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Written by Mark R. Payne, DC
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Saturday, 25 May 2013 15:04 |
M ost of us who have been in practice for a while would probably prefer to think that our accumulated experience must be of some benefit to our patients. Personally, I prefer a bit of experience in some professions... airline pilots for example (I just feel better when I see a gray haired, "Captain Sully" type in the cockpit!). But as you'll see, experience may not always be the best teacher when it comes to the practice of medicine. This month's column recaps our review of a 2011 article which sought to determine how physician experience might impact patient outcomes within a hospital setting. And while we don't have a comparable study that applies specifically to chiropractic, this study should provide food for thought, especially for those of us who have been in practice for a while. Thanks to our chiropractic sciences contributor Roger Coleman, DC (Othello, WA) for this interesting article. I hope you find it helpful.
The Study: Longer lengths of stay and higher risk of mortality among inpatients of physicians with more years in practice
The Facts:
- It has been reported that physicians who have more years in practice do not adhere as closely to established practice guidelines.
- The authors sought to determine if the number of years a physician had practiced was associated with any differences in patient outcomes.
- They looked at 59 physicians and 6,572 patient admissions.
- Physicians were divided into 4 groups.
- The groups were composed of physicians who had practiced 0-5, 6-10, 11-20 and over 20 years.
- Patients who were treated by each group of physicians tended to be rather similar.
- The length of hospital stay for patients was shortest for physicians with 0-5 years of practice experience at 4.77 days. The 6-10 years of practice physician group averaged 5.29 days of patient stay. Doctors with 11-20 years of practice averaged 5.42 days of patient stay while those with over 20 years of practice averaged slightly less at 5.31 days of patient stay.
- However, both "in hospital" mortality and the mortality within 30 days of discharge was highest among patients treated by physicians having 20+ years of practice experience.
Take Home:
Years of practice time may not equate to better outcomes. Regardless of experience, everyone needs to adhere to best standards of practice.
...encouragement for providers, such as yourself, who are making the effort to stay up to date with the scientific literature.
Reviewer's Comments:
I was surprised because I thought more experience would result in better outcomes. This may come as a wakeup call to keep providers on their toes and motivate them to stay up-to-date throughout their career. This would also seem to be an encouragement for providers, such as yourself, who are making the effort to stay up-to-date with the scientific literature.
Reviewer:
Roger Coleman, DC
Reference:
Southern WN, Bellin EY, Arnsten JH. Longer lengths of stay and higher risk of mortality among inpatients of physicians with more years in practice. Am J Med. 2011 Sep;124(9):868-74.
Link to Abstract:
Dr. Mark R Payne, Phenix City, AL is Editor of ScienceInBrief.com, a scientific literature review for busy chiropractors. He is also President of Matlin Mfg Inc. a manufacturer of postural rehabilitation products since 1988. Subscription to ScienceInBrief.com is FREE to doctors of chiropractic and chiropractic students. Reviews of relevant scientific articles are emailed weekly to subscribers.
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Written by Ronald Grisanti, DC, D.A.B.C.O., D.A.C.B.N., MS
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Saturday, 25 May 2013 14:29 |
F unctional Medicine is patient-centered medical healing at its best. Instead of looking at and treating health problems as isolated diseases, it treats individuals who may have bodily symptoms, imbalances, and dysfunctions.
 As the following graphic of an iceberg shows, a named disease such as diabetes, cancer, or fibromyalgia might be visible above the surface, but according to Functional Medicine, the cause lies in the altered physiology below the surface. Usually, the cause of the disease and its symptoms is an underlying dysfunction or an imbalance of bodily systems.
Named diseases are just the tip of the iceberg. Below the surface, according to Functional Medicine, are the real causes of a patient's health problems.
If health care treats just the tip of the iceberg, it rarely leads to long-term relief and vibrancy. Identifying and treating the underlying root cause or causes, as Functional Medicine does, has a much better chance to successfully resolve a patient's health challenge.
Using scientific principles, advanced diagnostic testing, and treatments other than drugs or surgery, Functional Medicine restores balance in the body's primary physiological processes. The goal is the patient's lifelong optimal health.
How Functional Medicine Heals a Key Health Care Gap
Today's health care system is in trouble because it applies a medical management model that works well for acute health problems to chronic health problems, where it is much less successful.
If you have a heart attack, accident, or sudden lung infection such as pneumonia, you certainly want a quick-thinking doctor to use all the quick-acting resources of modern medicine, such as life-saving technology, surgery, and antibiotics. We are all grateful for such interventions.
