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Ami Kapadia MD Joins Center for Environmental Medicine in Portland, Oregon

By camborw on January 9, 2012

December 1, 2011

Dear Patients and Friends,

We have been blessed over the past several years at the Center for Environmental Medicine with sustained growth with both interesting and challenging patients.  In a greater effort of meeting your health care needs we are expanding our services and availability.  I would like to introduce you to Ami Kapadia, MD who started to work with us at Center for Environmental Medicine this month.  Her training in family medicine has included studying integrative and holistic medicine, including environmental medicine.  Originally from outside of Philadelphia she has been making her way westward over the past few years and is finally settling here in Portland to work here at CEM. 

Her various career experiences have included being on faculty for the Family & Community  Medicine Department at Thomas Jefferson University Hospital, working at inner city clinics, working with Veterans Administration clinics and local urgent care centers here in Oregon.  She also has had the privilege of working with some outstanding integrative medicine practitioners in various settings over the past 7 years.

Dr. Kapadia is excited to be joining Center for Environmental Medicine and looks forward to working with patients who are seeking a more holistic paradigm to address their health.  I believe you will find her passionate about her work in assisting patients get to the root causes of their health problems, and empowering them to make positive changes in their lives.

Her special interests include gastrointestinal/digestive disorders,  detoxification, nutrition, and allergy identification and treatment. Some of the treatment modalities that will be offered include: nutritional therapies, IV therapy, functional medicine laboratory testing,  food & environmental allergy testing and treatment, applied kinesiology testing, and hormone evaluation.

In addition to Dr. Kapadia, we have also partnered with a colon hydrotherapist.  Linda Hallmark, with A Healthy Practice, has been actively participating in Holistic Health since the very early 80′s beginning with Macrobiotics teaching and starting East-West Center in Austin, Texas catering lunch and dinner daily to nearly 225 people.  She began doing colon hydrotherapy approximately 20 years ago.  She uses a Hydrosan closed system, FDA approved, with filtered water and disposable hoses and speculums.  She  is National Board Certified as well  as a member of     I-ACT (International Association for Colon Hydrotherapy).

So, please join us in welcoming Dr. Ami Kapadia and Linda Hallmark to the CEM team.  If someone you know is looking for an integrative physician to work with or someone wishes to add colonics to their program, please pass our contact information along.   We also appreciate your suggestions and feedback on how we can continue to improve the services we offer.

Finally, all the members of CEM extend to you and your family warm wishes for this Holiday Season and a prosperous New Year of increased health and harmony.  We appreciate your continued support and loyalty as well as your own efforts on behalf of your health.

Sincerely,

Chris Hatlestad, MD

The Staff of CEM

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Digestive Disorders Part I

By camborw on January 7, 2012

by  Ami Kapadia, MD

Digestive disorders include Irritable Bowel Syndrome,  GERD, and  Inflammatory Bowel Disorder to name a few.  Where do they come from and why? Infection? Food allergy? Stress?  It seems in recent years, the number of people suffering from gastrointestinal disorders continues to increase.  It is estimated that 20% of the U.S. population (or around 60 million individuals) suffer from irritable bowel syndrome, or IBS, and an additional 1.4 million individuals suffer from inflammatory bowel disorder, or IBD. Another estimated 7 million suffer from GERD, or gastroesopageal reflux disease.

Sometimes the cause of digestive disorders can seem elusive.  While there can be genetic links causing predisposition, there are several environmental factors that may also play a role.  In some individuals there seems to be a link with a previous gastroenteritis (prior intestinal infections such as salmonella, e. coli, etc.).  Previous antibiotic use can also be a risk factor for the development of intestinal symptoms.  For others, the cause of symptoms may be related to food allergy, either along with previous intestinal infections, or as a sole cause.  Another related issue seems to be alteration in gut microflora, or a change in the bacteria and other organisms that make up the intestinal ecosystem.  We call this “dysbiosis.”

In Part I of this series, I would like to focus on dysbiosis and how it can be related to intestinal symptoms.  Dysbiosis is defined as a state of altered microbial ecology that causes or contributes to disease/dysfunction.  Organisms of low intrinsic virulence, such as bacteria, yeast and protozoa/parasites, induce disease or dysfunction by altering the nutrition, neuroendocrine and/or immunologic responses of a person.

