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Acne is a skin condition characterized by reddened, inflamed lesions (sometimes called pustules or “whiteheads”) on the face, neck, shoulders, and elsewhere. Acne occurs most commonly in teenagers and to a lesser extent in young adults. The condition results in part from excessive stimulation of the skin by androgens (male hormones). Bacterial infection of the skin also appears to play a role. Dietary changes that may be helpful: Many people assume certain aspects of diet are linked to acne, but there isn’t much evidence. Preliminary research found chocolate was not implicated, for example.[1] Similarly, though a diet high in iodine can create an acne-like rash in a few people, this is rarely the cause of acne. In a preliminary study, people who thought that certain foods triggered their acne turned out to be consistently wrong.[2] Despite the lack of evidence, some doctors of natural medicine continue to believe that food allergy can play a role, at least in adult acne.[3] Nutritional supplements that may be helpful: Several studies indicate that zinc supplements reduce the severity of acne.[4] In one study, zinc was found to be as effective as oral antibiotic therapy.[5] Nutritionally oriented doctors sometimes suggest that people with acne take 30 mg of zinc two or three times per day for a few months, then 30 mg per day thereafter. It often takes twelve weeks before any improvement is seen. Large quantities of vitamin A—such as 300,000 IU per day for females and 400–500,000 IU per day for males—have been used successfully to treat severe acne.[6] However, those quantities of vitamin A are quite toxic. Moreover, unlike the permanent actions of synthetic prescription versions of vitamin A (such as Accutane), the acne will return several months after real vitamin A is discontinued. Therefore, vitamin A is generally a poor treatment for acne and should be taken only under the supervision of a health professional if at all. An isolated trial using pantothenic acid reported good results.[7] In that trial, people with acne were given 2.5 grams of pantothenic acid four times per day (for a total of 10 grams per day)—a remarkably high amount. A cream containing 20% pantothenic acid was also applied topically four to six times per day. With moderate acne, near complete relief was seen within two months, but severe conditions took at least six months to respond. Eventually, the level of pantothenic acid was reduced to 1–5 grams per day—still a very high level. Niacinamide was found to substantially help people with acne in a double blind trial lasting two months and using topical gel containing 4% niacinamide applied twice per day.[8] There is little reason to believe that the vitamin would have similar actions if taken orally, however. Vitamin B6 at 50 mg per day may alleviate premenstrual flare-ups of acne experienced by some women.[9] Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions. Herbs that may be helpful: A large study compared the topical use of 5% tea tree oil to 5% benzoyl peroxide for common acne. Although the tea tree oil was slower and less potent in its action, it had far fewer side effects and was thus considered more effective overall.[10] For topical treatment of acne, the oil may be used at a dilution of 5–15%. Historically, tonic or alterative herbs, such as burdock, have been used in the treatment of skin conditions. These herbs are believed to have a cleansing action when taken internally.[11] Burdock root tincture may be taken in 2–4 ml amounts per day. Dried root preparations in a capsule or tablet can be used at 1–2 grams three times per day. Many herbal preparations combine burdock root with other alterative herbs, such as yellow dock, red clover, or cleavers. Some older German literature suggests that vitex might contribute to clearing of premenstrual acne.[12] Women in these studies used forty drops of a concentrated liquid product once daily.[13] Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions. REFERENCES: [1] Fulton JE Jr, Plewig G, Kligman AM. Effect of chocolate on acne vulgaris. JAMA 1969;210:2071–74 [2] Anderson PC. Foods as the cause of acne. Am Family Phys 1971;3:102–3. [3] Gaby A. Commentary. Nutr Healing Feb 1997;1,10,11. [4] Hillstrom L et al. Comparison of oral treatment with zinc sulfate and placebo in acne vulgaris. Br J Dermatol 1977;97:679–84. [5] Michaelsson G et al. A double blind study of the effect of zinc and oxytetracycline in acne vulgaris. Br J Dermatol 1977;97:561–66. [6] Kligman AM et al. Oral vitamin A in acne vulgaris. Int J Dermatol 1981;20:278–85. [7] Leung LH. Pantothenic acid deficiency as the pathogenesis of acne vulgaris. Med Hypoth 1995;44:490–92. [8] Shality AR, Smith JR, Parish LC, et al. Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris. Internat J Dermatol 1995;34:434–37. [9] Snider B, Dietman DF. Pyridoxine therapy for premenstrual acne flare. Arch Dermatol 1974;110:130–31. [10] Bassett IB, Pannowitz DL, Barnetson RS. A comparative study of tea-tree oil versus benzoyl peroxide in the treatment of acne. Med J Austral 1990;53:455–58. [11] Hoffman D. The Herbal Handbook: A User’s Guide to Medical Herbalism. Rochester, VT: Healing Arts Press, 1988, 23–24. [12] Amann W. Improvement of acne vulgaris with Agnus castus (Agnolyt ™). Ther Gegenw. 1967;106:124–26 [in German]. [13] Amann W. Acne vulgaris and agnus castus (Agnolyt ™). Z Allgemeinmed 1975;51:1645–58 [in German]. The information contained in this article is for information and education purposes only and is not medical advice. Do not use this information as an alternative to obtaining medical advice from your physician or other professional healthcare provider. Always consult with your physician or other professional healthcare provider about any medical conditions you are experiencing. If you are experiencing a medical emergency, contact your local emergency services for help.

Question: Why do naturopathic doctors always want to have the “poop talk” with their patients? Answer: I love, love, love this question!! (Of course, I do… it’s about bowel movements, and I am, after all, a naturopathic doctor!) Doctors often inquire about your bowel movements (BMs) because your response provides us with a great deal of information. The frequency, size, consistency, color, and odor of your stool and bowel movement(s) can reveal several clues. BMs reveal information about your overall health, the function of your gastrointestinal (GI) tract, possible infectious agents, possible cancers, medication side effects, hydration status, and nutritional deficiencies. Having ‘normal’ bowel movements or being ‘regular’ is generally how most people describe their stools and/or bowel function. It is not until the clarifying questions are asked about their BMs do they realize a) they really pay no attention to them at all or b) they really pay too much attention to them. Because descriptions provided by patients are still very subjective, a “visual stool guide” was developed as a medical aid to classify stool into seven different categories. This tool is called the Bristol Stool Chart and is very helpful to educate yourself so you can know what your stool is trying to tell you. Remember, most everyone will have some variation within these categories, and being ‘regular’ really means that your stools are soft, yet, well formed, easily passed and basically have a non-offensive odor. ‘Regular’ frequency is considered to have BMs occurring anywhere from 1-3 times each day to 3 times a week. The information contained in this article is for information and education purposes only and is not medical advice. Do not use this information as an alternative to obtaining medical advice from your physician or other professional healthcare provider. Always consult with your physician or other professional healthcare provider about any medical conditions you are experiencing. If you are experiencing a medical emergency, contact your local emergency services for help.

