North Dakota Licenses Naturopathic Doctors!

Thanks to much hard work and committed individuals, Naturopathic Doctors will now be licensed to practice medicine in my home state of North Dakota. This process of introducing the bill to the legislature began just a short few months ago at the beginning of 2011, and is now a reality!

Read about the amazing work of doctors, students and helpful and willing individuals!

North Dakota Licenses Naturopathic Doctors!   
By Gene McGill, Director of State Government Relations

The North Dakota Legislative Assembly has passed SB 2271 for the licensure of naturopathic physicians and, as of this printing, the bill has made its way to the governors office and is schedule to be signed by North Dakota Governor Jack Dalrymple.

Congratulations to all involved in this tremendous accomplishment!

There is a saying that to get legislation passed you need a good sponsor, a good grassroots operation, and a good lobbyist. All those things were present in the passage of SB 2271. Senators Margaret Sitte and Tim Mathern worked in a bipartisan manner to move the legislation through the chambers. Upon passage, Senator Sitte said, “I’m so happy for our state that we have a new tool in medical care.”
North Dakota Association of Naturopathic Doctors President Faye Johnson, Treasurer Lezlie Link and Beth Allmendinger, ND Candidate (Bastyr), were crucial in the grassroots operation of finding additional sponsors, gathering community support, and the executing the email campaign. Also lending support were Kathleen Allen, ND, and Stephanie Nishek, ND. Special thanks to the other students who joined in the grassroots organization Sara: Christopherson (Bastyr), Brooke Halgren (NCMN), Scott Just (SCNM), and Sara Larson (NCMN).

The lobbying, planning, and organizing the push for licensure was all the work of Beth Allen, ND. Beth also serves as the secretary of NDAND. She worked tirelessly over the past several months to defend the bill, present testimony, and work with the legislature to ensure changes did not compromise the final legislation. Beth personally spent in excess of four hundred hours this year working on licensure.

SB 2271 will create “the state board of integrative health care.” The board will consist of a minimum of five members. Each profession regulated by the board must have one member on the board. Additionally, the board will consist of an MD or DO, a pharmacist, an advanced practice nurse, and up to two laypersons. A subgroup must be established for each profession being regulated with three to five members, all licensed or licensable in the regulated profession. The board as a whole may take no action that impacts a regulated profession unless they first consult with the subgroup.

The practice of naturopathic health care in North Dakota will permit nonprescriptive natural therapeutic substances, food, vitamins, dietary supplements, topical drugs, health-care counseling, nutritional counseling, and barrier devices for contraception. Naturopathic doctors may also perform or order for diagnostic purposes a physical or orificial examination, ultrasound, phlebotomy, clinical laboratory tests, and any other noninvasive diagnostic procedure commonly used by physicians in general practice and authorized by the board.

SB2271 offers NDs in North Dakota a very solid base to build upon. Congratulations again to everyone that that worked so hard to make it happen.

http://ndsfornys.com/blogs/blog/2011/04/23/north-dakota-licenses-naturopathic-doctors/

Published on Environmental Working Group (http://www.ewg.org)

 