There are normally around 100 trillion bacterial cells in the human intestinal tract along with a smaller number of yeast colonies (that are kept in check by the bacteria) that are part of our normal flora. These organisms are vitally important to the development and maintenance of a healthy immune system. Some of their “jobs” include: warding off pathogens, decreasing allergic responses, and helping in the excretion of toxins.  A fact you may not know is that 80% of the body’s immune system is located in the lining of the small intestine—allowing alterations in the intestinal ecology of bacteria and yeast (=dysbiosis) to have far-reaching impacts on our overall immune system function. When the natural microbial balance is disrupted, illness can result.

You may be wondering  what causes dysbiosis? Well, there are many factors.  For one, frequent or prolonged antibiotic use can have long-standing effects on the intestinal ecosystem because antibiotics destroy good bacteria as well as the target infection.  This fact is becoming increasingly well-known, as probiotics are becoming more commonly used as a method to replace the good bacteria in the intestinal tract. Unfortunately, sometimes probiotics are not enough, and further evaluation and treatment is necessary when intestinal symptoms start after frequent/prolonged antibiotic use.

Other medication related causes of dysbiosis can include use of oral steroids, as well as proton-pump inhibitors or acid-blocking medications.  Other infectious causes of dysbiosis involves parasitic infections. While we generally associate parasites with travel abroad, it is possible to pick up a parasite without leaving the country, just by drinking contaminated water or eating contaminated food (at a restaurant, etc.).   Finally, it has been shown that stress in and of itself, can cause imbalances in intestinal flora.

Fortunately, there are ways to detect and treat some of these hidden causes of dysbiosis.  In many instances, digestive symptoms can be greatly alleviated, if not resolved, with some detective work and the appropriate treatment.

Check back for the next part to this series.

Lebowitz, M and Kapadia, A.,  “Body Restoration: An Owners Manual” ; 2011.

Galland, L., “ The Four Pillars of Healing”,  New York: Random House; 1997.

uptodate.com (topics: IBS, IBD)

http://medinfo.ufl.edu/~gec/coa1/gerdfaq.html

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Article Review: HRT Bioidentical or Synthetic?

By camborw on June 12, 2011

Bioidentical Hormone Debate:  Are Bioidentical Hormones Safer or More Efficacious Than Commonly Used Synthetic Versions in HRT?

Source: Abstract from Postgraduate Medicine, Volume 121, Issue 1, January 2009, ISSN-0032-5481, e-ISSN-1941-9260

Author : Kent Holtorf, MD,  Holtorf Medical Group, Inc,  Torrance, Ca.

Due to the ongoing debate regarding safety and efficacy of bioidentical hormones (estradiol, estriol, and progesterone), this paper aimed at evaluating evidence comparing the same to commonly used  synthetic hormones and HRT.  Utilizing published papers identified from PubMed/MEDLINE, Google Scholar and Cochrane databases, evidence was collected regarding compared effects for physiologic actions on breast tissue, risks for breast cancer and cardiovascular disease, clinical outcomes and in vitro results.

Reported was patient satisfaction with HRT that contained progesterone compared to synthetic progestin.  Bioidentical hormones have “distinctly different, potentially opposite, physiological effects compared to synthetic counterparts, which have different chemical structures.”   While research indicated increased risk for synthetic progestin, conversely, progesterone consistantly is associated with diminished risk for breast cancer. Four articles were cited for progestin and seven articles for progesterone.   Regarding cardiovascular disease, progestins carry a variety of negative effects which may be avoided with progesterone.  Estriol has some unique physiological characteristics from estrogen counterparts and while it is expected to carry less risk for breast cancer, no randomized controls have been documented.

The effects of progesterone compared with progestins included a 30% reduction in sleep problems, a 50% reduction in anxiety, a 60% reduction in depression, a 30% reduction in somatic symptoms, a 25% reduction in menstral bleeding, a  40% reduction in cognitive difficulties, and a 30% improvement in sexual function resulting in 65% of women who felt HRT combined with progesterone was better than the HRT combined with progestin.

The conclusion of this article, based on thorough review of medical literature is support for the claim that bioidentical hormones  have some effects distinctly different or opposite of their synthetic  counterparts.   More randomized control trials of substantial size and length will be needed to determine these differences.

Dr. Holtorf discloses no conflicts of interest.

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Muscle-Wasting In the Aging Adult

By camborw on May 29, 2011

Sarcopenia is the loss of muscle tissue in the aging adult affecting mass, strength, and function.  This tissue loss may have a greater impact in an individual than even bone loss.  It appears after the age of 40 and accelerates after about 75.  It may be expected to be seen in the inactive adult, but it is also seen in life-long physically active people.  So while remaining active is essential to avoiding sarcopenia, there are other contributing factors such as decreased hormone levels, lack of protein, oxidative stress and disease.   Another factor is nutritional; namely creatine deficiency.

