MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Monthly Archives: May 2017

This study tested chondroitin sulfate 800 mg/day (CS) pharmaceutical-grade in the management of symptomatic knee osteoarthritis. It was designed as a prospective, randomised, 6-month, 3-arm, double-blind, double-dummy, placebo and celecoxib (200 mg/day)-controlled trial.  The primary endpoints were changes in pain on a Visual Analogue Scale (VAS) and in the Lequesne Index (LI). Minimal-Clinically Important Improvement (MCII), Patient-Acceptable Symptoms State (PASS) were used as secondary endpoints.

A total of 604 patients, diagnosed according to American College of Rheumalogy (ACR) criteria, were recruited in five European countries and followed for 182 days. CS and celecoxib showed a greater significant reduction in pain and LI than placebo. In the intention-to-treat (ITT) population, pain reduction in VAS at day 182 in the CS group (−42.6 mm) and in celecoxib group (−39.5 mm) was significantly greater than the placebo group (−33.3 mm) (p=0.001 for CS and p=0.009 for celecoxib). No difference observed between CS and celecoxib. Similar trend for the LI, as reduction in this metric in the CS group (−4.7) and celecoxib group (−4.6) was significantly greater than the placebo group (−3.7) (p=0.023 for CS and p=0.015 for celecoxib). Again, no difference was observed between CS and celecoxib. Both secondary endpoints (MCII and PASS) at day 182 improved significantly in the CS and celecoxib groups. All treatments demonstrated excellent safety profiles.
The authors concluded that a 800 mg/day pharmaceutical-grade CS is superior to placebo and similar to celecoxib in reducing pain and improving function over 6 months in symptomatic knee osteoarthritis (OA) patients. This formulation of CS should be considered a first-line treatment in the medical management of knee OA.

In my view, this is a good study with clear and useful results: CS seems to be efficacious and safe. Another recent study confirmed the superiority of CS over celecoxib at reducing cartilage volume loss in knee OA patients.

The current Cochrane review does not yet account for the new data; it concluded cautiously positive: A review of randomized trials of mostly low quality reveals that chondroitin (alone or in combination with glucosamine) was better than placebo in improving pain in participants with osteoarthritis in short-term studies. The benefit was small to moderate with an 8 point greater improvement in pain (range 0 to 100) and a 2 point greater improvement in Lequesne’s index (range 0 to 24), both seeming clinically meaningful. These differences persisted in some sensitivity analyses and not others. Chondroitin had a lower risk of serious adverse events compared with control. More high-quality studies are needed to explore the role of chondroitin in the treatment of osteoarthritis. The combination of some efficacy and low risk associated with chondroitin may explain its popularity among patients as an over-the-counter supplement.

The call for more high quality trials was justified but has now been answered. In my view, CS can be considered an evidence-based option in the management of OA.

The Rubicon Group (TRG) is a collaboration of chiropractic educational institutions, emerging educational efforts and interested parties. The seven institutional members include Barcelona College of Chiropractic (Barcelona, Spain); the Chiropraktik Akademie (Dresden, Germany); Life Chiropractic College West (San Francisco, California, USA); Life University (Atlanta, Georgia, USA); McTimoney College of Chiropractic (Abingdon, Oxfordshire, UK); New Zealand College of Chiropractic (Auckland, New Zealand); and Sherman College of Chiropractic (Spartanburg, South Carolina, USA).

TRG has issued the following statement:

Definition and Position Statement on the Chiropractic Subluxation

The term ‘subluxation’ has been used by the chiropractic profession for over a century.1, 2 It is an important element of chiropractic practice, embedded in legislation and regulation, and its clinical implications have been, and continue to be, scientifically explored.2, 3
The term subluxation, as used by chiropractors, is a researchable concept that is important to health and health care delivery.1, 2, 4 The need to properly define this entity has been widely recognized as a high priority within the profession, as evidenced by the number of groups and organizations who have offered definitions of subluxation.1, 2, 5-10

Many of the past definitions do not provide a testable definition of chiropractic subluxation.11 

Some do not reflect the current research that supports a neurologically-centered model of subluxation. 2 The Rubicon Group (TRG) has utilized the current available scientific evidence to define the chiropractic subluxation. Contemporary neurophysiological language and concepts, based on current scientific publications on the topic, have been used. As this definition is subject to ongoing scientific exploration that is likely to lead to new findings and understandings, modifications may be anticipated. However, this definition reflects what is currently known, and it is congruent with current neurophysiological scientific understanding.

“We currently define a chiropractic subluxation as a self-perpetuating, central segmental motor control problem that involves a joint, such as a vertebral motion segment, that is not moving appropriately, resulting in ongoing maladaptive neural plastic changes that interfere with the central nervous system’s ability to self-regulate, self-organize, adapt, repair and heal.”

(The Rubicon Group, May 2017.)

