haven't changed a thing; I eat the same food, do the same exercise and yet I have gained 10 pounds this year!" Although how we eat and exercise may not change, WE humans CHANGE! Our physiology is always in flux and changes day to day, especially over the years. Aging itself is associated with a reduction in our metabolic rate, which means we do not burn calories as effectively as we age. Reduction in cellular energy expenditure was, at one stage of our evolution, life saving when starvation was an issue and concern. Of course, starvation still exists, but when it does not, we need to be more proactive in our role to promote thermogenesis through changes in diet, exercise and the correct supplement program. This will eventually bring balance on a cellular level, so that we are better able to use stored fat as cellular energy and shift our metabolism away from the storage of energy as fat.

Proper nutrition is the hallmark for all good health, including a healthy weight-loss program. Unfortunately, it is not something we were all taught or raised on. "Health-full" eating takes time, thought and energy. Eating a whole foods diet is KEY. What does it mean to eat "whole foods"? Whole foods are all about eating fresh food. Some simple guidelines for wholesome eating are not to eat anything you need to cook in a microwave oven, and avoid anything that comes out of box, jar, can or freezer package. Shopping the perimeter of the grocery store for everything you put in your mouth will help this process A LOT!

"Eating Right" is a responsibility. It is as important as breathing and sleeping (two other aspects of healthy living that people are not great at!) It is always nice to learn that the more fresh (raw or lightly steamed/sautéed) vegetables a person eats daily, the easier it is to burn fat as fuel through Thermogenesis. Plus, eating fresh vegetables helps to eliminate retained water that stored fat brings into the tissues. Yes, that is right! Fresh vegetables burn fat and help to get rid of water retention!

Consider an effective weight loss program more like a shift in your metabolism. The TWO benchmarks for effective weight loss are:
1. Raise the metabolic rate for fat cell energy expenditure (i.e. burn fat as calories).
2. Don't store fat as calories.

Nutritional changes to reach your weight loss benchmarks
We must always remember that our bodies are designed to store calories. It may not sound fair, but we store calories better as we age, and our ability to burn calories naturally diminishes as we age. OUCH! It is up to us to keep those calories for fuel and not store them away as fat. Integral to correct calorie handling is to NOT stimulate Insulin. INSULIN STORES EVERYTHING. Starches such as pasta, rice and grains, potatoes of all colors, breads and all sugar-containing foods WILL stimulate insulin.

Dietary Strategies for reducing Fat Mass and increasing Lean Body Mass
~Reduce all starchy carbohydrates in the diet, such as bread products, pasta, rice and potatoes
~Avoid all sugar.
~Avoid anything from a box, can, jar or boxed from the freezer.
~Shop the perimeter of the grocery store for all of your food.
~Consume at least four cups of fresh vegetables daily.
~Limit fruit to 2 servings of low-glycemic idex (LGI) fruit a day. LGI fruits are all berries, apples, pears, citrus, peaches, plums and cherries. Avoid high-glycemic idex fruit. These are bananas, pineapples, grapes, mangoes, all dried fruit and most fruit juices.

A diet rich in lean proteins, vegetables and low-glycemic-index fruit does not stimulate insulin.

When we need to jump start the fat burning and calories expenditure machine, it would be worthwhile to consider Thermo-fit. Thermo-Fit contains botanical extracts which optimize metabolism, increase thermogenesis, and decrease the conversion of excess carbohydrates into fat. In conjunction with a healthy lifestyle, Thermo-Fit helps to promote and maintain healthy body composition.

To encourage the safe and effective process of weight loss, we can also look at the very innovative Isagenix nutritional and cleansing formulas created by John Anderson. Through the flushing of impurities that are often stored in the "stubborn fat", the Isagenix nutritional and cleansing systems, together with dietary changes and regular exercise, combine to maximize our thermogenesis potential.

