Dec

19

2012 Neurology Game Changers, Which Foods Are Best for the Brain?

Dietary advice is common practice in cardiology and primary care, but recently food and drink have become important considerations for neurologists, too. Diet is inextricably linked to conditions such as heart disease, obesity, and diabetes. However, what we consume also seems to have significant implications for the brain: Unhealthy diets may increase risk for psychiatric and neurologic conditions, such as depression and dementia, whereas healthy diets may be protective. 2012 saw coffee and berries warding off dementia, caffeine supplements improving motor function in Parkinson’s and the Mediterranean diet reducing the odds of developing Parkinson’s. Lycopene-rich tomatoes and the flavanones in citrus fruits were found to protect against ischemic stroke. As for what not to eat, a study published in January in Stroke supported previous work linking red meat consumption with higher stroke risk, while diets high in carbohydrates and sugar reportedly raise the risk for mild cognitive impairment and dementia in the elderly. A 2009 study published in the Archives of General Psychiatry found that people who follow Mediterranean dietary patterns — that is, a diet high in fruits, vegetables, nuts, whole grains, fish, and unsaturated fat, (common in olive oil and other plant oils) — are up to 30% less likely to develop depression than those who typically consume meatier, dairy-heavy fare. The olive oil-inclined also show a lower risk for ischemic stroke and are less likely to develop mild cognitive impairment and Alzheimer disease, particularly when they engage in higher levels of physical activity.

All data derived from Medscape, 2012.

May

4

A recent video circulating on the internet on the biochemistry of fructose has had almost one million views already.  Why?  As seen on recent TV commercials, sugar is sugar, be it table sugar, (sucrose), or high fructose corn syrup. In a recent NYT article, it was stated that our countries excessive consumption of sugar may be the primary reason that the numbers of obese and diabetic Americans have skyrocketed in the past 30 years.  The article goes on to say that sugar may also be the likely dietary cause of several other chronic ailments widely considered to be diseases of our western lifestyles; heart disease, hypertension and many common cancers. Another report has found that the United States is the fattest of 33 countries studied. Seventy percent of Americans are overweight, expected to increase to 75 percent by 2020 and 86 percent by 2030! So “Death by sugar” is not an overstatement.

So is sugar toxic?  Well in a word, YES!  There is increasing belief that sugar is the primary factor causing not just obesity, but also chronic and lethal disease. There is also no longer any doubt that sugar is indeed toxic, and just a matter of time before it is accepted as causative of most cancer, in the same way that we know smoking and alcohol abuse is a direct cause of lung cancer and liver cirrhosis.

Fructose is the primary source of calories in the US. The issue is that fructose is so cheap it is used in virtually all processed foods.  It’s important to realize that “sugars” include other types of sweeteners too, such as corn-based sweeteners like high fructose corn syrup, honey, agave and fruit. So in counting, you can’t just include table sugar.  It is recommended to limit total grams of fructose to below 25 per day, then it would not be an issue.  (Note that this is well below average intake).  Sugars are hidden everywhere.  It’s in your soft drinks, fruit juices, sports drinks, most processed foods, even most infant formulas contain the sugar equivalent of one can of Coca-Cola!  Drastically reducing your sugar consumption is the “miracle cure” everyone is looking for!  Cutting out a few desserts will barely make a difference however if you’re eating a “standard American diet”.

Fructose elevates uric acid, decreases nitric oxide, raises angiotensin, and causes smooth muscle constriction, thus raising blood pressure and damaging your kidneys. Increased uric acid also leads to chronic, low-level inflammation, which can lead to obesity, heart disease, hypertension, stroke, kidney disease, gout and cancers, as well as being a major cause of dizziness, which as you are by now no doubt aware, is my specialty.  Uric acid levels have been shown to almost triple in this county over the last century. It remains my opinion as well as others, that this process is indeed correlative with coronary artery disease rather than the commonly accused culprit “cholesterol”, for which most Americans now take prophylactic daily doses of highly profitable drugs.  It has been estimated that simply preventing these diseases by decreasing sugar consumption could save the US health care system around one trillion dollars a year! Imagine the effect this would have on our deficit. Although not without flaw, a good start to improving your diet, is the Mediterranean diet. A good resource for this is through a website run by a patient of mine; www.italialiving.com.  Rather than yoyo dieting, this “method of eating” will teach you how and what to eat to preserve your health.