There are three key elements, namely:

A chiropractic subluxation often relates to the spine and its connecting structures. 1 Chiropractic subluxation assessment generally involves evaluating the pathophysiological consequences of the central segmental motor control problem; 4, 12 these may include pain, asymmetry, biomechanical or postural changes (such as changes in relative range of intervertebral motion), changes in tissue temperature, texture and/or tone, and other findings that can be identified using special tests. 12 Once identified, subluxations are corrected using a variety of techniques including high velocity low amplitude chiropractic adjustments, instrument assisted adjustments, and lower force manual techniques and approaches.13

A growing body of scientific evidence has demonstrated that spinal function impacts central neural function in multiple ways,3, 4, 14-19 and that improving spinal function has an impact on clinical outcomes.20-24 Scientists have known for several decades that neurons continuously adapt in structure and function in response to our ever-changing environment.25-27 This ability to adapt is known as ‘neural plasticity’,27 and it is now well understood that the central nervous system can reorganize in response to altered input.28-35 Examples of increased sensory input that can lead to neural plastic changes include repetitive muscular activity 29, 36-41, such as typing or playing the piano, or repeated tactile sensory input such as occurs with blind Braille readers.42 Similar central nervous system change or reorganization may take place due to a decrease in behavior or activity.+ 32, 43-49 Thus the concept, that alterations in paraspinal muscle function due to abnormal spinal movement patterns are capable of changing central neural function, is totally congruent with current neuroscience understanding, as well as current scientific findings.3, 4, 14-19
[references can be found in the original]

MY COMMENT:

Subluxation is not so much a ‘self-perpetuating motor control problem’ as a self-perpetuating money-maker for chiropractors, it seems to me. The history of the use of this term shows that chiropractors have changed its meaning each time they were unable to deny its nonsensicality. To throw subluxation over board is not an option because chiropractic is at its hear a subluxation cult.

Yet, we have repeatedly been told that chiropractors have all but given up the concept of ‘subluxation’. This is clearly not the case. The above statement of TRG speaks for itself, and so does a recent study showing that “the majority of [North American chiropractic] students would like to see an emphasis on correction of vertebral subluxation”. It is the correction of the non-existent subluxation that stimulates the cash flow of chiropractors, a fact known even to the novices of the cult.

The new definition, it seems to me, is little more than self-serving nonsense. Wikipedia – I know, it’s not always the most reliable source, but in this case it is miles better that TRG – has this to say about subluxation: “In chiropractic, vertebral subluxation is a supposed misalignment of the spinal column leading to a set of signs and symptoms sometimes termed vertebral subluxation complex. It has no biomedical basis and is categorized as pseudoscientific by leading authorities. Traditionally, the “specific focus of chiropractic practice” is the chiropractic subluxation and historical chiropractic practice assumes that a vertebral subluxation or spinal joint dysfunction interferes with the body’s function and its innate intelligence, as promulgated by D. D. Palmer, the inventor of chiropractic.”

Wikipedia furthermore mentions that “in 2015, 8 internationally accredited chiropractic colleges: AECC, WIOC, IFEC-Paris, IFEC-Toulouse, USD-Odense, UZ-Zurich, UJ-Johannesburg and Durban University of Technology made an open statement which included: “The teaching of the vertebral subluxation complex as a vitalistic construct that claims that it is the cause of disease is unsupported by evidence. Its inclusion in a modern chiropractic curriculum in anything other than an historic context is therefore inappropriate and unnecessary”.”

Subluxation currently divides the chiropractic profession as we have seen here, for instance. But it is certainly not a concept that most chiropractors have been wise enough to declare obsolete.

In my view, the website of ‘FOODS 4 BETTER HEALTH’ should be more aptly called FOOD FOR QUICKER DEATH. At least this is the conclusion that came to my mind after reading their post on ‘Apricot Seeds: Nutrition, Health Benefits, and Their Role in Cancer Treatment’.

Under the heading ‘Apricot Seeds for Cancer Treatment’, we find the following explanations:

“Laetrile is a drug made from amygdalin. Apple seeds, Lima beans, plums, and peaches also contain amygdalin. Although laetrile isn’t a vitamin, it is labeled as amigdalina B17 or vitamin B17.

Dr. Kanematsu Sugiura received highest honors from the Japan Medical Association for his outstanding contributions in cancer research. He found that laetrile prevented the spread of malignant lung tumors in 10 to 20% of laboratory mice. Meanwhile, the mice given plain saline showed that lung tumor spread in 80 to 90% of the subjects. The study shows that laetrile reduces the spread of cancer and isn’t a cure for cancer.

According to a study published in the Public Library of Science, amygdalin blocks the growth of bladder cancer cells. The researchers studied the growth, proliferation, clonal growth, and cell cycle progression.

According to another study published in the International Journal of Immunopharmacology, the viability of human cervical cancer HeLa cell line was significantly inhibited by amygdalin. The researchers found apoptosis in amygdalin-treated HeLa cells.

However, a study published in The New England Journal of Medicine showed no substantial benefit of amygdalin on cancer patients. In fact, the blood cyanide levels of patients who received the substance intravenously increased alarmingly. But, the levels were relatively low in patients who received an oral dose.

A study conducted in 2002 at the Kyung Hee University in Korea found amygdalin to be helpful in killing prostate cancer cells. A similar study conducted on rats also linked the compound with pain relief, thus decreasing pain in cancer patients.

Amygdalin is considered as an alternative treatment for cancer. Since research so far has shown mixed and inconclusive results, apricot seeds may be helpful in the treatment of cancer, but shouldn’t be the only means to treat cancer. It is best to use it as a supplement with other cancer medications.”

END OF QUOTE

Cancer patients who read this sort of thing – and sadly the Internet offers plenty more of such irresponsible texts – might well decide to try Laetrile or start regularly consuming apricot seeds instead of chemotherapy or other effective cancer treatments. This decision would almost certainly hasten their deaths for two reasons:

  • Amygdalin is NOT an effective treatment for cancer.
  • It is highly toxic and would almost certainly kill some patients after chronic use.

