Nutrition Lecture: The Nutritional Physical
RANDOM NOTES
Johnathan Wright's book Nutritional Healing
look for s/sx of deficiencies and inborn errors of metabolism
quote from Hamish Munro, MD about how nutrition has become subtle science
involving role of nutrition in chronic dz
HTN or pre in 1/2 pop of US: stress, overwt, polypharmacy, suboptimal magnesium
CA: also common, def of vit D, folic acid, too much bisphenol A, pthalates from plastics
James Lind 1st scientist to study nutrit 1756 under vit C in text on scurvy
nutrition as preventative
3mg vit C/day is enough to prevent scurvy
folic to prevent neural tube defects
selenium to prevent cancer
nutrient dosing: frequency helps a lot with maintaining levels
CARDIOVASCULAR
CIMT to check BV thickness
1st atherosclerotic change is thickening, young
placques rare if HDL over 60
heavy metals are particularly damaging to fatty acids in membrames
iron and copper can also act as oxidants if too high
superoxide dismutase needs copper and zinc, those two need to be in balance
too much zinc in old man-->decr HDL, make CV dz worse
if pulse incr dramatically after a food: sensitivity
severe atherosclerosis txd w/ unesterified vit E-->dilation of BVs 1930's research
beta carotene, vit A protective of membranes
lipids with double bonds more susceptible to oxidation
make sure lipid supps not solvent extracted (corn, cottonseed oils, contain hexane)
likes extra virgin olive oil
polyunsaturated fatty acids potential oxidative damaged
vitamin E requirement goes up if you eat a lot of fish
oils, nuts and seeds should be stored in fridge, freezer
SLE-->vegetations on heart valves, chordae tendineae (image)
PHYSICAL
should take about an hour
BLOOD PRESSURE
start w/ BP, 110/70 or lower is good, if over that then concern esp in female
90/60 ideal for females, lower may cause dizziness, look for adrenal pathology
HTN: consider supplementing EFA, Mg, Ca, K, also allergies
Altura MD article on Mg
Decr BP: consider anemia, hypothyroid, hypoadrenal (low DHEA, cort), dehydration, meds
Orthostatic BP: pt lying no talking a few mins then take BP, then stand with arm straight out
if BP drops over 6 pts diastolic consider: anemia, hypoadrenal, dehydration, bedrest, meds
widened pulse pressure: low diastolic high systolic-->Mg def, also muscle spasm, HA
HEART RATE AND RHYTHM
MVP: Mg, L-carnitine def, taurine concentrated in heart muscle
MVP: lax ligs and hypermobile jts: vit C, Manganese, Hawthrone, silica, boron, copper
Cu def esp if hx of aneurisms, family or self
slow rate: hypothyroid, athletic, GH elevated, meds
irreg: K def dt diuretics, dehydration, Mg def, hypoglycemia, allergy
(normal K consumption 2g/day, this is low, paleolithic 6-8g/day)
(supp K too much-->diarrhea)
TACHYCARDIA: Mg, Ca, B-3 def, meds esp: antidepressants, hyperthyroid, pheochromocytoma
B-3 assoc w/ anxiety, paroxysmal tachycardia, also used for quitting smoking, is calming
niacinamide for smoking cessation, sometimes grams required
IHSS-murmur mb related to hypothyroid (TSH over 3)
(idiopathic hypertrophic subaortic stenosis) 15/17 responded w/ thyroid tx
CHEST AUSCULTATION
WHEEZING in lungs: allergy, B6, quercetin, omega 3s (downreg LKs by inhibiting lipoxygenase)
B12, sulfite sensitiviy (molybdenim def), staphage lysate
(B6 in large amounts tx for MSG toxicity)
BARREL CHESTED/SHALLOW BREATHING: emphysema, aspidosperma (botanical), lecithin, vit A
vit E not studied but involved in epithelial health
COUGHING (RALES & RHONCHI): allergies, decr immunity (vit C, A, zinc), flavonoids (reg WBC activity), ginger (fresh or frozen, anti-inflam, stabilize cell memb in addit to flavonoids)
PAIN, COSTOCHONDRAL: vit E topical w/ arnica & hypericum oil
or DMSO (Jeremy Appleton book w/ Stanley Jacobs), get pharmaceutical grade
SKIN
vit A and zinc
assym, border, color, diameter, evolution/enlarging, funny looking
malignant melanoma: susceptible if light skin low vit D
get it checked
acrodermatitis enteropathica, malabsorb zinc, seen on infant buttocks, face
tx: zinc oxide topical, zinc oral may cause nausea, def ubiquitous
zinc rda: 15mg, tx is 90-120mg
tx: additional EFAs, low zinc-->lacks enzyme to move lipids among pathways
inflam bowel-->zinc malabsorb-->skin condition, has higher requirement anyway
triad: hayfever, eczema, asthma
vit C
allergic eczema, acne
scleroderma, dupuytrens contracture, Raynaud's assoc, allergies?, neuro?