The cellular effects of chronic toxin exposure, stress and hormonal imbalance must be considered and addressed if we are to lose and keep off extra weight and inches. The key to supplementation for burning calories is to reach our TWO benchmarks for effective weight loss. Remember, these are to both raise the metabolic rate for fat cell energy expenditure (i.e. burn fat as calories) and to NOT store fat as calories. Eating right is the foundation for any weight loss program. But, you can always support yourself further with the supplement Thermo-fit to increase your metabolic rate through enhanced thermogenesis to burn stored fat more effectively. In turn, the Isagenix nutritional and cleansing formulas further support weight loss through the flushing of impurities that are often stored in the "stubborn fat". In combination, this very strong program WILL certainly allow your body to finally lose fat, unwanted pounds and inches for good! Good luck and always remember when it comes to food and you:
View the forest, not the trees, because you are what you eat!

Ariane Cometa MD, holistic doc
The Cometa Wellness Center

Cleanse the Stubborn Fat Away

2010-02-10T18:53:00.000-05:00

Cleanse the Stubborn Fat Away!
An integral aspect of any effective weight loss program is Cleansing our system gently. The storage of cellular waste and impurities can easily impede a strong nutritional and/or exercise weight loss program which would otherwise lead to success and happiness. It is important to distinguish the concept of Cleansing from the much talked about and popular topic of “Detox”. Indeed, we live in a world surrounded by “toxins”-- from pesticides, herbicides, petrochemicals, heavy metals, food additives to refined foods and pharmaceutical drugs to name a few. Certainly, we can all benefit from detoxification. A gentle cleansing program, however, is much more than detoxification. When we naturally cleanse our system, we enable the body to shed unwanted pounds and inches through the process of removing cellar waste and stored toxins. What follows is the gradual ability to burn off what I call “stubborn fat” as we eliminate the “storage depots” our body no longer needs. For many successful individuals, nutritional cleansing has been the missing link to weight loss when healthy eating and exercise were not enough. Eating right and exercise are integral to positive changes in our body composition. Yet, even with taking these steps, there is a time when the cells need to be addressed on a deeper, more therapeutic level. This internal cellular cleansing step is one that needs to take place FIRST, before any change in weight and body composition occurs. Otherwise, it occurs later, when one notices that they are at a plateau in their program progress. This ‘plateau’ may represent a cessation in weight lost, inches loss, symptom improvement or any combination of the three. In either case--the “initial step” or “plateau-breaking” scenario--we ALL benefit, and ultimately NEED to cleanse our cells. So, what do I mean by “cleanse” and how do we cleanse our cells?
A useful analogy to consider when conceptualizing the role of ‘cellular cleansing’ in weight loss is to imagine the difference between climbing a steep hill with a 50 pound lead weight around your waist OR climbing the hill without this excess weight. Ultimately, you have a say in the matter, right? You can either wear the burden or not? It would be one thing if you put the 50 pounds around your waist to boost your cardiovascular and strength training program! But, when you can’t take the extra weight off after you are done exercising (i.e. climbing the hill), it is an insult on your physiology and health all the way around. Our cells are analogously imposed upon after years of toxin exposure from the environment we live in, poor dietary choices and lifestyle. These insults burden our cellular function, interfering with normal cell functioning and efficiency. How can our cells help us lose unwanted pounds and inches as well as improve our quality of life when they are so busy “dealing with” and “tolerating” everything they must do from day to day just to get their job done? For example, most “detox” programs claim to cleanse the colon and/or the liver, right? What about the heart, the lungs, the brain, the muscles and the rest of the body? Don’t these organs need help detoxifying as well? This is where I want to clarify the difference between what we mean when we say “detox” vs. what we can do when we are cleansing. When we cleanse our system, we gently remove the cellular waste and impurities that impede cellular function by improving the cells' ABILITY to do so for themselves! BUT to improve our cells natural ability to do their job, we must FIRST nourish them. It is through correct nourishment that our cells can improve their inherent strength and stamina to gently detoxify themselves. Cellular nourishment provides the revitalizing support our cells need to function more efficiently and thus, provide for their own detoxification. Herein lays the integral difference between a mere “detox” program and a deep, effective cellular cleansing program.