To state, as the author of the above article does, that “research so far has shown mixed and inconclusive results” is irresponsible. The only thing that matters and the only message relevant for vulnerable patients is this: RESEARCH HAS NOT SHOWN THAT THIS STUFF WORKS FOR CANCER.

The website of ‘HOMEOPATHY 360’ has just published a new post offering a handy instruction for killing patients suffering from acute appendicitis. If you do not believe me – I don’t blame you, I too found it hard to believe – read this short excerpt advocating homeopathy for this life-threatening condition (for readers without a medical background: if acute appendicitis is not treated promptly, the inflamed appendix might burst, spilling faecal material into the abdominal cavity, resulting in a life-threatening peritonitis):

The post is entitled “A Cure of Acute Appendicitis Using Frequent Homeopathic Doses in Solution

Here is the abstract:

“Placing centesimal potencies in solution and prescribing them frequently for acute conditions is not widely practiced. It can be superior to dry doses in many cases, where a persistent mild medicinal action is preferred to a strong aggravation. By prescribing dissolved doses of Arnica Montana 1m, a case of acute appendicitis was cured quickly. This suggests that centesimal potencies given frequently in solution may be more efficacious, prompt and gentle than treatment with dry doses.”

Fascinating, isn’t it?

Here are more details demonstrating that the author has done his homework:

“When treating a patient with acute medical condi­tion, in certain cases we fail to cure. Even though our case taking, evaluation, analysis, remedy and potency selection seem correct. What is the cause? In the Organon 5th edition (1833) Dr. Hahnemann introduced olfaction and dissolved centesimal remedies as a new method of administering doses. Around the year 1840 Hahnemann began to introduce LM potencies into his practice. From 1840 to 1843 he used both centesimal and LM potencies side by side in medicinal solutions. By these methods he hoped to avoid unwanted aggravations and provide rapid cure.

In some acute cases the aggravation can be discouragingly pro­longed and often cannot be discerned from the patient’s own disease. Many times we change the original prescrip­tion which could very well have been the simillimum. In acute diseases, a dry dose will many times produce an un­necessary aggravation because of the patient’s increased susceptibility. I have much experience now with what I call a “watery dose.” To prepare it, one or two globules of size 10 are diluted in 15ml. of distilled water in which 5 drops of alcohol added with 20 to 30 succussions. From this solution 10 drops are added to another 15 ml of water, and from this solution 5 to 10 drops dose repeated according to the severity of the disease. In such diluted solutions the correct number of drops must be precise. Every time be­fore taking the dose the solution is succussed 5 to 10 times. The same solution can be used for several days or weeks. Hahnemann recommended using carefully measured and dosed solutions with sensitive patients. Many times I have used this method with great success. It is not necessary to take 4 oz. to 8 oz. of water, Just fifteen ml. of distilled water is sufficient. This technique of dosing is also known as a split dose because it uses one or two pills in a solution that is then split over several days or weeks.

The results using this type of dosing can be very dif­ferent from dry doses. There is continuous amelioration of the complaints without aggravation. This comes closer to the ideal of strengthening the weakened vital force than is seen when we simply produce a similar stronger artificial disease in the patient.”

The author also provides a detailed case history of a patient who survived this treatment (of course, without mentioning that acute appendicitis can, in rare cases, have a spontaneous recovery).

MY ADVICE:

I would not recommend Arnica or any other homeopathic remedy for routine use in acute appendicitis (or any other condition) – unless, of course, you want to kill a maximum number of your patients suffering from this medical/surgical emergency.

I am sure you always wanted to know what animal chiropractic is all about!

This website explains it quite well:

START OF QUOTES

…Animal chiropractic (veterinary spinal manipulative therapy) focuses on the preservation and health/wellness of the neuro-musculo-skeletal system. Chiropractic is the science that is centered around the relationship between the spine and the nervous system. The spine is your body’s foundation and the nervous system, including your brain, spinal cord and nerves, controls your entire body. They must work together harmoniously to improve one’s general health and their ability heal. If the systems are not functioning to their highest potential you may experience changes in digestion, heart and lung function, reproduction and most evidently musculature. When adjacent joints are in an abnormal position, called a subluxation, the nervous system and all that it controls will be negatively impacted. If these subluxations are not corrected, they can result in prolonged inappropriate stimulation of nerves. This could result in reduced function internally, musculo-skeletal dysfunction and pain.

Spinal manipulation is the art of restoring full and pain free range of motion to joints and can greatly benefit an animal after they have experienced subluxations. The veterinarian will use their hands to palpate joints both statically and in motion. By doing this, they can determine where the animal is experiencing decreased motion or misaligned joints. Once identified, an adjustment can be performed. An adjustment or spinal manipulation is a gentle, specific, quick and low force thrust that will be applied at an angle specific to the different areas of motion in the spine and extremities. Only a certified animal chiropractor will understand the complexity involved in adjustments and can best assess if an animal can benefit from chiropractic care.

Many animals can benefit from this alternative therapy. If you notice that your animal has a particularly sensitive spot somewhere on their body, is walking or trotting differently and or not performing to the same ability they have previously, they may be a candidate for a chiropractic assessment. However, an animal does not need to be sick or injured to benefit from chiropractic care. Animals in good health or ones used for sporting activities are also prime candidates for chiropractic care. By maintaining your pet’s proper spinal alignment and mobility they will attain optimal function of muscles, nerves and tissues that support the joints. When the body can move freely your pet will experience improved mobility, stance and flexibility, which can evolve into improved agility, endurance and overall performance. Finally, many people have never considered that chiropractic care can also benefit their animal by boosting their immune response. It can aid in providing a healthier metabolism and a vibrant nervous system which all facilitate your animal’s natural ability to heal themselves from within. Chiropractic care can enhance the quality of your pet’s life ensuring many active and healthy years to come.