Question: I have been losing hair like crazy, is there anything you can do to help? Answer: Quite often, yes, but first, it is necessary to determine why you are losing hair. It is normal to lose somewhere between 50-100 hairs each day as part of your body’s normal hair renewal process. However, some people suffer from excessive hair loss and may need to seek medical attention to determine why. There are several reasons for excessive hair loss to include genetics, medication, thyroid disease, radiation, chemotherapy, exposure to chemicals, hormonal and nutritional factors, generalized or local skin disease, and stress. It is important to understand that many of these causes are reversible but a few can lead to permanent hair loss. Here is a short list of the most common causes of hair loss seen in my practice. Hormonal changes tend to have the largest influence on hair loss. These fluctuations in hormone can affect both men and women and are often responsible for the “thinning” effect seen with aging. Men generally experience hair loss along the forehead and through the crown while women tend to have thinning throughout their whole head. This type of hair loss is influenced by the hormone DHT (a derivative from testosterone). There are some genetic influences that increase a person’s sensitivity to DHT and/or the number of DHT receptors on the hair follicles leading to more hair loss or hair loss that occurs earlier in life. Some birth control medications can also be a cause hormonal changes that lead to hair loss in younger women. The best approach for this type of hair loss is prevention or early intervention. There are prescriptions medications and several nutritional supplements and herbs that can help reduce the formation of DHT in the body. Topical applications of special shampoos and laser therapy also offer promising results. After childbirth, women can often experience sudden hair loss that can last up to 6 months. This is caused by many hair follicles entering into a resting phase of cellular turnover. In most cases, the hair loss completely resolves after the body recovers from the hormone fluctuations caused by pregnancy. Illness or disease can also contribute to hair loss. Thyroid disease is probably the most common cause of hair loss seen in my clinic. Both hyper- and hypothyroidism can influence the hair follicles leading to hair loss. This type of hair loss is usually diffuse and can occur in both men and women of any age. With a proper diagnosis, medications (when necessary), supplements and diet, hair loss caused by thyroid disease can be stopped and reversed. Dietary deficiencies can also be an underlying cause of hair loss. Low protein diets, extreme calorie restrictions or severely abnormal eating habits can all cause protein malnutrition and iron deficiencies. To help save protein the body shifts growing hair into the resting phase. If this happens massive amounts of hair shedding can occur two to three months later. A sign of this is if the hair can be pulled out by the roots fairly easily. This condition can be reversed and prevented by eating the proper amount of protein. It is very important to maintain an adequate protein intake and sufficient calories to maintain proper hair growth and maintenance. The information contained in this article is for information and education purposes only and is not medical advice. Do not use this information as an alternative to obtaining medical advice from your physician or other professional healthcare provider. Always consult with your physician or other professional healthcare provider about any medical conditions you are experiencing. If you are experiencing a medical emergency, contact your local emergency services for help.

Question: My family and I recently moved to Arizona and I am worried about dehydration and heat exhaustion. Any tips to avoid these? Answer: Summer time in Arizona means Mother Nature is cranking up the heat once again. Along with those soaring temperatures, heat-related illnesses can be a very real and serious health risk for those who are unprepared or vulnerable. Taking some basic preventative steps and gaining an awareness of the signs and symptoms of dehydration can be life saving for you or a loved one. You probably already know that water is good for you, but you may not really know why. …Water is considered an essential nutrient and may be the most important one when it comes to your health. Water is essential because there is no other fluid that can adequately take its place in your body – you cannot synthesize it on your own, and without it, serious life-threatening conditions can quickly arise. Unlike camels, you really have no way to store water so it must be consumed on a daily basis and in quantities that address your body’s needs. It is important to remember that just as with food, your water requirements are going to be individualized and based upon several factors to include your age, physical size, activity level, physical environment and overall health status. The “8 glasses of water a day” suggestion is a good place to start but be sure to adjust your water intake to match your lifestyle demands. The process of dehydration can be subtle at first and then becomes more severe over time. Early symptom recognition is important as dehydration and heat exhaustion tend to be most common for small children and the elderly, but anyone can become dehydrated. Here are some common causes of dehydration seen in my office: excessive sweating caused from fevers, exercise, or working outdoors vomiting and/or diarrhea caused from illnesses like the flu, food poisoning, irritable bowel syndrome or colitis. excessive urination caused from undiagnosed diabetes or diuretic medications often used to treat high blood pressure Recognizing the symptoms of dehydration is key to proper and early intervention. Avoidance of dehydration is even better. Thirst can be a great indicator of early dehydration, but not always reliable if you are chronically dehydrated and, remember, your thirst drive diminishes as you age. Therefore, I do not recommend waiting until you are thirsty to drink water as this may leave you less than optimally hydrated much of the time. A better way of determining if you are getting enough water is by monitoring your urine color and output. If your urine is dark yellow or if you are urinating infrequently or just scant amounts, you probably should increase your water intake. You may also need to drink more if you are exercising, working outdoors in elevated temperatures, or if you are ill. On the other hand, if you begin to urinate too frequently or your urine color looks pale to clear, you may be drinking too much water. Also, be sure you are eating plenty of fresh fruit, vegetables, nuts and seeds that are loaded with minerals. This ensures that the water you are drinking gets absorbed and transported to those cells, organs and tissues that need it. Drinking water is essential to your health. I encourage you to create a habit of drinking water as a way to ensure you stay hydrated and experience the highest quality of life. If you are an avid consumer of water, I commend you- keep up the good work! If not, today is a great day to start. The information contained in this article is for information and education purposes only and is not medical advice. Do not use this information as an alternative to obtaining medical advice from your physician or other professional healthcare provider. Always consult with your physician or other professional healthcare provider about any medical conditions you are experiencing. If you are experiencing a medical emergency, contact your local emergency services for help.

Question: Is gluten/wheat a real problem for everyone? I have seen lots of media attention about it and wondered if I should cut it out of my diet. Answer: Many people have developed “sensitivities” to gluten and/or wheat, and for others, overt allergies to wheat and/or gluten can lead to headaches, joint pain, auto-immunity, skin rashes, fatigue, or “leaky gut.” In most cases, people with a gluten “sensitivity” experience vague symptoms of discomfort like gas, bloating, and diarrhea. An initial assessment of patients with these types of symptoms is challenging because other food “sensitivities” can have the same side effects, so it can be difficult to identify if indeed wheat and/or gluten is the source of digestive troubles. If you think you might have a gluten and/or wheat sensitivity, intolerance, or allergy, there are several external symptoms that could point you in the right direction: Skin rash: Ever wonder what those little hard red dots on the back of your upper arms are? This is a condition called keratosis pilaris and can be the result of Vitamin A deficiency. If your body is unable to absorb gluten (the protein found in wheat), often times, you will not be able to absorb nutrients like Vitamin A. Migraines: Migraine headaches can be linked with any number of health problems, but many people present to my clinic with digestive problems along with the migraines. The two symptoms together can be a side effect of a gluten sensitivity. Acne: Our skin reveals a great deal about our “gut” health, and it has been said that the face is like a “road map to internal health.” If you are prone to breaking out, it could be a sign that your digestive health is off as a result of a gluten sensitivity or intolerance. Other food sensitivities: If you tend to develop stomachaches after every meal, even if you did not eat gluten, you may have other food sensitivities, intolerances, or allergies. Brain fog and chronic fatigue: If you are living a healthy lifestyle, get enough sleep, and stressors are managed but you are still feeling tired all day, it could mean that your body is inflamed or exhausted because of the added burden it is under trying to digest gluten when it can’t. Overly emotional or severe PMS: If you tend to feel emotional, have moods swings, or worse than normal PMS, it could also be a sign of a gluten sensitivity (or any number of other conditions that are made worse when you have a food sensitivity, intolerance or allergy). Of course, most of these symptoms could be the result of something else that is going on with your body. However, if you are experiencing more than one of them in conjunction with gas, bloating, and diarrhea, then it might be worth cutting gluten completely out of your diet to see if the symptoms go away. You can also consider food allergy testing as a place to start. The information contained in this article is for information and education purposes only and is not medical advice. Do not use this information as an alternative to obtaining medical advice from your physician or other professional healthcare provider. Always consult with your physician or other professional healthcare provider about any medical conditions you are experiencing. If you are experiencing a medical emergency, contact your local emergency services for help.