Apr

19

Over 40 million Americans – 1 in every 7- suffer with a movement disorder.  That’s more than double the number of people who suffer with diabetes, which, is in itself a staggering number.  A person who has a movement disorder will typically see on average 15 different doctors, over the course of 5 years before one of them actually recognizes and properly identifies the problem.  To those individuals suffering with movement disorders this is a very real problem and as such those suffering are very much underserved.  Making matters worse, movement disorders, once recognized, are typically treated by drugs which were not necessarily developed for the treatment of any particular movement disorders.  And if this is not bad enough, most of these drugs are actually known to cause movement disorders, such as tremors.  Surprisingly, one can develop these tremor side affects, (called tardive dyskinesias), from a single dose of prescribed medication.  Most people think that you have to take a lot of a drug before it will inflict side affects, though in actuality, this is clearly not the case.   So is there a better approach to this?  Well, actually in a word, yes.  As a functional neurologist, I routinely spend my day seeing patients with movement disorders, most of whom have been referred to me to ascertain what is going on with them what is causing them to move the way they do.  Many of these movement disorders can actually be treated better without drugs using neurologic rehabilitation, whereby we restructure the brains neurologic connections using simple exercises and activities, affording the brain appropriate integration of the many neuronal pools which all have to work synergistically together at all times.  The trick to this is that the diagnosis needs to be extraordinarily precise, as no two patients, even with the same movement parameters, are typically going to be managed the same. Because of the simplicity of this approach as well as the lack of harmful side affects, there is little sense in utilizing alternative drug therapies in favor of appropriate neurologic rehabilitation.  Another problem with the drug approach lies in the fact that since the drugs are not treating anything at all and at best hoping to ameliorate some symptoms, the underlying cause continues to worsen.  Often times as this goes on for a long time, the movement disorder becomes difficult or even impossible to entirely correct due to the vast reorganizational changes that have now occurred in the brains many interconnections.  This is particularly frustrating for me as a clinician as well as for a patient suffering with a movement disorder as had they presented years earlier the problem would have been much easier to treat successfully.

May

4

As a rule, the main types of disturbances that we feel as humans that present to the clinician as one form of dizzy feeling or another, are vertigo: a sense of spinning; disequilibrium: a sense of imbalance; or dizziness: a feeling of being off, or disoriented.  Dizziness is the vaguest of the symptoms.  Let’s talk about it this week.

Dizziness is in the top three reasons why individuals present to their doctors office.  It is often a confusing constellation of symptoms which patients find difficult to describe, and clinicians find difficult to diagnose.

Oftentimes, vertigo and disequilibrium will manifest such that the patient would complain to the clinician about dizziness.  It is up to the clinician to ask the right questions to discern between them to correctly diagnose the patient and refer to the appropriate specialist for neurologic or vestibular rehabilitation therapy, (what I do), vs. to an ENT for a sinus infection or similar.

So what then is Presyncope?  Well, syncope, means in medical terminology to pass out.  So presyncope is the sensation just before passing out, without progressing into actually passing out.  Most patients with presyncope will be referred to a cardiologist, assuming of course that they were even correctly diagnosed in the first place, which is not necessarily always the case.  This is not a bad plan as it rules out any cardiac problems as being causative, however, the patient gets cleared from cardiology and is still symptomatic.

