LETTER TO THE EDITOR Re: Brown, Sharma, Ardern, et al., Secular changes in the association betwee... more LETTER TO THE EDITOR Re: Brown, Sharma, Ardern, et al., Secular changes in the association between caloric intake, macronutrient intake and physical activity with obesity Sirs,
Resumen El Tribunal Constitucional avala la constitucionalidad de las estipulaciones contenidas e... more Resumen El Tribunal Constitucional avala la constitucionalidad de las estipulaciones contenidas en los nuevos Estatutos de Autonomía acerca de aguas y obras hidráulicas.
Functional medicine is essentially patient centered, rather than disease centered. A structure is... more Functional medicine is essentially patient centered, rather than disease centered. A structure is presented for uniting a patient-centered approach to diagnosis and treatment with the fruits of modern clinical science (which evolved primarily to serve the prevailing model of disease-centered care). The core scientific concepts of disease pathogenesis are antecedents, triggers, and mediators. Antecedents are factors, genetic or acquired, that predispose to illness; triggers are factors that provoke the symptoms and signs of illness; and mediators are factors, biochemical or psychosocial, that contribute to pathological changes and dysfunctional responses. Understanding the antecedents, triggers, and mediators that underlie illness or dysfunction in each patient permits therapy to be targeted to the needs of the individual. The conventional diagnosis assigned to the patient may be of value in identifying plausible antecedents, triggers or mediators for each patient, but is not adequat...
The human gut microbiome impacts human brain health in numerous ways: (1) Structural bacterial co... more The human gut microbiome impacts human brain health in numerous ways: (1) Structural bacterial components such as lipopolysaccharides provide low-grade tonic stimulation of the innate immune system. Excessive stimulation due to bacterial dysbiosis, small intestinal bacterial overgrowth, or increased intestinal permeability may produce systemic and/or central nervous system inflammation. (2) Bacterial proteins may cross-react with human antigens to stimulate dysfunctional responses of the adaptive immune system. (3) Bacterial enzymes may produce neurotoxic metabolites such as Dlactic acid and ammonia. Even beneficial metabolites such as short-chain fatty acids may exert neurotoxicity. (4) Gut microbes can produce hormones and neurotransmitters that are identical to those produced by humans. Bacterial receptors for these hormones influence microbial growth and virulence. (5) Gut bacteria directly stimulate afferent neurons of the enteric nervous system to send signals to the brain via the vagus nerve. Through these varied mechanisms, gut microbes shape the architecture of sleep and stress reactivity of the hypothalamic-pituitary-adrenal axis. They influence memory, mood, and cognition and are clinically and therapeutically relevant to a range of disorders, including alcoholism, chronic fatigue syndrome, fibromyalgia, and restless legs syndrome. Their role in multiple sclerosis and the neurologic manifestations of celiac disease is being studied. Nutritional tools for altering the gut microbiome therapeutically include changes in diet, probiotics, and prebiotics. KEY WORDS: D-lactic acid endotoxin microbial endocrinology microbiome prebiotics probiotics short-chain fatty acids trimethylamine oxide (TMAO)
I nflammation has recently emerged as an important aspect of the pathophysiology of age-related i... more I nflammation has recently emerged as an important aspect of the pathophysiology of age-related infirmity and the major chronic diseases of industrialized societies, including cardiovascular disease, type 2 diabetes mellitus, Alzheimer's disease, and many types of cancer. Most observational studies and clinical trials have used high-sensitivity C-reactive protein (HS-CRP) as a biochemical marker of inflammation, because it is relatively stable and easy to measure. Elevation of HS-CRP predicts future development of diabetes mellitus and hypertension more accurately than body mass index (BMI). Any attempt to create a diet for optimal health must consider the impact of the dietary prescription on systemic inflammation. Part of this impact results from visceral adiposity, because of the inflammatory effects of abdominal obesity. Part of this impact can be attributed to direct or indirect effects of nutrients and dietary pattern on components of the inflammatory response itself. This overview will first consider the relationship between nutrient intake and inflammatory mediators, relying mainly on human observational data, and will then describe observational and interventional trials, primarily
Scandinavian Journal of Clinical and Laboratory Investigation, 1994
The Nova ISE for IMg2+ was utilized to examine IMg2+ in plasma and serum of patients with a varie... more The Nova ISE for IMg2+ was utilized to examine IMg2+ in plasma and serum of patients with a variety of pathophysiologic and disease syndromes (e.g., long-term renal transplants [LTRT], during and before cardiac surgery, migraine headaches, head trauma, pregnancy, chronic fatigue syndrome [CFS], non-insulin dependent diabetes mellitus [NIDDM], asthma and after excessive dietary intake of Mg). The results indicate that LTRT treated with cyclosporin A, migraine, head trauma, pregnancy, NIDDM, diseased pregnant, and asthmatic patients all on the average, exhibit significant depression in IMg2+ but not total Mg (TMg). Patients with CFS failed to exhibit changes in serum IMg2+ or TMg levels. Increased dietary load of Mg, for only 6 days, resulted in significant elevations of serum IMg2+ but not TMg. Correlations between the clinical course of several of these syndromes and the fall in IMg2+ were found. The Ca2+/Mg2+ ratio appears to be an important guide for signs of peripheral vasoconstriction and or spasm and possibly enhanced atherogenesis. Overall, the data point to important uses for ISE's for IMg2+ in the diagnosis and treatment of disease states.