As stated above, the foundation for an effective weight loss program must start with the correct nutritional and exercise program. I have found that many of my patients are quite successful with one arm of this foundational base, yet are not necessarily able to consistently follow through with both.

Our goal is to rid the body of toxins and impurities which it is exposed to on a daily basis. Unlike most "detox" programs which can deplete the body of essential nutrients, we want to nourish the body every day. Nourishment supports the body in its natural ability to function efficiently while simultaneously allowing the body physical endurance and vitality. Such revitalization is energizing but not stimulating. Through the flushing of impurities that are often stored in the "stubborn fat", the body is allowed to finally lose fat and this will naturally expedite the loss of unwanted pounds and inches. To encourage the safe and effective process of weight loss, we can look at the very innovative formulas created by John Anderson. Through his Isagenix nutritional cleansing system, John Anderson has created a supercharged blend of ionic minerals, antioxidants, natural plants and gentle cleansing herbs that nourish and support the entire body on a cellular level. Together with dietary changes and regular exercise, these unique formulas have revolutionized the concept of weight loss by removing cellular impurities and providing cellular nutrition which together combine to burn off stubborn fat once and for all.

Consider yourself deserving and ready to make cellular change today!

Ariane Cometa MD, the holistic doc
Isagenix Independent Associate

Break the Fat Cycle

2010-01-31T07:14:00.001-05:00

The Cometa Wellness Center Holistic Pharmacy
In the previous blog, The Excess Weight Conundrum, I reviewed the vital role that leptin resistance plays in fat metabolism and human physiology. The phenomenon of leptin resistance is a complex metabolic process and requires a multifaceted treatment approach.

Fat cells are known as adipocytes. Adipocytes secrete command signals that regulate the size and number of their fat cells. One command signal is the hormone leptin. When released by adipocytes, leptin performs two critical roles. First, it stimulates centers in our brain to give us the signal of satiety. This means, we “feel full”, and stop eating. The other important job that leptin has is to help us access and utilize fat stores for fuel in our body. In other words, leptin helps us burn our stored fat.

The second command signal released by adipocytes is a hormone called adiponectin. Adiponectin enhances insulin sensitivity, and enhancing insulin sensitivity is important to restoring metabolic health in disease associated with Type 2 diabetes, obesity, and atherosclerosis. This hormone is an important modulator of insulin sensitivity and reversing insulin resistance.

The third adipocyte command signal is glycerol-3-phosphate dehydrogenase. This enzyme is produced in adipocytes to help convert blood sugar into triglyceride stores in fat cells.

The three adipocyte command signals are thus:
1. Leptin
2. Adiponectin
3. Glycerol-3-phosphate dehydrogenase

An ideal weight loss agent would:
1. Reverse leptin resistance
2. Increase adiponectin
3. Decrease glycerol-3-phosphate dehydrogenase

In the jungles of the central western region of Africa, Cameroon, there grows a plant with a long known use in local culinary tradition; it is called Irvingia gabonensis. The indigenous population of Cameroon has been eating Irvingia for centuries. It was the unexplained resistance to diabetes and obesity demonstrated by the members of two local Cameroon tribes that first caught the attention of researchers, Oben and associates. According to Professor Julius Oben, research scientist, biochemist, and lecturer at the University of Yaounde I in Cameroon, the two native communities shared something unique—they used Irvingia seeds as soup thickeners, and “bush mango”—as Irvingia is known locally—is a food sold in every market, where the locals typically eat it at least once a day.

