VITAMIN D


WE LIVE IN THE SUNSHINE STATE!

Ah Queensland, the Sunshine State. The sun is celebrated in Queensland and having recently moved to the East coast, I look forward to spending more time in the sun. A colleague of mine commented recently that vitamin D deficiency isn’t a major concern here; this got me thinking… will an increase in daylight hours correlate with getting adequate sun exposure?

The Australian Bureau of Statistics and Sullivan Nicolaides Pathology investigated multiple states across Australia. Both showed that Vitamin D deficiency was lower in the Summer months when compared with the winter months right across the country. When comparing the rates of Vitamin D deficiency in Queensland; during winter the range was between 15 – 32% (approximately 1 in 4 people) and in summer the range suggested deficiency exists somewhere between 6 – 22%, thats up to 1 in 5 people experiencing a deficiency! These results tell us that Queensland does indeed experience less Vitamin D deficiency when compared to other states like Victoria and Tasmania; however, the rates of deficiency in the Sunshine State do not paint a picture of health, in fact they indicate a significant health issue.

WHY VITAMIN D IS IMPORTANT

Vitamin D is required for the healthy function of multiple organ systems including parathyroid, the bone and muscle systems and the gut. Deficiency has been associated with diseases like osteoporosis, type 2 diabetes, obesity, cardio-vascular disease, multiple sclerosis, depression, inflammatory bowel disease and the list goes on.

So how do we get Vitamin D from the sun anyway? The UV-radiation in sunshine converts the precursor molecules in our system to active Vitamin D3 in the body, and is the best way to increase Vitamin D levels. In winter months it can take 15-40 minutes of sun exposure per day on around 15-20% of your skin to stimulate enough vitamin D for healthy bodily function. This time frame is even longer for those with darker skin. It is pertinent to mention at this point that covering up with clothing and broad spectrum sun creams will prevent adequate sun exposure required for the body to increase Vitamin D levels.

WHAT ABOUT WINTER?

In the winter months I recommend supplementing Vitamin D to support bone health, hormone health and general wellbeing. Studies also show a correlation between adequate levels of vitamin D and decreased rates of cold and flu. My brand of choice is Metagenics Vitamin D3 liquid as it is a high quality supplement and this product in particular is free from nuts, seeds, lactose, gluten, soy protein, dairy protein and corn.

The take-home here is just because we are blessed to be living in a subtropical climate with abundant sunlight, it does not guarantee sufficient sun exposure to achieve adequate Vitamin D production. If you want to know if your Vitamin D levels are within a healthy range (adequate levels: ≥50 nmol/L1), testing can be done through Medicare under referral from your GP.

For more information regarding correct supplementation of Vitamin D please feel free to get in touch with me via my website or Facebook page.

REFERENCES

1. Australian Bureau of Statistics. (2014). Australian Health Survey: Biomedical Results for Nutrients, 2011-12, FEATURE ARTICLE: VITAMIN D. http://www.abs.gov.au/ausstats/abs@.nsf/ Lookup/4364.0.55.006Chapter2002011-12

2. Sullivan Nicolaides Pathology (2012). Vitamin D – at risk from a little missed sunshine. Retrieved from http://www.snp.com.au/media/255136/item_08841_why_is_vitamin_d_detection_lower_in_ queensland__reviewed_february_2012.pdf

3. McGrath JJ, Kimlin M, Saha S, Eyles D, Parisi A. (2001) Vitamin D insufficiency in south-east Queensland. Medical Journal of Australia. 174; 150-151. http://citeseerx.ist.psu.edu/viewdoc/
download?doi=10.1.1.574.505&rep=rep1&type=pdf

4. Martineau Adrian R, Jolliffe David A, Hooper Richard L, Greenberg Lauren, Aloia John F, Bergman Peter et al. (2017). Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. Retrieved from http://www.bmj.com/content/356/bmj.i6583

VIBURCOL


An evidence-based homeopathic alternative to paracetamol (acetaminophen)

A series of events directed me to this next discussion regarding paracetamol (Panadol) and the homeopathic alternative in Viburcol.