JAMA: The Journal of the American Medical Association, 1976
To the Editor.— The advice of your consultant, Paul Wehrle, MD (234:430, 1975) that non-group A β... more To the Editor.— The advice of your consultant, Paul Wehrle, MD (234:430, 1975) that non-group A β-hemolytic streptococci are not respiratory pathogens is probably incorrect. While there has been no evidence to link these organisms with acute rheumatic fever or glomerulonephritis, there is considerable reason to suspect them of being primary respiratory pathogens. Glezen et al 1 found a 10.8% frequency of non-group A streptococci in the pharyngeal cultures of college students with sore throats and a 0.2% carrier rate in asymptomatic students. Nine of 42 students with non-group A streptococcal pharyngitis showed a rise in antistreptolysin O titer when paired sera were examined. No mention is made of the treatment these students received. Mogabgab 2 found a similarly high incidence of non-group A streptococcal pharyngitis in adults, and often found these organisms to be present in very high titer. I have reviewed the results of 300 consecutive throat cultures
LETTER TO THE EDITOR Re: Brown, Sharma, Ardern, et al., Secular changes in the association betwee... more LETTER TO THE EDITOR Re: Brown, Sharma, Ardern, et al., Secular changes in the association between caloric intake, macronutrient intake and physical activity with obesity Sirs,
Resumen El Tribunal Constitucional avala la constitucionalidad de las estipulaciones contenidas e... more Resumen El Tribunal Constitucional avala la constitucionalidad de las estipulaciones contenidas en los nuevos Estatutos de Autonomía acerca de aguas y obras hidráulicas.
Functional medicine is essentially patient centered, rather than disease centered. A structure is... more Functional medicine is essentially patient centered, rather than disease centered. A structure is presented for uniting a patient-centered approach to diagnosis and treatment with the fruits of modern clinical science (which evolved primarily to serve the prevailing model of disease-centered care). The core scientific concepts of disease pathogenesis are antecedents, triggers, and mediators. Antecedents are factors, genetic or acquired, that predispose to illness; triggers are factors that provoke the symptoms and signs of illness; and mediators are factors, biochemical or psychosocial, that contribute to pathological changes and dysfunctional responses. Understanding the antecedents, triggers, and mediators that underlie illness or dysfunction in each patient permits therapy to be targeted to the needs of the individual. The conventional diagnosis assigned to the patient may be of value in identifying plausible antecedents, triggers or mediators for each patient, but is not adequat...