Prenatal Pesticide Exposure Linked to Diminished IQ

Some Popular Fruits and Vegetables Contain Highest Levels

Published April 21, 2011

Washington, D.C. – Arriving at stunningly similar conclusions, a trifecta of studies published today (April 21) have each shown a connection between prenatal exposure to organophosphate pesticides and diminished IQs in children between the ages of 6 and 9.
Researchers at Mt. Sinai School of Medicine, University of California Berkeley’s School of Public Health and Columbia University’s Mailman School of Public Health separately recruited pregnant women and tested either their urine during pregnancy or umbilical blood after birth. The Columbia researchers measure levels of the pesticide chlorpyrifos in cord blood samples, while the teams from Berkeley and Mt. Sinai tested urine for metabolites of organophosphate pesticides.
All three studies are available for free and online at the Environmental Health Perspectives website [1].
Between 1999 and 2003, EPA put in place restrictions on the most toxic organophosphate pesticides on crops and in homes. In 2006 the Agency concluded those restrictions would be sufficient to protect children’s health, but these studies show further restrictions over the use of organophosphates in agriculture may be necessary to protect kid's health.
“For years, EPA used complex models to assure us that pesticide exposures were safe,” said Environmental Working Group senior scientist Sonya Lunder. “These studies strongly suggest that kids remain at risk. The next time EPA and the pesticide industry tell you all is well with the food system, don’t rush to believe them.”
“Organophosphates have been associated with learning delays and ADHD in children,” Lunder added. “But the fact that three separate studies arrived at such similar conclusions is overwhelming evidence that this family of pesticides presents profound and very serious health risks to children before they’re even born.”
Each year, the U.S. Department of Agriculture extensively tests fruits and vegetables for pesticide residues. The tests are conducted after each sample has been washed as if being prepared to eat or cook. Environmental Working Group (EWG) compiles USDA’s [2] data and ranks the most popular fruits and vegetables according to the levels of overall pesticide residues. Here are the 12 with the highest and lowest levels of pesticide residues From EWG’ 2010 Shopper’s Guide. The 2011 Guide will be out soon once USDA releases its latest round of produce testing.

Highest Levels	Lowest Levels
Celery Peaches Strawberries Apples Blueberries Nectarines Bell Peppers Spinach Cherries Kale/Collard Greens Potatoes Grapes (imported)	Onions Avocado Sweet Corn Pineapple Mangos Sweet Peas Asparagus Kiwi Cabbage Eggplant Cantaloupe Watermelon

Some tips to avoid or reduce exposure to organophosphate pesticides:

1. Organic produce is becoming much more available and the price gap between it and conventionally grown fruits and vegetables has narrowed somewhat, but buying organic can be a burden on families on tight budgets. EWG’s online Shopper’s Guide to Pesticides [3] provides an easy-to-use list of non-organic items that have the lowest levels of pesticide residues. EWG recommends sticking to those fruits and vegetables whenever possible.
2. Wash, wash, wash: Washing conventional produce won’t remove all of the residues, but it does make a difference. Wash all fruits and vegetables before serving.
3. Eating fruits and vegetables is an essential part of a healthy diet, but we recommend women who are pregnant choose organic produce or conventional fruits and veggies with the lowest levels of pesticide residues.
4. Eat food that is in season. It is more likely to be grown domestically where there are tighter restrictions on organophosphate pesticide use (as opposed to abroad).

EWG is a nonprofit research organization based in Washington, DC that uses the power of information to protect human health and the environment. http://www.ewg.org [4]

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Source URL:
http://www.ewg.org/release/prenatal-pesticide-exposure-linked-diminished-iq

Links:
[1] http://ehp03.niehs.nih.gov/home.action
[2] http://www.foodnews.org/fulllist.php
[3] http://www.foodnews.org/
[4] http://www.ewg.org

Natural Medicines Comprehensive Database

Explore Unbiased, Scientific Clinical Information on Complementary, Alternative, and Integrative Therapies with this incredibly thorough database. One of my favorites! 

http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND

Fungi Perfecti

Legendary mycologist Paul Stamets spoke today at National College of Natural Medicine about the wonderful health and environmental benefits of the much under-appreciated fungi.

Learn more about Paul, mushrooms and their health and environmental benefits on his website:

http://www.fungi.com/

Memorial Sloan-Kettering Cancer Center: About Herbs, Botanicals and other Products

Sloan-Kettering, a well-known Cancer Center, has an extensive information resource presented by their Integrative Medicine Service which provides evidence-based information about herbs, botanicals, supplements, and more. It is very user friendly and full of great information!

http://www.mskcc.org/mskcc/html/11570.cfm

This copy is for your personal, noncommercial use only. You can order presentation-ready copies for distribution to your colleagues, clients or customers here or use the "Reprints" tool that appears next to any article. Visit www.nytreprints.com for samples and additional information. Order a reprint of this article now.

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April 15, 2011

How Little Sleep Can You Get Away With?