First, one of my clients recently discovered their child has liver issues associated with the use of panadol (acetaminophen AKA paracetamol). Secondly, I noticed people friends sharing on Facebook a post about a recall on Panadol issued by the Therapeutic Goods Administration (TGA), of which I thought “here we go again” but upon further investigation I discovered it was the recall from May 2016 (1). Thirdly, a colleague shared an article with me for the purposes of verifying a particular application of Viburcol (a homeopathic medication), and I was surprised to find the paper actually demonstrated how Viburcol has been found to act as a beneficial alternative to acetaminophen (paracetamol).

Acetaminophen is used to reduced pain (analgesic) and reduce fever (antipyretic) and is in fact recommended by the World Health Organisation for use in children with temperatures greater than 39 degrees celsius (3,4,5). Acetaminophen is considered to be safe in therapeutic doses. TGA guidelines state the safe dosages as; “for children (1 month to 12 years) is 15 mg per kg, which can be given every four to six hours as required, with no more than four doses in 24 hours.” (2)

Acetaminophen use is not without its risks of side effects. At higher doses the livers ability to detoxify the reactive metabolite (the broken down molecules) of acetaminophen is compromised and can lead to acute liver failure. Acetaminophen overdoses account for approximately half of all acute liver failure in the United States and Great Britain (3) and is the leading cause of acute liver failure in the paediatric population in Australia and New Zealand (4). 

Acute liver failure presentations to emergency rooms have documented acetaminophen doses in children in excess of 120 mg/kg/day (which is double the recommendation of no more than 60 mg/kg/day), with other children simply receiving either a double dose, too frequent administration, co-administration of other medicines containing paracetamol, acetaminophen medications being used in conjunction with other medications, exposure to other toxic molecules (neurotoxins or heavy metals) or regular paracetamol use for sustained periods of time from several days or even weeks (3,4,5).

With such startling statistics, the good news is – there is a homeopathic alternative. A 2005 investigation by Derasse and associates identified that the complex homeopathic medicine “Viburcol was an effective alternative to acetaminophen and was significantly better tolerated,” “for the symptomatic treatment of children with acute infections accompanied by fever.” (5) An early study in 2002 concluded that Viburcol is “an effective and safe homeopathic remedy for the treatment of acute feverish infection in children” and also went on to say the therapeutic potential of Viburcol is comparable to that of paracetamol. (6)

For families, especially those with young children, the attraction of homeopathic medication is that it is has a relatively spotless track record. Under the supervision of a trained professional, homeopathic medicine is generally safe. A systematic review from 2007 captures homeopathic medicine as unlikely to cause severe adverse reactions. “However, like any drug or dietary supplement, these products could pose risks if they are improperly manufactured” or administered (self-administered) inappropriately (7). In my professional opinion and considering the amazing advancements in homeopathic medicine each day, it is a far better choice to seek out proven natural alternatives for ourselves and our children, than to risk these potentially dangerous side effects to medications. If you like to know more about why Viburcol should be your treatment of choice in times of pain or fever (and its many other uses) please contact me via the website or at the clinic.

(Please seek appropriate professional advice when using all types of medicine.)
* Viburcol as a complex homeopathic medicine contains; Chamomilla recutita, Atropa belladonna, Solanum dulcamara, Plantago major, Pulsatilla pratensis and Calcium carbonica Hahnemanni.

References:

  1. Children’s Panadol 5-12 years suspension 200 mL bottle: Recall – risk of allergic reaction due to potential contamination. https://www.tga.gov.au/node/726687
    Recommended paracetamol doses. https://www.tga.gov.au/community-qa/recommended-paracetamol-doses
  2. Hinson JA, Roberts DW and LP James. Mechanisms of Acetaminophen-Induced Liver Necrosis. Hands Exp Pharmacol. 2010; (196): 369-405.
  3. Rajanayagam J, Bishop JR, PJ Lewindon and HM Evans. Paracetamol-associated acute liver failure in Australia and New Zealand Children: high rate of medication errors. Arch Dis Child. 2015. 100: 77-80. https://www.ncbi.nlm.nih.gov/pubmed/25228327
  4. Derasse M, Klein P and M Weiser. The Effects of a Complex Homeopathic Medicine Compared with Acetaminophen in the Symptomatic Treatment of Acute Febrile Infection in Children: An Observational Study. Explore. 2005. 1(1):33-39.
  5. Müller-Krampe B, Gottwald R and M Weiser. Symptomatic Treatment of Acute Feverish Infections with a Modern Homeopathic Medication. Biologische Medizin. 2002, 31 (2); 79–85. Available from:https://www.researchgate.net/publication/289953699_Symptomatic_treatment_of_acute_feverish_infects_with_a_modern_homoeopathic_preparation
  6. Altunc U, Pittler MH and E Ernst. Homeopathy for childhood and adolescence ailments: systematic review of randomized clinical trials. Mayo Clinic Proceedings. 2007;82(1):69-75. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0023952/.