Well here’s the deal.  Syncope/presyncope is almost always a neurologic condition.  Yes, it is caused by the heart, however, the heart only does what the brain is telling it to do.  To make some sense of this, imagine you are standing up.  Your heart has to pump blood up to your head sort of like a small water tower.  Now imagine lying down.  As blood gushes into your head, baroreceptors in the carotid vessels tell your brain to tell you heart to slow down so you don’t shoot your head off.  Conversely, when you arise from lying down, your carotid baroreceptors tell your brain to tell your heart it had better pick up and fast to get blood back up to your brain, (like a water tower again).  When there is a problem with this regulatory system, you are going to experience presyncope.  As this problem worsens, you will actually experience syncope, (actually passing out).  The irony to all of this is that this is actually very easily fixed more often than not; these are the types of problems that I spend much of my day fixing for people. As syncopal problems worsen, it is not uncommon for simple head movements or turns, or visual stimulus from driving to provoke an attack.  This also often precipitates into panic disorder and panic attacks, not only because of the fear and anxiety associated with the symptoms, but also because of the sympathetic nervous system and its hard wiring.  (The whole “fight-fright-flight thing you learned in school).

Again, there are many causes of dizziness and presyncope is just one of them, but it is a fairly common problem and finding the right specialist early on can make a big difference in how far your symptoms will progress and whether or not they will progress into other conditions over time until properly treated.

Mar

5

So what is health, and how would you define it? It seems that everyone has a different idea of what they consider it is to “be healthy”. Through the years, I have seen many patients, who consider health to quite simply be the absence of disease. You may even be surprised to learn that many patients consider being able to live with diabetes, hypertension, obesity and other disorders through a delicate balance of drug therapies to be healthy. I think it is safe to suggest that this type of “eyes closed” mindset to taking care of oneself is less than being healthy and certainly less than desirable. Now don’t misunderstand me. I am all for the appropriate management of health conditions. What concerns me however is abandoning healthy habits and adopting poor habits with the assumption that the drug companies will make everything right. This is a tremendous wrong doing in society today and in fact the main reason for the endemic problems of obesity, heart disease, diabetes, cancer, hypertension, etc. that we now have.  There is much information on my Healthy Eating Page regarding, well, healthy eating.  There are also exercises on my Fitness page from beginner to advanced, using a stability ball.  To truly be healthy, is a lifestyle choice with a  balance of healthy diet, exercises and nutrition, and addressing health problems before they take away your health.

Mar

2

Of interest, the following topics are discussed in this weeks newsletter, composed from recent findings in the medical literature. To receive a copy of our E-News, sign up on our Subscribe Today! page.

Statin Drugs Related To Decreased Brain Function
Memory Is Proportional To Fitness Level
Literacy Level Associated With Poor Portion Control
Mild Traumatic Brain Injury And Seizure Disorder

Feb

19

Well, I guess it was inevitable.  Being a technical fellow that I am, I think we all knew that having my own blog page was soon to happen.  So, here it is.  This is where I will publish new information, recent medical literature findings on health and treatment, patient success stories with difficult neurologic cases, the whole enchilada. Perhaps even the occasional recipe share, restaurant find, or wine extraordinaire. So check back frequently to see the most recent topics and to derive as much benefit as can be had from this new section of our website.

Here’s to your health…

Feb

12

Quoted from Laurence J. Peter, US educator & writer (1919 – 1988), one must wonder if he somehow anticipated our current healthcare system.  We are living in an age where it is deemed ok to suggest prescription drugs on TV which can cure all of your woes, despite all of those nasty side effects, which don’t appear to be really significant anyway as the girl on TV is throwing rose petals during the part about the side affects.  In light of this “better living through chemistry” attitude, we have never been more unhealthy as a country.  Type II diabetes, solely a result of poor diet and lack of exercise, is now the norm.  It will be endemic with the next generation of adults, many of who suffer with the affliction now as adolescents.  Many of these same children who already suffer with ADD and other behavioral disorders attributable to a poor diet and lack of exercise, will be given drugs to quiet them down rather than treat the underlying problems.  In my office, I see many, many adult patients, who come to see me for dizziness and imbalance, and on examination I find that they have been prescribed vestibular suppressant drugs, known to have no beneficial effect on balance or dizziness, and in fact, known to cause dizziness, lethargy, and imbalance.  It seems that drugs have become the illogical alternative to taking care of ones self and that the latter has been ironically labeled “alternative therapy”.  Exactly when did this happen, and more importantly, how has this happened?   Well, there is no question that by and large our culture is much more sedentary than any of our ancestors.  And the TV, with its ability to brainwash anyone who sits before it that what you see must be true, after all, it’s on TV, right?  At some point, logic must prevail if we are to avoid the many traps set to rob us of our health.  And this logic must be from within ourselves.  Individuals must learn to scrutinize decisions made regarding their health management, (which has never been easier since the Internet), and stand up to those that do not pass the common sense test.