By MAGGIE JONES

We all know that we don’t get enough sleep. But how much sleep do we really need? Until about 15 years ago, one common theory was that if you slept at least four or five hours a night, your cognitive performance remained intact; your body simply adapted to less sleep. But that idea was based on studies in which researchers sent sleepy subjects home during the day — where they may have sneaked in naps and downed coffee.
Enter David Dinges, the head of the Sleep and Chronobiology Laboratory at the Hospital at University of Pennsylvania, who has the distinction of depriving more people of sleep than perhaps anyone in the world.
In what was the longest sleep-restriction study of its kind, Dinges and his lead author, Hans Van Dongen, assigned dozens of subjects to three different groups for their 2003 study: some slept four hours, others six hours and others, for the lucky control group, eight hours — for two weeks in the lab.
Every two hours during the day, the researchers tested the subjects’ ability to sustain attention with what’s known as the psychomotor vigilance task, or P.V.T., considered a gold standard of sleepiness measures. During the P.V.T., the men and women sat in front of computer screens for 10-minute periods, pressing the space bar as soon as they saw a flash of numbers at random intervals. Even a half-second response delay suggests a lapse into sleepiness, known as a microsleep.
The P.V.T. is tedious but simple if you’ve been sleeping well. It measures the sustained attention that is vital for pilots, truck drivers, astronauts. Attention is also key for focusing during long meetings; for reading a paragraph just once, instead of five times; for driving a car. It takes the equivalent of only a two-second lapse for a driver to veer into oncoming traffic.
Not surprisingly, those who had eight hours of sleep hardly had any attention lapses and no cognitive declines over the 14 days of the study. What was interesting was that those in the four- and six-hour groups had P.V.T. results that declined steadily with almost each passing day. Though the four-hour subjects performed far worse, the six-hour group also consistently fell off-task. By the sixth day, 25 percent of the six-hour group was falling asleep at the computer. And at the end of the study, they were lapsing fives times as much as they did the first day.
The six-hour subjects fared no better — steadily declining over the two weeks — on a test of working memory in which they had to remember numbers and symbols and substitute one for the other. The same was true for an addition-subtraction task that measures speed and accuracy. All told, by the end of two weeks, the six-hour sleepers were as impaired as those who, in another Dinges study, had been sleep-deprived for 24 hours straight — the cognitive equivalent of being legally drunk.
So, for most of us, eight hours of sleep is excellent and six hours is no good, but what about if we split the difference? What is the threshold below which cognitive function begins to flag? While Dinges’s study was under way, his colleague Gregory Belenky, then director of the division of neuroscience at the Walter Reed Army Institute of Research in Silver Spring, Md., was running a similar study. He purposely restricted his subjects to odd numbers of sleep hours — three, five, seven and nine hours — so that together the studies would offer a fuller picture of sleep-restriction. Belenky’s nine-hour subjects performed much like Dinges’s eight-hour ones. But in the seven-hour group, their response time on the P.V.T. slowed and continued to do so for three days, before stabilizing at lower levels than when they started. Americans average 6.9 hours on weeknights, according to the National Sleep Foundation. Which means that, whether we like it or not, we are not thinking as clearly as we could be.
Of course our lives are more stimulating than a sleep lab: we have coffee, bright lights, the social buzz of the office, all of which work as “countermeasures” to sleepiness. They can do the job for only so long, however. As Belenky, who now heads up the Sleep and Performance Research Center at Washington State University, Spokane, where Van Dongen is also a professor, told me about cognitive deficits: “You don’t see it the first day. But you do in five to seven days. Unless you’re doing work that doesn’t require much thought, you are trading time awake at the expense of performance.”
And it’s not clear that we can rely on weekends to make up for sleep deprivation. Dinges is now running a long-term sleep restriction and recovery study to see how many nights we need to erase our sleep debt. But past studies suggest that, at least in many cases, one night alone won’t do it.
Not every sleeper is the same, of course: Dinges has found that some people who need eight hours will immediately feel the wallop of one four-hour night, while other eight-hour sleepers can handle several four-hour nights before their performance deteriorates. (But deteriorate it will.) There is a small portion of the population — he estimates it at around 5 percent or even less — who, for what researchers think may be genetic reasons, can maintain their performance with five or fewer hours of sleep. (There is also a small percentage who require 9 or 10 hours.)
Still, while it’s tempting to believe we can train ourselves to be among the five-hour group — we can’t, Dinges says — or that we are naturally those five-hour sleepers, consider a key finding from Van Dongen and Dinges’s study: after just a few days, the four- and six-hour group reported that, yes, they were slightly sleepy. But they insisted they had adjusted to their new state. Even 14 days into the study, they said sleepiness was not affecting them. In fact, their performance had tanked. In other words, the sleep-deprived among us are lousy judges of our own sleep needs. We are not nearly as sharp as we think we are.

