May 1999 To Your Health Newsletter
Chiropractic: The First-line Treatment for Disc-Related Low Back Pain
With low back pain being the burden that it is to both patients and the health care system, patients and health care practitioners regularly must decide if surgery or more conservative management is the best option.
This review of the literature distills and synthesizes previously published research. The article lists various causes of low back pain, noting what findings in patient histories, physical examinations, and diagnostic imaging represent “red flags” that indicate the need for referral to a specialist for surgical intervention.
After patients are screened for red flags, conservative treatment should be the first line of treatment for patients without absolute signs for surgical intervention.
The authors concluded:
Of the available conservative treatments, chiropractic management has been shown through multiple studies to be safe, clinically effective, cost-effective, and to provide a high degree of patient satisfaction. As a result, in patients . . . for whom the surgical indications are not absolute, a minimum of 2 or 3 months of chiropractic management is indicated.
Troyanovich SJ, Harrison DD, Harrison DE. Low back pain and the lumbar intervertebral disk: Clinical consideration for the doctor of chiropractic. Journal of Manipulative and Physiological Therapeutics, Feb. 1999; vol. 22, no. 2, pp96-104.
Some Headaches Linked to Upper Cervical Spine
There is a common structural variation of the atlas vertebra at the top of the spine. It is called ponticulus posticus (also known as foramen arcuale or “Kimmerle’s anomaly”). Investigators studied the relationship between this condition and headache symptoms in 895 first-time chiropractic patients. The patients” complaints included migraine with aura (classical migraine), migraine without aura (common migraine), cervicogenic headache, neck pain only, and other problems. They were examined for the presence or absence of partial or complete ponticulus posticus.
The authors found a significant correlation of ponticulus posticus with migraine without aura. They explain that because the ponticulus posticus is intimately attached to the atlanto-occipital membrane (where the spine and skull meet) and this membrane, in turn, is attached to the dura (the outermost covering of the brain and spinal cord), small tensions exerted on the dura may result in excruciating head pain of a type experienced in migraine.
The beneficial results of chiropractic treatment for migraine and cervicogenic headache are probably related to the nature of the structures connecting the upper spine to the skull.
Wight S, Osborne N, Breen AC. Incidence of ponticulus posterior of the atlas in migraine and cervicogenic headache. Journal of Manipulative and Physiological Therapeutics, Jan. 1999; vol. 22, no. 1, pp15-20.
Pacifiers Cause Breastfeeding Problems
Because many of the infant health benefits attributable to breastfeeding depend on the duration of full breastfeeding, this study sought to determine if infrequent and shortened-duration breastfeeding is associated with pacifier use.
The subjects were breastfeeding mothers and their infants. Results showed that 68% of the mothers began using pacifiers before 6 weeks. Pacifier introduction this early significantly increased the chances for a shortened duration of full breastfeeding. Mothers who introduced pacifiers tended to breastfeed less frequently and they experienced breastfeeding problems consistent with infrequent infant feeding.
Howard CR, Howard FM, Lanphear EAD, et al breastfeeding. The effects of early pacifier use on breastfeeding duration. Pediatrics, Mar. 1999; vol. 103, no. 3, p. e33.
Early Day Care May Protect against Allergies
The hypothesis behind this study is that childhood infections may protect individuals from allergies later in life. Consequently, the investigators tried to learn if children who attend day care facilities away from home at an earlier age have a lower incidence of allergies later in life than children who attend at an older age.
This study’s findings supported other research that found that children from small families (usually one child) who entered day care early had a lower incidence of allergies. A related finding was that for children from large families, the age at which they began to go to day care did not influence whether or not they later developed allergies. It appears that early infections picked up while in day care may protect children from developing allergies (involving symptoms such as hay fever and irritated eyes) later in life.
KrŠmer U, Heinrich J, Wjst M, Wichmann H-E. Age of entry to day nursery and allergy in later childhood. Lancet, Feb. 6, 1999; vol. 353, no. 9151, 450-54.
Poor Cycling Technique and Low Back Pain
This study was inspired by a 24-year-old male chiropractic patient’s report that he was experiencing numbness and tickling in a small region of his upper right buttock. His chiropractor noted that the condition had developed in the few days since the man’s most recent bimonthly adjustment. A physical exam and close scrutiny of the patient’s history revealed that the complaint was probably gluteus medius syndrome (GMS) resulting from the man’s activities as an amateur cyclist.
The subject’s chiropractor learned that the ailing cyclist had just begun riding a new bicycle. Because the new bike had different gearing than his previous bicycle, by continuing to use his customary riding technique, the patient was fatiguing and straining himself, as he hadn’t done before getting the new bike. The patient’s cycling technique was modified to accommodate the changed gearing of the new machine. After only 2 days, the GMS symptoms resolved and did not return-results attributable to altering a cycling technique that was damaging him and interfering with his favorite pastime.
Green B, Johnson C, Maloney A. Effects of Altering Cycling Technique on Gluteus Medius Syndrome. Journal of Manipulative and Physiological Therapeutics, Feb. 1999; vol. 22, no. 2, pp108-13.
Mass Media and Dangerous Female Self-Image
The subjects of this study were 548 fifth- through twelfth-grade girls in a working-class suburb in the northeastern United States. The objective was to assess the influence of the media on girls’ weight concerns, weight control/loss behaviors, and perceptions of body weight and shape.
The study found that “the majority of preadolescent and adolescent girls . . . were unhappy with their body weight and shape. This discontent was related strongly to the frequency of reading fashion magazines, which was reported to influence their idea of the perfect body shape by 69% of the girls.” It also obtained data showing that frequent readers of fashion magazines were significantly more likely to diet and exercise to lose weight and to get their image of ideal body shape from the pictures of grossly underweight models.