EXERCISE THE WINTER BLUES AWAY



As the weather gets cooler, and the length of the day shortens, so does motivation to get to the gym to exercise. However, getting to the gym more regularly might simply save you from the de-motivated state known as the winter-blues, and yes it does occur in Sunny Queensland.

The winter blues or medically recognised Seasonal Affective Disorder (SAD), is characterised by depression during autumn and winter with spring and summer remission, although it can less commonly occur in reverse.

The causes of SAD are not clear-cut and involve a combination of factors, which become the focus for research around this condition. Study focus includes neurotransmitters, hormones, circadian rhythm dysregulation, genetic polymorphisms and psychological factors.

Light therapy is currently recognised as the best available treatment for SAD and results show that using light therapy in isolation measured remission in up to 54% of cases. When comparing this to the next best-known intervention, pharmacological anti-depressants (SSRIs), the results fell short at a measured remission in up to 50% of cases.

Regarding the treatment of non-seasonal major depression, aerobic exercise and strength training interventions have demonstrated efficacy and these treatment methods are now being studied in SAD.

In a study comparing light therapy to aerobic exercise* both treatments showed significant reductions in depression severity when compared to an untreated control group. It has also been identified there is an increased rate of oxygen consumption in both aerobic exercise and light therapy, which suggests there is an energy expenditure component to SAD. This means our bodies need to be metabolically active (i.e. exercising) to increase oxygen consumption and therefore will benefit from utilising energy – so get moving!

The time of the day when aerobic exercise is performed is yet to be fully investigated, however there is the understanding that exercise late at night might be contra-indicated in SAD because it can lead to a phase-delay in the onset of melatonin release the following night in humans, meaning we become less physically ready for sleep. (Fun fact: melatonin is one of the major hormones recognised in circadian rhythm or sleep cycle.) Strength training has also been identified as an effective therapy in management of depression and the common co-existing conditions like anxiety, chronic pain, fatigue and sleep disorders.

Strength training or resistance training (for example: body-weight, weight-training, tubing), is defined as that which increases muscular strength and endurance and consequently improves lean muscle mass. The advantage of exercise as therapy in the management of depression is the low cost and predominantly positive side effects (such as lowering your risk of cardiovascular disease and increasing bone density), particularly when compared to pharmacological and psychological management, which for some may still be necessary.

Dr Adam’s recommendations…

Finding daily exercise during the working week helps setup routine. While finding a great balance between aerobic exercise, strength training and high-intensity interval training (HIIT) is important, moving every day in some way is essential.

Classes like Bodypump, CXWorx, Pilates, Yoga and Bodybalance incorporate strength training components and classes like Bodycombat, Bodystep, Bodyattack and RPM have more aerobic components. Then to hit the HIIT, Les Mills Grit and SPRINT classes utilise these principles in a convenient 30 minute time frame.

Finding a blend of classes you enjoy will assist to maintain a high level of motivation, keep energy high and prevent the winter-blues taking over.

Note: *aerobic exercise consisted of two daily sessions on a stationary bike separated by five minutes of rest, each involving a 5-minute warm up followed by 10 minutes of basic pedalling and 10 minutes of pedalling at 75-percent maximal heart rate.

References:

Roecklein KA and Rohan KJ. Seasonal Affected Disorder: An Overview and Update. Psychiatry (Edgmont). 2005 Jan; 2(1): 20-26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004726/

O’Connor PJ, Herring MP and Caravalho A. Strength Training & Mental Health
Mental Health Benefits of Strength Training in Adults. American Journal of Lifestyle Medicine. 2010; 4(5).
http://journals.sagepub.com/doi/pdf/10.1177/1559827610368771

CXWORX – PRE-HABILITATION



CXWORX is a group fitness program created by the Les Mills franchise and is a program that should interest those eager to improve their physical performance; be it athletic in nature or even simply carrying the shopping to and from the car. Another significant attraction is that the class runs for only 30 minutes, but don’t get complacent the reminder of how intense a 30 minutes class of core annihilation can be, will be ever so present each time you laugh the next day.