Maggie Jones (margueritepjones@gmail.com) is a contributing writer for the magazine. Editor: Tony Gervino (t.gervino-MagGroup@nytimes.com).

This article has been revised to reflect the following correction:
Correction: April 15, 2011
An earlier version of this article referred imprecisely to a sleep study done in 2003. While the results were published that year, the subjects were assigned to the study earlier.

From AccessMedicine from McGraw-Hill

Updated Vitamin D and Calcium Recommendations

Peter A. Friedman; Laurence L. Brunton

Authors and Disclosures

Posted: 03/09/2011; AccessMedicine from McGraw-Hill © 2011 The McGraw-Hill Companies

Introduction

How much vitamin D is enough? Over the past decade, rickets has re-emerged as a noticeable public health issue in some areas (Lanham-New et al, 2010) and many physicians have been ordering lab values of blood vitamin D levels on their patients and prescribing large doses of the vitamin for the patients whose levels seemed low: <20-30 ng/ml. However, the accuracy of serum vitamin D assessments, the need for the vitamin D supplementation, and efficacy of the supplements have not been clear. Now, the Institute of Medicine recommends tripling the daily intake for most children and adults to 600 IU per day, up from 200 IU/day (Institute of Medicine, 2011). This recommendation is not without controversy.
Clinically, the level of 25-OH vitamin D is assessed because it is the major form of the vitamin and is readily converted to the active form, 1,25 [OH]₂ vitamin D (also called vitamin D₃ or calcitriol) by CYP27B1, primarily in the kidney. A quick scan of PubMed and internet health sites makes clear that there are wide-ranging opinions about how much vitamin D is enough to maintain growth and skeletal health and the role of vitamin D in a broad spectrum of diseases from the common cold and flu to cancer. Mechanistic research on actions of vitamin D in simple cell systems and rodents provides ample evidence of roles for vitamin D in gene regulation; thus, we know that vitamin D can modulate proliferation, differentiation, and apoptosis of many cell types (e.g., Anet al., 2010; Eganet al., 2010), and have effects on immune function, among others. The precise roles of vitamin D in human health, especially those effects not associated with calcium metabolism, and concentration-response curves of the effects in humans are, however, harder to define, especially since well-controlled, randomized in vivo studies in humans are difficult and expensive. The non-calcemic effects of vitamin D may occur along different concentration-dependence curves and require a re-evaluation of what defines adequate daily intake (Bikle, 2010). At present, however, much of what we think about vitamin D requirements and effects in humans is based on epidemiologic data.
How much vitamin D does a human need every day? The answer is not clear, although most current suggestions agree within a factor of ~3-4. As with many dietary components, and especially for vitamin D, which the human body can make upon exposure to sunlight, serum levels vary widely, probably reflecting genetic background, diet, latitude, time spent out-of-doors, body size, developmental stage, and state of health, as well as plasma levels of vitamin D binding protein. The actions of vitamin D could also vary with the expression of various isoforms of the vitamin D receptor and of the activating and inactivating CYPs, and with the presence of various nuclear co-activators. Because rigorous and well-controlled dietary studies are often lacking in humans, recommended daily intakes for vitamins are sometimes as much matters of opinion as of fact, or are extrapolated from studies in model systems. In practice, most urban dwellers do not get much exposure to sunlight and diet generally does not supply sufficient amounts of vitamin D: a serving of fish may contain 200-500 IU; a cup of a fortified dairy product (cow’s milk, yogurt, soy milk) supplies 100 IU. Thus, for many of us, supplementation is required.
The range of scientific opinion favoring increased vitamin D supplementation is well represented by two papers from a 2009 symposium-in-print: Garland et al. (Garland et al., 2009) used epidemiologic data to argue for increasing the average serum levels of vitamin D to 40-60 ng/ml (100-150 nM), a level that they suggest could be achieved by an intake of 2000 IU/day (50 µg/day) and which might decrease the rate of a number of cancers. Vieth (Vieth, 2009) argues that any benefit of vitamin D needs to be balanced by consideration of the toxicity of vitamin D and the related hypercalcemia, that 2000-4000 IU/day is generally satisfactory, and that toxicity should not be expected below 10,000 IU/day.
