| 1. | J Clin Lipidol. 2010 Mar-Apr;4(2):113-9. Epub 2010 Feb 6.Vitamin D is associated with atheroprotective high-density lipoprotein profile in postmenopausal women.Kazlauskaite R, Powell LH, Mandapakala C, Cursio JF, Avery EF, Calvin J.SourceDepartment of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St, Ste 470, Chicago, IL 60612, USA. rasa_kazlauskaite@rush.eduAbstractBACKGROUND:Low vitamin D has been associated with low levels of high-density lipoprotein (HDL) cholesterol, a marker of coronary risk. Whether atheroprotective HDL particle composition accounts for this association and whether fat affects this association is not known.OBJECTIVE:To explore the association between HDL particle composition and 25-hydroxy vitamin D (25[OH]D) in post-menopausal women.METHODS:Vitamin D levels and lipoprotein composition were assessed in fasting blood samples of apparently healthy women from a diverse Chicago community. Visceral (VAT) and subcutaneous (SAT) abdominal fat area were assessed using computed tomography. Total body fat mass was measured by dual-energy X-ray absorptiometry.RESULTS:We enrolled 78 women (50% black; 50% white), age 48 to 64 years, all of whom were participants in a longitudinal study of fat patterning. They had a mean 25[OH]D of 31 ± 15 μg/L, HDL cholesterol 57±11 mg/dL, and large HDL particle subclass 8.6±3.4 μmol/L. In a multivariable-adjusted regression model, each 5 μg/L higher 25[OH]D predicted 0.57 μmol/L (95%CI 0.20-0.95) higher large HDL particles, independent of race, season, and total HDL particle concentration. This association was only partially confounded by total body fat mass (0.49, 95%CI 0.10-0.89), SAT (0.50, 95%CI 0.11-0.90), or VAT (0.37, 95%CI 0.01-0.74). Age did not significantly influence the strength of associations.CONCLUSIONS:Higher 25[OH]D levels are associated with large HDL particles. This association is stronger than that of HDL cholesterol and only partially confounded by body fat. Theoretically, vitamin D may protect against cardiovascular risk by promoting formation of large HDL particles, affecting reverse cholesterol transport.Copyright © 2010 National Lipid Association. Published by Elsevier Inc. All rights reserved. |
About Me
- Brooke Halgren
- I am a 2012 Naturopathic Doctoral Candidate at National College of Natural Medicine in Portland, OR. I am excited to share and exchange knowledge about health and wellness on my journey to becoming a Naturopathic Doctor.
Wednesday, May 11, 2011
Cardiovascular Benefits of Vitamin D
Monday, May 9, 2011
Low-Salt Diet Ineffective, Study Finds. Disagreement Abounds.
Many studies have shown the benefits of a salt-restricted diet in treatment of hypertension. The study mentioned in this article examined patients who did not have a pre-existing diagnosis of hypertension. Though it has its flaws, it is certainly interesting to read up on what the investigators found in terms of salt restriction and hypertension. Happy reading!
Brooke H
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.
Brooke H
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.
May 3, 2011
A new study found that low-salt diets increase the risk of death from heart attacks and strokes and do not prevent high blood pressure, but the research’s limitations mean the debate over the effects of salt in the diet is far from over.
In fact, officials at the Centers for Disease Control and Prevention felt so strongly that the study was flawed that they criticized it in an interview, something they normally do not do.
Dr. Peter Briss, a medical director at the centers, said that the study was small; that its subjects were relatively young, with an average age of 40 at the start; and that with few cardiovascular events, it was hard to draw conclusions. And the study, Dr. Briss and others say, flies in the face of a body of evidence indicating that higher sodium consumption can increase the risk of cardiovascular disease.
“At the moment, this study might need to be taken with a grain of salt,” he said.
The study is published in the May 4 issue of The Journal of the American Medical Association. It involved only those without high blood pressure at the start, was observational, considered at best suggestive and not conclusive. It included 3,681 middle-aged Europeans who did not have high blood pressure or cardiovascular disease and followed them for an average of 7.9 years.