It may seem illogical that leptin is much more abundant in the blood of obese individuals, but this is because obese people have more adipocytes that secrete leptin and C-reactive protein. C-reactive protein (CRP) is a marker of systemic inflammation and predictor of cardiac risk. As our abdominal girth increases, pro-oxidant cytokines, such as CRP, react with fat and create oxidized free radicals which can lead to atherosclerosis (hardened arteries), heart attack, stroke and cancer. In fact the hormone leptin actually reacts and binds with the pro-inflammatory marker, C-Reactive-Protein (CRP). CRP binds with leptin and blocks both the leptin transport across the blood-brain-barrier to signal satiety and also blocks the leptin signaling at a cellular level to break fatty acids down for energy expenditure. Hence the release of C-reactive protein by adipocytes is a leptin-binding protein and neutralizes the natural adipocyte-controlling effects of leptin. The result is a vicious fat cycle, where more leptin accumulates in the blood of obese individuals because it is not able to be picked up by leptin receptor sites on cell membranes. This is leptin resistance.

Irvingia is associated with dramatically lower levels of C-reactive protein, thereby unblocking the “leptin resistance” that causes so many weight loss programs to fail.

Irvingia increases beneficial adiponectin levels. In up-regulating the expression of adiponectin, Irvingia improves insulin sensitivity and is capable of reversing insulin resistance.

Glycerol-3-phosphate dehydrogenase is an enzyme that facilitates the conversion of blood glucose into triglycerides that increase adipocyte size. Irvingia inhibits glycerol-3-phosphate dehydrogenase, thus reducing the amount of ingested sugars that are converted to body fat.

Amylase is an enzyme that converts starch to sugar in the digestive tract. Irvingia is an amylase inhibitor, but this is not its primary mechanism of fat loss induction.

A recent in vitro study indicated that Irvingia gabonensis favorably impacts adipogenesis through a variety of critical metabolic pathways including PPAR gamma gene expression, leptin, adiponectin, and glycerol-3 phosphate dehydrogenase. (Lipids Health Dis. 2008 Nov 13;7:44) The next study was done to evaluate the impact Irvingia may have on body weight and associated metabolic parameters in overweight human volunteers. (Lipids Health Dis. 2009 Mar 2;8:7.) The study participants comprised of 102 healthy, overweight and/or obese volunteers (defined as BMI > 25 kg/m2) randomly divided into two groups. The groups received on a daily basis, either 150 mg of Irvingia or matching placebo in a double blinded fashion, 30-60 minutes before lunch and dinner. Significant improvements in body weight, body fat, and waist circumference as well as plasma total cholesterol, LDL cholesterol, blood glucose, C-reactive protein, adiponectin and leptin levels were observed in the Irvingia group compared with the placebo group.

The above study outcome demonstrated Irvingia gabonensis administered 150 mg twice daily before meals to overweight and/or obese human volunteers favorably impacts body weight and a variety of parameters characteristic of the metabolic syndrome. This is the first double blind randomized placebo controlled clinical trial regarding the anti-obesity and lipid profile modulating effects of an Irvingia gabonensis extract. The positive clinical results, together with the previously published mechanisms of gene expression modulation related to key metabolic pathways in lipid metabolism, provide impetus for much larger clinical studies. Irvingia gabonensis extract appears to be a useful tool in dealing with the emerging global epidemics of obesity, hyperlipidemia, insulin resistance, and their co-morbid conditions.

Citations available at the end of this blog will help those of you to learn more about the research that has been done and continues to demonstrate that Irvingia extract causes fat loss and also markedly reduces total cholesterol, LDL, glucose, triglycerides and CRP levels.

In summary, Irvingia gabonensis has been proven safe and effective for those interested in modifying their metabolism and body composition naturally. The seed from this fruit-bearing plant has been shown to work via multiple pathways to promote effective fat loss by such mechanisms as:

1. Inhibiting α-amylase activity, reducing the absorption of sugar
2. Reducing glucose levels and insulin induced lipogenesis
3. Reducing adipocyte triglycerides and the glucose-3-phophate dehydrogenase enzyme (thus inhibiting the conversion of glycerol to triglycerides)
4. Reducing immune mediated inflammatory-molecule (CRP) binding to leptin, thereby reducing leptin resistance
5. Lowering serum leptin levels
6. Increasing adiponectin levels (anti-atherogenic, anti-inflammatory and anti-diabetic effects)
7. Reducing PPAR gamma gene expression, which has been implicated in insulin resistance and the pathology of numerous diseases including obesity, diabetes, atherosclerosis and cancer
For more information about Irvingia, join us at our Holistic Pharmacy!