The fast-twitch muscle fiber recritied during high-intensity, low-endurance movements such as weight lifting and sprinting are mostly affected by creatine deficiency.  There is plenty of research found to support that creatine in supplemental form can improve some of the physiological changes in aging.

After exercise, free radical production increases, a potentially negative effect if the body can’t manage them.  Creatine may help modulate inflammation due to some anti-inflammatory properties by reducing cell damage caused by exercise.

One of the most profound ways creatine affects individuals is improving the cell’s ability to raising ATP status in the mitochondria thus resulting in improved energy.  In vegetarians and non-vegetarians alike, creatine has been shown to improve brain function in healthy adults.  It may work better when combined with other nutrients such as chromium and alpha lipoic acid.

Usual dosages range from 2-3 grams in the healthy adult and those with muscle loss or brain injury may benefit from 5-10 grams per day.  A good source is often found in whey products.

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Osteoporosis and Interventions

By camborw on April 20, 2011

Osteoarthritis is the most common form of all arthritis conditions that can affect all joints but has an affinity for the weight-bearing joints of the knee, hip and spine.  While osteoarthritis is universal, it appears to have a hereditary tendency affecting both men and women, men usually before the age of 45 and women ages 45 and above.  Initiating factors include primarily a poor diet, then trauma, and repetitive forceful stress to a joint.

Osteoarthritis is the loss of articular cartilage (the cartilage covering bones) which thins and eventually wears out, resulting in a “bone against bone” joint, reduced motion accompanied with pain.  Progression includes concurrent subchondral bony sclerosis (located just below the cartilage) and bony proliferation at the joint margins and growth of osteophytes or bone spurs.

Osteoarthritis affects  the joints exposed to high stress and is therefore considered the result of “wear and tear” rather than a true disease.

The symptoms of osteoarthritis are a gradual onset of perhaps one or a few joints.  Pain ensues that is deep, aching, worse with movement and better with rest and warmth.  Stiffness is identified as worse in the morning upon rising and after periods of rest but improves with movement.  Patients incur sleeping issues related to pain and stiffness.   Cartilage in the joint spaces begins to wear and weakness of the joint when weight bearing is seen.  Chronic conditions have acute flare-ups of pain, swelling, and stiffness.

Many patients find relief with improved diet and addition of supplements.  Suggestions include glucosamine, chondroitin, MSM, vitamin E, calcium, magnesium, vitamin C, essential fatty acids and bosweillia acid, and cetyl myristoleate.

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ARTERIAL DISEASE; A Case for Personal Responsibility

By camborw on April 10, 2011

  • Low blood EPA/DHA- add fish oil such as Carlson’s DHA.  DHA and derivatives also reduces cancer risk.
  • Elevated C-Reactive Protein- an inflammation marker which may also signal cancer risk
  • Excess Cholesterol- aim for around 200mg/dl; cut the saturated fat including trans-fats and margarine.  Instead develop a taste for Extra Virgin Olive Oil, flax oil, use nuts and butter.   Avoid fried foods.
  • Excess LDL- Low Density Lipids- aim for about 100mg/dl; 70 mg/dl if at risk for heart disease.
  • Oxidized LDL- free-radical form of LDL requiring higher levels of antioxidants.
  • Low HDL- aim for 60mg/dl or above,  increase CoQ10 which is an antioxidant with similar chemical structure as vitamin K-
  • Excess Triglycerides-  Avoid refined sugars and starches
  • Excess Insulin- is a stimulant to the sympathetic nervous system increasing blood pressure
  • High Glucose-over time damages blood vessels and nerves increasing risks of CVD.
  • Nitric Oxide Deficit- Low levels of NO production are important in protecting  organs such as the liver from ischemic damage. Chronic expression of NO is associated with various carcinomas and inflammatory conditions including juvenile diabetes, multiple sclerosis, arthritis and ulcerative colitis.
  • Vit D Insufficiency- may  contribute to heart disease, osteoporosis, immune disfunction.
  • Excess Estrogen-may be an indication the efficiency of the liver to break down and eliminate efficiently.
  • Low Free Testosterone-may promote heart disease
  • Excess Fibrinogen-a clotting factor that increases with age causing the blood to be sticky.
  • Excess Homocysteine-  Platelets may become abnormally adhesive, causing blood to clot prematurely or excessively, may restrict arterial dilation (reduce the flexibility of arteries, preventing them from increasing in size to permit larger amounts of blood to flow) and plaque formation or thickening and subsequent scarring of tissue on the inside of arterial walls, allowing the buildup of plaques from excess LDL cholesterol, an atherosclerotic process that in turn leads to restricted blood flow.  Hypertension- causes thickening of the heart muscle causing it to work harder and can result in ischemia.
  • Low Vitamin K- protects the heart by helping with blood clotting.
  • Benign Prostatic Hyperplasia (BPH) and lower urinary tract symptoms- considerably higher prevalence of CVD than general population in old age.

