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The association between the use of non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs), such as Celebrex, Advil, Motrin, Voltaren, Aleve, Vioxx during pregnancy and the risk of spontaneous abortion remains unclear. The current study aimed to quantify the association between having a spontaneous abortion and types and dosages of non-aspirin NSAIDs in a cohort of pregnant women. Using a nested case–control design, data was obtained from the Quebec Pregnancy Registry for 4705 women who had a spontaneous abortion. Matched controls were also selected from the registry and the use of non-aspirin NSAIDs and nonuse were compared. The authors also investigated the association between different types and dosages of non-aspirin NSAIDs and having a spontaneous abortion. Adjusting for potential confounders, the use of non-aspirin NSAIDs during pregnancy was significantly associated with the risk of spontaneous abortion. Specifically, use of diclofenac (ie. Voltaren), naproxen (ie. Aleve), celecoxib (Celebrex), ibuprofen (ie. Advil, Motrin) and rofecoxib (ie. Vioxx) alone, and combinations thereof were all associated with increased risk of spontaneous abortion. No dose–response effect was seen, meaning that a pregnant woman taking just 200 mg Advil per day had no decreased risk of spontaneous abortion compared to a pregnant woman taking 800 mg. The authors concluded that gestational exposure to any type or dosage of non-aspirin NSAIDs may increase the risk of spontaneous abortion. Therefore, these drugs should be used with caution during pregnancy (CMAJ. 2011 Sep 6. PMID: 21896698).

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Observational studies have linked lower omega-3 (n-3) polyunsaturated fatty acids (PUFAs) and higher omega-6 (n-6) PUFAs with inflammation and depression. Unfortunately, randomized controlled trial data have been mixed. To determine whether n-3 PUFA supplementation decreases proinflammatory molecule production and depressive and anxiety symptoms in healthy young adults, a placebo-controlled, double-blind 12-week randomized controlled trial was conducted that compared n-3 supplementation with placebo. Sixty eight medical students provided blood samples during lower-stress periods as well as on days before an exam. The students received either n-3 (2085 mg EPA and 348 mg DHA) or placebo capsules that mirrored the proportions of fatty acids in the typical American diet. Compared to controls, those students who received n-3 showed a 14% decrease in an inflammatory molecule called lipopolysaccharide (LPS) stimulated interleukin 6 (IL-6) production. The students also experienced a 20% reduction in anxiety symptoms. Blood n-6:n-3 ratio showed that decreasing n-6:n-3 ratios led to lower anxiety and reductions in inflammatory molecules. These data suggest that n-3 supplementation can reduce inflammation and anxiety even among healthy young adults. The reduction in anxiety symptoms associated with n-3 supplementation provides the first evidence that n-3 may have potential anxiolytic benefits for individuals even without an anxiety disorder diagnosis. (Brain Behav Immun. 2011 Jul 19. PMID: 21784145).

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Polycystic ovary syndrome (PCOS) is a condition in which there is an imbalance of a woman's female sex hormones that may cause changes in the menstrual cycle, skin changes, small cysts in the ovaries, trouble getting pregnant, and other problems. Current studies clearly link PCOS and insulin resistance. A report released in the British Journal of Obstetrics and Gynecology in 2000 indicated that up to 40% of women with PCOS have either impaired glucose tolerance or Type 2 Diabetes by age 40. Symptoms of PCOS can vary significantly. Changes in the menstrual cycle can include: absent periods, usually with a history of having one or more normal menstrual periods during puberty; and irregular menstrual periods, which may be more or less frequent, and may range from very light to very heavy. PCOS may also lead to the development of male sex characteristics (virilization), including: decreased breast size; deepening of the voice; enlargement of the clitoris; increased body hair on the chest, abdomen, and face, as well as around the nipples (called hirsutism); and thinning of the hair on the head, called male-pattern baldness. Other skin changes can include: acne that gets worse; and dark or thick skin markings and creases around the armpits, groin, neck, and breasts due to insulin insensitivity.

N-acetyl cysteine (NAC) is an altered form of the amino acid cysteine, which is commonly found in food and synthesized by the body. NAC has been reported to have numerous health benefits and has been used in the treatment of mental health problems, infections, heart disease, insulin resistance, detoxification and liver dysfunction, and as a general antioxidant. Metformin, on the other hand, is an oral anti-diabetic drug that is a firstline treatment for diabetes, especially in individuals who are overweight/obese and have normal kidney function. Metformin affects the way insulin controls blood glucose and lowers testosterone production. It slows the growth of abnormal hair and, after a few months of use, may help ovulation to return.

A recent study, published in the European journal of obstetrics, gynecology, and reproductive biology was conducted to evaluate the clinical, endocrine and metabolic effects of metformin and NAC in patients with PCOS. In this prospective trial, 100 women with PCOS were randomly divided to receive metformin (500 mg three times daily) or NAC (600 mg three times daily) for 24 weeks. Androgen levels (ie. “male hormone” levels), lipid profiles, hirsutism scores (excessive hairiness in women), menstrual irregularity, insulin sensitivity and tumour necrosis factor-α (TNF-α) levels were measured at baseline and after the treatment period. Both treatments resulted in a significant decrease in body mass index (BMI; an indication of weight status), hirsutism score, fasting insulin, free testosterone and menstrual irregularity compared with baseline values, and both treatments had equal efficacy. NAC led to a significant decrease in both total cholesterol and LDL cholesterol (ie. the “bad” cholesterol), whereas metformin only led to a decrease in total cholesterol level. The authors concluded that Metformin and NAC appear to have comparable effects on high testosterone, high insulin, and menstrual irregularity in women with PCOS, representing a potentially novel treatment for this (Eur J Obstet Gynecol Reprod Biol. 2011 Aug 8, PMID: 21831508).