The researchers assessed the participants’ sodium consumption at the study’s start and at its conclusion by measuring the amount of sodium excreted in urine over a 24-hour period. All the sodium that is consumed is excreted in urine within a day, so this method is the most precise way to determine sodium consumption.
The investigators found that the less salt people ate, the more likely they were to die of heart disease — 50 people in the lowest third of salt consumption (2.5 grams of sodium per day) died during the study as compared with 24 in the medium group (3.9 grams of sodium per day) and 10 in the highest salt consumption group (6.0 grams of sodium per day). And while those eating the most salt had, on average, a slight increase in systolic blood pressure — a 1.71-millimeter increase in pressure for each 2.5-gram increase in sodium per day — they were no more likely to develop hypertension.
“If the goal is to prevent hypertension” with lower sodium consumption, said the lead author, Dr. Jan A. Staessen, a professor of medicine at the University of Leuven, in Belgium, “this study shows it does not work.”
But among the study’s other problems, Dr. Briss said, its subjects who seemed to consume the smallest amount of sodium also provided less urine than those consuming more, an indication that they might not have collected all of their urine in an 24-hour period.
Dr. Frank Sacks of the Harvard School of Public Health agreed and also said the study was flawed.
“It’s a problematic study,” Dr. Sacks said. “We shouldn’t be guiding any kind of public health decisions on it.”
Dr. Michael Alderman, a blood pressure researcher at Albert Einstein College of Medicine and editor of the American Journal of Hypertension, said medical literature on salt and health effects was inconsistent. But, Dr. Alderman said, the new study is not the only one to find adverse effects of low-sodium diets. His own study, with people who had high blood pressure, found that those who ate the least salt were most likely to die.
Dr. Alderman said that he once was an unpaid consultant for the Salt Institute but that he now did no consulting for it or for the food industry and did not receive any support or take any money from industry groups.
Lowering salt consumption, Dr. Alderman said, has consequences beyond blood pressure. It also, for example, increases insulin resistance, which can increase the risk of heart disease.
“Diet is a complicated business,” he said. “There are going to be unintended consequences.”
One problem with the salt debates, Dr. Alderman said, is that all the studies are inadequate. Either they are short-term intervention studies in which people are given huge amounts of salt and then deprived of salt to see effects on blood pressure or they are studies, like this one, that observe populations and ask if those who happen to consume less salt are healthier.
“Observational studies tell you what people will experience if they select a diet,” Dr. Alderman said. “They do not tell you what will happen if you change peoples’ sodium intake.”
What is needed, Dr. Alderman said, is a large study in which people are randomly assigned to follow a low-sodium diet or not and followed for years to see if eating less salt improves health and reduces the death rate from cardiovascular disease.
But that study, others say, will never happen.
“This is one of those really interesting situations,” said Dr. Lawrence Appel, a professor of medicine, epidemiology and international health at Johns Hopkins Medical Institutions. “You can say, ‘O.K., let’s dismiss the observational studies because they have all these problems.’ ” But, he said, despite the virtues of a randomized controlled clinical trial, such a study “will never ever be done.” It would be impossible to keep people on a low-sodium diet for years with so much sodium added to prepared foods.
Dr. Briss adds that it would not be prudent to defer public health actions while researchers wait for results of a clinical trial that might not even be feasible.
Dr. Alderman disagrees.
“The low-salt advocates suggest that all 300 million Americans be subjected to a low-salt diet. But if they can’t get people on a low-salt diet for a clinical trial, what are they talking about?”
He added: “It will cost money, but that’s why we do science. It will also cost money to change the composition of food.”
Saturday, May 7, 2011
So You Want to Be a Doctor?
original link: http://well.blogs.nytimes.com/2011/05/05/a-better-medical-school-admissions-test/?ref=health
I was impressed.
But her enthusiasm dipped sharply when she told me she was preparing for the MCATs, the Medical College Admission Test, the required standardized test that measures mastery of the pre-medical curriculum. She was putting all her extracurricular work on hold so she could focus on reviewing biology, physics, chemistry and organic chemistry for the exam. “Does my ability to memorize the Krebs cycle and Bernoulli’s equation really have anything to do with what kind of doctor I’ll be?” she asked.