However, jumping in with drugs, surgery, and other acute care treatments often does not succeed in helping those with chronic, debilitating ailments, such as diabetes, heart disease, or arthritis. Another approach is needed.
The Two-Pronged Healing Approach of Functional Medicine
To battle chronic health conditions, Functional Medicine uses two scientifically grounded principles:
- Add what's lacking in the body to nudge its physiology back to a state of optimal functioning.
- Remove anything that impedes the body from moving toward this optimal state of physiology.
Plainly put, your body naturally wants to be healthy. However, the body may be missing things needed to function at its best, or something might be standing in the way of its optimal functioning. Functional Medicine first identifies the factors responsible for the malfunctioning. Then it deals with those factors in a way appropriate to the patient's particular situation.
Functional Medicine practitioners often use advanced laboratory testing to identify the root cause or causes of the patient's health problem. Old-fashioned medical diagnosis helps too, in the form of listening carefully to the patient's history of symptoms and asking questions about his or her activities and lifestyle.
For treatment, Functional Medicine practitioners use a combination of natural agents (supplements, herbs, nutraceuticals, and homeopathics), nutritional and lifestyle changes, spiritual/emotional counseling, and pharmaceuticals, if necessary to prod a patient's physiology back to an optimal state. In addition, educating patients about their conditions empowers them to take charge of their own health, ultimately leading to greater success in treatment.
Treating Symptoms Versus Treating the Person
In the dominant health care model today, medication is used to get rid of people's symptoms. If the patient stops taking the medication, symptoms generally return.
Functional Medicine approaches health problems differently. Instead of masking the problem, it aims at restoring the body's natural functioning. Although Functional Medicine practitioners may prescribe pharmaceuticals, they use medications to gently nudge the patient's physiology in a positive direction so the patient will no longer need them.
Another important saying by Osler is: "If you listen carefully to the patient, they will tell you the diagnosis."
For example, conventional doctors would normally prescribe pharmaceuticals like Prilosec, Prevacid, or Aciphex to treat acid reflux or heartburn. When the patient stops taking such drugs, the heartburn symptoms come back. In contrast, a Functional Medicine practitioner might find that a patient's acid reflux is caused by Helicobacter pylori bacteria. Eradicating the Helicobacter pylori might very well lead to the end of heartburn symptoms, permanently.
It's also important to note that in Functional Medicine treatment for similar symptoms might vary tremendously for different patients, according to their medical histories and results of laboratory tests. Factors that can come into play in producing the same symptoms include toxic chemicals, pathogenic bacteria, parasites, chronic viral pathogens, emotional poisons like anger, greed or envy, and structural factors such as tumors or cysts.
The Roots of Functional Medicine
You may be surprised to learn that the concept of Functional Medicine isn't new. It actually represents a return to the roots of modern scientific medicine, captured in this statement by Sir William Osler, one of the first professors at Johns Hopkins University School of Medicine and later its Physician-in-Chief: "The good physician treats the disease; the great physician treats the patient who has the disease."
Another important saying by Osler is: "If you listen carefully to the patient, they will tell you the diagnosis." This encapsulates the importance that Functional Medicine places on taking a thorough history from the patient.
Your Experience of Functional Medicine
When you consult a Functional Medicine practitioner, the first step is always your history. Practitioners are trained on how to unravel and make sense of a complicated story. Often clues in the story lead to the identification of key imbalances.
The next set of clues comes from a comprehensive physical examination, which includes many nearly forgotten examination procedures used by famous diagnosticians (both living and long gone), such as chapman reflex points, ankle brachial reflex, and nail inspection.
The final set of clues comes from advanced laboratory testing. Innovative, cutting-edge lab tests help the practitioner look deeply into a patient's physiology to identify how it has been compromised and how physiological balance can be restored.
After diagnosis and treatment, a Functional Medicine patient can expect his or her symptoms to diminish in severity, along with a renewed sense of well-being and significant increase in health and vitality.
A Functional Medicine Sampler of Case Studies
CASE 1: Sinus Infections and Allergies
Traditional Medical Approach:
The patient was an adult male with a chief complaint of sinus infections and allergies for a period of six years. He had previously consulted with three medical physicians. Medical testing included a CT scan of the sinuses, which was negative for any pathology. Treatment consisted of the following prescriptions: Sudafed, Claritin-D, and Allegra. Results were poor.