Please email us (Kristin@cometawellnesscenter.com) for a complete citations list.

Ariane Cometa MD, holistic doc
The Cometa Wellness Center

The Excess Weight Conundrum

2010-01-16T19:25:00.001-05:00

The Cometa Wellness Center
Doctors cannot help the vast majority of obese people lose weight--and keep it off. This is because doctors don’t know what causes obesity. Many people, especially physicians, emphatically believe that obesity is caused by eating too much and not exercising enough. But such thinking is too simplistic, and is only part of the ‘obesity conundrum’. How society regards eating and the types of foods that are acceptable is a very real cultural explanation for obesity in this country. Published in the NY Times on November 20, 2008, a study from the November 2008 Journal of Law and Economics, concluded that banning fast food advertisements from children’s television programs would reduce the number of overweight children in the U.S. by 18 percent and decrease the number of overweight teens by 14 percent, as estimated by economists in this study. The researchers used several statistical models to link obesity rates to the amount of time spent viewing fast food advertising, finding that viewing more fast food commercials on television raised the risk of obesity in children.

In “Wired to Eat,” a 2005 article published in MIT Technology Review, Jeffrey Friedman, an obesity researcher at Rockefeller University, describes the scientific research to support a hunger "set point". Friedman is famous for his 1994 discovery of the gene that codes for the hormone called, leptin. Leptin is produced by fat cells in the belly. It plays a critical role in maintaining our LEAN body composition. Leptin operates in at least two different ways within our body to help prevent OBESITY. First, it stimulates centers in our brain to give us the signal of satiety. This means, we “feel full”, and stop eating. The other important job that leptin has is to help us access and utilize fat stores for fuel in our body. In other words, leptin helps us burn our stored fat.

According to Friedman, each of us has a "set point" of hunger and satiation. This "set point" we inherit genetically and may well be a genetic relic from what is called "the thrifty gene response". The geneticist James Neel in 1962 dubbed the "thrifty gene" theory and posited that in an environment prone to famine, hunter-gatherers gained a selective advantage if their genes predisposed them to storing fat when food was available. Those with such "thrifty genes" were more likely to survive famines and pass on their genes. But in modern times, the thrifty gene has proved a liability.

Why leptin resistance occurs in some people is poorly understood, Friedman says. With this statement, I take issue. In this country of "plenty", where we can buy abundant, cheap, calorically dense, nutritionally empty food, it is not hard to imagine why some people do and others do not have leptin resistance. In your average fast-food restaurant, just how many calories can you get for just four bucks? A LOT!

Just like the body can become resistant to insulin when it sees too much sugar, the body can become resistant to leptin. In fact, leptin resistance and insulin resistance go hand in hand. Leptin resistance leads to what I call "stubborn weight"; this is weight which is hard to lose and too easy to regain! Sound familiar? Basically, being chronically overweight, means that you have chronic leptin resistance and this leads to an uncontrolled appetite and difficulty burning your own stored fat as fuel.

