“Ironically, in many of our most iron and ferritin deficient patients, we also find elevated levels of hsCRP. This makes the case that investigating the causal link between inflammation and iron deficiency holds to thrombosis. Another frequent clinical observation is that infectious titers with EBV, CMV, HHV6, Mycoplasma and Chlamydia pneumoniae species are often elevated in the presence of severe iron deficiency [anemia]. These organisms are known to contribute to coagulopathies and blood vessel and heart disease. Low stomach acid/digestive function is also frequently finding in patients who are low on iron. The astute clinician should investigate patients dietary intake of iron rich foods, the digestive process and through testing other minerals, assess if absorption is affected. Zinc and magnesium deficiency frequently accompanies iron deficiency in our patient population, significantly affecting energy production and stamina, stomach acid production and immune function amongst many other important core functions. We recommend testing to understand the whole causal picture as best we can construct it.”
Next step is determining if treating iron deficiency wards off dangerous clots
By Robert Preidt
Low levels of iron in the blood are associated with an increased risk of dangerous blood clots that form in a vein, according to the results of a new study that included patients with an inherited blood vessel disease.
The findings suggest that treating iron deficiency may help prevent the condition known as deep vein thrombosis (DVT), according to the researchers at Imperial College London in England.
DVT typically occurs in the legs and can cause pain and swelling, and can be fatal if a blood clot dislodges and travels into the blood vessels of the lungs. Major surgery, immobility and cancer are recognized risk factors for blood clots, but there is no clear cause in many cases.
The new study included 609 patients with hereditary hemorrhagic telangiectasia (HHT), a genetic disease of the blood vessels that causes excessive bleeding from the nose and gut. Many HHT patients have low iron levels due to the loss of iron through bleeding.
Patients in the study with low iron levels were at increased risk for blood clots, but those who took iron supplements did not have a higher risk. This suggests that treating iron deficiency may help prevent DVT in the general population, the researchers said in a news release from the college.
“Our study shows that in people with HHT, low levels of iron in the blood is a potentially treatable risk factor for blood clots,” lead author Dr. Claire Shovlin, from the National Heart and Lung Institute at Imperial College London and an honorary consultant at Imperial College Healthcare NHS Trust, said in the news release.
“There are small studies in the general population which would support these findings, but more studies are needed to confirm this. If the finding does apply to the general population, it would have important implications in almost every area of medicine,” Shovlin added.
The study is published in the Dec. 14 issue of the journal Thorax.
About one billion people worldwide are believed to have iron deficiency anemia, according to the researchers.
Imperial College London, news release, Dec. 14, 2011
“This is a very good article describing the importance of diagnosing apnea and correcting it through appropriate interventions by a sleep specialist. Airway devices are sometimes helpful for the very mild forms of apnea, though we’ve seen incredible improvements in our Fibromyalgia Syndrome FMS and Chronic Fatigue Immune Dysfunction Syndrome CFIDS patients after Obstructive Sleep Apnea OSA has been appropriately been diagnosed and corrected.
We’ve seen in practice, as the study below indicates, that energy levels, concentration, sense of well being, blood pressure, weight and body composition improves after appropriate correction of OSA. The opposite is also true, in patients that did not have their sleep apnea corrected, treatments for their chronic degenerative conditions were not as effective as patients who experienced restorative sleep with adequate oxygenation.”
CPAP During Sleep Improved Blood Pressure, Cholesterol, Blood Sugar, Waist Size
Along with helping people with obstructive sleep apnea get a better night’s sleep, machines that help keep the airways open during sleep can also help improve the symptoms of metabolic syndrome, according to new research.
Metabolic syndrome is a group of symptoms that indicate a higher risk of heart disease. These symptoms include excess weight, especially in the abdomen, high blood pressure, abnormal cholesterol levels, higher blood sugar levels and insulin resistance. Many people with obstructive sleep apnea also have metabolic syndrome, according to the study.
After three months of continuous positive airway pressure (CPAP) treatment, study participants with obstructive sleep apnea and metabolic syndrome had improvements in their blood pressure, cholesterol, and blood sugar levels. Thirteen percent of those who received the breathing treatment had such significant reductions in their symptoms that they no longer qualified as having metabolic syndrome after three months of therapy.
“Patients with obstructive sleep apnea should be actively screened for metabolic syndrome or constituents of metabolic syndrome, and, in addition to lifestyle modification, weight reduction and dietary modification, [should be given] proper counseling for CPAP use, and a CPAP machine should be used regularly,” said the study’s lead author, Dr. Surendra Sharma, a professor and head of the department of internal medicine at the All India Institute of Medical Sciences in New Delhi, India.