rule out "spinal tumor" causing dz
HEAD
DRY HAIR: hypothyroidism (can't mobilize vit A from liver, follicular hyperkeratosis), low EFAs, chlorinated water
HAIR LOSS: generalized parasites, heavy metal or envir toxicity, hypothyroid, chemo, BCP-->consider folate and B6 def, B plex, EFA, B5
PREMATURE GRAY: B5, PABA def
ITCHY skin: CA, parasites, PSC=PolySystemicCandidiasis, EFA def (see high TGs),
Cl in H2O, liver dz, vit K def
DANDRUFF: hypochlorhydria, XS refined CHOs-->yeast, DM, etc; EFA def, antioxidants (selenium topical & oral), B6, Bplex, biotin (selsun blue contains selenium)
NECK
MULTIPLE PIGMENTED SKIN TAGS: blood sugar elevated, syndrome X,
also may find thse around arms, upper back
do glucose insulin tolerance test
CHRONIC LAD: allergies, if local consider dermatitis, envir toxin,
Hodgkins, HIV, CA, parasites
**FACE**
skin tags, multiple and pigmented-->high insulin, sug
chronic LAD: allergies, depressed immunity, local dermatitis, envir toxins, Hodgkins, HIV
SEBORRHEIC DERM (forehead shiny/scaley, yellow/greasy, into brows, nose, cheeks, chest)
Tx: Bplex, PABA, B6 (topical may make worse at first), EFA esp GLA, avoid refined carbs
VERTICAL CREASES @ forehead midline: sign of hx of duodenal ulcers
esp w/ epigastric and L shoulder/scapula pain
check H pylori
ACNE on face and back
think chronic paniculofibrocytis: adhesions between skin & muscle,
trigger: xs methylxanthine, test via skin rolling, warn re pain, jump off table = positive
avoid sugar, eat more leafies, detox,
check for decr BTT (bowel transit time)(capsules w/ charcoal & indican)
urinary indican tells of putrification in bowel
supp zinc, EFA, vit A
adults over 22 consider allergy and hypochlorhydria (Jonathan Wright)
herbal bitters to stim HCl, apple cider vinegar
ROSACEA usudt alcoholism need B1, light tx, vit D
PSORIASIS vit D topical
**NOSE**
SALUTE SIGN: horiz line dt rubbing nose, allergies, sinus, dairy
INTRA NASAL POLYPS: allergies, salycylate sensitivity
DARK CIRCLES UNDER EYES: allergies, kidney
ANOSMIA: zinc def, allergies (eating disorders related to taste/smell def)
Alexander Shous PhD?MD? Diet, Crime and Delinquency
RASH: red butterfly rash (SLE?) consider EFA, antiox, quercetin, allergies
ALLERGIES: GMO soy allergy prevalent, dairy, wheat
**EARS**
DIAGONAL EARLOBE CREASE: 80% correl w/ CV dz (doesn't apply to Amer Indians, Asians)
lack of blood flow to ear-->adhesions-->crease
esp in males
TOPHI: GOUT: incr folate and decr purines in diet
EAR WAX: lots of dark sticky wax, or none with dry/scaly/hyperemic canal indic low EFA
WHITE ON TM: candida? consider yeast antigen test, tx w/ anti-yeast diet
FLUID BEHIND TM: allergies esp dairy, xs sug
MENIERE'S: allergies
TINNITIS: aspirin toxicity, CVD, allergies
**TEETH**
MERCURY AMALGAMS: effect on thyroid, adrenals, CNS, kidneys
evaluate heavy metal burden: do DMPS/DMSA challenge, 6 hr urine collection
replace fillings carefully if MS present
record on chart # of fillings, root canals
TOOTH DECAY
consider poor mineral absorption: low boron, silica, calcium, B6
PDX has soft water-->teeth decay more
avoid simple carbs
consider lead toxicity, Ca can't bind
check for bulemia (1/4 of females 11-14) back of teeth enamel erosions, gum recession
use stevia and B6 topically, xylitol, protective
end of lecture tuesday
PERIODONTAL DZ
GUMS reflect quality of fiber consumed
def Ca, CoQ10, quercetin, antiox esp high dose C, folate and zinc as mouth wash, also IPSAB, crataegus, sanguinaria.
