Metformin is a medication commonly prescribed for type two diabetics.  Metformin is also sold as Glucophage,Fortamet,Glumetza. A recent study in the scientific research journal of the brazilian medical association found a high prevalence of vitamin B12 deficiency in Metformin treated diabetic patients.

Vitamin B12 is a water soluble vitamin that is naturally present in  foods such as fish,shellfish, poultry,milk, eggs and meat.   Vitamin B12 is necessary proper function of your nervous system,the manufacture of red blood cells as well as to make DNA.  Vitamin B12 is also associated with regulating Homocysteine levels which is associated with heart disease.

Symptoms associated with vitamin B12 deficiency include confusion, forgetfulness, feeling tired and weak, tingling in the hands and feet, constipation,trouble with balance and walking, mood changes including depression and weight loss. Physical signs you may notice include soreness of the tongue, bleeding gums , frequent bruising and paleness of the skin.

Vitamin B12 levels are typically evaluated by serum or plasma analysis.This type of testing can be performed at any of your standard laboratories such as Quest Diagnostics or lack or and as such are readily available to patients in the United States.

Ten  to thirty percent of those over 50 years of age suffer from a condition called atrophic gastritis.  In a trophic gastritis, there is reduced level of hydrochloric acid produced by the stomach.  The consequence of this low  hydrochloric  acid production is diminished absorption of vitamin B12. Thus if you are elderly and a diabetic taking metformin, the chances of your having a vitamin B12 deficiency increase. Vegetarians who by definition do not eat animal proteins, the most prevalent source of vitamin B12 and those with digestive disorders such as crohn’s disease also need to beware of possible B12 deficiency. Once again, this is especially true if coupled with being a diabetic was taking metformin.

If you’re a diabetic and taking Metformin and feel that several of the signs and symptoms listed above pertain to you, contact your physician for a vitamin B12 analysis. Many physicians are not aware of the nutritional consequences of the medication they prescribe and therefore a visit to a functional medicine practicioner may be in order.

Acid reflux is a condition in where food, solid or liquid regurgitates back up into your esophagus and can cause symptoms such as nausea, heartburn, sore throat and hoarseness.  A common medication prescribed for gastroesphageal reflux (acid reflux) is Reglan, generically known as metoclopramide. One of the side effects of Reglan is a condition called Tardive Dyskinesia. A Tardive Dyskinesia is a neurological syndrome  that typically produces involuntary movements that may include tongue protrusion, eye blinking and lips smacking in the face, as well as produce involuntary irregular movements of the trunk, legs and fingers.  The movement disorder that the side effects produce can be very  “Parkinson like” in symptoms such as stiffness of muscles, slowness of movement, depression and tremors.  If one develops a tardive dyskinesia do to side effects from medication the first course of action is typically to decrease or discontinue the use of the medication.  This however does not guarantee that the uncontrolled movements will stop.  This side effect may be permanent.  This is why I feel so strongly about getting this information to the public.  I have had several patients that have developed tardive dyskinesia that either were not told that this was a possible side effect or do not recall being told that a dyskinesia may develop as a consequence to a particular medication.  These movement disorders are believed to develop do to influence  the medication has on a part of the brain called the basil ganglia.  Although there is no regular treatment for these types of movement disorders, functional neurology has had success with these conditions by exciting or inhibiting various inputs to the basil ganglia.  The functional neurology approach for these movement disorders is not a traditional approach at this time, however, many have had success with this approach and there are no side effects as a consequence of this treatment.  If you feel you have developed a movement disorder secondary to the use of Reglan, contact the prescribing physician and discuss the situation with him.  If you’re interested in using the therapeutics of functional knowledge and to attempt to reduce or eliminate your tremors and slash or difficulty with movement consult a functional neurologist in your area.

A.D.H.D, attention deficit hyperactive disorder currently affects 5 to 10% of school age children in the United States.  Your child may have ADHD if he has difficulty focusing, difficulty waiting in line, interrupts conversations, has difficulty keeping still, cannot remain seated in the classroom, is easily distracted, procrastinates, makes careless mistakes with schoolwork or homework and is disorganized.  Children with ADHD tend to have difficulty in school and at times socializing with others.  Approximately 50% of children with ADHD grow up to be  adults with ADHD.  The same issues make it more difficult to obtain and sustain employment as adults. A recent study in the scientific journal Attention Deficit Disorder found two factors associated with ADHD which everyone concerned with this condition should be a aware of especially since these factors are modifiable.  Specifically, the study found a more than two fold increase in the incidence of ADHD from mothers who smoked during their pregnancy.  Obviously, if your child has already been born and has ADHD, you can not go back in time.  However, if you’re an expectant mother or planning to have children and are concerned about having a child with ADHD then not smoking during pregnancy should be a top priority for you.  If you have a child that has ADHD you should be aware that this study also found the rate of children with ADHD is five times as great in children with obesity.  Thus, if you are pregnant and smoke or your child is overweight, these are issues that are difficult to deal with but will certainly make a difference over your child’s lifetime and is worth putting in the effort.