Jan

31

Despite the multitude of dramatic success stories associated with chiropractic medicine over the past 200 years, the profession is ridden with myths, wives tails and many unfortunate beliefs, or as it may be, disbeliefs.  I have been running a center, which, very successfully, treats patients with vertigo, dizziness and dystonia for over ten years now.  Because of my success in this area, I have attracted many patients from many states, who come to see me because there is hope.  Many of my patients are referred to me by their doctor, but there are many others who are on the fence because of the assumptions they make based on the myths.  I know this because many of my patients confess after I get them better that they have been reading my articles for some time but assumed inappropriately that I could not help them. The obvious calamity here is the prolonged and needless suffering. Making matters worse is the simple fact that individuals with dizziness have increased risk of fall, and falls are the leading cause of accidental death and non-fatal injuries as reported by the CDC.  Because of this fact, centers such as mine are instituting fall risk screening and fall prevention programs, which are now becoming required by hospital regulatory boards.  Fortuitously, I have been doing this since before these regulations came along; realizing the endemic threat fall risk poses.  So what makes my practice so different?  Well, through education, training and board certification, I chose to limit practice to my specialty to assist other physicians in the diagnosis and treatment of patients suffering from a variety of neurologic conditions.  Typically, I serve in the same consulting manner as a medical neurologist. Patients come in for medical history and examination, they may or may not require specialized testing, which we either perform or prescribe, they get diagnosed, and they get treated according to their diagnosis.  No big surprises here.  The difference is that my therapies and applications do not include drugs or surgery. Our office uses an integrative functional neurologic rehabilitative approach to treatment paradigms. As a result, although many conditions may require drugs or surgery for efficacious treatment, many more do not.  And these would be the individuals best served by me.

Dec

22

It does seem that each year the holiday season comes faster than the year before.  And with that, comes the stress of rushing to prepare for the family festivities, which the holiday centers around.  With all of this hectic behavior, come accidents.  As accidents are one of the biggest reasons why patients develop vertigo, dystonia, headaches, and other neurologic disorders, which eventually present to my office, this month I have decided to devote this article to prevention.  With just a little forethought and pausing that extra minute before rushing to the next task at hand, you may actually be able to cross things off your to-do list and enjoy the holidays, safely, in the process.  Remember to allow extra time when traveling in anticipation of traffic.  If you do get a late start, or, get stuck in heavy traffic, remember that worrying will offer no reprieve of the situation and only present you with one more problem.  Remember to only try to control those things that are within your realm to control, and to let go of those things that are not.  Try to be more pleasant in crowded stores rather than irritable, as this just raises you blood pressure and stresses your adrenals unnecessarily thus making an accident more likely by decreasing judgment and response time when you need it most.  All of this undue stress leads to a myriad of health issues as well, all of which can be averted by not stressing over things that you cannot change in the first place.  Be compassionate to those less fortunate then yourself.  Adopt a tradition of giving to your favorite charity, as the benefits to your spirit are immeasurable.  Always hold doors open for the elderly.  If you are young and healthy, park further away leaving the close spots for the elderly and those less healthy.    Needless to say, do not operate a vehicle after alcohol consumption.  If you do not have a designated driver, stick with nonalcoholic beverages.  Only eat half your dessert, as you will likely have twice as many deserts over the season.  Remember Linus from Charlie Brown who extolled the true meaning of the season is spending time with family and friends, not commercialism.  And most importantly, leave a dish of cut vegetables out on Christmas Eve for Santa as too many cookies could lead to premature diabetes.  I wish a Merry Christmas and happy, healthy holiday season to all.