The answer, it turns out, is yes — and no.
The first MCAT, then referred to as the Scholastic Aptitude Test for Medical Schools, was administered in 1928 and represented an effort to address the significant medical school dropout rates of the time. Up until that point, medical school applicants had been evaluated, and accepted, on the basis of stray bits of biographical information, random letters of endorsement, a few prior grades or the existence of a high school diploma. As many as half of those accepted eventually quit, resulting in huge losses of time, energy, educational resources and money. But thanks in part to the MCAT, by the mid-1940s the medical school attrition rate had plummeted to less than 10 percent, even as the standardized exam was becoming a much-maligned rite of passage for aspiring young doctors.
Over the years, the MCAT has gone through four major revisions and has only strengthened its ability to predict success in medical school, particularly when evaluated in combination with grades. Each year more than 70,000 students take the exam, vying for a little more than 19,500 medical school slots. These days, fewer than 4 percent of those finally accepted drop out.
But the MCAT has had one major failing in its otherwise brilliant performance: It has been unable to consistently predict personal and professional characteristics. As early as 1946, medical educators were trying to design the MCAT in a way that might tease out such information, but they, and those who followed, were unable to succeed.
Now the MCAT is about to undergo its fifth revision, the first in nearly 25 years. Last month, the Association of American Medical Colleges, the national organization that administers the MCAT, released the preliminary recommendations of a 22-member advisory committee that has been studying the issue for the last three years. They recommend, among other things, lengthening the four-and-a-half hour exam by 90 minutes and adding questions on disciplines like sociology and psychology. The new exam would also test analytical and reasoning skills in areas like ethics, philosophy and cross-cultural studies, which could include questions about how someone living in a particular demographic situation, for example, might perceive and interact with others.
Despite what some view as a long overdue re-examination of this linchpin of medical school admissions, many medical educators, including members of the advisory committee, remain cautious about tampering with a test that has proved successful so far.
“It’s like trying to improve a Honda,” said Dr. Ronald D. Franks, vice chairman of the committee and vice president of health sciences at the University of South Alabama College of Medicine in Mobile. “When you’ve got something that’s working extremely well, you can make improvements, but you’ve got to be mindful of the services it has rendered.”
Those services can be gargantuan. Jefferson Medical College in Philadelphia, for example, receives almost 10,000 applications each year and must whittle those numbers down to 800 for interviews for the 260 available slots in each class. In combination with grades, the MCAT can help admissions officers eliminate a quarter of the applications.
“But we and other medical schools have so many great applications from the standpoint of just numbers that we usually also need to go through other parts of the application as well,” said Dr. Clara A. Callahan, dean of student affairs and admissions at Jefferson and the lead author of one of the largest longitudinal studies on the predictive validity of the MCAT. “You want to make sure someone isn’t just saying that he or she wants to help people.”
It’s likely that Dr. Callahan and other medical school admissions officers will have to continue to look beyond the MCAT to learn more about their applicants’ personal qualities. The science of personality testing has advanced tremendously over the last 25 years, but the committee felt it was still unclear how accurately a test could predict traits like integrity, altruism and the ability to collaborate. Some members were uncomfortable, too, with the long-term implications. “Will we end up labeling someone forever with a 9.2 for their personality?” Dr. Franks asked.
Only time will tell whether this newest version succeeds where earlier ones have not. But one thing is certain: Taking the MCAT is likely to remain a rite of passage for doctors-to-be for years to come.
“The reality is that we doctors are taking standardized tests – in-service exams, board exams, recertification exams – all our life,” Dr. Callahan said. “It’s something people have to master in medical school and beyond, so it’s nice to be able to accurately predict at the outset how someone will do with them in medical school and beyond.”
The MCAT advisory committee is continuing to solicit opinions through its Web site until February. The new exam will be administered beginning in 2015.
A Better Medical School Admissions Test
By PAULINE W. CHEN, M.D.Jesus Jauregui/Getty Images
Recently the college-age daughter of a friend talked to me about her dream of becoming a doctor. She was doing well as a psychology major and in her pre-medical courses, was working as a research assistant for a pediatrician at a nearby medical school and volunteered on the cancer ward at a children’s hospital.I was impressed.