Do you have numbness and tingling in the fingers and hands that seems not to affect the little finger ?   Do you have pain about the wrist? Is your grip weak? Do you have trouble opening jars? Have you been dropping things?  Are your fingers  coordinated?  Does the pain, tingling and numbness wake you up at night? You may have carpal tunnel syndrome. 

The median nerve  passes through the carpal tunnel as it travels from the forearm, across the wrist and into the hand.  The median nerve is one of the main nerves that control the feeling and muscles in your hand.  Simply put carpal tunnel syndrome is a pinched nerve at the wrist.  If you have symptoms in both hands, be careful as you may also have underlying systemic conditions  such as diabetes, alcoholism, kidney disease, rheumatoid arthritis and hypothyroidism.  Many women  develop carpal tunnel syndrome during their pregnancy.  If you’re a female between the ages of 40 and 60, taking birth control pills or going through menopause and/or taking estrogen hormone replacement, you are also at increased risk for carpal tunnel syndrome.  If you smoke or are anemic this may also increases your chances of developing carpal tunnel syndrome.

 Jobs requiring repetitive movements, computer work and using tools that vibrate have also been suggested to be associated with carpal tunnel syndrome. Hobbies such as sewing, playing musical instruments and writing may also increase your chances of developing carpal tunnel syndrome because of the repetitive use of the hands.  Many times victims of car accidents suffer carpal tunnel syndrome if they were holding the steering wheel when the impact occurred.

Carpal tunnel syndrome can usually be diagnosed with an appropriate history and physical examination.  Occasionally, additional diagnostic testing such as a nerve conduction study or  imaging including x rays and MRI may be  0rdered.  Beware that there are several other conditions that can mimic carpal tunnel syndrome and that addressing any underlying systemic condition is imperative in order to increase the chances of your treatment regimen having a more successful outcome. Blood work may be necessary in order to identify  underlying conditions such as diabetes.

Treatment can range from lifestyle adjustments, bracing, vitamins, physical therapy and surgery.  I personally have had success in having patients avoid carpal tunnel surgery and treating patients with failed carpal tunnel surgery (they had the surgery and they still have the symptoms) using high power laser therapy.  Laser therapy has been shown to reduce pain, accelerate tissue growth and repair, improve nerve function, reduce inflammation reduce scar tissue formation and increase circulation.  If  you have the symptoms  at the beginning of this article and/or are in a high risk group you may wish to consult your physician so as to address this condition in its early stages in order to avoid potential surgery.

Treating diabetes is not just about adjusting insulin levels. Although, in the end insulin levels will have to be adjusted, frequently there are possible causes for diabetes that are not  investigated.  This is particularly important for the patient that is on several different types of insulin, following a strict diet and yet cannot seem to bring his or her diabetes under control.  Common symptoms for diabetes include an increase thirst as well as an increase in appetite, increased trips to the bathroom to urinate, abnormal weight gain, dry mouth, feeling tired all the time, cuts and wounds that won’t heal, blurred vision, repeated yeast infections in the vaginal area for women, tingling or numbness in your hands or feet. If you know you are diabetic or suspect that you have diabetes after reading the preceding list of symptoms you should have an evaluation by a physician that treats diabetes and that can differentiate diabetes from other conditions that can cause these types of symptoms. Many times the treating physician only attempts to get this condition under control and does not take the next step to try to determine perhaps why you are diabetic.  In May of 2008, the scientific journal “Diabetes in Research and Clinical Practice” released a study confirming that toxic metals may play a role in the development of diabetes. The toxic metals that were evaluated in the study included lead, cadmium, and arsenic. Common sources of lead exposure include toys, toy jewelry, water, candy and artificial turf.  Increased cadmium levels have been found in those exposed to industrial uses such as  silver solder and cadmium plating.  Cadmium is found in batteries and in some paints.High cadmium levels have sometimes been found in the soil and water around industrial areas.  Factories that refine and smelt metals can also be a culprit. A very common way to increase your cadmium levels is through cigarettes. Arsenic can also be found in plants that smelt, refine, and plates metals.  Arsenic is used on golfing greens and can be found in pesticides. Arsenic is used in chicken feed to control the intestinal parasites.  Although the levels of cadmium  passed on to humans in this way is thought to be minimal.  There is some suggestion that these levels are higher than what was thought in the past. If you have symptoms of arsenic involvement and have positive laboratory tests confirming high arsenic levels then this may be a source that you want to consider. If you’re a diabetic, or suspect that you may be diabetic or perhaps have heavy metal involvement you should consult a physician that is familiar with diabetes and that practices functional medicine for further investigation.