Probiotics are “friendly” bacteria that create and maintain health and balance throughout the digestive tract. This is a strange concept for many because we have primarily been taught that bacteria are “bad” and must be killed, which is where antibiotics come in. There is no doubt that antibiotics have a place in medicine and have saved many lives, but as medicine advances we are learning more and more about how necessary it is to human health to have these good “bugs” on board. Probiotics can be consumed as foods (fermented foods like yogurt, kefir, kombucha, kimchi, sauerkraut, and many more) or taken in the form of a powdered or encapsulated dietary supplement. The standard American diet (“SAD”) tends to lack enough fermented foods, nutrition and fiber to support beneficial bacteria growth and maintenance, so many people do benefit from taking probiotics. Aside from improving general health through improving absorption and utilization of nutrients, specific conditions that may benefit from probiotics include almost all digestive disorders (constipation, diarrhea, gas and bloating, Crohn’s disease, Ulcerative Colitis, Celiac disease, etc.) and many conditions that may be linked to a diminished digestive capacity (allergies, skin rashes, headaches, brain fog, fatigue, loss of appetite, etc.). There is also evidence that suggests taking probiotics can improve immune system function, decrease the chance of preterm labor in pregnancy and lessen the recurrence of ear infections in children. Purchasing probiotics can be tricky. The first step is to find and stick to a reputable source. The company you are purchasing from should have in-house and/or third party testing showing that their products actually contain the organisms and quantities that they claim to contain. Health food stores may not have these fact sheets but by researching the company online (or speaking with your naturopathic doctor, health coach or other qualified professional) you should be able to find this out. Next, know what your intention for taking the product is. Probiotics contain different strains of organisms because they have been shown to accomplish different things (like decrease constipation in children or lower the likelihood of contracting an upper respiratory tract infection). A couple of simple guidelines that I suggest when buying probiotics, without having a specific product recommendation from your health care professional, are (1) buy something refrigerated, (2) do not buy “enteric coated” products (the “why” here is a long story that I, unfortunately, do not have the article space to expand upon), (3) look for something that contains at least three or four different organisms (examples would be L. acidophilus and B. lactis) and (4) go for 1 billion organisms or higher. As always, speak to your doctor or health care professional before starting any new supplementation regimen. The information contained in this article is for information and education purposes only and is not medical advice. Do not use this information as an alternative to obtaining medical advice from your physician or other professional healthcare provider. Always consult with your physician or other professional healthcare provider about any medical conditions you are experiencing. If you are experiencing a medical emergency, contact your local emergency services for help.

Question: I was finally diagnosed with hypothyroidism and started on thyroid replacement, so why do I keep gaining weight? Answer: There are a few possibilities as to why you are continuing to gain weight in spite of starting on thyroid replacement hormone: The type of thyroid replacement medication and/or dosage may not be meeting your body’s needs. You may be deficient in trace minerals and/or other nutritional co-factors. You may have other underlying health issues that have not been addressed. If you were put on a T4-only drug like Levothyroxine, Synthroid, or Levoxyl, you may not be able to efficiently convert this “storage form” of the thyroid hormone to its active form of T3 in the body. Worse, yet, your body may be converting it to another form called Reverse T3, which is inert in the body. When this happens, your original symptoms of weight gain, constipation, body aches, fatigue, hair loss and intolerance to cold may remain or even worsen. Ideally your doctor will evaluate more than just your TSH (thyroid stimulating hormone) and consider looking at the free (or unbound) forms of T3 and T4 and Reverse T3 on your lab work. Another possibility for the ongoing weight gain is a mineral or nutritional deficiency in your body. The thyroid, along with all other metabolic activities in our body, requires a myriad of minerals and vitamin co-factors to up-regulate or down-regulate normal metabolic activity in the body. To optimize thyroid function, our body requires tyrosine, iodine, iron, selenium, zinc, B-6, B-12, vitamin A and vitamin D…just to name a few. Remember, our thyroids do not exist in a vacuum, so the thyroid gland is also dependent on how other endocrine glands are functioning and how well “communication” between these glands is working. For example, if you have been through chronic stress of any kind, your adrenal glands have been working overtime to keep you going by producing cortisol and adrenaline…eventually, you can “burn out” the adrenals and they will produce less and less cortisol over time. This commonly leads to cravings for high carb foods and fats that only further compromise your blood sugar and keep the vicious cycle of weight gain and frustration continuing. (Realize this is a complicated process and I have oversimplified here for the sake of brevity). Unaddressed insulin resistance can start years before full-blown diabetes is diagnosed and is a big contributor to weight gain. Imbalances in the sex hormones related to irregular menstruation, pregnancy, or menopause can also wreak havoc with the thyroid and other metabolic activities in the body. Also, undiagnosed auto-immune conditions and other inflammatory processes can also influence weight gain and lead to hypo functioning thyroid symptoms. As you can see, there is no simple answer to your question. Properly addressing any health concern requires appropriate testing, nutritional evaluation and thorough screening by a qualified health professional. The information contained in this article is for information and education purposes only and is not medical advice. Do not use this information as an alternative to obtaining medical advice from your physician or other professional healthcare provider. Always consult with your physician or other professional healthcare provider about any medical conditions you are experiencing. If you are experiencing a medical emergency, contact your local emergency services for help.

Question: I was finally diagnosed with hypothyroidism and started on thyroid replacement, so why do I keep gaining weight? Answer: There are a few possibilities as to why you are continuing to gain weight in spite of starting on thyroid replacement hormone: The type of thyroid replacement medication and/or dosage may not be meeting your body’s needs. You may be deficient in trace minerals and/or other nutritional co-factors. You may have other underlying health issues that have not been addressed. If you were put on a T4-only drug like Levothyroxine, Synthroid, or Levoxyl, you may not be able to efficiently convert this “storage form” of the thyroid hormone to its active form of T3 in the body. Worse, yet, your body may be converting it to another form called Reverse T3, which is inert in the body. When this happens, your original symptoms of weight gain, constipation, body aches, fatigue, hair loss and intolerance to cold may remain or even worsen. Ideally your doctor will evaluate more than just your TSH (thyroid stimulating hormone) and consider looking at the free (or unbound) forms of T3 and T4 and Reverse T3 on your lab work. Another possibility for the ongoing weight gain is a mineral or nutritional deficiency in your body. The thyroid, along with all other metabolic activities in our body, requires a myriad of minerals and vitamin co-factors to up-regulate or down-regulate normal metabolic activity in the body. To optimize thyroid function, our body requires tyrosine, iodine, iron, selenium, zinc, B-6, B-12, vitamin A and vitamin D…just to name a few. Remember, our thyroids do not exist in a vacuum, so the thyroid gland is also dependent on how other endocrine glands are functioning and how well “communication” between these glands is working. For example, if you have been through chronic stress of any kind, your adrenal glands have been working overtime to keep you going by producing cortisol and adrenaline…eventually, you can “burn out” the adrenals and they will produce less and less cortisol over time. This commonly leads to cravings for high carb foods and fats that only further compromise your blood sugar and keep the vicious cycle of weight gain and frustration continuing. (Realize this is a complicated process and I have oversimplified here for the sake of brevity). Unaddressed insulin resistance can start years before full-blown diabetes is diagnosed and is a big contributor to weight gain. Imbalances in the sex hormones related to irregular menstruation, pregnancy, or menopause can also wreak havoc with the thyroid and other metabolic activities in the body. Also, undiagnosed auto-immune conditions and other inflammatory processes can also influence weight gain and lead to hypo functioning thyroid symptoms. As you can see, there is no simple answer to your question. Properly addressing any health concern requires appropriate testing, nutritional evaluation and thorough screening by a qualified health professional. The information contained in this article is for information and education purposes only and is not medical advice. Do not use this information as an alternative to obtaining medical advice from your physician or other professional healthcare provider. Always consult with your physician or other professional healthcare provider about any medical conditions you are experiencing. If you are experiencing a medical emergency, contact your local emergency services for help.