There is a substantial health risk associated with being overweight, and in the past 2 decades the prevalence has increased sharply among children and adolescents. The authors concluded: “It is not prudent to suggest that overweight girls should accept their body shape and not be encouraged to lose weight. However, aspiring to look like underweight models may have deleterious psychological consequences.”
Field AE, Cheung L, Wolf AM, et al. Exposure to the mass media and weight concerns among girls. Pediatrics, Mar. 1999; vol. 103, no. 3, p. e36.
Antibiotic-Resistant Bacteria in Nursing Homes
A citywide outbreak of multiple antibiotic-resistant infections in Chicago prompted this study of the epidemiology of the outbreak.
The study investigated ceftazidmine-resistant Klebsiella pneumoniae and Escherichia coli bacteria recovered between 1990 and 1992 from patients who were residents of Chicago-area nursing homes. The aim was to identify factors that may have contributed to making the nursing home patients particularly likely to become infected and spread the infection.
The independent risk factors identified included having previously received suspected antibiotics, having been exposed to infective agents during visits to area hospitals, and being at an increased risk of infection because hand-washing rates during patient care are often low among nursing home personnel.
Conclusions: Nursing home patients appear to be a reservoir for antibiotic-resistant bacteria. Nursing homes should monitor infection control practices, control antibiotic use, and regularly survey antibiotic resistance patterns among various germs.
Weiner J, Quinn JP, Bradford PA, et al. Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. Journal of the American Medical Association, Feb. 10, 1999; vol. 281, no. 6, pp517-23.
Regular House Cleaning Can Protect Toddlers from Lead Poisoning
Household dust may be a major source of exposure for children with elevated blood lead levels. This randomized trial was designed to test the hypothesis that regular vigorous household cleaning could reduce exposure to lead and blood lead levels.
All mothers in the study were educated on the importance of adequate housecleaning and biweekly assistance with household cleaning. Two trained lay workers did the cleaning, focusing on wet mopping floors, damp-sponging walls and horizontal surfaces, and vacuuming with a high-efficiency particle-accumulating vacuum. Household dust lead levels, blood lead levels of the children, and maternal knowledge of lead poisoning were measured before and after the study.
Results after a year of follow-up: “Blood lead fell 17% in the intervention group and did not change among controls. Household dust and dust lead measures also fell significantly in the intervention group. Children in homes cleaned 20 or more times throughout the year had an average blood lead reduction of 34%.”
Conclusion: The utility of regular home cleaning, accompanied by maternal education, is “a safe and partially effective intervention that should be recommended for the large majority of lead-exposed children for whom, unfortunately, removal to lead-safe housing is not an option.”
Rhoads GC, Ettinger AS, Weisel CP, et al. The effect of dust lead control on blood lead in toddlers: A randomized trial. Pediatrics, Mar. 1999; vol. 103, no. 3, pp551-55.
Carbohydrates Can Cause Overeating!
Carbohydrate-containing foods that are rapidly digested and absorbed or transformed into glucose have a high glycemic index (GI). Starchy foods such as refined grain products and potatoes have a GI that is higher than table sugar by some 50%. Vegetables, legumes, and fruits tend to have a low GI.
The objective of this study was to test the hypothesis that consumption of high dietary GI foods induces a sequence of hormonal changes that lead to decreased availability of metabolic fuels, excessive hunger, and overeating in obese individuals.
The subjects of this study were 12 boys (mean age 15.7) who were more than 120% of ideal body weight. They were given identical test meals at breakfast and lunch that had a low, medium, or high GI. The results showed that energy intake after a high-GI meal was 53% greater than after a medium-GI meal and 81% greater than after a low-GI meal. Insulin levels were also elevated.
The investigators concluded: “Rapid absorption of glucose after consumption of high-GI meals induces a sequence of hormonal and metabolic changes that promote excessive food intake in obese subjects.” Excessive fat consumption should not remain the prime focus of what causes and maintains obesity. Eating food with a high-GI should be considered a factor in obesity and the risk of diabetes.
Ludwig DS, Majzoub JA, Al-Zahrani A, et al. High glycemic index foods, overeating, and obesity. Pediatrics, Mar. 1999; vol. 103, no. 3, p. e26.
Dangers of Chinese Herbal Creams?
Because of reports by patients that their eczema was improving after using Chinese herbal medicine, the authors of this paper investigated the preparations that were used. They tested herbal creams that had been employed by adults and children (ages 4 months to 36 years).
The research was done in London, employing high-resolution gas chromatography and mass spectrometry to identify the ingredients in 11 herbal creams, 9 of which had no list of ingredients on their containers. The patients had turned to this alternative medical treatment in part because they believed the herbal medicine was safe and natural. But as the tests revealed, in 8 of the 11 creams the effective active ingredient was dexamethasone, a potent steroid.
The creams prescribed for children had a dexamethasone concentration 5.2 times higher than those prescribed for adults. The dispensing of such potent steroids by unauthorized people is illegal in the United Kingdom. The use of creams with such high concentrations of dexamethasone is inappropriate, especially when applied to the thin skin of the face or to children. Such creams can even exacerbate eczema herpeticum, the very condition for which the herbalists prescribed them.
Keane FM, Munn SE, du Vivier AWP, et al. Analysis of Chinese herbal creams prescribed for dermatological conditions. British Medical Journal, Feb. 27, 1999; vol. 318, no. 7183, pp563-64.