Functional Medical Approach:
Based on an extensive history and review of his medical records, Dr. Grisanti ordered an Airborne Allergy test and food sensitivity test. The results revealed that the patient was highly allergic to Aspergillus fumigatus and Alternaria alternata molds. Dr. Grisanti instructed the patient in how to identify molds in his residence and at work and what steps to take to eliminate them. The patient was prescribed a natural pharmaceutical that increases his immune system's defense against molds and fungi.
After three weeks, the patient was completely free of symptoms and has remained that way for the past two years.
CASE 2: Irritable Bowel Syndrome and Fatigue
Traditional Medical Approach:
The patient was a 27-year-old female with an 11-year history of irritable bowel syndrome and fatigue. She had previously consulted with four medical physicians before scheduling an appointment with Dr. Grisanti.
Medical testing included an upper and lower GI study and colonoscopy, all of which were found to be negative for any pathologies. Treatment consisted of the prescription Hyoscyamine. Results were poor.
Functional Medical Approach:
Based on an extensive history and review of her medical records, Dr. Grisanti ordered a Digestive Stool Test and Allergy Blood Test. Two bacterial pathogens were found to be infecting her intestines: Pseudomonas aeruginosa and Citrobacter freundii. The medical literature clearly linked these two pathogens to diarrhea disease. In addition, her allergy test revealed a significant sensitivity to gluten and rice. The patient was prescribed a natural pharmaceutical that helped eradicate the two bacterial pathogens and was placed on an elimination diet addressing the rice and gluten.
After one month, she was symptom-free.
CASE 3: Menopausal Symptoms
Traditional Medical Approach:
The patient was a 61-year-old female with menopausal symptoms, including hot flashes, decreased libido, and weight gain over a period of five years. The patient had previously consulted with one medical physician, who performed no medical testing. Treatment consisted of the prescription Estrace.
Results were fair, but the patient was concerned about the drug's potential side effects.
Functional Medical Approach:
Based on an extensive history and review of the patient's medical records, Dr. Grisanti ordered a Women's Hormonal Panel. The results were quite revealing. Her estrogen/progesterone balance was significantly compromised, with too much estrogen and not enough progesterone. This imbalance was the main cause of the patient's roller-coaster emotional challenges.
After presenting this information to her physician, she was prescribed the proper balance of estrogen and progesterone. The patient eventually went to a compounding pharmacy and had a special formula of estrogen/progesterone made. She became symptom-free and experienced an increase in energy.
In addition, she lost 54 pounds in eight months.
Ronald Grisanti DC, D.A.B.C.O., D.A.C.B.N., MS, is medical director of Functional Medicine University. If interested in improving your diagnostic skills and increasing your community reputation and recognition, we strongly recommend subscribing to our Free Clinical Rounds Series. These challenging case studies will give you the unique opportunity to test your clinical skills and, at the same time, improve your ability to handle many of the most difficult cases. Go to the following link to get your free access: www.ClinicalRounds.com.
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Written by Tedd Koren, DC
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Thursday, 25 April 2013 22:05 |
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"Lions and tigers and bears, oh my!" Dorothy in The Wizard of Oz reminds us that the world is full of many dangers. It’s the same with the body. There are many things that can disconnect us from our inborn perfection and prevent us from functioning at our optimum, thus creating dis-ease.
 D.D. Had It RightD.D. Palmer had it right; three things that ruin our health are toxins, trauma, and thoughts (autosuggestion).
D.D. and B.J. Palmer’s understanding of the subluxation is more profound than most chiropractors originally realized.
Let’s Begin at the Very Beginning (a very nice place to start)
D.D. Palmer acknowledged that spinal adjusting was used in ancient healing systems. For example, in The Chiropractors Adjustor (p. 12):
These axioms, rediscovered and known as Chiropractic, were also known and practiced by Aesculapius and his followers . . . [I took] two Greek words, cheir (hand) and praxis (done by) . . . from which I coined the word Chiropractic.
However, before ancient Greece, there was a land that was ancient to the Greeks, and that land was Egypt. Palmer writes (ibid):
Dr. Atkinson has frequently informed me that the replacing of displaced vertebrae for the relief of human ills had been known and practiced by the ancient Egyptians for at least 3,000 years.
The Cause of Illness
Chiropractic’s connection to ancient Greek and Egyptian healing practices was highlighted in Blessed by Illness by L.F.C. Mees, MD (Anthroposophic Press, 1983, p. 50). Mees reports that the Greeks believed “deformation” caused illness and was treated by “temple sleep, prayers, herbs, laying on of hands, baths, diet, lifestyle.”