The common condition of brittle nails is often not definitively linked with any known cause. Nonetheless, natural medicine may be able to help strengthen brittle nails. Most conditions that affect nails are unrelated to nutrition; instead they are caused by a lack of oxygen associated with lung conditions, hemorrhage due to infection, or inflammation around the nail due to infection. If there is any question about what the problem is, it is important to get a diagnosis from a healthcare practitioner. Nutritional supplements that may be helpful: Nutrition can affect the health of nails in a variety of ways. Iron deficiency can cause spoon-shaped nails.[1] For years, some doctors of natural medicine have believed that zinc deficiency can cause white spots to appear on nails.[2] In China, excessive selenium has been linked to nails actually falling out.[3] Biotin, a B vitamin, is known to strengthen hooves in animals. As a result, Swiss researchers investigated the use of biotin in strengthening brittle fingernails in humans, despite the fact that it remains unclear exactly how biotin affects nail structure.[4] Using 2.5 mg of biotin per day, women with brittle nails who had nail thickness measured before and after six to fifteen months, found their nail thickness increased by 25%. As a result, splitting of nails was reduced. In a follow-up study of people who had been taking biotin for brittle nails in America, 63% showed improvement from taking biotin.[5] Although the amount of research on the subject is quite limited and positive effects do not appear in all people, people with brittle nails may want to consider a trial period of at least several months using 2.5 mg per day of biotin. Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions. Herbs that may be helpful: Anecdotal reports suggest that horsetail may be of some use in the treatment of brittle nails. Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions. REFERENCES: [1] Bates B. A guide to physical examination, 2d ed. Philadelphia: J. B. Lippincott, 1979, 51. [2] Pfeiffer CC. Mental and Elemental Nutrients. New Canaan, CT: Keats Publishing, 1975, 229. [3] Yang G, Wang S, Zhou R, Sun S. Endemic selenium intoxication of humans in China. Am J Clin Nutr 1983;37:872–81. [4] Colombo VE, Gerber F, Bronhofer M, Floersheim GL. Treatment of brittle fingernails and onychoschizia with biotin: Scanning electron microscopy. J Am Acad Dermatol 1990;23:1127–32. [5] Hochman LG, Scher RK, Meyerson MS. Brittle nails: Response to daily biotin supplementation. Cutis 1993;51:303–305. The information contained in this article is for information and education purposes only and is not medical advice. Do not use this information as an alternative to obtaining medical advice from your physician or other professional healthcare provider. Always consult with your physician or other professional healthcare provider about any medical conditions you are experiencing. If you are experiencing a medical emergency, contact your local emergency services for help.

Bronchitis is an inflammation of the trachea and bronchial tree. Bronchitis can be either acute or chronic. Acute bronchitis may be caused by viral or bacterial infections and is often preceded by an upper respiratory tract infection. In addition, acute bronchitis can result from irritation of the mucous membranes by environmental fumes, acids, solvents, or tobacco smoke. Bronchitis usually begins with a dry, non-productive cough. After a few hours or days, the cough may become more frequent and produce mucus. A secondary bacterial infection may occur, in which the sputum (bronchial secretions) may contain pus. People whose cough and/or fever continues for more than seven days should visit a medical practitioner. Chronic bronchitis may result from prolonged exposure to bronchial irritants. Cigarette smoking, environmental toxins, and inhalant allergens can all cause chronic irritation of the bronchi. The cells lining the bronchi produce excess mucus in response to the chronic irritation; this excess mucus production can lead to a chronic, productive cough. Bronchitis can be particularly dangerous in the elderly and in people with compromised immune systems. These individuals should see a doctor if they develop a respiratory infection. Lifestyle changes that may be helpful: Breast-feeding provides important nutrients to an infant and improves the functioning of the immune system. Studies have shown that breast-feeding prevents the development of lower respiratory tract infections during infancy.[1] [2] Whether that protective effect persists in adulthood is not known. Exposure to environmental chemicals, including passive smoke, can increase the incidence of respiratory illness in children.[3] Chronic bronchitis is frequently associated with smoking and/or environmental exposure to chemicals or allergens. These exposures should be avoided to allow the cells of the bronchi to recover from chronic irritation and to decrease the burden on the immune system. Dietary changes that may be helpful: Dietary factors may influence both inflammatory activity and antioxidant status in the body. Increased inflammation and decreased antioxidant activity each may lead to an increased incidence of chronic diseases, such as chronic bronchitis. People suffering from chronic bronchitis may experience an improvement in symptoms when consuming a diet high in anti-inflammatory fatty acids, such as those found in fish. In a double blind study of thirty-eight children with recurrent respiratory tract infections, a daily essential-fatty acid supplement (containing 855 mg of alpha linolenic acid and 596 mg of linoleic acid) reduced both the number and the duration of recurrences.[4] In individuals with bronchitis, lipids in the lung tissue may undergo oxidation damage (also called free-radical damage), particularly when the bronchitis is a result of exposure to environmental toxins or cigarette smoke. A diet high in antioxidants may protect against the free radical-damaging effect of these toxins. Studies comparing different populations have shown that increasing fruit and vegetable consumption may reduce the risk of developing chronic bronchitis.[5] [6] Food and environmental allergies may be triggering factors in some cases of chronic bronchitis.[7] Some doctors of natural medicine believe that dairy products can increase mucus production, and that people suffering from either acute or chronic bronchitis should therefore limit their intake of dairy products. Ingestion of simple sugars (such as sucrose or fructose) can lead to suppression of immune function;[8] therefore, some doctors of natural medicine believe simple sugars should be avoided during illness. Nutritional supplements that may be helpful: In a study of elderly patients hospitalized with acute bronchitis, those who were given 200 mg per day of vitamin C improved to a significantly greater extent, compared with those who were given a placebo.[9] The common cold may lead to bronchitis in susceptible individuals. A double blind study has shown that vitamin C (500 mg per day preventively, 1,500 mg on the first day of a cold, and 1,000 mg per day for the next four days) can decrease the severity and duration of the common cold in otherwise healthy individuals.[10] Vitamin C and vitamin E may prevent oxidative damage to the lung lipids by environmental pollution and cigarette smoke exposure. It has been suggested that amounts in excess of the RDA (recommended dietary allowance) are necessary to protect against the air pollution levels currently present in North America.[11] In a double blind study, individuals with chronic bronchitis who received N-acetyl cysteine (NAC; 600 mg a day, three days a week by mouth) had a significant reduction in the number of exacerbations of their illness.[12] Smokers have also been found to benefit from taking NAC.[13] In addition to helping break up mucus, NAC may reduce the elevated bacterial counts that are often seen in the lungs of smokers with chronic bronchitis.[14] In another study, people with chronic bronchitis who took NAC showed an improved ability to expectorate and a reduction in cough severity.[15] These benefits may result from NAC’s capacity to reduce the viscosity (thickness) of sputum.[16] Vitamin A status is low in children with measles,[17] an infection that can result in pneumonia or other respiratory complications. Supplementation with vitamin A has been found to decrease morbidity and mortality from measles.[18] In another study, supplementing with vitamin A reduced the number of respiratory tract infections in children who were prone to such infections;[19] however, other research found that vitamin A did not exert a preventive effect.[20] Large amounts of vitamin A were not found to benefit children with acute respiratory infections.[21] The thymus gland plays a number of important roles in the functioning of the immune system. An extract from calf thymus gland known as thymomodulin has been found, in a double blind study, to decrease the frequency of respiratory infections in children who were prone to such infections.