All the more concerning, is the fact that the more fat cells grow and multiply, the more leptin they produce in an attempt to get the body to burn fat and to control the appetite ( i.e. promote satiety). But, again as in insulin resistance, the cells that are producing the leptin (or insulin) have receptor overload, and consequently can not respond to the hormone that they are producing, either insulin by the pancreas in diabetes, or leptin by the fats cells in leptin resistance. The result is that fats are not burned for fuel and hence, fatty acids are not well utilized for fuel (energy) production. This leads to fat deposition and voila, the person starts to gain weight, and in many cases becomes obese. As diabetes goes hand in hand with this problem, the blood sugar that is rising with insulin resistance feeds the obesity problem. How? The insulin resistance of diabetes makes it difficult for the cells to utilize sugar for fuel due to insulin resistance. The body tries to eliminate the circulating sugar in an attempt to get the sugar levels down. The body, hence, breaks the sugar into fatty acids, adding additional fatty acids for fat storage.

If you are overweight, you indeed have some level of leptin resistance. The development of abdominal obesity is by the far, the first and foremost dangerous type of fat deposition. As our abdominal girth increases, pro-oxidant cytokines react with fat and create oxidized free radicals which can lead to atherosclerosis (hardened arteries), heart attack, stroke and cancer. In fact the hormone leptin actually reacts and binds with the pro-inflammatory marker, C-Reactive-Protein (CRP). By binding to the CRP protein, leptin is effectively unable to pass through the blood brain barrier and bind to the satiety centers of our brain. Hence, appetite is left unchecked and people eat more food than they need. This is how leptin resistance affects the brain’s satiety centers.

Unfortunately, once we are overweight, leptin resistance can make it very difficult to consistently lose unwanted pounds and inches. How many of you are familiar with the plateau that is experienced in weight loss after a period of steady weight loss? This is common and well addressed when leptin resistance is corrected. In fact, what happens initially with weight loss is those same leptin producing fat cells that were so resistant to their own leptin are now shrunk and smaller in size and number. Now these fat cells do not produce enough beneficial leptin to burn fat and diminish appetite. It is at this time that most people who are on ‘a diet’ start to get discouraged and return to old eating habits. So what do you do? How do you lose those unwanted pounds and inches consistently?

Of course all change in our body composition which leads to a more lean physique and less fat must start with exercise and healthy eating habits. Everyday, it is essential to consume cups of vegetables and lean protein, either as a vegetarian or non-vegetarian. Lean protein helps build lean body mass and vegetables help support a healthy, fat burning metabolism and reduce excess fluid. Refined carbohydrates, processed foods and sugar all can lead to leptin resistance and obesity. As Friedman says, “some people are just programmed to eat more, and high-caloric fast foods simply allow them to do so quickly and therefore cause a faster weight gain”.

Please stay tuned. The next few blogs will focus on how to reduce leptin resistance and effectively lose inches and pounds permanently.

Ariane Cometa MD, holistic doc
The Cometa Wellness Center

Thermography: the true breast cancer screening tool

2010-01-10T07:30:00.002-05:00

http://www.cometawellnesscenter.com/thermo.htm

As a doctor who has always believed that each patient deserves what makes the most sense for them personally, the individual risk for breast cancer and the risk imposed by mammography are always discussed in tandem with each patient. This country is slowly coming around to the fact that there is not a one-size-fits all approach or treatment program for patients in the practice of medicine. Our medical paradigm normally shifts very slowly and this makes change quite difficult in the medical field. Hence, the new guidelines recommended for breast cancer screening by the USPSTF studies in November 2009 has literally catapulted the medical community and patients alike into uncertainty regarding the last two decades. What are we to believe? Is it possible that we must consider that there has been an “oversell” so to speak, going on for the last twenty years with the routine use of mammography for screening breast cancer?

To quote the surgeon and scientist who writes Respectful Insolence under the nom de blog, “Orac.”…”In the end, mammography remains a pretty crude tool. The reason it persists is because it is inexpensive, at least compared to newer modalities.” But 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. 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?

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 exists in this country and all over the world, it is called Thermography. As we are all aware, 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. Digital Infrared Thermal Imaging (DITI), also known simply as Thermography, offers a very promising modality in differentiating between malignant and benign breast lesions. Rather than detecting anatomical changes in breast morphology, this non-invasive technology detects changes on a physiologic level. In light of technological advances and maturation of the thermographic industry over the last two decades, we as a medical community need to recognize and utilize the potential of thermography to provide an effective, non-invasive, and low risk adjunctive tool for earlier detection of breast cancer.