rule out sensitivity to SLS
bruxism
allergies
bulimia
AUTOIMMUNE
mbdt parasites
MINERAL DEF
#1 iron
selenium also
BIRTH CONTROL PILLS
cause B6 and folate def
THYROID DZ
AI and toxic etio
low iodine
CELIAC DZ
low absorption of fat soluble nutrients
ZINC DEF
hangnails
white spots on fingernails
dermatitis
acne (responds to zinc & vit A, and lowering blood sugar)
MAGNESIUM DEF
widened pulse pressure (more than 50 btw sys & dias)
muscle spasms, LBP
headache
Gittelman's syndrome: malabsorb, only get ~20%
ADRENALS
concentrate: vit C, pantothenic, vit E
animals make their own vit C, in liver, from glucose, enzyme: ?
(except bats, gorillas, chimps, us) to the tune of 3-4g/day
Roger Williams, Biochemical Individuality discovered B5 panthothenic acid (tx allergy)
HYPO consider supp: vit c, B5, E, adrenal extract, DHEA, serophos, licorice, Dioscorea, hydrocortisone
ANEMIA
consider supp: B-12, folate,
iron (microcytic hypochromic), B-6 (microcytic hypochromic),
Cu, B-1 (biotin def may also cause micro-hypo)
further testing: ferritin, soluble transferrin receptors
LITHIUM
5mg to tx depression
also for alcohol recidivism
Oja caliente in NM has lithium in springs
wide ranges of consumption in diff pops
DIABETES TYPE I
mb triggered by gluten sensitivity
hypothyroid -->susceptible to AI
WEEK 3
EARS CTD
TM-white matter mb yeast
fluid behind TM: allergies, esp diary, xs sugar
Meniere's: allergies
tinnitis: aspirin toxicity, CVD, allergies
SKIN
too much sugar
MOUTH
teeth: many Hg fillings: thyroid, CNS
tooth decay: poor mineral abs, low boron, silica, Ca, B6, tx: avoid sug, consider Pb
this stuff seems repeated...
angular chelilits: B vits esp B2 riboflavin but usu severeal
TONGUE
glossitis: def spleen chi, poor digestion, def in Fe, B12, folate, zinc,
geographic tongue: allergies, B vits
pale: if lower conjunctiva also pale consider Fe def
swollen tongue with teeth marks: def spleen qi, poor digestion and allergies
white patches inner cheek: leukoplakia, if yeast check fasting sug, CHO intake, yeast immune complexes, immune system, hx of abx
(artificially elevated ferritin: infx, inflam, chronic colds, flu, IBS, UC)
EYES
dark circles: allergic shiners, consider avoiding milk. quercetin, vit C rose hips, cromolyn
(nasochrom is chromolyn for your nose)
blepharitis: think allergies (dry flaky skin?), EFA def, shower water chlorine swimming pool
conjunctivitis: inflam rxn consider anti-ox and lube for eyes. similisan, vit A and C drops (compounded at pharmacy or herb pharm product with eye bright), vit A, cromolyn
xanthomas: may indic incr TGs, metabolic syndrome
retinal hemorrhages: think DM or preDM, tx with flavonoids esp purple (maki berry, blueberries), vit C, antiox, bilberry extract
(correl between 9lb+ babies and DM)
(for kids mix quercetin with vanilla extract, the alcohol solublizes it)
floaters: def blood of vit K (def in most), vit C, Iodine, bioflavonoids
(with coumadin give vit K and check INR and balance the two)
(young pt with excessive clotting: test INR, ESR, CRP, ferritin & %sat, fibrinogen, HCT, mbdt CA or liver dysfx)
cataracts: blood sugar elevated, sorbitol buildup, block aldose reductase with quercetin
glaucoma: tx riboflavin, vit c high dose
denies' lines: allergies
pupillary light reflex: if can't hold pupil fixed-->weak adrenals, check ASI, orthostatic BP
dry eyes: see in those who've had chemo & radiation, need more vit A? give A & similisan drops, or A & C, and A oral
NAILS
flat angle and spooning: Fe def