But her enthusiasm dipped sharply when she told me she was preparing for the MCATs, the Medical College Admission Test, the required standardized test that measures mastery of the pre-medical curriculum. She was putting all her extracurricular work on hold so she could focus on reviewing biology, physics, chemistry and organic chemistry for the exam. “Does my ability to memorize the Krebs cycle and Bernoulli’s equation really have anything to do with what kind of doctor I’ll be?” she asked.
The answer, it turns out, is yes — and no.
The first MCAT, then referred to as the Scholastic Aptitude Test for Medical Schools, was administered in 1928 and represented an effort to address the significant medical school dropout rates of the time. Up until that point, medical school applicants had been evaluated, and accepted, on the basis of stray bits of biographical information, random letters of endorsement, a few prior grades or the existence of a high school diploma. As many as half of those accepted eventually quit, resulting in huge losses of time, energy, educational resources and money. But thanks in part to the MCAT, by the mid-1940s the medical school attrition rate had plummeted to less than 10 percent, even as the standardized exam was becoming a much-maligned rite of passage for aspiring young doctors.
Over the years, the MCAT has gone through four major revisions and has only strengthened its ability to predict success in medical school, particularly when evaluated in combination with grades. Each year more than 70,000 students take the exam, vying for a little more than 19,500 medical school slots. These days, fewer than 4 percent of those finally accepted drop out.
But the MCAT has had one major failing in its otherwise brilliant performance: It has been unable to consistently predict personal and professional characteristics. As early as 1946, medical educators were trying to design the MCAT in a way that might tease out such information, but they, and those who followed, were unable to succeed.
Now the MCAT is about to undergo its fifth revision, the first in nearly 25 years. Last month, the Association of American Medical Colleges, the national organization that administers the MCAT, released the preliminary recommendations of a 22-member advisory committee that has been studying the issue for the last three years. They recommend, among other things, lengthening the four-and-a-half hour exam by 90 minutes and adding questions on disciplines like sociology and psychology. The new exam would also test analytical and reasoning skills in areas like ethics, philosophy and cross-cultural studies, which could include questions about how someone living in a particular demographic situation, for example, might perceive and interact with others.
Despite what some view as a long overdue re-examination of this linchpin of medical school admissions, many medical educators, including members of the advisory committee, remain cautious about tampering with a test that has proved successful so far.
“It’s like trying to improve a Honda,” said Dr. Ronald D. Franks, vice chairman of the committee and vice president of health sciences at the University of South Alabama College of Medicine in Mobile. “When you’ve got something that’s working extremely well, you can make improvements, but you’ve got to be mindful of the services it has rendered.”
Those services can be gargantuan. Jefferson Medical College in Philadelphia, for example, receives almost 10,000 applications each year and must whittle those numbers down to 800 for interviews for the 260 available slots in each class. In combination with grades, the MCAT can help admissions officers eliminate a quarter of the applications.
“But we and other medical schools have so many great applications from the standpoint of just numbers that we usually also need to go through other parts of the application as well,” said Dr. Clara A. Callahan, dean of student affairs and admissions at Jefferson and the lead author of one of the largest longitudinal studies on the predictive validity of the MCAT. “You want to make sure someone isn’t just saying that he or she wants to help people.”
It’s likely that Dr. Callahan and other medical school admissions officers will have to continue to look beyond the MCAT to learn more about their applicants’ personal qualities. The science of personality testing has advanced tremendously over the last 25 years, but the committee felt it was still unclear how accurately a test could predict traits like integrity, altruism and the ability to collaborate. Some members were uncomfortable, too, with the long-term implications. “Will we end up labeling someone forever with a 9.2 for their personality?” Dr. Franks asked.
Only time will tell whether this newest version succeeds where earlier ones have not. But one thing is certain: Taking the MCAT is likely to remain a rite of passage for doctors-to-be for years to come.
“The reality is that we doctors are taking standardized tests – in-service exams, board exams, recertification exams – all our life,” Dr. Callahan said. “It’s something people have to master in medical school and beyond, so it’s nice to be able to accurately predict at the outset how someone will do with them in medical school and beyond.”