[22] Herbs that may be helpful: Practitioners of herbal medicine have used many herbs to help fight respiratory tract infections and bronchitis. The following herbs have been used traditionally for these ailments, although scientific studies have not yet confirmed their effectiveness: Pimpinella anisum (anise) has been found to relieve coughs and bronchitis. This herb appears to loosen bronchial secretions, making it easier to expectorate. This effect may be due to the chemical constituents (creosol and alphapinene) found in this plant. Horehound has expectorant properties, possibly due to the presence of a diterpene lactone in the plant known as marrubiin. Asclepias tuberosa (pleurisy root) is an expectorant and is thought to be helpful against all types of respiratory infections. Lobelia contains many active alkaloids, of which lobeline is considered the most active. Very small amounts of this herb are considered helpful as an antispasmodic and antitussive agent. Anti-inflammatory properties of the herb have been demonstrated, which may be useful, since bronchitis is associated with inflammation in the bronchi.[23] Elecampane has been used to treat coughs associated with bronchitis, asthma, and whooping cough. Although there have been no modern clinical studies with this herb, its use for these indications is based on its high content of soothing mucilage as inulin and alantalactone. The following herbs have undergone scientific study and are found to be beneficial in a variety of ailments, including colds and flu, which often precede acute bronchitis. One or a combination of these herbs, depending on the cause of the bronchitis and the symptoms experienced, may assist in preventing or relieving acute bronchitis: Licorice acts as an anti-inflammatory and antitussive agent. These properties may be due to the presence of 18-betaglycyrhinic acid.[24] Thyme contains an essential oil (thymol) and certain flavonoids. This plant has anti-spasmodic and expectorant properties and antibacterial actions, and it is considered helpful in cases of bronchitis.[25] Hederae helicis folium (ivy leaf) can also be used against chronic inflammatory bronchial conditions.[26] Echinacea is widely used by herbalists for individuals with acute respiratory infections. This herb stimulates the immune system in several different ways, such as enhancing macrophage function and increasing T-cell response.[27] Echinacea also contains a natural antibiotic compound known as echinacoside.[28] This herb may therefore be useful for preventing a cold, flu, or viral bronchitis from progressing to a secondary bacterial infection. Barberry contains numerous alkaloids, of which berberine is considered of primary significance. Berberine appears to have both antibiotic[29] [30] [31] and immune-stimulating effects.[32] Goldenseal has actions similar to those of barberry. Goldenseal contains berberine and hydrastine, which are considered the primary active constituents. Although this herb has not been tested specifically in people with bronchitis, the alkaloids present in goldenseal appear to have broad-spectrum antibiotic activity.[33] Garlic has been shown to have mild antimicrobial activity and therefore may be of value for people with bronchitis.[34] Elderberry has been found to have antiviral activity against influenza B virus, and to reduce the duration of illness in individuals with the flu.[35] REFERENCES: [1] Pisacane A, Graziano L, Zona G, et al. Breast feeding and acute lower respiratory infection. Acta Paediatr 1994;83:714–18. [2] Kerr AA. Lower respiratory tract illness in Polynesian infants. New Zealand Med J 1981;93:333–35. [3] Jin C, Rossignol AM. Effects of passive smoking on respiratory illness from birth to age eighteen months, in Shanghai, People’s Republic of China. J Pediatr 1993;123:553–58. [4] Venuto A, Spano C, Laudizi L, Bettelli F. Essential fatty acids: the effects of dietary supplementation among children with recurrent respiratory infections. J Intl Med Res 1996;24:325–30. [5] La Vecchia C, Decarli A, Pagano R. Vegetable consumption and risk of chronic disease. Epidemiology 1998;9:208–10. [6] Rautalahti M, Virtamo J, Haukka J, et al. The effect of alpha-tocopherol and beta-carotene supplementation on COPD symptoms. Am J Respir Crit Care Med 1997;156:1447–52. [7] Rowe AH, Rowe A. Food Allergy: its role in emphysema and chronic bronchitis. Dis Chest 1965;48:609–12. [8] Sanchez A, Reeser JL, Lau HS, et al. Role of sugars in human neutrophilic phagocytosis. Am J Clin Nutr 1973;26:1180–84. [9] Hunt C, Chakravorty NK, Annan G, et al. The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections. Int J Vitam Nutr Res 1994;64:212–19. [10] Anderson TW, Beaton GH, Corey P, Spero L Winter illness and vitamin C: the effect of relatively low doses. Can Med Assoc J 1975 Apr 5;112(7):823–26. [11] Menzel DB Antioxidant vitamins and prevention of lung disease. Ann N Y Acad Sci 1992;669:141–55. [12] Grassi C, Morandini GC. A controlled trial of intermittent oral acetylcysteine in the long-term treatment of chronic bronchitis. Eur J Clin Pharmacol 1976;9:393–96. [13] Boman G, Backer U, Larsson S, et al. Oral acetylcysteine reduces exacerbation rate in chronic bronchitis: report of a trial organized by the Swedish Society for Pulmonary Diseases. Eur J Respir Dis 1983;64:405–15. [14] Riise GC, Larsson S, Larsson P, et al. The intrabronchial microbial flora in chronic bronchitis patients: a target for N-acetylcysteine therapy? Eur Respir J 1994;7:94–101. [15] Jackson IM, Barnes J, Cooksey P. Efficacy and tolerability of oral acetylcysteine (Fabrol) in chronic bronchitis: a double-blind placebo controlled study. J Int Med Res 1984;12:198–206. [16] Tattersall AB, Bridgman KM, Huitson A. Acetylcysteine (Fabrol) in chronic bronchitis—a study in general practice. J Int Med Res 1983;11:279–84. [17] Arrieta AC, Zaleska M, Stutman HR, Marks MI. Vitamin A levels in children with measles in Long Beach, California. J Pediatr 1992;121:75–78. [18] Fawzi WW, Chalmers TC, Herrera MG, Mosteller F. Vitamin A supplementation and child mortality. A meta-analysis. JAMA 1993;269:898–903. [19] Pinnock CB, Douglas RM, Badcock NR Vitamin A status in children who are prone to respiratory tract infections. Aust Paediatr J 1986;22:95–99. [20] Pinnock CB, Douglas RM, Martin AJ, Badcock NR. Vitamin A status of children with a history of respiratory syncytial virus infection in infancy. Aust Paediatr J 1988;24:286–89. [21] Kjolhede Cl, Chew FJ, Gadomski AM, Marroquin DP. Clinical trial of vitamin A as adjuvant treatment for lower respiratory tract infections. J Pediatr 1995;126:807–12. [22] Fiocchi A, Borella E, Riva E, Arensi D, et al. Double-blind clinical trial for the evaluation of the therapeutical effectiveness of a calf thymus derivative (Thymomodulin) in children with recurrent respiratory infections. Thymus 1986;8:331–39. [23] Philipov S, Istatkova R, Ivanovska N, et al. Phytochemical study and antiinflammatory properties of Lobelia laxiflora L. Z Naturforsch 1998;53:311–17. [24] Blumenthal M, Busse WR, Goldberg A, et al. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin, Texas: American Botanical Council, 1998,161–62. [25] Blumenthal M, Busse WR, Goldberg A, et al. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin, Texas: American Botanical Council, 1998, 219–20. [26] Blumenthal M, Busse WR, Goldberg A, et al The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin, Texas: American Botanical Council, 1998, 153. [27] See DM, Broumand N, Sahl L, Tilles JG. In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacol 1997;35:229–35. [28] See DM, Broumand N, Sahl L, Tilles JG. In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacol 1997;35:229–35. [29] Amin AH, Subbaiah TV, Abbasi KM. Berberine sulfate: Antimicrobial activity, bioassay, and mode of action. Can J Microbiol 1969;15:1067–76. [30] Sun D, Courtney HS, Beachey EH. Berberine sulfate blocks adherence of Streptococcus pyogenes to epithelial cells, fibronectin, and hexadecane. Antimicrob Agents Chemother 1988;32:1370–74. [31] Ghosh AK, Rakshit MM, Ghosh DK. Effect of berberine chloride on Leishmania donovani. Indian J Med Res 1983;78:407–16. [32] Kumazawa Y, Itagaki A, Fukumoto M, et al. Activation of peritoneal macrophages by berberine-type alkaloids in terms of induction of cytostatic activity. Int J Immunopharmacol 1984;6:587–92. [33] Hahn FE, Ciak J. Berberine. Antibiotics 1976;3:577–88. [34] Hughes BG, Lawson LD. Antimicrobial effects of Allium sativum L. (garlic), Allium ampeloprasum L. (elephant garlic) and Allium cepa L. (onion), garlic compounds and commercial garlic supplement products. Phytother Res 1991;4:154–58. [35] Zakay-Rones Z, Varsano N, Zlotnik M, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med 1995;1:361–69. The information contained in this article is for information and education purposes only and is not medical advice. Do not use this information as an alternative to obtaining medical advice from your physician or other professional healthcare provider. Always consult with your physician or other professional healthcare provider about any medical conditions you are experiencing. If you are experiencing a medical emergency, contact your local emergency services for help.