CXWORX is a functional workout that strengthens the core muscles and helps tighten and tone the midsection, speeding your way to aesthetic pleasure. The workout uses a combination of floor work and standing strength exercises enhanced by the use of plates and tubing, all backed by scientific research.

The program focuses on training and utilising fascial (soft tissue) and muscular slings. These slings are an important combination of muscles and soft tissues that unite to generate powerful movement patterns. Using CXWORX to target these muscular slings, not only aids in improving the power the body can generate but also enhances the transfer of power from the lower body and legs, through the core, and into the upper body and arms.

Athletes will be particularly interested in this focus of training. To recognise the transfer of power between the upper and lower body through the core is integral to all types of activities, from golf to martial arts, cycling to surfing and everything in between.

While the benefits are very clear to athletes, CXWORX pays attention to participants who may not necessarily be athletically driven and Les Mills has put time into researching why it is a program everyone should do.

Pre-habilitation is a term that captures the pro-active approach to ones health and physical well-being. This is a program that will benefit any individual committed to taking care of their physical well-being. By training the core muscles and associated muscular slings we know through research that limb and body co-ordination improves and the flow on effect is simple, with improved co-ordination one is less likely to be vulnerable to injury. Training will improve muscular endurance, again helping to decrease the risk of injury. Strengthening the muscular slings also directly influences ones posture and again with improved posture the body is more able to efficiently navigate this terrestrial existence we called life.

Other core training programs, such as Abs, Butt and Thighs, Pilates and Yoga all include the same training principles. CXWORX brings elements of all these regimes into an intense 30 minute class, tried and tested on thousands of participants before its release as a world-wide product, thats the benefit of a choreographed Les Mills product.

It should be made clear that CXWORX is a workout – not a rehabilitation program. Yes the program is fabulous to improve ones fitness post injury but only after initial care and rehabilitation of the injury has progressed to functional training stages. Those with injuries or who are pregnant should make themselves known to their group fitness instructor so that each case can be considered appropriately.

CXWORX is a fun and challenging program perfect for those who are pushed for time, it is intense enough to know you are changing the body with every repetition and the benefits are well researched. It is important to know that CXWORX is not just a program aimed at athletes (although it may just very well make you look like one!) but aimed at every “body” to improve how we walk, climb stairs, carry our children or tend the garden. To improve how you move and live day to day.

This program caters to all fitness levels so that you will feel successful after every CXWORX class.

Dr. Adam Epskamp

Chiropractor BChiro(Hons), BSc(Chiro)

www.silverbackchiropractic.com

MAKING A SUCCESSFUL CHANGE



Why haven’t you started this earlier? What do you want? How long have you wanted to make the changes?

I had one of those conversations that shed some light and brutal truths about why some people don’t initially succeed with care or health regime be it diet or working out but extends to pain management, wellness and actively achieving all our goals.

A good friend and colleague highlighted some important considerations when striving to change or achieve changes in health, fitness and wellness. A lady and her son consulted my colleague looking to lose weight and improve their overall fitness. The lady mentioned she has wanted to make the changes to her health for over 6 years now. She was asked what was the situation or the reasons that held her back from making the changes 6 years ago, or even in that time leading up to now. Time poor, children and relationship and financial difficulties, all of which are very common obstacles for people to begin and even continue working towards health, fitness and wellness goals.

The next consideration was something that is obvious but I had not fully considered, yet detrimental to the outcome and likely success of each individuals efforts towards achieving their personal goals. Having considered the obstacles to making the changes at and during this time over the last 6 years, have those obstacles changed?

If those same obstacles have not changed then should we expect success if there remains no time for commitment and the stresses of child rearing, relationships and finances continue to persist. If the same obstacles that prevented an earlier initiation and concerted effort towards health, fitness and wellness goals still exist then we are are setting up a situation that doesn’t have all the right conditions for success, we could go as far as to suggest that it is setup to fail.