The human gut microbiome impacts human brain health in numerous ways: (1) Structural bacterial co... more The human gut microbiome impacts human brain health in numerous ways: (1) Structural bacterial components such as lipopolysaccharides provide low-grade tonic stimulation of the innate immune system. Excessive stimulation due to bacterial dysbiosis, small intestinal bacterial overgrowth, or increased intestinal permeability may produce systemic and/or central nervous system inflammation. (2) Bacterial proteins may cross-react with human antigens to stimulate dysfunctional responses of the adaptive immune system. (3) Bacterial enzymes may produce neurotoxic metabolites such as Dlactic acid and ammonia. Even beneficial metabolites such as short-chain fatty acids may exert neurotoxicity. (4) Gut microbes can produce hormones and neurotransmitters that are identical to those produced by humans. Bacterial receptors for these hormones influence microbial growth and virulence. (5) Gut bacteria directly stimulate afferent neurons of the enteric nervous system to send signals to the brain via the vagus nerve. Through these varied mechanisms, gut microbes shape the architecture of sleep and stress reactivity of the hypothalamic-pituitary-adrenal axis. They influence memory, mood, and cognition and are clinically and therapeutically relevant to a range of disorders, including alcoholism, chronic fatigue syndrome, fibromyalgia, and restless legs syndrome. Their role in multiple sclerosis and the neurologic manifestations of celiac disease is being studied. Nutritional tools for altering the gut microbiome therapeutically include changes in diet, probiotics, and prebiotics. KEY WORDS: D-lactic acid endotoxin microbial endocrinology microbiome prebiotics probiotics short-chain fatty acids trimethylamine oxide (TMAO)
I nflammation has recently emerged as an important aspect of the pathophysiology of age-related i... more I nflammation has recently emerged as an important aspect of the pathophysiology of age-related infirmity and the major chronic diseases of industrialized societies, including cardiovascular disease, type 2 diabetes mellitus, Alzheimer's disease, and many types of cancer. Most observational studies and clinical trials have used high-sensitivity C-reactive protein (HS-CRP) as a biochemical marker of inflammation, because it is relatively stable and easy to measure. Elevation of HS-CRP predicts future development of diabetes mellitus and hypertension more accurately than body mass index (BMI). Any attempt to create a diet for optimal health must consider the impact of the dietary prescription on systemic inflammation. Part of this impact results from visceral adiposity, because of the inflammatory effects of abdominal obesity. Part of this impact can be attributed to direct or indirect effects of nutrients and dietary pattern on components of the inflammatory response itself. This overview will first consider the relationship between nutrient intake and inflammatory mediators, relying mainly on human observational data, and will then describe observational and interventional trials, primarily
Scandinavian Journal of Clinical and Laboratory Investigation, 1994
The Nova ISE for IMg2+ was utilized to examine IMg2+ in plasma and serum of patients with a varie... more The Nova ISE for IMg2+ was utilized to examine IMg2+ in plasma and serum of patients with a variety of pathophysiologic and disease syndromes (e.g., long-term renal transplants [LTRT], during and before cardiac surgery, migraine headaches, head trauma, pregnancy, chronic fatigue syndrome [CFS], non-insulin dependent diabetes mellitus [NIDDM], asthma and after excessive dietary intake of Mg). The results indicate that LTRT treated with cyclosporin A, migraine, head trauma, pregnancy, NIDDM, diseased pregnant, and asthmatic patients all on the average, exhibit significant depression in IMg2+ but not total Mg (TMg). Patients with CFS failed to exhibit changes in serum IMg2+ or TMg levels. Increased dietary load of Mg, for only 6 days, resulted in significant elevations of serum IMg2+ but not TMg. Correlations between the clinical course of several of these syndromes and the fall in IMg2+ were found. The Ca2+/Mg2+ ratio appears to be an important guide for signs of peripheral vasoconstriction and or spasm and possibly enhanced atherogenesis. Overall, the data point to important uses for ISE's for IMg2+ in the diagnosis and treatment of disease states.
JAMA: The Journal of the American Medical Association, 1976
To the Editor.— The advice of your consultant, Paul Wehrle, MD (234:430, 1975) that non-group A β... more To the Editor.— The advice of your consultant, Paul Wehrle, MD (234:430, 1975) that non-group A β-hemolytic streptococci are not respiratory pathogens is probably incorrect. While there has been no evidence to link these organisms with acute rheumatic fever or glomerulonephritis, there is considerable reason to suspect them of being primary respiratory pathogens. Glezen et al 1 found a 10.8% frequency of non-group A streptococci in the pharyngeal cultures of college students with sore throats and a 0.2% carrier rate in asymptomatic students. Nine of 42 students with non-group A streptococcal pharyngitis showed a rise in antistreptolysin O titer when paired sera were examined. No mention is made of the treatment these students received. Mogabgab 2 found a similarly high incidence of non-group A streptococcal pharyngitis in adults, and often found these organisms to be present in very high titer. I have reviewed the results of 300 consecutive throat cultures
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