soft poor growth: multiple mineral def usudt hypochlorhydria
cuticle inflam: Zinc def (also eczema, anosmia
brittle nails: hypothyroid or decr HCL or prot or mineral def
acrodynia = red tips w/ abn nail growth: advanced/chronic Hg tox (neuro sx), scleroderma-->adhesions
ridging: infx? decr mineral absorption, decr HCl, psoriasis, candida
(more useful than HGBA1C is glycomark test: eval sugar spikes instead of steady state)
(Raynauds mbdt heavy metals)
splinter hemorrhage: infective endocarditis (think zinc & vit A)
(ZINC def classic presentation: pale fingers rosy nail beds poor nail growth)
psoriasis: topical vit D donnitol (see oil drop discoloration, distal onychol.., pitting)
SKIN
dry: EFAs, hypothyroid, vit A def, too much soap, chlorine
follicular hyperkeratosis: bumps at follicles on back of arm, anterior thigh, buttock; mbdt hypothyroid, vit A, EFA, Zinc, hep, malabsorption TX; Panc enzymes (lipase), bile salts (standard process product: cholechol)
((high TGs can sequester vit D, shows lower than it is, if drawing your own sample, collect in non gel tube or spin down and separate immediately, gel sequesters D as well))
Dermatographism: high levels of sensitized mast cells, atopy (systemic)
Pruritis, generalized: hypothyroid, CA, parasites, Vit A toxicity (50,000 units usu well tolerated, if getting preg tops at 20,000, many docs won't go over 10,0000, vit A protective vs neural tube defects, retinol consumption combo with liver dz, alc, hep, NASH-ultrasound look for fatty infilt), allergies, chlorine, vit K def (for CA or def), heavy metals, test inflam markers (ferritin, %sat), look for skin dryness, ask for GI sx
Acrodermatitis: black currant oil, zinc topical
Lichen planus: EFAs, if high TGS use omega 3 (flax, walnuts, pumpkin, plankton, krill), zinc
Thickened skin on hypothenar evidence in scandinavians: dupuytren's contracture, tx: vit E, DMSO to drive topical in
Hypertrophy of skin: psoriasis, abn gut flora, polyamines w/ flora imbalance, tx: nutrients to stabilize production of cGMP: p53 in book biochem diagram polyamines inhib leukotriene formation, vit D topical, UV light
Slow wound healing: DM, def of vit A, C, zinc, EFA
Tinea: blood sug?, r/o candida, check GI, versicolor-->hypopig, tx w/ topical yogurt, selenium, selsun blue shampoo
Easy bruising: vit C, bioflavonoids, vit E, warfarin, coumadin (want vit K)
scorbutic = scurvy related
Callous (hell): tinea, supp A, E, EFA
Numb/Ting: r/o DM, B12 def, B6 toxicity or def
Skin sensitivity to rolling: paniculofibrositis esp if chronic HA, back pn jaw pn, TX: B6, bromelain (lg dose for breaking up adhesions, use potency not mg to measure dose: gelatin dissolving units GDU more potent than milk clotting units on older labels, 1.5MCU=1GDU, give bromelain on empty stomach for absorption when useing for fibrinolytic, he uses highest potency over 3,000GDA), curcumin, boswelia, skin roll, acupx, plum blossom, avoid allergies esp coffee, methylxanthenes
HANDS
Eczema
Sore btw fingers: sugar
Dupuytren's contrax: vit E 1600-2000IU/day for long time, topical arnical oil w/ DMSO & vit E
ULNAR deviation: consider RA, avoid grass family, gluten or all grains. consider parasites (dientamoeba fragilis, low toxicity but cause AI), omega 3s, boswellia, curcumin, bromelain, zinc, Cu salycylate (protects vs stomach ulcer but pricey, nonscrip, very anti-inflam, Cu in SOD)(lg doses of zinc & cu)
Heberden's nodes: distal phalanges, osteoarth,
Hypothenar atrophy: RA?