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Summary

Short sleep duration is closely related to several diseases but evidence of an association between insufficient sleep and bone health has been limited. The present study published online on August 12, 2011 in the journal, Bone, was aimed to examine the relationships between sleep duration and bone mineral density (BMD) in Chinese women. 602 women aged 18–80 years were analyzed. Sleep duration was collapsed to form categories of 5 hours or less, 6 hours, 7 hours, 8 hours, and 9 hours or more. Total and regional BMD were measured using dual-energy X-ray absorptiometry. Women with a short sleeping duration were more likely to have lower total and all body regional BMD. Compared to those who slept 8 hours, individuals who slept 5 hours or less and 6 hours had significant lower total and regional BMD. The authors concluded that decreased sleep duration was closely associated with lower BMD, especially in middle-age and elderly women. This finding will hopefully lead to better osteoporosis prevention since sleep is a modifiable risk factor (not available to date on PubMed; doi:10.1016/j.bone.2011.08.008).

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Introduction

An allergy is an exaggerated immune response or reaction to substances that are generally not harmful. Allergies are widespread in the population and have increased in prevalence and severity over the past 30 years in all industrialized countries. Allergies are thought to be the 6th leading cause of chronic disease.

Common allergens are pollen, mold, pet dander, dust, foods, drugs, insect bites, jewelry, cosmetics, spices, and other substances. Both genetics and environmental factors play a role in the development of allergies.

The immune system normally protects the body against harmful substances, such as bacteria and viruses. It also reacts to foreign substances called allergens, which are generally harmless and in most people do not cause a problem. But in a person with allergies, the immune response is oversensitive. When it recognizes an allergen, it releases chemicals such as histamines, which fight off the allergen. This causes allergic symptoms, which vary from person to person.

Common allergy symptoms:

• Breathing problems (coughing, shortness of breath, wheezing)
• Burning, tearing, or itchy eyes
• Conjunctivitis (red, swollen eyes)
• Coughing
• Diarrhea, stomach cramping
• Headache
• Hives
• Itching of the nose, mouth, throat, skin, or any other area
• Runny nose
• Skin rashes
• Stomach cramps
• Vomiting

The Immune System

When the body comes under attack, it uses immune molecules called helper T-cells to produce cytokines. Cytokines are hormonal messengers that are responsible for biological effects in the immune system. The cytokines fall into two groups: those that are pro-inflammatory (these tend to fall within the Th1 branch of the immune system) and those that are anti-inflammatory (these tend to fall within the Th2 branch of the immune system).

Th1 and Th2 are polarised immune responses that should be fully-functioning. Unfortunately, if one of these immune branches becomes dominant, disease develops.

Th1 Cytokines

The Th1-type cytokines produce inflammation to kill intracellular parasites (parasites that live outside of the cell). When Th1 cytokines become dominant, they can contribute to the development of autoimmune diseases (ie. Insulin-dependent Diabetes, Multiple Sclerosis, etc).

Th2 Cytokines

The Th2 cytokines counteract the effects of the Th1 cytokines – they have an anti-inflammatory action. But they also help kill extracellular pathogens (viruses and bacteria that live outside of the body’s cells). When Th2 cytokines become dominant, they can induce a pronounced allergic response and atopy (a genetic tendency to develop classic allergic diseases such as rhinitis or runny nose, asthma, and eczema). If you suffer from allergies or atopy, you are likely over-producing the Th2-types of cytokines and have a Th2-weighted imbalance.

Th17 Cytokines

A new set of T-helper cells has been identified: the Th17 cells. These are found where the body’s internal and external environments interact, such as the skin and the lining of the intestinal tract. They attack bacteria on those surfaces, but with accompanying inflammation. Th17 cells are thought to be implicated in: Crohn's disease (an inflammation of the small intestine), ulcerative colitis (inflammation of the large intestine), and psoriasis (inflammation of the skin). I’m not going to discuss these cytokines today but just wanted to draw attention to the fact that a third set of cytokines does exist.

Establishing Balance Within the Immune System

In a well-functioning immune system, Th1 and Th2 cytokines are both produced by the helper T-cells, and work together to keep everything in balance.

Researchers working on allergies are looking at ways to drive up the Th1 response – to rebalance the system away from leaning heavily into a Th2 response by redirecting the body into using the Th1 cytokines instead. Likewise, researchers working with diseases where the Th1 response is driving the system, are looking at using high-dose exposure to allergens to ‘kick-start’ the Th2 immune response, and rebalance the system.

An additional strategy is being used to prevent the onset of disease; this involves the study of pregnancy and early postnatal life. Both of these states are chiefly viewed as Th2 dominant (to reduce the risk of miscarriage, a strong Th2 response is necessary to modify the Th1 cellular response in utero). The fetus can switch on an immune response early in pregnancy, and because pregnancy is chiefly a Th2 situation, babies tend to be born with Th2 biased immune responses. It is hypothesized that babies who go on to develop full blown allergies may be born with a generally weaker Th1 response, although it is becoming apparent that babies with allergies actually produce both weak Th1 and Th2 responses.

Th2 Polarization

There are many theories that may explain a tilt in Th1/Th2 balance toward Th2. These may include the decreasing incidence of infections in the industrialized world—a concept known as the hygiene hypothesis; the increasing success of immunizations and antibiotic therapies that deprive the body of signals that promote Th1 development; increased pollution; or exposure to environmental products that activate Th2 cells.