Rheumatoid arthritis (RA) is a chronic inflammatory condition; it is an autoimmune disease, in which the immune system attacks the joints and sometimes other parts of the body. Dietary changes that may be helpful: The role of dietary fats in rheumatoid arthritis is complex, but potentially important. In experimental animals that are susceptible to autoimmune disease, feeding a high-fat diet increases the severity of the disease.[1] There is evidence that people with RA eat more fat, particularly animal fat, than those without RA.[2] In short-term studies, diets completely free of fat reportedly helped people with RA;[3] however, since at least some dietary fat is essential for humans, the significance of this finding is not clear. Strict vegetarian diets that were very low in fat have also been found to be helpful.[4, 5] In one trial, fourteen weeks of a gluten-free (no wheat, rye, or barley) pure vegetarian diet gradually changed to a lactovegetarian diet (permitting dairy), which led to significant improvement in symptoms and objective laboratory measures of disease.[6] In the 1950s through the 1970s, Max Warmbrand, a naturopathic doctor, used a very low-fat diet for individuals with both rheumatoid arthritis and osteoarthritis. He recommended a diet free of meat, dairy, chemicals, sugar, eggs, and processed foods.[7] Dr. Warmbrand claimed that his diet took at least six months to achieve noticeable results; a short-term (ten weeks) study with a similar approach failed to produce beneficial effects.[8] Rheumatoid arthritis may be linked to food allergies and sensitivities.[9] In many people, RA is made worse when they eat foods to which they are allergic or sensitive, and made better by avoiding these foods.[10, 11, 12, 13] English researchers suggest that one-third of people with RA can control the disease completely through allergy elimination.[14] Finding and eliminating foods that trigger symptoms should be done with the help of a nutritionally oriented physician. Lifestyle changes that may be helpful: Although exercise may increase pain initially, gentle exercises help people with RA.[15, 16] Many doctors recommend swimming, stretching, or walking. Nutritional supplements that may be helpful: The concentration of vitamin E has been found to be low in the joint fluid of individuals with rheumatoid arthritis.[17] This reduction in vitamin E levels is believed to be caused by consumption of the vitamin during the inflammatory process. In a double blind study, approximately 1,800 IU per day of vitamin E was found to have a beneficial effect in people with rheumatoid arthritis.[18] Research suggests that people with RA may be partially deficient in pantothenic acid (vitamin B5).[19] In one trial, those with RA had less morning stiffness, disability, and pain when they took 2,000 mg of pantothenic acid per day.[20] Many nutritionally oriented doctors suggest pantothenic acid (sometimes in lower amounts such as 1,000 mg) to people with RA. Zinc metabolism is altered in RA. Some studies have found zinc helpful,[21] whereas others have not.[22, 23] It has been suggested that zinc might help only those who are deficient.[24] Although there is no universally accepted test for zinc deficiency, some doctors check white blood cell zinc levels. The relationship of copper to RA is complex. Copper acts as an anti-inflammatory agent, because it is needed to activate superoxide dismutase, an enzyme that protects joints from inflammation. People with RA tend toward copper deficiency.[25] The Journal of the American Medical Association quoted one researcher as saying that while “Regular aspirin had 6% the anti-inflammatory activity of [cortisone]. . . copper [added to aspirin] had 130% the activity.”[26] Several copper compounds have been used successfully with RA,[27] and a single blind trial using copper bracelets reported surprisingly effective results.[28] However, under certain circumstances, copper might actually increase inflammation in rheumatoid joints.[29] Moreover, the most consistently effective form of copper, copper aspirinate (a combination of copper and aspirin), is not readily available. A reasonable amount of copper might be 1–3 mg per day. Many double blind trials have shown that omega-3 fatty acids in fish oil, called EPA and DHA, help relieve symptoms of RA.[30, 31, 32, 33, 34, 35] The effect results from the anti-inflammatory activity of fish oil.[36] Many doctors recommend 3 grams per day of EPA and DHA. This amount is commonly found in 10 grams of fish oil. Positive results can take three months to become evident. Oils containing the omega-6 fatty acid gamma liolenic acid (GLA), such as borage oil,[37, 38] black current seed oil,[39] and evening primrose oil (EPO),[40, 41] have also been reported to be effective in the treatment of RA. The most pronounced effects were seen with borage oil; however, that may have been due to the fact that larger amounts of GLA were used (such as 1.4 grams per day). The results with EPO were conflicting and somewhat confusing, possibly because the placebo used in these studies (olive oil) appeared to have an anti-inflammatory effect of its own. In a double blind study, positive results were seen when EPO was used in combination with fish oil.[42] GLA appears to be effective because it is converted in part to prostaglandin E1, a compound known to have anti-inflammatory activity. Preliminary research suggests that boron supplementation at 3–9 mg per day may be beneficial, particularly in juvenile RA.[43] However, more research on this is needed. The DL form of phenylalanine (DLPA) has been used to treat chronic pain, including rheumatoid arthritis, with mixed effectiveness.[44] Some doctors of natural medicine suggest that individuals with arthritis may benefit from cartilage; however, well-designed research is lacking, and many experts question the use of cartilage in this regard. Some individuals with rheumatoid arthritis have low levels of the amino acid histidine; taking histidine supplements may improve arthritis symptoms in some of these individuals. The use of DMSO for therapeutic applications is controversial; but there is some evidence that when applied directly to the skin, DMSO has anti-inflammatory properties and alleviates pain, such as that associated with rheumatoid arthritis.[45, 46] DMSO appears to reduce pain by inhibiting the transmission of pain messages by nerves.[47] There is limited evidence that some individuals with RA may have inadequate stomach acid.[48] Some doctors of natural medicine believe that when stomach acid is low, supplementing with betaine HCl can reduce food-allergy reactions by improving digestion. Bromelain has significant anti-inflammatory activity. Preliminary evidence in people with rheumatoid arthritis shows that bromelain might help reduce symptoms, such as joint swelling and impaired joint mobility.[49] Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions. Herbs that may be helpful: Boswellia, a traditional herbal remedy from the Indian system of Ayurvedic medicine, has been investigated for its effects on arthritis. A double blind study using boswellia found a beneficial effect on pain and stiffness, as well as improved joint function.