When consulting in health, fitness and wellness cases, this is a common scenario. To setup for success when talking about long term achievement of health, fitness and wellness goals, changes in and around our lives need to be made. Need is a strong word and most often met with resistance in Australian culture, but I’m using it here because it is so significant in terms of making long term lifestyle changes.

If the situation that holds an individual back from achieving their goals doesn’t change how can we expect change to occur. This holds true also when the situation remains consistent and there is minor effort put in with the expectation to have major change.

It is harsh but people inherently know the reasons behind why their health, fitness and wellness is not where they wished it to be, yet when consulting most hope for an easy fix yet realise they have been sabotaging their efforts for an exhaustive period of time.

Those cases I do see succeed are those who get the bigger picture and work real hard towards maintaining a healthy lifestyle. Athletes bounce back from injuries because they already have a healthy situation surrounding their lifestyle and they have time built into their life-style for self-preservation.

Other situations usually surround an event, life-changing, take heart-attack for example. Some get to within an inch of losing everything before they make that significant change. Its at this stage a realisation is made that significant change is required to preserve life. I read a quote recently “make time for your health because you may be forced to make time for illness”.

In order to achieve success and make health, fitness and wellness changes, an effort needs to be made, be it creating time for fitness, getting adjusted more regularly (wondering why it doesn’t happen in 10 mins), changing how you feed the body and reduce that which poisons it. If you want significant change you need to make a significant effort towards those goals which will correlate with a significant change in your situation.

Dr. Adam Epskamp

www.silverbackchiropractic.com

TONGUE-TIE IN INFANTS



Dr. Adam Epskamp
Chiropractor BChiro(Hons), BSc(Chiro)

As a Chiropractor with a keen interest in the pediatric population it often surprises clients how much attention I focus on around infant feeding and particularly breastfeeding when consulting for infant children.

Obviously the infant can’t communicate directly with the practitioner so its necessary to hone in on behavior around certain activities to guide and help identify certain vertebral subluxation complexes or even other developmental changes that indicate appropriate progression towards the child’s milestones.

Breastfeeding and the behavior and experiences around breastfeeding give significant information and direction to an infants case. Feeding should be a rewarding experience and some mothers never have a problem while others are left wondering if they are doing it right and notice a preference to certain positions or slightly differing technique when comparing notes with other mothers, wellness nurses and lactation consultants. Some mothers even find breastfeeding painful.

If breastfeeding is painful or difficult this should raise concerns. The next step is to find help as most cases can be corrected. As a Chiropractor I’ve helped many infants improve their ability to breastfeed simply by finding the nerve interference and correcting the subluxation/misalignment. Even more commonly I’ll correct the vertebral subluxation/misalignment in a reportedly asymptomatic infant and receive feedback about how much easier breastfeeding has become, the feeding times are shorter and much more regularly spaced. The majority of cases I’ve managed have responded significantly well to Chiropractic care.

There have been a few cases where the Chiropractic adjustment only gave temporary relief to the infant and in particular the mother from painful feeding. These cases are where  the practitioner must consider their differentials (other conditions that cause similar symptomatology). One such differential is ankyloglossia or otherwise commonly known as tongue-tie.

Tongue-tie occurs when there is a congenital tightness or shortening of the skin that anchors the tongue to the floor of the mouth. This skin is known as the lingual frenulum.

When the lingual frenulum is short this can restrict the mobility of the tongue and consequently the reduce function of the tongue. Restricted tongue movement can lead to poor sucking, poor feeding and painful breastfeeding for the mothers. If the infant cannot suck properly then breastfeeding becomes nipple-feeding and nipple-feeding is typically traumatic to the nipple and will lead to injury and painful feeding.

Here are some of the signs associated with tongue-tie in infants;

  • nipple pain and injury,
  • after breastfeeding the nipple becomes flattened,
  • compression or “stripe” mark on the nipple following breastfeeding,
  • the infant has poor suction while feeding,
  • the infant in attempt to suck harder sucks in air and becomes gassy,
  • the infant makes clicking sounds while feeding,
  • cannot poke tongue out beyond lips or maybe even gums,
  • unable to move tongue sideways,
  • tip of the tongue mis-shaped be it notched, flat, heart-shaped,
  • failure to thrive or appropriately gain weight.