The shift in balance of Th subsets toward a polarized Th2 response is generally accepted to occur in atopic and allergic disorders and may account for the great increase seen in allergic diseases over the last 3 decades.

The Allergic Process

The term “allergy” is most commonly associated with IgE- mediated hypersensitivity. IgE is an immune molecule that is associated with allergies. In susceptible individuals, the first exposure to an allergen (ie. peanut) causes a mild immune response that sensitizes the immune system so that it will recognize the substance when presented again. In this first exposure to an allergen, no symptoms are typically seen. The second exposure and subsequent exposures to this very same allergen usually result in symptoms.

Initial Exposure

The first time an allergen enters the body, it favors Th2 development and IgE production. These IgE molecules attach themselves to the surfaces of mast cells (concentrated in the lungs, skin, tongue, and linings of the nose and intestinal tract) or basophils (in circulation) and remain bound to them for weeks or months.

Second and Subsequent Exposures

The next time a person comes in contact with the same allergen, it will bind to the IgE antibodies, which are already present on the surfaces of mast cells and basophils after the initial exposure to the allergen. This process leads to the development of an “allergen-antibody” complex, which activates the mast cell or basophil and causes them to open up and release mediators (ie. histamine, proteases, chemotaxins, leukotrienes, prostaglandins) into the bloodstream.

These mediators induce localized inflammation and other responses that cause symptoms associated with allergy. Because mast cells and basophils can be located in diverse areas of the body, allergic symptoms can occur in a variety of locations and cause such varied symptoms as mucus production/nasal congestion, hives, coughing, wheezing, muscle spasm, itchy and watery eyes, swelling, and nausea.

Treatments

There are 5 common approaches to the treatment of allergies, such as avoidance, medication, immunotherapy, natural therapy or achieving Th1/Th2 balance, and natural therapy that targets the allergic cascade.

1) Avoidance: Avoiding the allergen causing your symptoms is the ideal approach to treatment. Unfortunately, many allergens cannot be avoided.

2) Medication: Common medications include anti-histamines, decongestants, sodium cromoglycate, nedocromil sodium, and leukotriene antagonists. These medications are treating the symptoms of allergies. Remember above when I mentioned that when the allergen-antibody complex activates the mast cell or basophils to release mediators (ie. histamine, proteases, chemotaxins, leukotrienes, prostaglandins)? Well, it is these mediators that the common allergy medications are working on. For example, anti-histamines inhibit the action of histamines by blocking it from attaching to histamine receptors, thereby treating symptoms of allergies, such as runny nose and watery eyes. Although effective, some of these medications can cause some side effects, such as drowsiness, sedation, and hyperactivity, making them unappealing to many patients. More concerning, however, is that the long-term use of high-doses of corticosteroids, particularly when taken orally, can result in numerous side effects including facial swelling, muscle weakness, peptic ulcer, osteoporosis, cataracts, and a reduced growth rate in children. Furthermore, relief from these common allergy medications is often temporary and works downstream to just treat the symptoms of allergies. They do not help to establish Th1 and Th2 balance.

3) Immunotherapies: While other common allergy medications treat only the symptoms of allergic disease, immunotherapy can modify the natural course of the allergic disease, by reducing sensitivity to allergens. A three-to-five-year individually tailored regimen of injections may result in long-term benefits. It does not work for everyone and is only partly effective in some people, but it offers allergy sufferers the chance to eventually reduce or stop symptomatic/rescue medication. This type of therapy is most indicated for people who are extremely allergic or who cannot avoid specific allergens. Although effective, immunotherapy is both time consuming and expensive. This is not a therapy that is offered at the Natural Way Health Clinic.

4) Natural Therapies for Re-establishing Th1 and Th2 Balance: Inhibiting Th2-type cytokines may downregulate an overactive Th2 response. In addition, inducing the Th1 response and the production of its cytokines may shift the system and produce balance in some individuals. Many nutritional factors and herbs are thought to influence Th1 and Th2 responses. By addressing this initial step in the allergic process, the incidence and/or severity of an allergic reaction may be manipulated.

5) Natural Therapies that Target the Allergic Cascade: Combining Th1/Th2 balancing therapies with natural therapies that address certain downstream events may offer even greater protection and/or relief.

(a) Because of the very significant role played by IgE in the development and propagation of allergic inflammation, inhibiting IgE production creates an important target for intervening in the allergic cascade.

(b) When mast cells and basophils open up and release chemicals (ie. histamine), various tissues are affected and produce allergic symptoms. This perpetuates the Th2 polarization and inflammation, while continuing the allergic response. Reduction of these mediators or inhibition of their activities may play an important role in providing relief to those suffering from allergic disease.

(c) Arachidonic acid (AA), an omega 6 fatty acid, is released from the mast cell or basophil cell membranes when they open up and release the chemical mediators. Different enzymes, called lipoxygenase and cyclooxygenase metabolize arachidonic acid to produce potent pro-inflammatory molecules, called leukotrienes and prostaglandins. Both leukotrienes and prostaglandins are involved in the allergic process and cause such symptoms as constriction of the airways in the lungs (ie. leading to shortness of breath, wheezing, and coughing) and narrowing of the blood vessels (ie. leading to increased heat and itching in the skin). Limiting or inhibiting the formation of these inflammatory molecules is a critical and necessary component of any anti-allergy therapy.