…during veterinary school I began the process of researching how to become an animal chiropractor or veterinary spinal manipulative therapist. As I researched further, I noticed that this specialized profession has grown. It became apparent that one should be certified by either the College of Animal Chiropractors or American Veterinary Chiropractic Association to practice on animals…  It was surprising to find out that there are only four programs in the USA and Canada that are approved by both organizations. The courses consisted of over 200 hours of intensive study and hands on learning followed by certification testing…

END OF QUOTE

Yes, I did shorten the quote a bit but, rest assured, I did not cut out a single word about the efficacy of animal chiropractic. Even if I had wanted to, I couldn’t: there is no mention of it in the article.

I wonder why!

Looking into Medline, I found several reports related to the subject:

  • One study suggested an association between chiropractic findings in the lumbar vertebrae and urinary incontinence and retention in dogs.
  • A case report highlighted the potential benefits of combining traditional medical management with chiropractic treatment and physical therapy techniques for management of severe acute-onset torticollis in a giraffe.
  • A review explained that there is limited evidence supporting the effectiveness of spinal mobilization and manipulation in animals.
  • An observational study suggested that chiropractic manipulations elicit slight but significant changes in thoracolumbar and pelvic kinematics.
  • A comparative study measured the spinal mechanical nociceptive thresholds in 38 horses, and showed that they increased by 27, 12 and 8% in the chiropractic, massage and phenylbutazone groups, respectively.

… and that was basically it. Not a single study to suggest that chiropractic is effective for specific conditions of animals.

Frustrated, I went on the site of the ‘College of Animal Chiropractic’; surely there I would find the evidence I was looking for. They offer lots of platitudes and this largely nonsensical statement:

“When a joint become restricted in its range of motion(hypomobile or ‘locked-up’), through trauma, repetitive injury, degenerative changes, or structural stresses, the surrounding tissues are affected. This, in turn, further affects the joints ability to move freely and sensitive structures are activated causing the area to be sensitive or painful. Nerves are the communication links between all tissues in the body to the brain and spinal cord; when joint dysfunction is present, messages to other areas are also affected, which can lead to pain, weakness, reduced function, and compensatory changes. Animal chiropractic focuses on the restoration of movement and the promotion of heath by restoring normal joint mechanics and soft-tissue function, thus, normalizing neurological patterns that facilitate healing . The main tool an animal chiropractor uses to restore joint motion is called an “adjustment”, or veterinary spinal manipulation. This gentle, specialized, manual skill, involves the application of a quick, low-force maneuver that is directed to a specific area of a joint at a specific angle. A certified animal chiropractor understands these joint angles intimately and can best asses if an animal can benefit from chiropractic care, and, is the only professional who is qualified to adjust your pet.”

But no evidence!

By now I was desperate. My last hope was the ‘American Veterinary Chiropractic Association’. All I found there, however, was this: the “American Veterinary Chiropractic Association (AVCA) is a professional membership group promoting animal chiropractic to professionals and the public, and acting as the certifying agency for doctors who have undergone post-graduate animal chiropractic training.”

Not a jot of evidence!

The assumption that animal chiropractic is effective seems to rely on the evidence from human studies…

… and we all know how solid that body of evidence is!

My conclusion from all this: chiropractors treating animals and those treating humans have one important characteristic in common.

THEY HAPPILY PROMOTE BOGUS TREATMENTS.

The US ‘FEDERAL TRADE COMMISSION’ has issued an important statement about homeopathic products. The full text with references can be found here; below are a few quotes which I thought were crucial:

“…Homeopathy, which dates back to the late-eighteenth century, is based on the view that disease symptoms can be treated by minute doses of substances that produce similar symptoms when provided in larger doses to healthy people.  Many homeopathic products are diluted to such an extent that they no longer contain detectable levels of the initial substance.  In general, homeopathic product claims are not based on modern scientific methods and are not accepted by modern medical experts, but homeopathy nevertheless has many adherents…

Efficacy and safety claims for homeopathic drugs are held to the same standards as similar claims for non-homeopathic drugs.  As articulated in the Advertising Substantiation Policy Statement, advertisers must have “at least the advertised level of substantiation.”  Absent express or implied reference to a particular level of support, the Commission, in evaluating the types of evidence necessary to substantiate a claim, considers “the type of claim, the product, the consequences of a false claim, the benefits of a truthful claim, the cost of developing substantiation for the claim, and the amount of substantiation experts believe is reasonable.”  For health, safety, or efficacy claims, the FTC has generally required that advertisers possess “competent and reliable scientific evidence,” defined as “tests, analyses, research, or studies that have been conducted and evaluated in an objective manner by qualified persons and [that] are generally accepted in the profession to yield accurate and reliable results.”  In general, for health benefit claims, particularly claims that a product can treat or prevent a disease or its symptoms, the substantiation required has been well-designed human clinical testing.