Results of the study are published in the Dec. 15 issue of the New England Journal of Medicine. Funding for the study was provided by a grant from Pfizer. Sharma said that Pfizer does not produce CPAP machines, and they were not involved in the study’s design, implementation or interpretation.
Obstructive sleep apnea occurs when the airways close during sleep, causing a lack of oxygen that startles the person awake momentarily, though they may not be aware of awakening. This can happen several times to 100 times an hour, according to the U.S. National Heart, Lung, and Blood Institute.
The current study included 86 adults between the ages of 30 and 65. All had obstructive sleep apnea, but none was being treated with CPAP. Eighty-seven percent also had metabolic syndrome.
The study volunteers were randomly assigned to receive CPAP or sham CPAP treatment for three months. CPAP treatment involves wearing a face mask during sleep that continuously delivers air into the airway so it remains open. The sham CPAP had modifications to reduce the airflow, and the mask used had tiny holes that allowed extra air to escape. The modifications were done in such a way that even the researchers couldn’t tell who was receiving standard CPAP and who received the sham treatment.
After three months, the study volunteers went one month without treatment, and then switched groups for another three months of therapy with the opposite treatment.
Compared to the sham treatment, people treated with CPAP had an overall drop of 3.9 mm Hg systolic (the top number) blood pressure and 2.5 mm Hg diastolic blood pressure. Total cholesterol levels went down 13.3 milligrams per deciliter (mg/dL), and LDL cholesterol, the bad type, dropped by 9.6 mg/dL in the treatment group. Levels of triglyceride, another important and potentially harmful blood fat, went down by 18.7 mg/dL in those who received treatment, according to the study.
Blood sugar levels went down slightly, as did waist circumference, according to the study.
Eleven patients (13 percent) no longer qualified as having metabolic syndrome after receiving CPAP, compared with just 1 percent receiving sham CPAP.
Sharma said these positive effects likely come from the restoration of normal oxygen levels. When the body becomes oxygen-deprived in obstructive sleep apnea, it causes the body to become distressed, which causes the release of hormones that can cause cell damage that may lead to metabolic syndrome, according to Sharma.
“This study adds to the growing body of knowledge that obstructive sleep apnea has long-term consequences for your health, and that treatment reverses some of those consequences,” said Dr. David Rapoport, an associate professor of medicine and director of the Sleep Disorders Program at NYU Langone Medical Center in New York City.
Rapoport said it wasn’t clear from this study if any of the benefits seen came solely from weight loss in those on CPAP and weight gain for those on sham treatment.
“This study is thought-provoking and could be really wonderful news that using a breathing machine could have all of these beneficial effects. But, ultimately, we’d want to see clinical end points, such as the incidence of cardiovascular deaths, in order to know if an intervention is appropriate and helpful,” said Dr. Tara Narula, a cardiologist at Lenox Hill Hospital in New York City.
Surendra K. Sharma, M.D., Ph.D., professor, and head, internal medicine, All India Institute of Medical Sciences, New Delhi, India; David Rapoport, M.D., associate professor of medicine, and director, Sleep Disorders Program, NYU Langone Medical Center, New York City; Tara Narula, M.D., cardiologist, Lenox Hill Hospital, New York City; Dec. 15, 2011, New England Journal of Medicine
All medications come with side effects, some minor and others extreme. In cases of advanced disease, high-risk infections and other extreme health conditions, the benefits of medication greatly outweigh the side effects. For others, the medications are used largely as a form of preventative medicine, and the potential side effects may not be a worthwhile risk.
Especially in our elderly population, overprescription is common, and fewer medications may improve quality of life and prevent hospitalizations. A study on the USA’s geriatric population (New England Journal of Medicine) published earlier this year found that over 99,000 medication-related emergency hospitalizations occurred between 2007 and 2009. Four common drug prescriptions were responsible for 67 percent of these emergencies:
Oral antiplatelet agents
Oral hypoglycemic agents
Of these four medication classes, none are considered “high-risk.” In fact, only 1.2 percent of the hospitalizations mentioned above were due to high-risk medications.
Why is this significant?
Firstly, because medications perceived as lower-risk are more likely to be prescribed, and to be used for disease prevention. This study shows that such forms of “prevention” are more likely to be life-threatening to our elderly population than expected.
Secondly, because the four medication classes addressed in this study are often used for diseases (Diabetes Type II, Coronary Artery Disease) that are preventable through natural medicine, and manageable with integrated care that requires fewer prescriptions.
The key to reducing hospitalizations due to adverse drug reactions is to reduce the need for such drugs. This can be done safely and effectively through natural and integrative medicine.
Dr. Kaley Bourgeois
Daniel S. Budnitz, MD, et al. Emergency Hospitalizations for Adverse Drug Events in Older Americans. N Engl J Med. 2011 Nov 24;365(21):2002-12