(d) Low tissue antioxidant levels are associated with allergies and asthma, while inflammatory cells involved in the allergic process generate and release reactive oxygen species, which can promote damage of affected tissues. Combating these harmful free radicals with antioxidants is another important aspect of therapy.

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Introduction

The thyroid is a small butterfly-shaped gland located in the front part of the neck below the thyroid cartilage (ie. the Adam’s apple). The major role of this gland is to produce thyroid hormones to control metabolic rate. Thyroid hormones are important in regulating body energy, the body's use of other hormones and vitamins, and the growth and maturation of body tissues. By some estimates, as many as 20% of Canadians could have undiagnosed thyroid disease. Thyroid disease refers to both HYPOthyroidism and HYPERthyroidism and I have outlined some of the common symptoms associated with both conditions below.

Conditions and Symptoms Associated with Hypothyroidism

Heart Disease
Research reveals that the following laboratory values can be increased in hypothryoidism, thereby increasing cardiovascular disease risk:
- total cholesterol;
- C-reactive protein (a measure of inflammation in the blood that is a very accurate predictor of future heart problems);
- homocysteine (an abnormal protein that can damage your arteries if not cleared out of your system properly);
- blood pressure.

Weight Gain
Hypothyroidism results in decreased metabolism, which in turn may lead to weight gain. Sometimes people have such a struggle with weight gain, that they cannot lose a single pound, even after heroic efforts at weight loss with ultra-low-calorie diets.

Easy Fatigue, Early Exhaustion, or Lack of Motivation
This can occur even in people who sleep for more than 8 or 9 hours per night.

Skin, Hair, Musculoskeletal
Numerous changes can be noted in the skin, hair, and musculoskeletal system, including:
- dry skin;
- roughness and thickening of skin on hands, forearms or elbows;
- carpal tunnel syndrome;
- hair loss;
- thinning of the eye-brow hair;
- a puffy, swollen face (particularly under the eyes);
- muscle cramps in the calves, toes, fingers, diaphragm, thighs and upper arms;
- rheumatoid pain, joint, tendon and muscle swelling and stiffness;
- slow speech;
- slowing of physical functions;
- dull facial expressions.

Depression
A general slowing of mental functions can be seen in hypothyroidism.

Headache
Migraine and tension headaches can be associated with hypothyroidism.

Constipation
A hard bowel movement less than once every 2 days may be an indicator of hypothyroidism.

Cold intolerance
The hands and feet can be cold to the touch and frequent chills (or being “always cold”) is a common complaint.

Aside from the typical symptoms associated with hypothyroidism, it’s important to note that undiagnosed hypothyroidism can potentially be blamed for many conditions and symptoms in women, including:
- infertility and recurrent pregnancy loss;
- heart attacks and clogged arteries;
- high cholesterol levels;
- difficulty losing weight;
- exacerbated menopausal symptoms;
- fibromyalgia and chronic fatigue syndrome;
- carpal tunnel syndrome and tendinitis;
- low sex drive.

Symptoms Associated with Hyperthyroidism

Although hyperthyroidism isn’t nearly as common as hypothyroidism, it’s important to recognize some potential symptoms, including:
- weight loss;
- increased appetite;
- nervousness;
- restlessness;
- heat intolerance;
- increased sweating;
- fatigue;
- frequent bowel movements;
- menstrual irregularities in women;
- goiter.

Physiology Review

I have to give a little bit of background information regarding how thyroid hormones work so that you can understand some of the limitations regarding mainstream thyroid testing.

The process of hormone synthesis begins in a part of the brain called the hypothalamus. The hypothalamus releases thyrotropin-releasing hormone (TRH). The TRH travels to the pituitary gland, which is also located in the brain. The pituitary gland then releases thyroid-stimulating hormone (TSH) into the blood. The TSH travels to the thyroid gland and stimulates the thyroid to produce and release T4, which goes to the liver, where it is converted into T3. T4 is essentially a storage hormone and doesn’t perform the tasks of T3. T3 is the active form of thyroid and is responsible for most of its functions.

Just to reiterate, TSH is synthesized and secreted by the pituitary gland, meaning that TSH is a pituitary hormone and NOT a thyroid hormone. TSH can be viewed like a messenger sent to knock on the door of the thyroid. Its purpose is to regulate the thyroid gland by telling the thyroid to produce more or less thyroid hormones (T3 and T4). In a healthy individual, this message is based on how much thyroid hormone is in the blood. When the thyroid gland slows down and fails to do its job adequately (aka hypothyroid), the TSH knocks and knocks on the door, and theoretically, the TSH lab value will show a high number. On the contrary, if the thyroid gland is working far too hard and overproduces thyroid hormones (aka hyperthyroid), the TSH lab value will theoretically go down in an effort to alert the body that TSH in your body isn’t knocking.

Blood Testing

The reason I’m concentrating on TSH is because it is the diagnostic "gold standard" for diagnosing thyroid disease. The TSH is used almost exclusively in Ontario by most conventional physicians as the means of diagnosing thyroid disease, irrespective of symptoms. A high TSH result usually means an underactive thyroid (hypothyroidism) and a low TSH usually means an overactive thyroid gland (hyperthyroidism). If one of these abnormal results is discovered on a blood test, then your medical doctor will do some further exploration. Unfortunately, most mainstream physicians in Canada rely on an outdated reference range for TSH (the reference range is 0.35-5.5 mu/I). In January 2001, the American Association of Endocrinologists announced that any TSH score above 3 should be considered an indication of probable hypothyroidism but according to the much-published British expert, A.P. Weetman M.D., the ideal TSH score is 1-2. We have not adopted these guidelines in Canada. This means that if you have testing done through your doctor to explore your thyroid and TSH comes back “normal”, you will be told that your thyroid is not the problem.