Carpal Tunnel Synd: if Phalen sign + consider lg dose up to 3000mg/day of B6, bromelain, acupx, homeopathic rhus, ginger, tumeric
((enzyme EGOT erythrocyte glutamic oxaloacetic transaminase induced by vit B6, measure enzyme activity to note B6 def or sufficiency))
MUSCULOSKELETAL
HEADACHES chronic: consider B6, bromelain, mag (time release) arnica oil, B6, avoid all methylxanthines
ARTHRITIS: consider allergies, nightshade/grain avoidance x6wks, take zinc (cures RA?? up to 150mg lg dose, worry about Cu and nausea, if low Cu then HDL goes down), B6, glucosamine sulfate, Cu, boron, B3, arthrivite Gold (a formula with lots of those, bright yellow dt curcumin, if using curcumin/tumeric/blkpep in cooking, sautee in oil)
OSTEOPorosis: test BMD, grains, incr pH, supp Ca, Mg, boron, vit K, ipriflavone, multi w/ K boron, trace mins
BURSITIS, tendonitis: decr arachidonic acid in diet (less animal), consider short fast, bromelain, curcumin, DMSO topical, B12 shots, for sciatica add B1 to B12 (use bplex daily x3-4 days to get relief of sciatica)
ABDOMINAL
ask if pts needs to urinate, when last ate, palpate least sensitive first
light palp 1st, watch face
HIATAL hernia syndrome: tenderness L of xiphoid and 4th intercostal interspace at mid-axillary line, mb assoc w/ heartburn, chronic fatigue, indigestion, tx: he pulls stomach down, can tell you've got it if pt feels in esophagus
MURPHY SIGN if pos consider GB of liver pathol: usu food allergies for gall not stone (onions, eggs, pork, dairy, fowl), liver flush (beware), decr fats, further eval LV fx, cytochrome p448, p450, salicylate clearance test (genova labs)
nutmeg liver in chronic passive congestion
TENDER COLON consider yeast, irrit, diverticulosis/itis, colitis, sluggish bowel, Ca esp w/ occult blood
IBS is usu inadequate fiber, goal 35-50gm fiber/day
r/o celiac w/ endomyseal AB test, but he uses genetic testing for HLA dt good price
GASTRITIS: alco, drugs, stress, infx
UROGENITAL
ABN PAP: consider B6, folate, beta carotene, painting carotenoid on cx, suppository with vit A absorbed better than carotene
(folate is #1 def overall)
Chronic UTI: yeast, sugar high
PROSTATE exam: determine size, if enlarged consider EFA esp omega 3 (flax, pumpkin, walnut, krill, fish), zinc blocks T-->DHT conversion (also saw palmetto, must use lots), vit A, tripeptide of aa's: glycine, lysine, alanine, can check PSA esp if FHx and if hard w/ masses, ask re long bike ride day before, anal sex, prost massage; enlarged prostate-->high PSA w/o CA, avoid bx and monitor PSA, no need to bx if stays same or goes down. Get measurements from urologist. If low flow, urine stagnation, his dad was retaining 2qts urine with few sx, had a turp with good results, on flomax, monitor BUN/creat
next week Dr Michael Gregor
fish assoc w/ certain CA: beware of fatty fish intake
prolotherapy induces local inflam-->healing
avoid imaging; "you're gonna need your whole body replaced"
he likes sky mall mag for medical stuff
pre-DM: skin mottling dt glycosylation esp in lower legs, topical zinc oxide to hydrate skin
DM: glycosylation around lesion-->small capillaries damaged-->poor wound healing, ck: fibrinogen if 400-500 needs lowering, look for chronic inflam, CRP, in IV add: zinc, A, C esp, Mg dilates BVs, other tx: EFAs, heat sensation after IV magnesium, DM pts may not feel anything with 1st few tx, need 3-4 gms Mg, when start feeling they feel it down to groin, then later reaches legs, another DM pt morbidly obese no feeling below knees 10.5 yrs, 6 tx iv nutrients-->felt lower legs, pain, was happy to have return of sensation even pain
Hypothyroid: eliminate toxins esp Hg, Uranium, supp iodine, tyrosine, zinc, selenium, protomorphogens (extracts without hormones), check for autoimmune, Fhx, gluten intolerance
Schizo pt: EPA lg doses, usu have more DHA already
metenex: folic, methy B12, pyridoxine for peripheral neuropathy