For the vast majority of OTC homeopathic drugs, the case for efficacy is based solely on traditional homeopathic theories and there are no valid studies using current scientific methods showing the product’s efficacy.  Accordingly, marketing claims that such homeopathic products have a therapeutic effect lack a reasonable basis and are likely misleading in violation of Sections 5 and 12 of the FTC Act.  However, the FTC has long recognized that marketing claims may include additional explanatory information in order to prevent the claims from being misleading.  Accordingly, the promotion of an OTC homeopathic product for an indication that is not substantiated by competent and reliable scientific evidence may not be deceptive if that promotion effectively communicates to consumers that: (1) there is no scientific evidence that the product works and (2) the product’s claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts.  To be non-misleading, the product and the claims must also comply with requirements for homeopathic products and traditional homeopathic principles.  Of course, adequately substantiated claims for homeopathic products would not require additional explanation.

Perfunctory disclaimers are unlikely to successfully communicate the information necessary to make claims for OTC homeopathic drugs non-misleading.  The Commission notes:

• Any disclosure should stand out and be in close proximity to the efficacy message; to be effective, it may actually need to be incorporated into the efficacy message.

• Marketers should not undercut such qualifications with additional positive statements or consumer endorsements reinforcing a product’s efficacy.

• In light of the inherent contradiction in asserting that a product is effective and also disclosing that there is no scientific evidence for such an assertion, it is possible that depending on how they are presented many of these disclosures will be insufficient to prevent consumer deception.  Marketers are advised to develop extrinsic evidence, such as consumer surveys, to determine the net impressions communicated by their marketing materials.

• The Commission will carefully scrutinize the net impression of OTC homeopathic advertising or other marketing employing disclosures to ensure that it adequately conveys the extremely limited nature of the health claim being asserted.  If, despite a marketer’s disclosures, an ad conveys more substantiation than the marketer has, the marketer will be in violation of the FTC Act.

In summary, there is no basis under the FTC Act to treat OTC homeopathic drugs differently than other health products.  Accordingly, unqualified disease claims made for homeopathic drugs must be substantiated by competent and reliable scientific evidence.  Nevertheless, truthful, nonmisleading, effective disclosure of the basis for an efficacy claim may be possible.  The approach outlined in this Policy Statement is therefore consistent with the First Amendment, and neither limits consumer access to OTC homeopathic products nor conflicts with the FDA’s regulatory scheme.  It would allow a marketer to include an indication for use that is not supported by scientific evidence so long as the marketer effectively communicates the limited basis for the claim in the manner discussed above.”

 

 

Alternative medicine is deeply rooted in the notion of ‘detox’. This website is one of thousands and displays some of the issues in an exemplary fashion:

START OF QUOTES

…There are more than 80,000 chemicals used in the industrialized world. Accumulate enough of these toxins and you might suffer, at the very least, fatigue, headaches, muscle soreness, bloating, depression and, at the worst, chronic disease and cancer… This is why regular detoxification is so important in our modern world. It helps your body eliminate toxic waste stored in your tissues. Plus you’ll get:

  • More energy
  • Stronger immunity
  • Faster fat burning
  • Fewer allergies
  • Fewer aches and pains
  • Healthier skin, hair and nails

You’ll find plenty of detoxification kits – or “detox in a box” – at pharmacies and health-food stores. But there is little if any scientific evidence that any of these quick fixes work. Instead, you’re better off using natural detoxification methods that are safe and reliable. Here’s what I recommend:

Step 1: Live without Toxins

There are many natural ways to rid yourself of toxins to look and feel your best:

  • Limit your exposure to hormones. If you eat grain-fed meat, eat only lean cuts and trim off the fat. If you eat grass-fed beef, it’s okay to eat the fat – it’s good for you.
  • Reduce your intake of caffeine, grains, carbohydrates and sugar. They make it harder for your body to fully process estrogen.
  • Stretch and massage your limbs. This will release acids and toxins stored in your own tissues so your body can eliminate them.
  • Hit the sauna. Perspiring in the heat releases toxins through your skin.

Step 2: Eat Purifying Foods

Did you know there are everyday foods that act as detoxifiers to help your body discard built-up toxins? Foods rich in vitamin C like fruits, berries and fresh vegetables will help do the trick, along with fiber-rich nuts, seeds and grains.

Signs You Need to Detox

  • You have unexplained headaches or back pain
  • You have joint pain or arthritis
  • Your memory is failing
  • You’re depressed or lack energy
  • You have brittle nails and hair
  • You’re suffering from psoriasis
  • You have abnormal body odor, a coated tongue or bad breath
  • You’ve experienced an unexplained weight gain
  • You have frequent allergies

Grapefruit is another food that binds to toxins and helps flush them from your body. It contains a flavonoid called naringenin, a potent antioxidant that decreases your body’s insulin resistance to help prevent diabetes, and reprogram your liver to melt excess fat, instead of storing it.

Why is this important to detoxification? Because toxins tend to collect in the fat around your tissues, like your liver, and eating grapefruit will help you stop this process.

Another food that can help clean out your body is garlic. Garlic increases phagocytosis. This boosts the ability of your white blood cells to fight the effects of toxins in your body.

Eating three cloves of fresh garlic per day will help you detox. If you don’t like the smell of garlic, you can get odorless aged garlic supplements at any health food store.

There’s also chlorella. You can find in most health-food stores, and C. Pyreneidosa is the form with the best metal-absorbing properties.

Most people can tolerate high doses of it with great success. Take 1 gram with breakfast, lunch, and dinner. You can increase the dose to up to 3 grams 3 to 4 times a day.