A collection of these signs in combination with physical exam and history lead the practitioner to consider tongue-tie as a diagnosis, particularly if there is poor feeding and significant discomfort for the mother.

Once confirmed, the treatment is to snip the lingual frenulum (frenectomy, frenotomy, frenulectomy) to release the tongue and allow the infant to achieve good tongue mobility. It can be performed up to 16 weeks of age with out anesthetic (although in my experience through referral, practitioners don’t like to treat much beyond 12 weeks of age). The procedure is usually painless in this population, and once performed the mother is encouraged to immediately breastfeed to aid with healing, distract from discomfort and the breast milk will act as an analgesic. Beyond this age the procedure can still be performed but under anesthesia.

Once corrected immediate function is restored and all signs should significantly diminish if not resolve.

For more information or to make a Chiropractic appointment please email me at or phone the Caloundra Clinic, Childrens Sunshine Chiropractic on 07 5353 0989.

IMPROVING FITNESS FOR SPECIFIC ACTIVITIES



The human body is an amazingly adaptive vessel. The human body is dependent on stress not only to challenge it and consequently change it but also to simply maintain it.

Understanding the stresses is important for training for specific activities, and when you understand how the body responds to the stresses imposed upon it then you can direct your training to improve your fitness in specific ways.

A client put to me, “are there certain exercises I can do to improve my fitness on a bike?”

My response is simple and complicated.

“Yes. Yes there are exercises or activities you can do to improve your fitness on a bike.”

That’s the simple part.

My first thought with improving performance in a specific activity comes back to the SAID principle. The SAID principle captures the bodies response in that the body will make Specific Adaptations to Imposed Demands. That means the most specific way to train for an activity is to perform the activity.

My conversation with my client continued with that principle. “If you want to jump higher, start jumping, if you want to improve cycling get cycling. The body is designed to respond specifically to the stress imposed upon it.”

I go on to consider the complexities of the question further.

If it doesn’t challenge you, it doesn’t change you. A powerful quote I love using and considering when training.

So when considering the actual activity and in this case cycling, there are multiple ways we can challenge the body. The bike is a good example where training can be varied but maintain very specific adaptations by overloading or challenging the body. Types of training include;

  • sustained distance training. Challenge the body by riding further than what your comfortable with.
  • cadence training. typically train the activity at a high pace or tempo, turn the pedals faster (higher RPM)
  • interval training. Work hard then recover then work hard and recover, can be used in multiple ways too, speed, strength or a combination of both to generate power.

Then I discussed cross-training principles where training other activities will have a cross-over effect with the intent to challenge fitness components that will also improve on the target activity too.

  • resistance training to target strength fitness into the legs, performing squats, lunges dead-lifts will improve strength into the muscles also required to pedal on the bike or using more compound activities like clean and press to train power into the same muscles.
  • cardiovascular training to improve cardiovascular capacity/fitness, running, swimming, rowing or BodyAttack classes are all examples of activities that will improve cardiovascular fitness and consequently also roll over into the target activity, cycling in this case.

All these activities will stress and stimulate an adaptive response in the human body to improve the ease in which the body can complete the task, improve the bodies fitness to perform.

One component I did overlook in our discussion was the physical therapy component. When I first met this particular client, they were unable to walk up stairs or jog across the road due to low back and sciatic pain which was chronic in nature. Through Chiropractic and some fairly unique sciatic therapy the body was stimulated to heal and consequently adapt to the stress and improve performance. Chiropractic care was integral to improving the fitness or ability to perform physical activity.

“Yes. Yes there are exercises or activities you can do to improve your fitness on a bike.”

Dr Adam Epskamp
Chiropractor (BSc, BChiro), Fitness Instructor

A practicing Chiropractor at Childrens Sunshine Chiropractic in Caloundra, Queensland, Australia. Compliments his active role in health care by leading a range of group fitness classes around Sunshine Coast. A qualified pilates instructor as well as a certified Les Mills instructor for Bodypump, CXWorx and RPM and also a Les Mills SPRINT Coach. Dr Adam is also a National Presenter and Master Trainer for Les Mills Bodypump.