Many children on the Autism Spectrum have difficulty recognizing emotional cues such as nonverbal  expressions which are thought to be conveyed through the eyes as well as connecting with others emotionally on an interpersonal basis.  A large part of communication between humans is nonverbal communication.  This means to say that it is not just the words that are spoken but in addition how they are spoken, inflection, as well hand gestures, body postures and facial expression.  The inability to recognize faces and facial expression is called prosopagnosia.  This inability to interpret facial expressions often leads to difficulty in social situations with others.  It is also been thought to be involved with a lack of empathy toward others which also is at times associated with autism.  The area of the brain most associated with prosopagnosia is the fusiform gyrus of the temporal lobe. Although it is thought that the fusiform gyrus has a specific face area, it is also thought to be responsible for things such as processing of color information as well as number and word recognition.  As an example, people with prosopagnosia can recognize a different pens or forks but not faces.  Until recently it was thought that propsopagnosia or face blindness and is is sometimes called could not be improved.  Instead,  patients were taught techniques to compensate for the face recognition deficiency such as looking at clothing, voice or hair color in order to attempt to identify who the patient was speaking with. A recent study in the Journal of Autism and Developmental Disorders published out of the University of Alabama Birmingham used a computer based social skills training program for children with autism spectrum disorders.  This interactive program showed a positive impact in a group with Autism and a group with Asperger’s Syndrome.  Both groups showed improvement in the ability to recognize faces as well as improvements in the ability to recognize emotion. The Asperger’s group also showed improvement in social interactions in a natural environment. This should come as great news to parents who see their children have difficulty making friends and struggle while attempting to socialize at school or the park. This feeds well into the current model of neuroplasticity, the brain’s ability to change, in which practitioners of functional neurology are looking for tools to activate specifically targeted under functioning areas of the brain. With regular stimulation of these areas at the correct intensity and frequency, positive changes can be made to help address various deficiencies whether sensory, motor or in this case social. If you have a child on the Autism Asperger’s Syndrome and this type of treatment sounds interesting to you, look for a physician that practices functional neurology in your area.

One million Americans a year are diagnosed with gallstones.  Some common signs and symptoms associated with gallbladder dysfunction  are  abdominal gas or bloating, greasy or fatty foods upset your stomach, nausea, unexplained itchiness, yellowing of the skin or whites of the eyes, sour or bitter metallic taste in the mouth especially in the morning, pale colored stools, foul smelling stools, stools that float, abdominal pain particularly in the right upper quadrant.

The following increases your chances of having gallbladder disease : being female, being over 40 years of age, being overweight, being pregnant, a diet high in fat or cholesterol, a diet low in fiber, medications such as cholesterol lowering drugs and hormone replacement therapy, diabetes, being Mexican American or American Indian.  Of course, a family history of gallbladder disease always increases your risk. 

The gallbladder is a small sack that sits just below the liver.  The gallbladder stores bile which is produced by the liver.  Bile helps in the digestion of fat.

Gallbladder symptoms can  present from a variety of causes including early stage gallbladder dysfunction and inflammation,  infection, gallstones, blockage and even cancer although cancer of the gallbladder is very rare.

The diagnosis of gallbladder disease is done by history and clinical exam as well as specific laboratory testing.  The symptoms associated with gallbladder disease can also be confused with conditions such as irritable bowel syndrome and pancreatitis.  Simple blood work can help confirm the diagnosis, particularly liver function test.  In addition imaging with ultrasound and at time C.A.T scans may verify the presence of stones.