Let’s face it: mammography has its limitations. As we all know, 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.

As cancer develops in the breast, cellular abnormalities occur. Such abnormal cellular changes are what thermography detects. A portion of the heat that is released from the body is in the form of infrared radiation. Physiologic changes which relate to cancer evolution such as increased blood flow and increased cellular activity contribute to the infrared image. 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 is able to assist in differentiating benign tissue from malignant tissue due to the difference in their respective infrared signal.

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. As a viable early breast cancer screening tool, thermography challenges the present protocols within the standard medical paradigm. Thermography however supports and complements mammography; it does not replace it. Although no single tool currently provides absolute predictability, a combination of a mammogram and DITI will help to improve both the sensitivity and specificity of cancer detection. Ideally, this enhanced identification can result in improved outcomes for those who have breast cancer, especially in its early stages, and the avoidance of unnecessary procedures for those who do not.

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 Lutherville, Maryland. A compilation of citations pertinent to thermography is available upon request. As the founder of the Cometa Wellness Center, I welcome all professional inquiries, encourage you to visit our website and look forward to our potential collaboration in the future.

Ariane Cometa MD, the holistic doc

The Mammography Controversy

2010-01-10T04:35:00.000-05:00

http://www.cometawellnesscenter.com/The most recent recommendation from the U.S. Preventative Services Task Force which came out in November 2009 stating that women under 50 should not undergo routine mammography has created a flurry of controversy. For many women, doctors and more, this drastic statement from the USPSTF feels like a slap in the face. This is not an unreasonable response because the new screening recommendation lays to rest the “brainwash” style message women have been receiving for two decades that they should have yearly screening starting at age 40. It is naturally difficult for the American public to have faith in any system put in place which has so much control over their lives and well being, if it appears that the rules can so dramatically change overnight. Almost as a de je vu from the WHI study in the late 90s, when women were told overnight that they must stop their HRT because it may kill them or do them more harm than good, the women of this country feel duped again. Is this such a surprise?

The USPSTF is responsible for providing evidence-based recommendations and treatment guidelines for clinicians. In reality, the task force members were quite thorough in the research which established the proposed guidelines for breast cancer screening. In order to formulate its guidelines, the task force used new data from mammography studies in England and Sweden and also commissioned six groups to make statistical models to analyze the aggregate data. Models were considered the way to answer questions like: “how much extra benefit do women get if they are screened every year?” The task force concluded that one cancer death is prevented for every 1,904 women age 40 to 49 who are screened for 10 years, compared with one death for every 1,339 women age 50 to 59, and one death for every 377 women age 60 to 69. Furthermore, the risk of false-positive results in mammography is significantly higher in women aged 40-49. Additionally, for the same reason that women in this age group can be falsely suspected of having breast cancer, mammography is less likely to be able to detect cancer. This is due to the fact that women in their 40s have dense breasts and this reality makes true cancer detection more challenging as well as false cancer detection more likely.

While many women do not think a screening test can be harmful the risks are real. Potential risks of mammography include radiation exposure, false-positive results that can lead to unnecessary anxiety and potential surgery, such as breast biopsy or more, false reassurance and over diagnosis. In the case of “over-diagnosis”, the concern is that mammography is more likely to inaccurately detect areas in the breast between ages 40-49 that would never progress to cancer or may disappear on their own. These women end up with unnecessary surgery and stress.

For these reasons and more completely cited in the Annals of Internal Medicine article dated November 17, 2009, the USPSTF recommends against routine screening mammography in women aged 40-49 years, but instead in women age 40 to 49 years of age, clinicians should periodically perform individualized assessment of risk for breast cancer to help guide decisions about screening mammography before age. 50.