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Cleaning Tip- Shower Glass

By camborw on June 28, 2010

Have you tried everything on the market trying to get your shower glass free of water spots?  I have.   Frustrated and disappointed after hours of work, I have vowed to rip the doors off the wall and toss them out.

A few weeks ago I was listening to a radio talk show and a gentleman in the car business called in responding to a woman with the same frustration.  He said to use automobile buffing compound and fine steel wool as instructed on the can to successfully clean  shower doors.  I just tried it and I am excited to report it does a great j0b.  After all these years, having suffered with multiple chemical sensitivity in the past, I find this is very low odor and seemingly non-toxic.  Within  30 t0 45 minutes my shower was sparkling clean looking almost new.  It also cleaned the brass and floors as well.

You will need:

Rubbing Compound
Gloves
Fine steel wool
A pale of water
Rags

Instructions are to clean a small area at a time with the steel wool as an applicator.  Do not allow the compound to dry.  Instead, once applied and rubbed for desired amount of time,  wipe it off with a damp cloth.  You will want to rinse out your rags as you go.  Change the steel wool as you need but do not get it wet.

A word of caution;  do not use any other clean in conjunction with the rubbing compound.   Spraying the shower with a bleach or mildew cleaner,  for example,  will result in toxic fumes.

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EDTA Chelation Therapy Clinical Trial – Enrollment About To End

By camborw on February 14, 2010

The effectiveness of chelation therapy has long been debated.  In 2002, the National Center for Complementary and Alternative Medicine announced a study, “ To Assess Chelation Therapy (TACT)” to establish adequate research to verify chelation therapy as a safe and effective alternative therapy.  The trial represents an important milestone in assessing the role of chelation therapy.  A large scale randomized, double blind study includes patients of 50 or older who have had a heart attack and there are a few other criteria you can reference below.

It’s not too late to participate.  This randomized, double-blind study is nearing its end to enroll patients but there is still room for interested patients that would like an opportunity to contribute and possibly benefit.  This $30 million study led by Gervasio A. Lamas, MD is director of cardiovascular research and academic affairs at Mount Sinai Medical Center-Miami Heart Institute in Miami Beach, Florida.  The Data Coordinating Center and Quality of Life Coordinating Center are located at Duke Clinical Research Institute in Durham, North Carolina.  Further, an independent Data Safety Monitoring Board oversees the study.   The purpose of this study is to determine if EDTA therapy and/or high dose vitamin therapy is effective for the treatment of coronary artery disease.

For more information, please review the attachments below:

ClinicalTrials.gov

sciencebasedmedicine.org/?p=217

nccam.nih.gov/news/2002/chelation/pressrelease.htm

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Sulfation-Another Liver Function

By camborw on February 25, 2009

Sulfate is a major pathway in the body that is essential for many biological processes.  For example, sulfate is needed to start the cascade of digestive enzymes from the pancreas.  Without protease, lipase and amylase, food is not digested efficiently. Biochemical sulfation is a phase II enzyme reaction in the liver effective in rendering manmade (xenobiotic) pharmacological drugs and toxic substances less active.  Sometimes the pathway of phase I is imbalanced with phase II and can actually cause these same substances to be more active.  Sulfation is the derivative of the target  amino acid tyrosine.   

Many people will state they are allergic to sulfate when they mean they had a reaction to a sulfa medication, a phamaceutical drug classification for sulfonamides.  Sulfonamides are antibacterial medications that prevent the growth of the bacteria by disrupting the metabolism.   

Sulfate is needed for formation of proteins in joints.  Low levels of sulfate are found in plasma and synovial fluid in patients with rheumatoid arthritis. 

Sulfate is essential in forming the mucin proteins which line the gut walls.  These have two main functions–they stop the gut contents from sticking and they block transport of toxins from the gut to the bloodstream.  Low plasma sulfate is found in patients with irritable bowel syndrome.  Irritable bowel syndrome is identified with symptoms that may include constipation, diarrhea, alternating bowel habit, abdominal bloating and pain, and flatulence.  