In addition, in most medical communities, medical doctors will follow up abnormal TSH testing with T4 testing because T4 is known as the barometer of metabolic health. What’s important to realize is the fact that a person can have a perfectly normal level of T4 and still be lacking sufficient thyroid hormone because of the inability to convert T4 to T3 (remember, T4 is the storage form of thyroid hormone and T3 is the active form of thyroid hormone). Unless your body can properly convert T4 into T3, you will lack the essential ingredient for a properly acting metabolism.

If you have symptoms of hypothyroidism and feel that there is something going on with your thyroid, don't despair or think that you're going crazy. You can have a full thyroid panel done through a Naturopathic Doctor (although you will pay out of pocket for it). This panel would include TSH, free T3, free T4, total T3, and anti-thyroid peroxidase antibody (anti-TPO). All of these tests should be done together to give much more accurate information regarding your thyroid health rather than just testing TSH alone. Someone who has experience interpreting these results can also take it a step further and compare values to each other to see how much free T3 is present in relation to both total T3 and free T4. Breaking this information down provides further insight into thyroid gland functioning.

Urinary Thyroid Assessment

A 24-hour Urinary Thyroid Assessment can also be performed to measure free T3, free T4, and selenium. There are several reasons why a urinary thyroid assessment may be beneficial:

• A specimen collected over a 24-hour period may better reflect the average behaviour of the thyroid gland, since thyroid gland activity varies throughout the day. Urinary thyroid hormone levels correlate well with classical symptoms of hypothyroidism. In fact, some experts suggest that urinary T3 (in a 24 hour specimen) can be better correlated to hypothyroid symptoms than blood TSH and Total T4;

• Quantities of T3 and T4 in a 24-hour urine sample are significantly higher than those found in a spot serum sample, so levels can be more reliably measured;

• Selenium is a cofactor for 5’-deiodinase, the enzyme required to convert T4 to T3. A low 24-hour urinary selenium level likely correlates with overall selenium deficiency and decreased tissue availability of T3 due to decreased conversion of T4 to T3;

• Please note that the Urinary Thyroid Assessment does not replace blood testing in the diagnosis of thyroid illness but is instead meant to help evaluate patients whose symptoms are not readily explained by blood thyroid testing.

Basal Body Temperature

There is also a temperature test, called the basal body temperature that can be done at home to help assess whether or not you might have an under-active thyroid. Charting of your basal body temperature is a simple and sensitive way to evaluate thyroid function. The thyroid gland produces hormones that largely control the metabolic rate of your body and this metabolic rate is reflected in your temperature. To perform this test, follow these guidelines:

1) Prior to going to sleep, shake down the glass mercury thermometer to below 35°C (95°F). Place it next to your bed. An automatic digital thermometer may also be used for the test. Automatic digital thermometers tend to be more temperamental than glass mercury thermometers. To ensure accuracy, take a series of three repeated readings. If the readings are within 0.1, then the thermometer may be used for the test.

2) On waking, without getting out of bed or moving about, place the thermometer in the center of your armpit. It is best to lie still with your eyes closed while waiting to take a reading. For mercury thermometers, leave the thermometer in your armpit for 10 minutes. For digital thermometers, record the temperature at the beep. Proper positioning of the digital thermometer in the center of your armpit is important. Improper positioning may result in temperature readings below actual values. It is also best to take your temperature about the same time every morning (but don’t become a slave to your thermometer).

3) Record the temperature everyday for one month.

4) Record the results on the graph.

If your basal body temperature is consistently 36.4 °C (97.5 °F) or lower, then you might want to consider a blood thyroid panel and possibly a 24-hour urine thyroid assessment.

Adrenal Gland Connection

It is common for those with adrenal fatigue to have some degree of thyroid involvement and it is also common for those with thyroid problems to have adrenal involvement. Dr. James Wilson spoke during his 2008 New Zealand adrenal fatigue conference of this common but often overlooked connection between the thyroid gland and the adrenal gland.

The main purpose of the adrenal glands is to produce and release certain regulatory hormones and chemical messengers. The two primary adrenal hormones, adrenaline and cortisol, help control body fluid balance, blood pressure, blood sugar, and other central metabolic functions. Low adrenal function can actually cause someone’s thyroid problem to be much worse than it would be otherwise, and this occurs primarily due to the decreasing amount of circulating cortisol.

Cortisol affects the Thyroid Gland in Three Ways
1. Cortisol is required to facilitate release of TSH from the pituitary gland;
2. Cortisol facilitates conversion of the inactive T4 hormone to the active T3 form;
3. Cortisol allows each T3 cell receptor to more readily accept T3, meaning that the body will respond more efficiently to T3.

Hypothyroid patients need to be aware of their adrenal hormone levels since many of the symptoms of adrenal problems are the same as hypothyroid symptoms. Many conventional medical doctors commonly overlook adrenal problems except in extreme cases such as Cushing’s Syndrome (excess adrenal function) and Addison’s Disease (extreme decreased adrenal function).

Conventional tests aren’t adequate for adrenal functions since they generally consist of a blood test or a 24- hour urine test that does not take into account different levels of hormones at different times of the day. A more accurate test is to collect samples of saliva at 4 different times of the day, giving a more detailed picture of your daily cyclical adrenal function.