[50] Boswellia showed no negative effects in this study. The herb has a unique anti-inflammatory action, much like the conventional non-steroidal anti-inflammatory drugs (NSAIDs) used by many for inflammatory conditions. But unlike NSAIDs, long-term use of boswellia is generally considered safe and does not lead to irritation or ulceration of the stomach. Some doctors of natural medicine suggest using 400–800 mg of gum resin extract in capsules or tablets three times per day. Turmeric is a yellow spice that is often used to make brightly colored curry dishes. The active principle is curcumin, a potent anti-inflammatory compound, which protects the body against the ravages of free radicals.[51] A preliminary double blind study found that 400 mg curcumin three times per day was as effective as the drug phenylbutazone for people with rheumatoid arthritis.[52] Many doctors of natural medicine recommend 400 mg of curcumin in capsules or tablets three times per day. Ginger has been used in Ayurvedic medicine as an antiinflammatory. Several published case studies of people with rheumatoid arthritis taking 6–50 grams of fresh or powdered ginger per day indicated that gingermight be helpful.[53] A cream containing small amounts of capsaicin, a compound found in cayenne peppers, can help relieve pain when rubbed onto arthritic joints, according to the results of a double blind study.[54] It does this by depleting the nerves of a pain-mediating neurotransmitter known as substance P. Although application of capsaicin cream may initially cause a burning feeling, the burning will lessen with each application and soon disappear for most people. A cream containing 0.025–0.075% of capsaicin can be applied to the affected joints three to five times a day. Yucca, a traditional remedy, is a desert plant that contains soap-like components known as saponins. Yucca tea (7 or 8 grams of the root simmered in a pint of water for fifteen minutes) is often drunk for symptom relief three to five times per day. Burdock root has been used historically both internally and externally to treat painful joints. Horsetail is thought in traditional medicine to exert a connective tissue strengthening and anti-arthritic action, possibly because of the high silicon content of this herb. Devil’s claw has anti-inflammatory and analgesic actions. Several open and double blind studies have been conducted on the anti-arthritic effects of devil’s claw.[55] The results of these studies have been mixed, so it is unclear if devil’s claw lives up to its reputation in traditional herbal medicine for people with rheumatoid arthritis. A typical amount used is 800 mg of encapsulated extracts or 2–4 ml of tincture three times per day. Sarsaparilla has anti-inflammatory properties that may be helpful for people with rheumatoid arthritis. White willow bark has anti-inflammatory and pain-relieving effects. Extracts providing 60–120 mg salicin per day are approved for people with rheumatoid arthritis by the German government.[56] Although the analgesic actions of willow are typically slow-acting, they last longer than aspirin. Topical applications of several botanical oils are approved by the German government for relieving symptoms of rheumatoid arthritis.[57] These include primarily cajeput (Melaleuca leucodendra) oil, camphor oil, eucalyptus oil, fir (Abies alba and Picea abies) needle oil, pine (Pinus spp.) needle oil, and rosemary oil. A few drops of oil or more can be applied to painful joints several times a day as needed. Southwestern Native American and Hispanic herbalists have long recommended use of chaparral topically on people’s joints affected by rheumatoid arthritis. The anti-inflammatory effects of chaparral found in the test tube suggests this practice could have value, though studies have not yet confirmed chaparral’s usefulness in humans. Chaparral should not be used internally for this purpose. Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions. The information contained in this article is for information and education purposes only and is not medical advice. Do not use this information as an alternative to obtaining medical advice from your physician or other professional healthcare provider. Always consult with your physician or other professional healthcare provider about any medical conditions you are experiencing. If you are experiencing a medical emergency, contact your local emergency services for help. References: Levy JA, Ibrahim AB, Shirai T, et al. Dietary fat affects immune response, production of antiviral factors, and immune complex disease in NZP/NZW mice. Proc Natl Acad Sci 1982;79:1974–78. Jacobson I, et al. Correlation of fatty acid composition of adipose tissue lipids and serum phosphatidylcholine and serum concentrations of micronutrients with disease duration in rheumatoid arthritis. Ann Rheum Dis 1990;49:901–905. Lucas CP, Power L. Dietary fat aggravates active rheumatoid arthritis. Clin Res 1981;29:754A [abstr]. Skoldstram L. Fasting and vegan diet in rheumatoid arthritis. Scand J Rheumatol 1987;15:219–21. Nenonen M, Helve T, Hanninen O. Effects of uncooked vegan food—”living food”—on rheumatoid arthritis, a three month controlled and randomised study. Am J Clin Nutr 1992;56:762 [abstr#48]. KjeldsenúKragh J, Haugen M, Borchgrevink CF, et al. Controlled trial of fasting and oneúyear vegetarian diet in rheumatoid arthritis. Lancet 1991;338:899–902. Warmbrand M. How Thousands of My Arthritis Patients Regained Their Health. New York: Arco Publishing, 1974. Panush RS, Carter RL, Katz P, et al. Diet therapy for rheumatoid arthritis. Arthrit Rheum 1983;26:462–71. Zeller M. Rheumatoid arthritis—food allergy as a factor. Ann Allerg 1949;7:200–5,239. Darlington LG, Ramsey NW, Mansfield JR. Placebo-controlled, blind study of dietary manipulation therapy in rheumatoid arthritis. Lancet 1986;i:236–38. Beri D et al. Effect of dietary restrictions on disease activity in rheumatoid arthritis. Ann Rheum Dis 1988;47:69–72. Panush RS. Possible role of food sensitivity in arthritis. Ann Allerg 1988;61(part 2):31–35. Taylor MR. Food allergy as an etiological factor in arthropathies: a survey. J Internat Acad Prev Med 1983;8:28–38 [review]. Darlington LG, Ramsey NW. Diets for rheumatoid arthritis. Lancet 1991;338:1209 [letter]. Kay DR, Webel RB, Drisinger TE, et al. Aerobic exercise improves performance in arthritis patients. Clin Res 1985;33:919A [abstr]. Harkcom TM, Lampman RM, Banwell BF, Castor CW. Therapeutic value of graded aerobic exercise training in rheumatoid arthritis. Arthrit Rheum 1985;28:32–38. Fairburn K, Grootveld M, Ward RJ, et al. Alpha-tocopherol, lipids and lipoproteins in knee-joint synovial fluid and serum from patients with inflammatory joint disease. Clin Sci 1992;83:657–64. Scherak O, Kolarz G. Vitamin E and rheumatoid arthritis. Arthrit Rheum 1991;34:1205–1206 [letter]. Barton-Wright EC, Elliott WA. The pantothenic acid metabolism of rheumatoid arthritis. Lancet 1963;ii:862–63. General Practitioner Research Group. Calcium pantothenate in arthritic conditions. Practitioner 1980;224:208–211. Simkin PA. Oral zinc sulphate in rheumatoid arthritis. Lancet 1976;ii:539–42. Peretz A, Neve J, Jeghers O, Pelen F. Zinc distribution in blood components, inflammatory status, and clinical indexes of disease activity during zinc supplementation in inflammatory rheumatic diseases. Am J Clin Nutr 1993;57:690–94. Job C, Menkes CJ, de Gery A, et al. Zinc sulphate in the treatment of rheumatoid arthritis. Arthrit Rheum 1980;23:1408. Simkin PA. Treatment of rheumatoid arthritis with oral zinc