Another option is fresh cilantro, one of the best detoxifiers for your central nervous system. It mobilizes so much mercury, it can’t always carry it out of the body fast enough. So use it in combination with chlorella.

Eat organic cilantro, make a pesto or tea, or buy a tincture. Take 2 drops 2 times a day before meals or 30 minutes after taking chlorella. Increase your dose to up to 10 drops three times a day.

Step 3: Cleanse Your Internal Organs

Herbs can help clear toxins from your bloodstream, restore liver function and help flush out your kidneys. Detoxifying your liver a couple of times a year can also lower your cholesterol.

Here’s a list of herbal products that work well:

Milk thistle – I recommend 200 mg in capsule form twice a day. Look for dried extract with a minimum of 80 percent silymarin – the liver-cleaning active ingredient.

Alfalfa – This herb has been known to lower cholesterol by 25 percent in lab animals. It’s a good source of protein, vitamins A, D, E, B-6 and K, calcium, magnesium, iron, potassium, trace minerals and digestive enzymes.

Dandelion – This root stimulates bile and acts as a diuretic for excess water. Asians use it to treat hepatitis, jaundice, swelling of the liver, and deficient bile secretion. Use 4-10 grams of the dried leaf or 4 to 10 milliliters (1:1) of fluid extract.

Sarsaparilla – This is one of my favorite teas. It tastes great and acts as an effective blood detox. Native Americans have used it as a restorative tonic for centuries. Use 1-4 grams of the dried root, or 8-12 milliliters (2 to 3 teaspoons) (1:1) liquid extract, or 250 milligrams (4:1) of solid extract.

Burdock Root – This ancient remedy is a diuretic and a diaphoretic. It increases urine and perspiration production by exercising and strengthening these natural purging systems.

Step 4: Cleanse Your Colon

For an effective, natural way to flush out your colon, find and take the following herbs in combination:

  • Cascara Sagrada bark
  • Aloe leaf
  • Marshmallow root
  • Flax seed
  • Rhubarb root
  • Slippery Elm bark

Take them all at once, but be careful not to take too much because you could get some gurgling and it could loosen up your stool. They’re pretty powerful when you use them in this combination.

Step 5: Rid Your Tissues of Heavy Metals

These two compounds will remove chemicals and keep your body clean and pure like it’s supposed to be.

DMSA – This is a compound that removes heavy metal toxins (its real name is meso-2, 3-dimercaptosuccinic acid, but forget that tongue twister… it’s known simply as DMSA).

DMSA has receptor sites that the toxins bind to. The toxins reside inside the cells of the body and DMSA cannot enter the cells. Instead glutathione (your body’s natural toxin remover) residing in the cell pushes the metals out of the cell, where they’re picked up by DMSA and excreted.

DMSA should be taken in on-again/off-again cycles – ideally, three days on and 11 days off because your body needs 11 days to regenerate its glutathione levels.

Activated Charcoal – This is a form of carbon that’s been processed into a fine, black powder. It’s odorless, tasteless, safe to consume and very potent.

In fact, you can take a small amount of charcoal and wipe out decades of toxic heavy metals like arsenic, copper, mercury and lead that have been building up in your body.

You can find activated charcoal in any health-food store. It’s relatively inexpensive and easy to take. Because it’s a powder, you can take it just like you would your favorite protein drink, mixed into a liquid.

Take 20-30 grams a day of powdered activated charcoal (in divided doses) mixed with water over a period of 1-2 weeks.

Step 6: Detoxify Naturally with Citrus Pectin

Modified citrus pectin is made from the inner peel of citrus fruits and is one of the most powerful detoxifying substances I’ve found in the world. It’s also been proven to work in human clinical studies.

In one U.S.D.A. study, scientists gave modified citrus pectin to people for six days and measured the amount of toxins excreted in their urine before taking it and 24 hours after taking it. Here’s what they found:

  • The amount of deadly arsenic excreted increased by 130 percent
  • Toxic mercury excreted increased by 150 percent
  • Cadmium excreted increased by 230 percent
  • Toxic lead excreted increased by 560 percent4

What’s great about modified citrus pectin is that while it eliminates toxic metals and pesticides, it doesn’t deplete your body of zinc, calcium or magnesium. However, consult your physician before taking modified citrus pectin capsules and caplets to make sure they are the kind used in clinical studies and the proper dosage.

END OF QUOTES

This text is so full of unproven notions, disproven theories, implausible assumptions and misunderstood science that I cannot possible address them all here (almost as bad as Prince Charles’ famous ‘detox tincture’). I will therefore only focus on the author’s final CITRUS PECTIN recommendation which apparently is even supported by real evidence. The study cited might have been this one:

This clinical study was performed to determine if the oral administration of modified citrus pectin (MCP) is effective at lowering lead toxicity in the blood of children between the ages of 5 and 12 years. Hospitalized children with a blood serum level greater than 20 microg/dL, as measured by graphite furnace atomic absorption spectrometry (GFAAS), who had not received any form of chelating and/or detoxification medication for 3 months prior were given 15 g of MCP (PectaSol) in 3 divided dosages a day. Blood serum and 24-hour urine excretion collection GFAAS analysis were performed on day 0, day 14, day 21, and day 28.  This study showed a dramatic decrease in blood serum levels of lead (P = .0016; 161% average change) and a dramatic increase in 24-hour urine collection (P = .0007; 132% average change). The need for a gentle, safe heavy metal-chelating agent, especially for children with high environmental chronic exposure, is great. The dramatic results and no observed adverse effects in this pilot study along with previous reports of the safe and effective use of MCP in adults indicate that MCP could be such an agent. Further studies to confirm its benefits are justified.