Jun

20

I saw a young woman in my office this week, who presented to see if I could help her with her vertigo and dizziness, which she has been suffering with for several years.  This is not an uncommon presentation in my office, in fact quite the contrary; it is what folks commonly come in to see me for.  What made this case different was the fact that this young lady fell last year as a result of her balance being affected, not only from the vertigo and dizziness, but from the drugs being used in the failed attempt to treat her (the main side affect being that of dizziness).  The fall resulted in a fractured shoulder, causing severe limitation of movement of that arm and as such, with her activities of daily living.  As I talked to this young lady, I thought to myself, “if only she had come in sooner, I could have treated her successfully without the use of the drugs which likely caused her balance loss, which would have averted the fall and thus the fractured shoulder.”  This is all too common a problem as individuals often times wait painstakingly long intervals in anticipation that the problems will resolve on their own, when in fact, they rarely do.  Procrastination is the mother of disaster, causing a bad situation to become worse, especially with problems such as vertigo and dizziness.  Over time, these conditions affect your balance by altering the pathways in your brain that monitor the postural systems.  Ultimately, you wind up with a new problem, that of balance loss.  With falls being the #1 cause of nonfatal injuries in all age groups, and the leading cause of accidental death in people over the age of 65, it is only a matter of time before something bad happens.  Typically with dizziness types of disorders, the sooner an individual presents for treatment, the easier and less involved that treatment is, which is really true of almost everything.  As the disorders progress, they oftentimes cause the introduction of new problems involving other areas of the brain or the neuraxis.  If you or someone you love suffers with vertigo or dizziness, finding the cause and treating it early can make all the difference between getting on with your life vs. getting on with a lifetime of anguish and medical bills.

Apr

25

As in other medical professions, we have individual specialists within the chiropractic profession. Through education, training and board certification, we choose to limit practice to a certain specialty to assist other physicians in the diagnosis and treatment of a variety of conditions.  Typically, a chiropractic neurologist serves in the same consulting manner as a medical neurologist. The difference is that the therapies or applications of a chiropractic neurologist do not include drugs or surgery. As a result, certain conditions are more customarily amenable to treatment by a chiropractic neurologist as opposed to a medical neurologist, and vice versa. In my own practice, I see patients with a variety of vertigo, balance, dizziness and movement disorders, dystonia, headaches, and pain.  There are naturally conditions for which drugs and surgery are more appropriate, and, many conditions for which drugs and surgery are inappropriate.  It is my job to discern the two and treat those conditions that are amenable to the type of treatment, which we provide. There is a growing demand for the drug free treatments that we provide. Although not against the utilization of surgery or drugs when appropriate, our treatment focuses on not using them. We will refer a patient to another appropriate specialist who uses these modalities if that treatment is the most appropriate for a given condition.

How does one become a chiropractic neurologist?

The training to become a board certified neurologist in the chiropractic profession is an additional three years didactic and clinically based residency program, (after the doctor’s degree), which is conducted through an accredited university or college.  Board examination is provided annually for which the candidate must sit to become board certified. Certification is provided through NOCA, (National Organization for Competency Assurance).

When do I make the decision to see a chiropractic neurologist?

Neurologists from a Chiropractic medicine background, trained extensively in neurologic rehabilitation applications, are in great demand.  Nonetheless, the unfortunate reality is that most patients will go through the usual channels of failed allopathic treatments, before making the appointment to come see us.  Many of these patients suffer needlessly for years prior to making that decision, oftentimes making themselves worse in the process.  It is far more appropriate to engage our type of drug free treatment first, escalating to more complicated treatments secondarily, rather than vice versa, which oddly has been the trend, although more recently we see this changing.

Dr. Scopelliti is a chiropractic neurologist, practicing at the 279 Professional Arts Bldg at the rear of Monmouth Medical Center, in Long Branch, NJ.  He is also currently the president of the NJ Chiropractic Council on Neurology.  His office specializes in the drug free management of vertigo, dizziness, balance loss, syncope, dystonia and headaches.