Here are some different yet similar clinical presentations of adrenal fatigue and hypothyroidism:

The Most Common Defining Features of Hypothyroidism
- Fatigue that lasts all day long and becomes pronounced by 9:30pm (no second wind at 11pm);
- Low basal body temperature and intolerance to cold;
- Hair loss (ie. especially in the eyebrow);
- Dry skin;
- Cravings for sweet foods, refined carbohydrates, and caffeine;
- Constipation despite following a healthy diet;
- Inability to increase stamina;
- Pronounced depression;
- Weight loss is very difficult without treatment and weight tends to concentrate on thighs and hips.

The Most Common Defining Features of Adrenal Fatigue
- Early morning and mid-afternoon fatigue. People with adrenal fatigue find it very difficult to wake up in the morning but feel much better if they’re able to sleep until am. In addition, energy tends to be best after 6pm;
- Low body temperature will be present only in severe adrenal fatigue;
- Hair loss might be present on the lateral calf in men but changes are not typically seen in the eyebrows;
- Dry skin;
- Cravings for salt or salty foods, fats, protein, and caffeine;
- Mild constipation;
- Stamina changes throughout the day;
- Depression is intermittent;
- Hypoglycemia symptoms are present and greatly increase with stress;
- Weight gain is not always present but when it is present, weight can gradually decrease with exercise, decreased stress, and decreased carbohydrate intake. In addition, weight tends to concentrate in the abdominal region).

Hypothyroidism and Adrenal Fatigue Similarities
• Fatigue is the most common symptom;
• Depression is not usually responsive to antidepressants and medications can actually make you feel worse;
• Apathy, tiredness, weakness;
• Loss of enjoyment in life;
• Difficulty focusing, “brain fog”;
• Stress exacerbates symptoms;
• Poor short-term memory;
• Sleep disturbances;
• Over-reactions to trivial matters;
• Accelerated aging;
• Dry skin;
• Decreased immunity.

I have a whole blog post on adrenal gland dysfunction if you would like to read more.

To conclude, I have hopefully convinced you that thyroid testing isn’t quite as straightforward as it seems. If you feel that you might be suffering from a thyroid and/or adrenal gland issue, come on into the clinic for an assessment!

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Introduction

Most of my patients have heard me preach about the benefits of fish oils. In fact, many people are surprised to hear that when push comes to shove, I recommend fish oils over a multivitamin. The reason for this recommendation is our extremely low intake of the essential fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are found in fish. The average North American eats fish every 11 days, making our daily EPA and DHA intake equivalent to 130 mg. To consume a dose that will achieve optimal health functioning, however, you should consume fish anywhere between 5-7x/week so that you are getting 800-1000 mg per day. Unfortunately, eating fish this often isn’t considered the wisest dietary choice to make because of recent concerns regarding mercury and other environmental toxins that have crept into our fish supply. Fish 1-2x/week is ideal, with fish oil supplementation on the other days.

Before I begin, I wanted to give you the heads up that I tend to use the terms fish oil and omega 3’s interchangeably since fish oil is the most significant source of dietary omega 3 fatty acids. Thousands of studies have been conducted on the use of omega 3’s for the treatment of various conditions, such as heart disease, high blood fats, rheumatoid arthritis, cancer, alzheimers, depression, etc. Before I get into the clinical benefits of fish oils, I must briefly mention a little physiology to lay the framework for fish oil’s mechanisms of action.

Arachidonic acid, an omega 6, is converted into inflammatory molecules (called prostaglandins and leukotrienes) via certain enzymes (called cyclooxygenase and lipoxygenase). The takeaway from this statement is that too much arachidonic acid increases inflammation! I’m sure you have all heard the expression “you are what you eat”. Well, this is true in that your cell membranes are made up of fats so when you consume increasing levels of omega 3’s, these become incorporated into the cell membrane instead of arachidonic acid. The net effect is reduced inflammation. This is supported by studies that show that fish oil significantly decreases potent inflammatory molecules. It is this anti-inflammatory effect of fish oil that underlies most of the health benefits of these important oils. Certainly there are other mechanisms of action, but I will leave that for another blog post.

If you are interested in having your essential fatty acids measured, come into The Natural Way Health Clinic for a fatty acid blood test. This test measures the primary omega-6’s and omega’s, along with monounsaturated, saturated and trans fats that are present in the red blood cells. Each fatty acid is reported as a percentage of the total fatty acids measured and important fatty acid ratios are presented.

Ok, now I’m going to outline some of the research conducted on fish oils and their benefit in various health conditions. I want to point out that this is only some of the research. There is far too much to summarize in this post (or even 10 posts) so I just wanted to give you a brief summary of some of the key findings.

Cardiovascular Disease

The benefits of fish oil for heart disease have been demonstrated time and time again. Epidemiological studies reveal that diets high in omega 3’s are associated with decreased risk of death due to heart disease, heart attack, and sudden death (Kromhout 1985, Daviglus 1997, Hu 2002, Albert 1998, Albert 2002). Randomized clinical trials also reveal promising results. When patients who recently suffered from a heart attack added 1.8 grams of fish oil into their diet for 1 year, their risk of a cardiac event decreased by 29% while both fatal and nonfatal heart attacks decreased by 48% (Singh 1997). Another study randomized men who had suffered from a heart attack into different groups and those in the group that consumed fatty fish had a 29% reduction in death due to any cause after 2 years compared to those who weren’t instructed to consume fatty fish. Most of the benefits were from a reduction in cardiovascular deaths (Burr 1989). Another trial randomized over 11 000 men who had a heart attack within the previous 3 months into a group consuming 850 mg fish oil per day or a control group. The fish oil group had a 15% reduction in death, nonfatal heart attacks, and stroke after 3.5 years. Most of the benefit came from a 30% reduction in cardiac mortality and a 45% reduction in sudden death (Gruppo Italiano 1999). Based on the mounting evidence in support of fish oils protecting against heart disease, the American Heart Association recommends 1 gram of fish oils per day for those with diagnosed heart disease (Kris-Etherton 2002).