Apart from the fact that it was published in one of the most notorious altmed journals ever, one ought to mention that it has been rightly criticised for its many and fatal flaws:

• Although the trial was conducted at a university hospital, there is no mention of the study’s approval by an institutional review board  

• The study’s criteria for inclusion and exclusion were not noted.  Although the authors state the MCP product was used for other children not in the study, their results were not included because they did not fit the inclusion criteria. 

• The study had no control/placebo group, although the article states the study was conducted at a hospital that works with lead-poisoned individuals where it is reasonable to assume a group control would be available. 

• Aside from baseline blood levels, only discharge levels were reported.  Presumably, weekly measurements were taken in order to monitor progress and determine when to discharge, but that data was not reported.

There are one or two other human studies on this subject but all of them are of a similar calibre as the one above.

I think this story provides several important lessons:

  • the detox notion is hugely popular in alternative medicine;
  • it is alarmist and takes advantage of our fear to get poisoned by modern life;
  • it is packaged into sciency language in order to appear plausible to lay people;
  • one hardly needs to scratch the surface to find that the ‘science’ is, in fact, pseudoscience of the worst kind;
  • alternative detox thus turns out to be little more than a cunning but dishonest and unethical sales pitch.

If your life-style is unhealthy, don’t think that detox will help, but change your ways.

If the air that you breathe or the water that you drink are polluted, don’t think that detox is the solution, but punish the government that is responsible for these disasters and vote for someone more responsible.

Detox, as used in alternative medicine, is stupid, unethical nonsense promoted by charlatans of the worst kind; don’t fall for it!!!

The fact that some alternative medicine (the authors use the abbreviation ‘CAM’) practitioners recommend against vaccination is well-known and often-documented. Specifically implicated are:

As a result, children consulting homeopaths, naturopaths or chiropractors are less likely to receive vaccines and more likely to get vaccine-preventable diseases. These effects have been noted for several childhood infections but little is known about how child CAM-usage affects influenza vaccination.

A new nationally representative study fills this gap; it analysed ∼9000 children from the Child Complementary and Alternative Medicine File of the 2012 National Health Interview Survey. Adjusting for health services use factors, it examined influenza vaccination odds by ever using major CAM domains: (1) alternative medical systems (AMS; eg, acupuncture); (2) biologically-based therapies, excluding multivitamins/multi-minerals (eg, herbal supplements); (3) multi-vitamins/multi-minerals; (4) manipulative and body-based therapies (MBBT; eg, chiropractic manipulation); and (5) mind-body therapies (eg, yoga).

Influenza vaccination uptake was lower among children ever (versus never) using AMS (33% vs 43%; P = .008) or MBBT (35% vs 43%; P = .002) but higher by using multivitamins/multiminerals (45% vs 39%; P < .001). In multivariate analyses, multivitamin/multimineral use lost significance, but children ever (versus never) using any AMS or MBBT had lower uptake (respective odds ratios: 0.61 [95% confidence interval: 0.44-0.85]; and 0.74 [0.58-0.94]).

The authors concluded that children who have ever used certain CAM domains that may require contact with vaccine-hesitant CAM practitioners are vulnerable to lower annual uptake of influenza vaccination. Opportunity exists for US public health, policy, and medical professionals to improve child health by better engaging parents of children using particular domains of CAM and CAM practitioners advising them.

There is hardly any need to point out that CAM-use is associated with low vaccination-uptake. We have discussed this on my blog ad nauseam – see for instance here, here, here and here. Too many CAM practitioners have an irrational view of vaccinations and advise against their patients against them. Anyone who needs more information might find it right here by searching this blog. Anyone claiming that this is all my exaggeration might look at these papers, for instance, which have nothing to do with me (there are plenty more for those who are willing to conduct a Medline search):

  • Lehrke P, Nuebling M, Hofmann F, Stoessel U. Attitudes of homeopathic physicians towards vaccination. Vaccine. 2001;19:4859–4864. doi: 10.1016/S0264-410X(01)00180-3. [PubMed]
  • Halper J, Berger LR. Naturopaths and childhood immunizations: Heterodoxy among the unorthodox. Pediatrics. 1981;68:407–410. [PubMed]
  • Colley F, Haas M. Attitudes on immunization: A survey of American chiropractors. Journal of Manipulative and Physiological Therapeutics. 1994;17:584–590. [PubMed]

One could, of course, argue about the value of influenza vaccination for kids, but the more important point is that CAM practitioners tend to be against ANY immunisation. And the even bigger point is that many of them issue advice that is against conventional treatments of proven efficacy.

In a previous post I asked the question ‘Alternative medicine for kids: when is it child-abuse?’ I think that evidence like the one reported here renders this question all the more acute.

How often have I pointed out that most studies of chiropractic (and other alternative therapies) are overtly unethical because they fail to report adverse events? And if you think this is merely my opinion, you are mistaken. This new analysis by a team of chiropractors aimed to describe the extent of adverse events reporting in published RCTs of Spinal Manipulative Therapy (SMT), and to determine whether the quality of reporting has improved since publication of the 2010 Consolidated Standards Of Reporting Trials (CONSORT) statement.