The MCAT advisory committee is continuing to solicit opinions through its Web site until February. The new exam will be administered beginning in 2015.
Monday, May 2, 2011
CranioSacral Therapy
I just completed CranioSacral Therapy I training through the Upledger Institute, http://www.upledger.com
This powerful modality offers practitioners and patients alike a different approach to working with physical restrictions in the body. There are a lot of differing opinions on the validity of CranioSacral Therapy, as its mechanism of action is not fully understood.
Though the best place to read about CranioSacral Therapy is from the leaders in training themselves at Upledger Insitute, even Wikipedia has something to say about it! I found some of this information helpful in understanding the history and basics of this modality.
Original Link: http://en.wikipedia.org/wiki/Craniosacral_therapy
Craniosacral therapy (also called CST, also spelled Cranial Sacral bodywork or therapy) is an alternative medicine therapy used by osteopaths, massage therapists, naturopaths, and chiropractors. A craniosacral therapy session involves the therapist placing their hands on the patient, which allows them to tune into what they call the craniosacral rhythm. The practitioner claims to gently work with the spine and the skull and its cranial sutures, diaphragms, and fascia. In this way, the restrictions of nerve passages are said to be eased, the movement of cerebrospinal fluid through the spinal cord is said to be optimized, and misaligned bones are said to be restored to their proper position. Craniosacral therapists use the therapy to treat mental stress, neck and back pain, migraines, TMJ Syndrome, and for chronic pain conditions such as fibromyalgia Several studies have reported that there is little scientific support for the underlying theoretical model for which no properly randomized, blinded, and placebo-controlled outcome studies have ever been published.
Sutherland stated the dural membranes act as 'guy-wires' for the movement of the cranial bones, holding tension for the opposite motion. He used the term reciprocal tension membrane system (RTM) to describe the three Cartesian axes held in reciprocal tension, or tensegrity, creating the cyclic movement of inhalation and exhalation of the cranium. The RTM as described by Sutherland includes the spinal dura, with an attachment to the sacrum. After his observation of the cranial mechanism, Sutherland stated that the sacrum moves synchronously with the cranial bones. Sutherland began to teach this work to other osteopaths from about the 1930s, and continued to do so until his death. His work was at first largely rejected by the mainstream osteopathic profession as it challenged some of the closely held beliefs among practitioners of the time.
In the 1940s the American School of Osteopathy started a post-graduate course called 'Osteopathy in the Cranial Field' directed by Sutherland, and was followed by other schools. This new branch of practice became known as "cranial osteopathy". As knowledge of this form of treatment began to spread, Sutherland trained more teachers to meet the demand, notably Drs Viola Frymann, Edna Lay, Howard Lippincott, Anne Wales, Chester Handy and Rollin Becker. The Cranial Academy was established in the US in 1947, and continues to teach DOs, MDs, and Dentists "an expansion of the general principles of osteopathy" including a special understanding of the central nervous system and primary respiration. Towards the end of his life Sutherland believed that he began to sense a "power" which generated corrections from inside his patients' bodies without the influence of external forces applied by him as the therapist. Similar to Qi and Prana, this contact with, what he perceived to be the Breath of Life changed his entire treatment focus to one of spiritual reverence and subtle touch.This spiritual approach to the work has come to be known as both 'biodynamic' craniosacral therapy and 'biodynamic' osteopathy, and has had further contributions from practitioners such as Becker and James Jealous (biodynamic osteopathy), and Franklyn Sills (biodynamic craniosacral therapy). The biodynamic approach recognizes that embryological forces direct the embryonic cells to create the shape of the body, and places importance on recognition of these formative patterns for maximum therapeutic benefit, as this enhances the ability of the patient to access their health as an expression of the original intention of their existence.
From 1975 to 1983, osteopathic physician John E. Upledger and neurophysiologist and histologist Ernest W. Retzlaff worked at Michigan State University as clinical researchers and professors. They set up a team of anatomists, physiologists, biophysicists, and bioengineers to investigate the pulse he had observed and study further Sutherland's theory of cranial bone movement. Upledger and Retzlaff went on to publish their results, which they interpreted as support for both the concept of cranial bone movement and the concept of a cranial rhythm. Later reviews of these studies have concluded that their research is of insufficient quality to provide conclusive proof for the effectiveness of craniosacral therapy and the existence of cranial bone movement.