High Triglycerides

Hypertriglyceridemia, a condition in which triglyceride (a type of blood fat) levels are elevated, is a common disorder in the North America. It is often caused or exacerbated by uncontrolled diabetes mellitus, obesity, and sedentary habits. High triglycerides are a risk factor for coronary artery disease. A review of over 70 trials (Harris 1999) and a systematic review (Balk 2004) have demonstrated the consistent and potent triglyceride lowering effects of fish oil supplementation. One study even demonstrated a 79% reduction in triglycerides with 20 grams of daily fish oil supplementation (Phillipson 1985). Another study showed a 45% reduction in those with severe high triglycerides with 3.4 grams of daily fish oil intake (Harris 1997). Even those taking triglyceride-lowering medication can benefit from fish oil supplementation. Adding 3 grams of fish oil to a statin medication (prevastatin) reduced triglycerides by an additional 33% (Contacos 1993) and another study found that adding 3.4 grams of fish oil to a different statin (simvastatin) showed a reduction by 20 to 30% (Durrington 2001). It appears that there is a dose-dependent lowering of triglycerides with fish oil supplementation, meaning that the higher the dose of fish oil, the greater the reduction of triglycerides. Unfortunately, no significant effects on cholesterol (ie. LDL, HDL or total cholesterol) are seen with fish oil supplementation (Balk 2004).

Rheumatoid Arthritis

Patients with rheumatoid arthritis (RA) benefit from fish oil supplementation according to 2 meta-analyses (Fortin 1995, MacLean 2004). Fish oil supplementation consistently shows symptom improvement and the reduction of nonsteroidal anti-inflammatory drug (NSAID) use. One randomized clinical trial found a significant reduction of NSAID use in subjects receiving 2.8 grams of fish oil compared to a placebo group after 3 months and this effect peaked at 12 months (Lau 1993). Another study showed that fish oil supplementation of 130 mg/kg/day decreased the number of tender joints, duration of morning stiffness, pain, and global arthritis activity versus placebo (Kremer 1995). Although fish oil supplementation may benefit clinical symptoms of RA, it has potential to reduce or even eliminate NSAID use (Kremer 2000) and this is extremely important.

Prostate Cancer

Prostate cancer incidence varies 60-fold globally, which suggests that lifestyle and dietary factors play a role in its cause. Harvard researchers found that a high fish intake does not protect against the initial development of prostate cancer. However, they noted a clear correlation between increased survival and fish intake, particularly from oily fish, with men eating fish 5 or more times weekly having half the risk of dying from prostate cancer when compared to men eating fish less than once a week (Chavarro 2008). A more recent study by Szymanski (2010) found a 63% reduction in prostate cancer-specific mortality in those who consumed fish.

Colon Cancer

Several epidemiological studies have shown that high fat diets are associated with an increased risk of colon cancer while others have shown that diets rich in fish and fish oils are protective against colon cancer. In fact, a strong inverse correlation has been found between recent fish consumption and colon cancer in men (Caygill, 1995). Encouraged by findings such as this, researchers at the Catholic University of Rome set out to determine if fish oil supplementation would inhibit the development of benign polyps (ie. precursors of colon cancer). Their study involved 34 men and 26 women who had just undergone surgery to remove benign polyps from their colon. The patients were divided into 4 groups. Group 1 was supplemented with 1.4 grams of EPA and 1.1 grams of DHA per day, group 2 with 2.7 grams of EPA and 2.4 grams of DHA, group 3 with 4.1 grams of EPA and 3.6 grams of DHA while group 4 received placebo capsules containing mainly olive oil. Overall, patients in the fish oil groups experienced a significant decline in the number of abnormal cells in their colon lining as compared to members of the placebo group. Further analysis showed that the reduction in the number of abnormal cells was limited to patients who had a large number of abnormal cells at the beginning of the trial. A separate 6-month trial involving 15 patients taking 1.4 grams per day of EPA and 1.1 grams per day of DHA also showed a significant drop in the number of abnormal colon lining cells. The researchers concluded that low-dose supplementation with fish oils inhibits the proliferation of abnormal cells in patients at risk for colon cancer and that this effect can be maintained with long- term treatment (Anti 1994).

Geelen (2007) conducted meta-analysis of studies that evaluated the association between fish consumption and colorectal cancer incidence or mortality and found that fish consumption slightly reduced colorectal cancer risk. A more recent randomized, double-blind, placebo-controlled study was conducted on patients with colon polyps and found that treatment with an EPA-containing supplement was associated with a 22% reduction in polyp number and a 30% decrease in polyp diameters. The authors concluded that EPA holds promise as a safe, colorectal cancer chemoprevention agent (West 2010).

Esophageal Cancer

Cancer of the esophagus has a poor prognosis and is increasing in frequency. Esophageal cancer is usually preceded by a condition called Barrett's esophagus in which the tissue lining the lower esophagus becomes abnormal. There is evidence that the COX-2 enzyme is upregulated in Barrett's esophagus and esophageal cancer. This COX-2 enzyme increases inflammation. Mehta (2008) conducted a clinical trial in patients with Barrett’s esophagus and found that after 6 months, patients consuming 1.5 grams of EPA per day experienced significantly increased EPA and decreased COX-2 proteins in their esophageal tissue.