sulfate. Agents Actions 1981;8(suppl):587–96. DiSilvestro RA, Marten J, Skehan M. Effects of copper supplementation on ceruloplasmin and copper-zinc superoxide dismutase in free-living rheumatoid arthritis patients. J Am Coll Nutr 1992;11:177–80. Medical News. Copper boosts activity of anti-inflammatory drugs. JAMA 1974;229:1268–69. Sorenson JRJ. Copper complexes—a unique class of anti-arthritic drugs. Progress Med Chem 1978;15:211–60 [review]. Walker WR, Keats DM. An investigation of the therapeutic value of the ‘copper bracelet’—dermal assimilation of copper in arthritic/rheumatoid conditions. Agents Actions 1976;6:454–59. Blake DR, Lunec J. Copper, iron, free radicals and arthritis. Brit J Rheumatol 1985;24:123–27 [editorial]. Kremer JM, Jubiz W, Michalek A, et al. Fish-oil fatty acid supplementation in active rheumatoid arthritis. Ann Int Med 1987;106(4):497–503. Kremer JM, Lawrence DA, Jubiz W, et al. Dietary fish oil and olive oil supplementation in patients with rheumatoid arthritis. Arthrit Rheum 1990;33(6):810–20. Geusens P, Wouters C, Nijs J, et al. Long-term effect of omega-3 fatty acid supplementation in active rheumatoid arthritis. Arthrit Rheum 1994;37:824–29. van der Tempel H, Tulleken JE, Limburg PC, et al. Effects of fish oil supplementation in rheumatoid arthritis. Ann Rheum Dis 1990;49:76–80. Cleland LG, French JK, Betts WH, et al. Clinical and biochemical effects of dietary fish oil supplements in rheumatoid arthritis. J Rheumatol 1988;151471–75. Kremer JM, Lawrence DA, Petrillow GF, et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Arthrit Rheum 1995;38:1107–14. Lee TH, Hoover RL, Williams JD, et al. Effect of dietary enrichment with eicosapentaenoic and docosahexaenoic acids on in vitro neutrophil and monocyte leukotriene generation and neutrophil function. N Engl J Med 1985;312(19):1217–24. Leventhal LJ, Boyce EG, Zurier RB. Treatment of rheumatoid arthritis with gammalinolenic acid. Ann Intern Med 1993;119:867–73. Zurier RB, Rossetti RG, Jacobson EW, et al. Gamma-liolenic acid treatment of rheumatoid arthritis. A randomized, placebo-controlled trial. Arthritis Rheum 1996;39:1808–17. Leventahn LJ, Boyce EG, Zuerier RB. Treatment of Rheumatoid arthritis with blackcurrant seed oil. Brit J Rheumatol 1994;33:847–52. Brzeski M, Madhok R, Capell HA. Evening primrose oil in patients with rheumatoid arthritis and side-effects of non-steroidal anti-inflammatory drugs. Brit J Rheumatol 1991;30:370–72. Jantti J, Seppala E, Vapaatalo H, Isomaki H. Evening primrose oil and olive oil in treatment of rheumatoid arthritis. Clin Rheumatol 1989;8:238–44. Belch JJF, Ansell D, Madhok R, et al. Effects of altering dietary essential fatty acids on requirements for non-steroidal anti-inflammatory drugs in patients with rheumatoid arthritis: a double blind placebo controlled study. Ann Rheum Dis 1988;47:96–104. Newnham RE. Arthritis or skeletal fluorosis and boron. Int Clin Nutr Rev 1991;11:68–70 [letter]. Balagot RC, Ehrenpreis S, Kubota K, et al. Analgesia in mice and humans by D-phenylalanine: Relation to inhibition of enkephalin degradation and encephalin levels. Adv Pain Res Ther 1983;5:289–93. 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Question: I am so frustrated with diets that make me feel like I am starving. Why have I become a fat storing machine? Answer: Ultimately, fat accumulation is the direct result of a failing endocrine system and the glands and hormones that are involved. Hormones are chemical messengers produced by the glands and are the primary driving forces affecting your metabolism, which in turn regulates fat burning. Barring any known metabolic disorders, the most common root cause of increasing fat storage is not just what you are putting into your mouth but how your endocrine system is triggered by that food. Trigger #1: The Absence of Sugar The biggest influence on your metabolism is sugar. Sugar triggers the powerful fat making, fat-storing hormone insulin. In the presence of insulin not only is fat blocked from being used as fuel, sugar becomes fat. Trigger #2: Vegetables Raw vegetables are one of the most concentrated sources of vitamins, minerals and plant chemicals. They are also high in fiber and significantly buffer the fat-maker insulin. Trigger #3: Protein Protein is a powerful trigger for two fat burning hormones: glucagon and growth hormone. Trigger #4: Fats Healthy fats typically do not influence fat-making hormones, but they can stress the liver, which indirectly affects hormone flows through the liver. Fat has little effect on fat-storing hormones and is, therefore, neutral when it comes to fat making. Trigger #5: Skipping Meals, Reducing Calories, or Allowing Yourself to Get Hungry Skipping meals causes blood sugar to drop and stimulates several hormones. The stress hormone cortisol increases turning your body tissues into sugar fuel. If this sugar is not burned up completely, it changes into fat and specifically deposited around your vital organs in the abdomen. Trigger #6: Gland Destroyers Alcohol – triggers insulin, causes weight gain, and also destroys the liver. Caffeinated Products – Caffeine accelerates and weakens the adrenal glands and liver. It irritates the gallbladder, increases cortisol, and parks fat into and around the abdominal organs. Drugs – Medications of all kinds have side effects on the glands, especially the liver. Growth Hormones – Many animal products we consume are fed growth hormones. Endocrine Disruptors – Pesticides, insecticides, heavy metals, etc., can mimic estrogen. Food and Cosmetic Chemicals – Food preservatives, dyes, synthetic sugars, and hydrogenated oils have deleterious effect on our glands. Also, skin creams, makeup, shampoos and perfumes can have adverse affects on detox pathways and your liver. Trigger #7: Water Retainers Monosodium glutamate (MSG) is the big culprit in causing water retention. Other causes are artificial sweeteners, sodium, refined sugars, carbohydrates and alcohol. Trigger #8: Exercise A very interesting yet rarely understood fact about exercise is that few calories are actually burned during exercise. Although, the delayed fat burning effects from this exercise are quite significant. The majority of the fat burning occurs 14 – 48 hours after exercise. Trigger #9: Stress Stress increases cortisol, which can lead to abdominal fat deposition. This happens because the adrenal hormone releases a good supply of stored sugar into the bloodstream, causing insulin to store it as fat. Trigger #10: Sleep Fat burning growth hormone is active throughout the night while you sleep, but it accelerates during the first two hours of deep sleep, especially between midnight and 4:00 a.m. Insomnia often prevents this fat burning effect. Obviously you have to trigger your fat burning hormones, but, more importantly, avoid the things that prevent fat burning to begin with. Summarized from The 7 Principles of Fat Burning, by Dr. Eric Berg, D.C. The information contained in this article is for information and education purposes only and is not medical advice. Do not use this information as an alternative to obtaining medical advice from your physician or other professional healthcare provider. Always consult with your physician or other professional healthcare provider about any medical conditions you are experiencing. If you are experiencing a medical emergency, contact your local emergency services for help.