Upledger developed his own treatment style, and when he started to teach his work to a group of students who were not osteopaths he generated the term 'CranioSacral therapy', based on the corresponding movement between cranium and sacrum. Craniosacral therapists often (although not exclusively) work more directly with the emotional and psychological aspects of the patient than osteopaths working in the cranial field.
Craniosacral Therapy Associations have been formed in the UK, North America, and Australia
Practitioners work with cycles of various rates:
It has been theorized that during[who?] craniosacral treatment the membranes act as a fulcrum for fascial restrictions throughout the body, and craniosacral therapists may perceive a change in quality as a result of disturbance such as infection or allergic irritation.
Cranial textbooks propose that motion of the skull is possible during flexion and extension because the sutures are mobile. The sphenobasilar synchondrosis (SBS) - the junction between the base of the sphenoid and the occiput- is thought to fuse by the mid- to late twenties, but still retain limited mobility . An alternative theory to SBS Motion taught in craniosacral training suggests that sutures are "lines of folding", like pre-folded marks on cardboard, rather than necessarily being fully open.
The therapist places their hands lightly on the patient's body, tuning in to the patient by ‘listening’ with their hands or, in Sutherland's words, "with thinking fingers". A practitioner's feeling of being in tune with a patient is described as entrainment. Patients often report a sense of deep relaxation during and after the treatment session, and may feel light-headed. This is popularly associated with increases in endorphins, but research shows the effects may actually be brought about by the endocannabinoid system.
There are few reports of Adverse side effects from CST treatment. In one study of craniosacral manipulation in patients with traumatic brain syndrome, the incidence of adverse effects from treatment was 5%.
This powerful modality offers practitioners and patients alike a different approach to working with physical restrictions in the body. There are a lot of differing opinions on the validity of CranioSacral Therapy, as its mechanism of action is not fully understood.
Though the best place to read about CranioSacral Therapy is from the leaders in training themselves at Upledger Insitute, even Wikipedia has something to say about it! I found some of this information helpful in understanding the history and basics of this modality.
Original Link: http://en.wikipedia.org/wiki/Craniosacral_therapy
Craniosacral therapy (also called CST, also spelled Cranial Sacral bodywork or therapy) is an alternative medicine therapy used by osteopaths, massage therapists, naturopaths, and chiropractors. A craniosacral therapy session involves the therapist placing their hands on the patient, which allows them to tune into what they call the craniosacral rhythm. The practitioner claims to gently work with the spine and the skull and its cranial sutures, diaphragms, and fascia. In this way, the restrictions of nerve passages are said to be eased, the movement of cerebrospinal fluid through the spinal cord is said to be optimized, and misaligned bones are said to be restored to their proper position. Craniosacral therapists use the therapy to treat mental stress, neck and back pain, migraines, TMJ Syndrome, and for chronic pain conditions such as fibromyalgia Several studies have reported that there is little scientific support for the underlying theoretical model for which no properly randomized, blinded, and placebo-controlled outcome studies have ever been published.
History
Cranial Osteopathy was originated by physician William Sutherland, DO (1873-1954) in 1898-1900. While looking at a disarticulated skull, Sutherland was struck by the idea that the cranial sutures of the temporal bones where they meet the parietal bones were "beveled, like the gills of a fish, indicating articular mobility for a respiratory mechanism."
Sutherland stated the dural membranes act as 'guy-wires' for the movement of the cranial bones, holding tension for the opposite motion. He used the term reciprocal tension membrane system (RTM) to describe the three Cartesian axes held in reciprocal tension, or tensegrity, creating the cyclic movement of inhalation and exhalation of the cranium. The RTM as described by Sutherland includes the spinal dura, with an attachment to the sacrum. After his observation of the cranial mechanism, Sutherland stated that the sacrum moves synchronously with the cranial bones. Sutherland began to teach this work to other osteopaths from about the 1930s, and continued to do so until his death. His work was at first largely rejected by the mainstream osteopathic profession as it challenged some of the closely held beliefs among practitioners of the time.