The Egyptians (thousands of years earlier) also said “deformation” caused illness and was treated by “temple sleep, prayers, and herbs.”
Deformation
We do not know precisely what these ancient people meant by deformation. However, we do know that a deformed object does not work as well as a properly formed object. This coincides nicely with chiropractic’s relationship between structure and function.
What Does This Have to Do with Subluxations?
Dis-ease is a communication disorder and subluxations result from that dis-ease or communication disorder.
The subluxation is a metaphor for interference, blockage, deformation, distortion, or stagnation (of energies, too much or too little).
Chiropractors Treat the Symptom
B.J. Palmer reinforced this understanding when he said:
Vertebral Subluxation is a symptom of interference of Innate and not a cause. (Palmer BJ. The hour has arrived – lecture. Lyceum, Palmer College, 1931.)
[Thank you to Richard Barwell, DC of Neuroinfiniti for this quote.]
The subluxation is secondary, not primary. The primary problem is lack of or altered communication.
How do We Remove the Subluxation?
Different healing systems use different methods to remove blockages, interferences, and subluxations to reestablish communication:
- Chiropractic
- Homeopathy
- Acupuncture
- Classical osteopathy
- Shiatsu
- Qigong
- Yoga
- Tai chi
Many other systems, both ancient and modern may also reestablish communication. How else could an acupuncturist putting a single needle in the body relieve sciatica? How could a homeopath using a little sugar pellet in water do the same? How else could a qigong master release sciatica without touching the patient? Let’s expand our understanding of chiropractic philosophy, build bridges with other vitalist healing systems, and resist merging with those that do not share our philosophy. Let us not emulate the narrow-mindedness of modern medicine holding fast to discredited mechanistic models of life.
Chiropractic is information healing. B.J. Palmer said it well:
Adjusting a vertebra is what happens when my hands leave the back … My work is an enticement to get innate to make the adjustment. (Palmer BJ. The hour has arrived – lecture. Lyceum, Palmer College, 1931.)
[Thanks again to Dr. Barwell.]
The adjustment is energy/information the body uses to create:
- Connection
- Wholeness
- Healing
- Release
- Integration
- Restoration
- Renewal
Flexibility is a sign of health. Remember, when things don’t fit our theory, we change our theory. Let us heed the words of John Wilmot, Earl of Rochester: “Before I got married I had six theories about bringing up children; now I have six children and no theories.”
Tedd Koren, DC’s years of suffering were a blessing in disguise because they led to the discovery of the Koren Specific Technique (KST), which now helps millions of people achieve greater health and well-being. KST’s protocol of challenge, check, and correct can be easily applied to physical and emotional issues. Practitioners and patients alike say KST gives them “the best adjustment of my life.” To learn more about this healthcare breakthrough visit www.korenspecifictechnique.com or call 800-537-3001 or 267-498-0071.
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Written by Mark R. Payne, DC
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Thursday, 25 April 2013 21:31 |
G reetings and welcome to Science In Brief. This column is an extension of ScienceInBrief.com, our chiropractic literature review service. The Science In Brief project scans the scientific literature base, both past and current, for articles of interest to practicing chiropractors, and then distills each paper’s pertinent points into “plain English” format for busy practitioners. Reviews are delivered weekly to your in-box and there is absolutely no charge to subscribe. The American Chiropractor has graciously allowed us to publish a monthly column to help in our efforts to keep the profession abreast of the latest relevant research. The following is a review of a 2008 article that didn’t get a lot of attention at the time. Thanks to our chiropractic sciences contributor Roger Coleman, DC (Othello, Washington) for this interesting article. I hope you find it and future articles to be helpful.
 Title: Spinal extension exercises prevent natural progression of kyphosis
The Facts:
- The authors sought to determine if spinal extension exercises could prevent the natural progression of thoracic kyphosis in women.
- Kyphosis tends to progress with age and increases are greatest in the 50 to 59 age group.
- The study involved 250 women who did not exhibit either scoliosis or compression fracture of the thoracic spine.
- Participants were prescribed a series of nine extension exercises directed at the middle back, shoulder girdle, neck, and lower back. Participants were to perform the exercises three times weekly and were followed up at one year.
- Participants exhibited less progression of kyphosis than the controls who did not do the exercises.
- The difference in the two groups was “highly significant.”
- Compliance was a problem as they were only able to get 18% of the subjects to perform the exercises regularly.
Take Home:
Although this was only a pilot study, extension exercises appear to be helpful in the prevention of kyphosis progression. More study is needed.