Sulfate is necessary for formation of brain tissue.  Before birth, the functional units of the brain, neurons, are laid down on a scaffolding network of sulfated carbohydrate chains.  Reduced sulfation can leand to faulty neuronal connections and later dysfunction. 

Sulfate is not easily absorbed across the gut wall.  Recent research has shown that it can be absorbed across the skin.  It is also formed in the body by oxidation of the amino acids cysteine and methionine.  This pathway is often suboptimal and many people benefit from sulfate supplementation.   

A comprehensive detoxification test that demonstrates the liver’s health regarding detoxification is available to help identify the efficiency of the process of phase I and phase II detoxification.  The advantages of properly identifying the balance of the detoxification system are you can support it nutritionally and identify areas of concern such as amino acid deficiency, heavy metal burden, and also pesticide toxicity.    One should not indescriminately add tyrosine supplementation into their regimen as it can produce unintended consequences since it is also a target amino acid for the cascade of neurotransmitters called catecholamines.

www.cemmed.com                                    Clinic in Portland, Oregon

www.mynetimpact.com/1153052         Science based nutritional products

www.multipureusa.com/hwc                     The best water system on the planet

www.mybiopro.com/jmwade                      Related to EMF sensitivity

Today’s Quote:  ” If you ask me anything I don’t know, I’m not going to answer.”  Yogi Berra

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Yeast Infections-Vaginal Symptoms, Preventative Steps

By camborw on February 18, 2009

Vaginal yeast infections are caused by a fungus called candida albicans and affect some women more than others.  You recognize the symptoms of yeast by itching and burning in the vagina and around the vulva which is the skin that surrounds your vagina.  You will note a white vaginal discharge that may look like cottage cheese and experience pain during intercourse.  Sometimes the vulva swells.  While the infection can be very uncomfortable, the symptoms usually aren’t very serious.  Health information regarding  candidia offers practical self-help preventative steps to limit or avoid developing an infection. 

Candidia is a natural organism found in the vaginal area. Usually the acidic balance of the vagina keep yeast from over producing, but that balance can be altered by menstruation, pregnancy, diabetes, antibiotics, birth control pills as well as the moist environment. 

You will want to talk to your doctor to make sure a yeast infection is the cause of your yeast infection.  A prescription may be required.

Here are some simple suggestions to help you avoid and control yeast infections:

1.  Wear cotton underpants.  Avoid nylon underwear since it retains moisture and  heat which encourages the growth of harmful bacteria.

 2.  Don’t share washcoths, towels, or bathing suits with others.

 3.  After bowel movements, wipe front to back to avoid anal-vaginal contamination.

 4.  Avoid chemicals in your personal hygiene regimen (e.g., harsh soaps, perfumes, commercial douches, tampons, sprays, perfumed toilet paper, etc.).

 5.  Avoid sugar, sweets and refined foods in your diet.

 6.  Include ample amounts of vitamins A, B, C, and E in your diet.

 7.  Get an adequate amount of sleep.

 8.  Don’t douche except for curative reasons; avoid commercial douches.

 9.  Avoid wet or damp towels.

 10.  After bathing, pat genital area dry and keep it dry.

 11.  Avoid pants that are tight in the crotch.

 12.  If using antibiotics, eats lots of yogurt.

 13. Take showers instead of baths.  Soaps can more easily get into the vagina with baths.  Soap or bubble baths are “basic”– the vagina is normally an acidic environment.

 14.  Make sure your sexual partner is clean or use a condom.

 15.  Make sure you have proper lubrication for intercourse.   Poor lubrication can cause irritation and inflammation, which can lead to the growth of bacteria.

 16.  Be aware of and avoid vaginal irritants such as tampons, unclean diaphragms,  aggressive intercourse,  and examining instruments.

 17.  Avoid emotional stress.

 18.  Avoid leaving tampons in too long, trapping normal discharge. Change  tampons at least twice a day.

19. Wipe from front to back after using the toilet. This may help prevent the bacteria that normally live in your rectum from getting into your vagina.

20. Also avoid using colored or perfumed toilet paper. These items seem to affect the balance of acidity in the vagina and can lead to yeast infections.

www.cemmed.com                                    Clinic in Portland, Oregon

www.mynetimpact.com/1153052         Science based nutritional products

www.multipureusa.com/hwc                     The best water system on the planet

www.mybiopro.com/jmwade                      Related to EMF sensitivity

 

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How to Contact Us

CENTER FOR ENVIRONMENTAL MEDICINE

10748 NE Halsey Street
Portland, OR 97220-3961 USA

Tel.: (503) 261-0966
Fax: (503 252-2691
Tel.: (360) 690-0017