In the 1940s the American School of Osteopathy started a post-graduate course called 'Osteopathy in the Cranial Field' directed by Sutherland, and was followed by other schools. This new branch of practice became known as "cranial osteopathy". As knowledge of this form of treatment began to spread, Sutherland trained more teachers to meet the demand, notably Drs Viola Frymann, Edna Lay, Howard Lippincott, Anne Wales, Chester Handy and Rollin Becker. The Cranial Academy was established in the US in 1947, and continues to teach DOs, MDs, and Dentists "an expansion of the general principles of osteopathy" including a special understanding of the central nervous system and primary respiration. Towards the end of his life Sutherland believed that he began to sense a "power" which generated corrections from inside his patients' bodies without the influence of external forces applied by him as the therapist. Similar to Qi and Prana, this contact with, what he perceived to be the Breath of Life changed his entire treatment focus to one of spiritual reverence and subtle touch.This spiritual approach to the work has come to be known as both 'biodynamic' craniosacral therapy and 'biodynamic' osteopathy, and has had further contributions from practitioners such as Becker and James Jealous (biodynamic osteopathy), and Franklyn Sills (biodynamic craniosacral therapy). The biodynamic approach recognizes that embryological forces direct the embryonic cells to create the shape of the body, and places importance on recognition of these formative patterns for maximum therapeutic benefit, as this enhances the ability of the patient to access their health as an expression of the original intention of their existence.
From 1975 to 1983, osteopathic physician John E. Upledger and neurophysiologist and histologist Ernest W. Retzlaff worked at Michigan State University as clinical researchers and professors. They set up a team of anatomists, physiologists, biophysicists, and bioengineers to investigate the pulse he had observed and study further Sutherland's theory of cranial bone movement. Upledger and Retzlaff went on to publish their results, which they interpreted as support for both the concept of cranial bone movement and the concept of a cranial rhythm. Later reviews of these studies have concluded that their research is of insufficient quality to provide conclusive proof for the effectiveness of craniosacral therapy and the existence of cranial bone movement.
Upledger developed his own treatment style, and when he started to teach his work to a group of students who were not osteopaths he generated the term 'CranioSacral therapy', based on the corresponding movement between cranium and sacrum. Craniosacral therapists often (although not exclusively) work more directly with the emotional and psychological aspects of the patient than osteopaths working in the cranial field.
Craniosacral Therapy Associations have been formed in the UK, North America, and Australia
The primary respiratory mechanism
The Primary Respiratory Mechanism (PRM) has been summarized in five ideas.Inherent motility of the central nervous system
The inherent motion of the brain is described as a "dynamo," beginning with the cerebellum. The postulated intracranial fluid fluctuation can be described as an interaction between four main components: arterial blood, capillary blood (brain volume), venous blood and cerebrospinal fluid (CSF). The function of such a mechanism is postulated by Lee as being based on a fulcrum created by the root of the cerebellum and its hemispheres moving in opposite directions, resulting in an increase in pressure which squeezes the third ventricle. The pulsation is described as essentially a recurrent expression of the embryological development of the brain.Fluctuation of the cerebrospinal fluid
Sutherland used the term "Tide" to describe the inherent fluctuation of fluids in the Primary Respiratory Mechanism. Tide alludes to the concept of ebbing and flowing, but also the contrast between waves on the shore having one rhythm, with the longer rate of lunar tides below. The Tide incorporates not only fluctuation of the CSF, but of a slow oscillation in all the tissues of the body, including the skull.Practitioners work with cycles of various rates:
- 10-14 cycles per minute - the original "Cranial Rhythmic Impulse" (CRI) (also described as 6-14 times per minute)
- 2-3 cycles per minute - the "mid-Tide"
- 6 cycles every 10 minutes - the "long Tide"
Mobility of the intracranial and intraspinal dural membranes
In 1970, Upledger observed during a surgical procedure on the neck what he described as a slow pulsating movement within the spinal meninges. He attempted to hold the membrane still and found that he could not due to the strength of the action behind the movement.It has been theorized that during[who?] craniosacral treatment the membranes act as a fulcrum for fascial restrictions throughout the body, and craniosacral therapists may perceive a change in quality as a result of disturbance such as infection or allergic irritation.