Treatment for gallbladder disease may range from natural supplementation with various  herbs, vitamins and minerals, dietary changes as well as medication and possible surgery for the removal of gallstones should the condition have progressed to the point that you have a symptomatic gallstone that needs to move the as you may be at risk of blockage. Many underestimate how effective treatment with supplemention and diet can be. For this reason, it is important to identify gallbladder disease early in the progression of the disease in order to attempt to avoid having surgery for symptomatic gallstones.  If you suspect you have symptoms relating to gallbladder disease you should contact a physician to have a proper history and physical exam performed as well as possible additional laboratory testing.  Remember, it is key to address gallbladder disease  early in order to avoid possible surgery.

Autism and the spectrum 0f disorders associated with Autism are increasing at an alarming rate throughout our society.  The current statistics relate that approximately one and 100 children are affected by Autism.  Only 10 to 20 years ago that number was one in 10,000. This is a frightening trend.  There has been no single cause identified that explains the disorder that is Autism or its rate of increase over the last several decades. What has been identified are risk factors and early indicators.  The dictionary defines a risk factor as something that increases a persons chances of developing the disease.  Below are some questions associated with risk factors that have been identified relating to Autism.

Is there someone in your family that has autism?

Was your child premature?

Was your child breech birth?

Was your child jaundice?

Was your child of low birth weight, less than 5.5 pounds?

Is your child a boy?

Were you older parents?

Is there less than two years from birth to birth of your children?

Did you smoke while you were pregnant?

Did your child have a low Apgar score at 5 minutes, less than 7?

Were you exposed to toxins during your pregnancy?

Now let’s look at questions regarding three early indicators of Autism.  Is your child not looking, vocalizing and smiling at others?  Is your child a picky eater?  Does your child have issues with joint attention?  Joint attention is how we alert others about an object or event  in a nonverbal way utilizing techniques such as gaze and pointing with another person. An example would be when you see something interesting and point at it (initiating joint attention ) in an attempt to get somebody else to become engaged.  This type of activity should be present at about nine months of age.

These questions are important for those concerned with Autism because the current thought is that early intervention produces better outcomes.  This is in part because younger brains have a greater ability to change. This is called neural plasticity. Thus the sooner you identify that your child may have some deficiencies and get him or her treatment, the higher the likelihood that the child will do better.  If you suspect that your child is having difficulties and may fall onto the Autism Spectrum consult a physician familiar with the identification and treatment of Autism Spectrum Disorders as soon as possible. Early intervention is key for these children.

Statistics show that ADHD  affects 5 to 10% of school aged children. This means we all know a child or adult with ADHD whether that be a child,  spouse or sibling who suffer from ADHD.  Boys are affected 3 times more than girls. The standard treatment for ADHD is stimulant medications such as Ritalin, Adderal, Vyvanse, Concerta and Dexetrine. Stimulant medications are effective in reducing ADHD symptoms in approximately 70% of patients suffering from ADHD. However stimulant medications have been shown to have many side effects including  trouble sleeping, loss of appetite, mood swings, anxiety, irritability, heart palpitations, headaches, upset stomach, slower growth and weight gain and repetitive movements or sounds (tics.) Many mothers and fathers do not want their  children on medication and many are trying to avoid the previously sited side effects. Additionally, if the medications work for 70% of those suffering with ADHD then it stands to reason that 30% of children and adults do not respond to this treatment. A new study in Lancet determined that use of a restricted elimination diet improved symptoms of ADHD in 78% of children. The children were ages 4 to 8 and had an ADHD diagnosis. The study had a sample size of 100 children. The results come as no surprise to those of us that use these types of interventions to treat children with ADHD and learning disabilities but it is nice to have some validation. The study did not find that measuring IgG (antibodies) levels for food sensitivities were helpful but practitioners who supervise parents introducing these types of treatments find that IgG food sensitivity test are useful and help guide parents in what may be a difficult diet to implement, particularly at first. My experience has found IgG food sensitivity tests to provide a considerable amount of direction and comfort to parents. The testing period may have been too short to see a significant change in IgG levels in this particular study. Therefore, if you have a loved one who suffers with the frustration that is ADHD, be aware of the elimination rotation diet as a tool that may give you a choice as to whether  your child needs to be on the medication.  This approach may give you another option to investigate with regard to treatment of your child. This of course may be of greatest benefit for the 30%  for whom stimulant medication is ineffective. If you are interested in this type of approach consult a physician who treats ADHD and is familiar with dietary and nutritional interventions.