A prominent proponent of increasing vitamin D intake is Dr. Michael Holick, an endocrinologist at Boston University Medical Center. Holick summarizes his views and research in a recent review (Holick, 2011) and a book (Holick, 2010). To quote from his review:
"Vitamin D deficiency and insufficiency have been defined as a 25-hydroxyvitamin D <20 ng/ml and 21-29 ng/ml respectively. For every 100 IU of vitamin D ingested the blood level of 25-hydroxyvitamin D, the measure vitamin D status, increases by 1 ng/ml. It is estimated that children need at least 400-1000 IU of vitamin D a day while teenagers and adults need at least 2000 IU of vitamin D a day to satisfy their body's vitamin D requirement." (Holick, 2011)
Endocrinology Clinics of North America recently published a compendium of articles by researchers who work on aspects of vitamin D metabolism and action (Multiple Authors, 2010). In general, these authors recommend maintenance of plasma levels of 25-OH-D ≥30 ng/mL, requiring a daily intake of ≥1000 IU for most children and adults, and twice that for pregnant and lactating women. Others argue that in special cases, such as that of pregnant women, up to 6000 IU/day are needed (Hollis, 2007).
The recommendations of the Institute of Medicine fall short of the values advanced by these proponents, but do advise higher daily intakes than previously indicated for both calcium and vitamin D, as discussed below. Thus, the recommended daily allowance of vitamin D will continue to be controversial; happily, proponents of greater increases in vitamin D intake generally recommend an amount at or below what the IOM considers the upper limit of 4000 IU/day.
The Linus Pauling Institute at Oregon State University maintains a well-informed website on vitamin D (Higdon and Drake, 2010).

Overview

A report issued on 30 November 2010 by the Institute of Medicine (IOM) of the National Academy of Sciences provides new guidelines for daily vitamin D and calcium supplementation (Institute of Medicine, 2011). These recommendations, referred to as Dietary Reference Intakes (DRIs) are the reference values used for nutrition standards for school meals, food labeling, and are widely employed for assessing vitamin D and calcium sufficiency. These values are more commonly known as the Recommended Dietary Allowance (RDA). The recommendations, new and previous, are shown in Table 1 .
The IOM evaluation focused on three central issues:

• the health outcomes influenced by vitamin D and calcium;
• the vitamin D and calcium requirements to achieve the desirable health outcomes;
• adverse actions arising from over medication.

Background for IOM Study

Increasing medical and public interest over the last 10 years focused on claims of enhanced benefits of vitamin D and calcium on human health. It is also commonly believed that there is negligible risk associated with taking vitamin D and calcium supplements, which are widely available in North America. Scientific research suggested relationships between vitamin D intake and cancer prevention, increased immunity; and possible roles in preventing diabetes or preeclampsia. These findings come on a background of clinical findings that many adults and children may be deficient in vitamin D. Based on this array of issues and several preceding comprehensive reviews (Cranney et al., 2007) [summarized in (Cranney et al., 2008)] and (Chung et al., 2009), the IOM was approached by the U.S. and Canadian governments to conduct a review of data pertaining to calcium and vitamin D requirements and to identify DRIs based on current scientific evidence about the roles of calcium and vitamin D in human health. Health outcomes considered bone and skeletal health, physical performance and falls, cancer and site-specific neoplasms (breast, colorectal, prostate), cardiovascular diseases and hypertension, type 2 diabetes and metabolic syndrome (obesity), falls, immune disorders and infectious diseases, neuropsychological functioning (autism, cognition, and depression), and disorders of pregnancy (preeclampsia).