Reviewer's Comments:
Most doctors of chiropractic utilize exercise in their treatment programs, although it is probable that many do not recommend exercises specifically for thoracic kyphosis. This paper should encourage doctors to look more closely at implementing appropriate programs of extension exercises for their patients with thoracic kyphosis.
Reviewer:
Roger Coleman, DC
Reference:
Ball JM, Cagle P, Johnson BE, Lucasey C, Lukert BP. Spinal extension exercises prevent natural progression of kyphosis. Osteoporos Int. 2009;20:481-9. Epub 2008 Jul 26.
Link to Abstract:
The authors point out that more study is needed. Nevertheless, I think the paper has practical application. Patients with kyphosis present in chiropractic offices with great regularity, so the subject is relevant. Also, by chiropractic standards, this wasn’t a particularly small study. Furthermore, the design and conclusions seem fairly straightforward. Best of all, there’s minimal risk and cost associated with the treatment involved. Taken together, I’m very comfortable recommending extension exercise for my patients with kyphotic deformity.
Finally, it’s noteworthy that the authors, who are all faculty members of the Department of Physical Therapy Education, University of Kansas, experienced the same problems with patient compliance that many of us see in practice. This study tells us that, although it can be frustratingly difficult to actually get patients to do their self-care programs, the results for those who do participate are definitely worthwhile.
This column extends out of ScienceInBrief.com, our chiropractic literature review service.
Dr. Mark R Payne, Phenix City, AL is Editor of ScienceInBrief.com, a scientific literature review for busy chiropractors. He is also President of Matlin Mfg Inc. a manufacturer of postural rehabilitation products since 1988. Subscription to ScienceInBrief.com is FREE to doctors of chiropractic and chiropractic students. Reviews of relevant scientific articles are emailed weekly to subscribers.
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Written by James L. Wilson, DC, PhD
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Thursday, 25 April 2013 21:14 |
S tress is one of the largest understated health problems in our country.1 Every chiropractor understands the important role the autonomic nervous system (ANS) plays in stress, and which adjustments enhance sympathetic/parasympathetic balance, decrease nervous tension, and produce relaxation and calm.
However, many may not be as familiar with the function of the hypothalamic-pituitary-adrenal (HPA) axis, which is intimately related to the ANS and influences production of adrenal hormones that regulate stress adaptation. Chronic or excessive stress can overtax the ability of the HPA axis to respond adequately, which results in suboptimal adrenal function (adrenal fatigue). Unlike the relatively rare Addison disease,2 adrenal fatigue is a widespread problem that manifests as a unique circadian energy/fatigue pattern.3 By addressing adrenal fatigue in stressed patients, chiropractic can achieve deeper changes that increase patient well-being, vitality, and the ability to handle stress. In addition, adjustments hold better once the HPA axis and adrenal hormones are balanced.
Begin by listening for the common signs and symptoms of adrenal fatigue:
 Difficulty getting up and being fully awake in the morning, even after a full night’s sleep- Caffeine is often necessary to get going and stay going
- Energy lows occur midmorning and/or midafternoon
- Increased energy from 6 p.m. (dinner) to around 9 p.m. — often feeling the best of the day
- Experience a second wind from 11 p.m. to 2 a.m.
- Most refreshing sleep is from 7 to 9 a.m., given the opportunity to sleep in
- Crave salt or salty foods
- Often also exhibit many signs and symptoms of hypoglycemia due to cortisol’s role in gluconeogenesis
- Difficulty bouncing back from stress or illness
- Decreased sex drive
If these are present, there are three quick clinical tests to confirm suboptimal adrenal function: iris contraction, postural low blood pressure, and Sergent’s white line.4
A positive test result can be followed with lab tests to establish baseline cortisol levels. My preference is the salivary hormone test, which patients can do during their regular daily routines. It measures salivary cortisol levels (more indicative of tissue levels than serum levels5) at four times during the day, usually at 8 a.m., noon, 4 p.m., and bedtime. Many labs can also measure salivary estrogen, progesterone, testosterone, and DHEAS.
Much can be done to help chiropractic patients with adrenal fatigue, even when the severity is so great that they cannot hold down jobs or function well in daily life. The core of effective treatment is a combination of lifestyle and dietary modifications plus specific dietary supplements designed for adrenal fatigue. Spinal adjustments that release tension are helpful and about 25% of patients with adrenal fatigue have fixations at T-11 through L-2 motor units. Diathermy with the heads placed over the adrenals can also aid adrenal function.