The formal USPSTF conclusions are as follows:

For biennial screening mammography in women aged
40 to 49 years, there is moderate certainty that the net
benefit is small. Although the USPSTF recognizes that the
benefit of screening seems equivalent for women aged 40
to 49 years and 50 to 59 years, the incidence of breast
cancer and the consequences differ. The USPSTF emphasizes
the adverse consequences for most women—who will
not develop breast cancer—and therefore use the number
needed to screen to save 1 life as it’s metric. By this metric,
the USPSTF concludes that there is moderate evidence
that the net benefit is small for women aged 40 to 49 years.
For biennial screening mammography in women aged
50 to 74 years, there is moderate certainty that the net
benefit is moderate.
For screening mammography in women 75 years or
older, evidence is lacking and the balance of benefits and
harms cannot be determined.

Although many view the task force as an independent body of experts whose job is to take an objective look at the data and are the people we should be listening to when it comes to public health messages, others such as the American College of Radiology consider the USPSTF recommendations “unfounded”, “incredibly flawed”, “seem to reflect a conscious decision to ration care” and if adopted, they will “result in many needless deaths”. But, a morsel of truth to consider is the estimate of 3.3 billion dollars spent on mammography alone in the last year. This figure was given by the American College of Radiology itself, giving them a good reason to worry about the long-term effects of the most recent recommendations since the guidelines should initially make health plans less likely to aggressively prompt women in their 40s to have mammograms as well as older women to have the test annually. In addition to the American College of Radiology, the American Cancer Society and the National Cancer Institute are strongly opposed to the new screening for breast cancer recommendations set forth by the USPTF under the premise that the guidelines are created for the government s so that it may justify rationing health care. But with careful scrutiny, the studies clearly demonstrate the various harms of mammography are nearly cut in half when women have mammograms every other year instead of every year and yet the benefits are almost unchanged.

I believe that mammography is overrated and the risk/benefit ratio is definitely skewed towards risk in women between 40-49 years of age. This is well substantiated throughout the international medical research and the USPSTF has frankly further re-enforced this fact. As I could not more accurately nor eloquently state the present reality brought to face the American public most recently by the new USPSTF breast cancer screening guideline recommendations, I would like to quote Naomi Freundlich, free lance writer and Health Program writer at The Century Foundation:

“In the end, the Preventative Task Force mammography recommendations are supported by strong data and good science. The study authors do not have conflicts of interest and despite charges from some critics, they are not connected to the government and did not have rationing of health care resources as their underlying mission. Therefore it seems short-sighted and counter-productive for groups like the American Cancer Society to so forcefully dismiss the recommendations out of hand. Instead, why not use them as the first step in advancing a changing view of breast cancer screening and the real risks and benefits involved. It’s only by accepting these shortcomings that we can truly focus on developing better methods for detecting early tumors, better methods for distinguishing lesions that will progress from those that won’t, and eventually, giving women a better “safety belt” to use against the threat of breast cancer.”

The practice of medicine in this country is slowly coming around to the fact that there is no one-size-fits all approach or treatment program in the practice of medicine. As the medical paradigm has always been very slow to shift in this country, the USPSTF studies have forced the medical community and patients alike to consider that there is quite likely an “oversell” so to speak going on right now with the routine use of mammography for screening breast cancer. In fact is it not possible that as we have become so entrenched in the diagnosis of cancer, we may well be impeding the development and acceptance of better tests that more accurately distinguish between aggressive tumors and tumors that are unlikely ever to lead to cancer? In my opinion, this is where the crux of the problem exists with mammography as the “gold standard” breast cancer screening tool. It is often not possible for mammography to distinguish between the nonmalignant or low malignancy tumor and the aggressive tumors. The good news but much misunderstood or unknown fact is that such an accurate breast screening test exists in this country and all over the world. It is called Thermography. To learn more about this incredibly important, noninvasive and highly accurate screening tool check out the Themography Center on our website. More will be posted about Thermography in future posts.