The Physiotherapy Evidence Database and the Cochrane Central Register of Controlled Trials were searched for RCTs involving SMT. Domains of interest included classifications of adverse events, completeness of adverse events reporting, nomenclature used to describe the events, methodological quality of the study, and details of the publishing journal. Data were analysed using descriptive statistics. Frequencies and proportions of trials reporting on each of the specified domains above were calculated. Differences in proportions between pre- and post-CONSORT trials were calculated with 95% confidence intervals using standard methods, and statistical comparisons were analysed using tests for equality of proportions with continuity correction.

Of 7,398 records identified in the electronic searches, 368 articles were eligible for inclusion in this review. Adverse events were reported in 140 (38.0%) articles. There was a significant increase in the reporting of adverse events post-CONSORT (p=.001). There were two major adverse events reported (0.3%). Only 22 articles (15.7%) reported on adverse events in the abstract. There were no differences in reporting of adverse events post-CONSORT for any of the chosen parameters.

The authors concluded that although there has been an increase in reporting adverse events since the introduction of the 2010 CONSORT guidelines, the current level should be seen as inadequate and unacceptable. We recommend that authors adhere to the CONSORT statement when reporting adverse events associated with RCTs that involve SMT.

We conducted a very similar analysis back in 2012. Specifically, we evaluated all 60 RCTs of chiropractic SMT published between 2000 and 2011 and found that 29 of them did not mention adverse effects at all. Sixteen RCTs reported that no adverse effects had occurred (which I find hard to believe since reliable data show that about 50% of patients experience adverse effects after consulting a chiropractor). Complete information on incidence, severity, duration, frequency and method of reporting of adverse effects was included in only one RCT. Conflicts of interests were not mentioned by the majority of authors. Our conclusion was that adverse effects are poorly reported in recent RCTs of chiropractic manipulations.

The new paper suggests that the situation has improved a little, yet it is still wholly unacceptable. To conduct a clinical trial and fail to mention adverse effects is not, as the authors of the new article suggest, against current guidelines; it is a clear and flagrant violation of medical ethics. I blame the authors of such papers, the reviewers and the journal editors for behaving dishonourably and urge them to get their act together.

The effects of such non-reporting are obvious: anyone looking at the evidence (for instance via systematic reviews) will get a false-positive impression of the safety of SMT. Consequently, chiropractors are able to claim that very few adverse effects have been reported in the literature, therefore our hallmark therapy SMT is demonstrably safe. Those who claim otherwise are quite simply alarmist.

A recent post discussed a ‘STATE OF THE ART REVIEW’ from the BMJ. When I wrote it, I did not know that there was more to come. It seems that the BMJ is planning an entire series on the state of the art of BS! The new paper certainly looks like it:

Headaches, including primary headaches such as migraine and tension-type headache, are a common clinical problem. Complementary and integrative medicine (CIM), formerly known as complementary and alternative medicine (CAM), uses evidence informed modalities to assist in the health and healing of patients. CIM commonly includes the use of nutrition, movement practices, manual therapy, traditional Chinese medicine, and mind-body strategies. This review summarizes the literature on the use of CIM for primary headache and is based on five meta-analyses, seven systematic reviews, and 34 randomized controlled trials (RCTs). The overall quality of the evidence for CIM in headache management is generally low and occasionally moderate. Available evidence suggests that traditional Chinese medicine including acupuncture, massage, yoga, biofeedback, and meditation have a positive effect on migraine and tension headaches. Spinal manipulation, chiropractic care, some supplements and botanicals, diet alteration, and hydrotherapy may also be beneficial in migraine headache. CIM has not been studied or it is not effective for cluster headache. Further research is needed to determine the most effective role for CIM in patients with headache.

My BS-detector struggled with the following statements:

  • integrative medicine (CIM), formerly known as complementary and alternative medicine (CAM) – the fact that CIM is a nonsensical new term has been already mentioned in the previous post;
  • evidence informed modalities – another new term! evidence-BASED would be too much? because it would require using standards that do not apply to CIM? double standards promoted by the BMJ, what next?
  • CIM commonly includes the use of nutrition – yes, so does any healthcare or indeed life!
  • the overall quality of the evidence for CIM in headache management is generally low and occasionally moderate – in this case, no conclusions should be drawn from it (see below);
  • evidence suggests that traditional Chinese medicine including acupuncture, massage, yoga, biofeedback, and meditation have a positive effect on migraine and tension headaches – no, it doesn’t (see above)!
  • further research is needed to determine the most effective role for CIM in patients with headache – this sentence does not even make the slightest sense to me; have the reviewers of this article been asleep?

And this is just the abstract!

The full text provides enough BS to fertilise many acres of farmland!

Moreover, the article is badly researched, cherry-picked, poorly constructed, devoid of critical input, and poorly written. Is there anything good about it? You tell me – I did not find much!

My BS-detector finally broke when we came to the conclusions:

The use of CIM therapies has the potential to empower patients and help them take an active role in their care. Many CIM modalities, including mind-body therapies, are both self selected and self administered after an education period. This, coupled with patients’ increased desire to incorporate integrative medicine, should prompt healthcare providers to consider and discuss its inclusion in the overall management strategy. Low to moderate quality evidence exists for the effectiveness of some CIM therapies in the management of primary headache. The evidence for and use of CIM is continuously changing so healthcare professionals should direct their patients to reliable and updated resources, such as NCCIH.

WHAT IS HAPPENING TO THE BMJ?

IT USED TO BE A GOOD JOURNAL!

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