Lifestyle recommendations include minimizing sources of stress, one or two brief rests during low-energy times of day (preferably lying down), sleeping in until 9 a.m. whenever possible, eating at regular intervals, and engaging in enjoyable, revitalizing activities. Dietary choices are important with emphasis on easily digestible protein, unrefined carbohydrates, and good quality fats or oils in every meal and snack, plus five to six servings of fresh vegetables daily. Frequent small meals help avoid getting too hungry and help keep blood sugar levels more normal. It is also important to eat by 10 a.m. and again before noon. Patients should avoid caffeine, alcohol, sugar and white flour. Ask your patients to read Adrenal Fatigue: The 21st Century Stress Syndrome and it will save you time by answering their questions and providing detailed lifestyle and dietary information to aid recovery.
The right dietary supplements are integral to full recovery in all but the mildest cases of adrenal fatigue. Chief among these are glandular extracts. In more than thirty years of professional experience, I have found that a combination of hormone-free, porcine extracts from the adrenals, hypothalamus, pituitary, and gonads works best. This provides the essential building blocks for repair and maintenance of the HPA axis, especially the adrenal glands. Herbs that balance the HPA axis function include ashwagandha,6 maca,7 Eleutherococcus senticosus,8 and licorice.9 They are especially beneficial when taken together, promoting a sense of balance and well-being during the day, and then calm and restful sleep when taken at bedtime. Specific nutrients are essential for normalizing and maintaining adrenal hormone cascade function, including relatively large quantities of niacin, vitamin B6, pantothenic acid, vitamin C, and magnesium, among others.10, 11, 12, 13 Vitamin C should be pH-balanced, to avoid aggravating the physiological acidity that occurs during adrenal fatigue, and sustained release for optimal clinical effect.
During a regular or briefly extended office visit, you can use this protocol to listen for signs and symptoms of adrenal fatigue, assess adrenal function, and start your patient down the road to recovery.
References
- Tangri R. What Stress Costs. http://www.clarityseminars.com/stress_clinical_research.html
- Liotta EA. Addison Disease Jun 7, 2010; http://emedicine.medscape.com/article/1096911-overview
- Wilson JA. Adrenal fatigue: the 21st century stress syndrome. Petaluma: Smart Publications.; 2001. 43p.
- Wilson JA. Adrenal fatigue. the 21st century stress syndrome. Petaluma: Smart Publications; 2001. 82p.
- Riad-Fahmy D, Read GF, Walker RF. Salivary steroid assay for assessing variation in endocrine activity. J Steroid Biochem. 1983;19(1A):265-72.
- Archana R, et al. Antistressor effect of Withania somnifera. J Ethnopharmacol. 1999;64:91-3.
- López-Fando A, Gómez-Serranillos MP, Iglesias I, et al. Lepidium peruvianum chacon restores homeostasis impaired by restraint stress. Phytother Res. 2004 Jun;18(6):471-4.
- Panossian A, Wikman G. Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity. Curr Clin Pharmacol. 2009 Sep;4(3):198-219.
- Al-Dujaili EA, Kenyon CJ, Nicol MR, Mason JI. Liquorice and glycyrrhetinic acid increase DHEA and deoxycorticosterone levels in vivo and in vitro by inhibiting adrenal SULT2A1 activity. Mol Cell Endocrinol. 2010 Dec; 22.
- Patak, P, Willenberg HS, Bornstein SR. Vitamin C is an important cofactor for both adrenal cortex and adrenal medulla. Endocrine Res. 2004 Nov;30(4):871-5.
- Groff JL, Gropper SS, Hunt SM. The water soluble vitamins: Advanced nutrition and human metabolism. Minneapolis: West Publishing Company; 1995. 221-37p.
- Murck H, Steiger A. Mg2+ reduces ACTH secretion and enhances spindle power without changing delta power during sleep in men—possible therapeutic implications. Psychopharmacology (Berl). 1998 Jun;137(3):247-52.
- Yoshida E, Fukuwatari T, Ohtsubo M, Shibata K. High-fat diet lowers the nutritional status indicators of pantothenic acid in weaning rats. Biosci Biotechnol Biochem. 2010;74(8):1691-3. Epub 2010 Aug 7.
For more than thirty-five years, Dr. Wilson has dedicated himself to helping people regain their health and vitality, and to promoting a deeper understanding of the physiology underlying stress. His book, Adrenal Fatigue: The 21st Century Stress Syndrome, is used as a university textbook, and many of the clinical tools he developed to help stressed patients are available at icahealth.com, including his original Adrenal Fatigue Questionnaire.
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