Summary of IOM Findings

Using an evidence-based approach, the review committee found compelling support favoring a role for calcium and vitamin D in sustaining skeletal health. This, along with analysis of parameters regulating mineral ion homeostasis were used to generate the new DRIs. Evidence for a role of supplemental vitamin D or calcium on non-skeletal outcomes was inconclusive.
The IOM determined that the extent of vitamin D deficiency among the North American population has been overestimated because of inflated cut-points for serum 25(OH) vitamin D. The IOM recommendations now suggest that persons are at risk of deficiency at serum 25(OH) vitamin D levels below 30 nmol/L (12 ng/mL). Some, but not all, persons are potentially at risk for inadequacy at serum 25(OH) vitamin D levels between 30 and 50 nmol/L (12 and 20 ng/mL). Practically all persons are sufficient at serum 25(OH) vitamin D levels of at least 50 nmol/L (20 ng/mL). Serum 25 (OH) vitamin D concentrations above 75 nmol/L (30 ng/mL) are not consistently associated with increased benefit. Serum 25-OH D levels above 125 nmol/L (50 ng/mL) are a cause for concern.
Potential toxicities of vitamin D and calcium were also assessed and revised Upper Limits (UL) for daily supplementation were issued. The UL is the level above which the risk for adverse actions begins to increase. The UL is the highest average daily nutrient intake level likely to pose no risk of adverse health effects for nearly all people in a particular group. The revised ULs are based on increased fortification of foods with nutrients and the use of larger doses of dietary supplements. In general, the risk of adverse effects for vitamin D begins when intake surpasses 4,000 IUs per day. The risk of harm for calcium begins when intake surpasses 2,000 milligrams per day. Side effects of excess vitamin D or calcium most immediately include hypercalcemia and hypercalciuria.

Pharmacology Summary

Serum calcium levels are tightly regulated at 2.2-2.6 mmol/L (9-10.5 mg/dL) for total calcium and 1.1-1.4 mmol/L (4.5-5.6 mg/dL) for ionized calcium. When serum calcium falls, parathyroid hormone (PTH) secretion increases. PTH exerts direct effects on the kidney to retain calcium and on bone, where it mobilizes calcium. PTH also induces the expression of renal 1α vitamin D hydroxylase (CYP1α), which converts 25(OH) vitamin D to its active form, 1,25[OH]₂ vitamin D (calcitriol). Vitamin D, in turn, stimulates intestinal calcium absorption. The major therapeutic uses of vitamin D include treatment of nutritional or metabolic rickets; osteomalacia, particularly in the setting of chronic renal failure; hypoparathyroidism; and osteoporosis. Vitamin D supplementation may help prevent fractures, but the relationship between blood vitamin D concentrations and fracture risk is unclear (Cauley et al., 2008). The IOM investigation failed to find evidence indicating a significant reduction in risk of falls that was related to vitamin D intake or blood levels (Institute of Medicine, 2011). Calcium is used in the treatment of calcium deficiency states and as a dietary supplement. The role of supplemental calcium in supporting skeletal integrity is controversial.
Gender, age, diet, and health impact the requirements for calcium and Vitamin D. Milk, yogurt, cheese, and foods and juices fortified with calcium and vitamin D remain the best dietary sources of calcium and vitamin D. If these do not provide the desired RDA, supplements can be used to supply the balance of recommended daily amounts. A one-cup serving of most dairy products contains 200-300 mg of calcium.

References