Mobility of the cranial bones
Cranial sutures are almost immobile after fusion, inhibiting movement between cranial bones. According to Lee (2005), this understanding arose in the mid-1900s and was misinterpreted from the work of authors hoping to correlate suture closure with the chronological age of a skull in archaeological specimens. Lee suggests the authors found there was no correlation between suture closure and the chronological age of the individual, and also most skulls demonstrated no suture closure at all except as structural evidence of pathological physical trauma. Lee cites many references giving evidence for mobility in human skulls, and modern anatomy books suggest incomplete fusion of some sutures. According to Gray's Anatomy, "[w]hen such sutures are tied by sutural ligament and periosteum, almost complete immobility results."Cranial textbooks propose that motion of the skull is possible during flexion and extension because the sutures are mobile. The sphenobasilar synchondrosis (SBS) - the junction between the base of the sphenoid and the occiput- is thought to fuse by the mid- to late twenties, but still retain limited mobility . An alternative theory to SBS Motion taught in craniosacral training suggests that sutures are "lines of folding", like pre-folded marks on cardboard, rather than necessarily being fully open.
Craniosacral Treatment
A typical craniosacral therapy session is performed with the client fully clothed, in a supine position, and usually lasts about one hour. In the Upledger method of craniosacral therapy, a ten-step protocol serves as a general guideline, which includes (1) analyzing the base (existing) cranial rhythm, (2) creating a still point in that rhythm at the base of the skull, (3) rocking the sacrum, (4) lengthening the spine in the lumbar-sacral region, (5) addressing the pelvic, respiratory and thoracic diaphragms, (6) releasing the hyoid bone in the throat, and (7-10) addressing each one of the cranial bones. The practitioner may use discretion in using which steps are suitable for each client, and may or may not follow them in sequential order, with time restraints and the extent of trauma being factors.The therapist places their hands lightly on the patient's body, tuning in to the patient by ‘listening’ with their hands or, in Sutherland's words, "with thinking fingers". A practitioner's feeling of being in tune with a patient is described as entrainment. Patients often report a sense of deep relaxation during and after the treatment session, and may feel light-headed. This is popularly associated with increases in endorphins, but research shows the effects may actually be brought about by the endocannabinoid system.
There are few reports of Adverse side effects from CST treatment. In one study of craniosacral manipulation in patients with traumatic brain syndrome, the incidence of adverse effects from treatment was 5%.
Criticisms
There are extensive criticisms of cranialsacral therapy from the scientific and health care professions as to the validity and efficacy of Cranial Type techniques and principles. The following criticisms are cited against this form of therapy.- Lack of evidence for the existence of "cranial bone movement":
- Scientific evidence does not support the theories for cranial bone movement claimed by craniosacral practitioners. This research shows that partial fusion between cranial bones occurs during growth and development.
- Lack of evidence for the existence of the "cranial rhythm":
- While evidence exists for cerebrospinal fluid pulsation, one study states it is caused by the functioning of the cardiovascular system and not by the workings of the craniosacral system.
- Lack of evidence linking "cranial rhythm" to disease:
- Research to date to support the link between the "cranial rhythm" and general health is cited as "low grade" and "unacceptable to meet scientific measures".
- Lack of evidence "cranial rhythm" is detectable by practitioners:
- Operator interreliability has been very poor in studies that have been done. Five studies showed an operator interreliability of zero. In a report to the British Columbia Office of Health Technology Assessment one study in this report shows some operator interreliability but has been criticized as deeply flawed.
Regulation
In the United Kingdom, resulting from a regulation programme facilitated by The Prince's Foundation for Integrated Health, craniosacral therapy is to be regulated on a voluntary basis by the Complementary and Natural Healthcare Council (CNHC) from late 2009 onwards. The standards of competence required for registration are craniosacral therapy techniques plus hands on practice, anatomy and physiology, business, legal and ethical issues. Registrants must have full public and professional liability insurance and annual continuing professional development is a condition of re-registration.
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