Kidney Cancer

An epidemiological Swiss study provides evidence that eating fatty fish is a simple strategy to reduce kidney cancer risk. This study was initiated in the late 1980s and involved 90 000 Swedish women who were questioned about their dietary habits and then followed for more than a decade. Women who consumed at least one portion of fatty fish each week during the study period had a reduced risk of kidney cancer of 74% when compared to those who ate no fatty fish. Eating non-fatty fish (ie. cod, tuna, fresh water fish, shrimp, and lobster) produced no protection (Wolk 2006).

Lung Cancer

Lung cancer is the leading cause of death due to cancer in Canada. It causes approximately 29% of cancer deaths among men and 22% among women. Takezaki (2001) aimed to determine the association between lung cancer and diet by conducting a study on men and women who had been diagnosed with lung cancer. They found that both men and women who ate cooked or raw fish five times a week or more had half the incidence of lung cancer when compared to participants who ate cooked or raw fish less than once a week.

End Stage Cancer

Chemotherapy and other conventional medical treatments have proven ineffective in improving quality of life and survival of patients with end stage cancer. Greek medical researchers have reported that fish oil supplementation may actually increase the survival time for cancer patients with generalized malignancy. Gogos (1998) conducted a study involving 60 patients with generalized solid tumors whereby the patients were divided into two groups with one group receiving 18 grams/day of fish oil and the other group receiving a placebo. Both malnourished and well-nourished patients who received the fish oil supplement survived significantly longer than did patients on placebo. The researchers speculated that fish oils exert their beneficial effect by decreasing the body's production of a molecule called prostaglandin E2, which is believed to play an important role in the initiation and progression of cancer. They concluded that supplementation with fish oils may offer significant palliative support to cancer patients with end stage metastatic disease.

Crohn’s Disease

Crohn's disease is an inflammatory disease involving intestinal pain, diarrhea, and malabsorption of nutrients. The disease is characterized by periods of active disease interspersed with periods of remission. Elemental diet (ED) therapy is a common treatment for Crohn’s, which involves tube feeding, but as you can imagine, compliance with this diet is poor, resulting in shorter periods of remission. The medications, prednisone and salycylates, are other common conventional treatments but they have only been marginally successful in extending the periods of remission. Tsujikawa (2000) report that adjusting the elemental diet can be effective for those opting for this route of treatment. They replaced one of the three daily enteral meals with a special meal consisting of rice, cooked fish, and soup. This meal was eaten normally and had an omega-3 to omega-6 ratio of only 0.5. The researchers tried out the new diet regimen on 20 patients with Crohn's disease who had been using ED therapy for over a month. The patients were allowed to eat this new diet for lunch or dinner and continued with the ED regimen for the other 2 meals and the results were very encouraging. Prior to this diet, 9 out of 10 patients experienced a relapse within one year whereas on the new regimen, only 4 out of the 10 had a flare-up within one year, suggesting that the combination of the enteral diet and the new diet is effective in extending the remission periods in Crohn's disease. Another study investigated the benefits of fish oil supplementation in Crohn’s patients. Belluzzi (1996) randomized half the patients to receive 2.7 grams of omega 3’s daily, while the other half received placebo capsules. The results of the fish oil therapy were spectacular. While 69% of the patients in the control group had a relapse during the one-year study period, only 28% in the fish oil group did. At the end of the one-year period, 59% of the patients in the fish oil group were still in remission as compared to only 26% in the placebo group, suggesting that fish oil is effective at preventing relapses in patients with Crohn's disease in remission.

Ulcerative Colitis

Ulcerative colitis is a form of inflammatory bowel disease that is accompanied by an increased level of an inflammatory molecule (called leukotriene B4) in the lining of the colon. Fish oils are known to inhibit the synthesis of leukotrienes and it has therefore been postulated that they might be beneficial in the treatment of ulcerative colitis. Researchers at the Mount Sinai School of Medicine conducted a study aimed at testing this hypothesis. Their small pilot study involved 10 patients with mild to moderate ulcerative colitis who had not been helped by conventional medical therapy. The patients were given 2.7 grams of EPA and 1.8 grams of DHA for 2 months. At the end of the 2 months, 7 out of the 10 patients showed marked to moderate improvement and 4 out of 5 patients on prednisone were able to reduce their daily dose by 20 to 66% (Salomon 1990). Another study was conducted a couple of years later involving 11 male patients aged 31 to 74 years who had been diagnosed with ulcerative colitis. The patients were randomized into two groups with one group receiving 2.7 grams of EPA and 1.8 grams of DHA daily, and the other group receiving placebo capsules (olive oil). After 3 months, mean disease severity score for the patients on fish oil declined by 56% as compared to 4% for the placebo group. In addition, 72% of the patients were able to markedly reduce or totally eliminate their use of anti-inflammatory medication and steroids while taking the fish oils (Aslan 1992).

Psoriasis

Psoriasis is a fairly common skin disease characterized by thick, silvery white scales surrounded by a red, inflamed border. Psoriasis is accompanied by high concentrations of arachidonic acid and a high level of inflammatory molecules (such as leukotriene B4) in the plaques. It is well-established that fish oils suppress the formation of these inflammatory mediators. Researchers at the University of Buenos Aires Faculty of Medicine decided to investigate whether topical application of fish oil to skin areas affected by psoriasis would alleviate the symptoms. Their clinical trial involved 25 patients with psoriasis who were randomly assigned to apply either fish oil or liquid paraffin to their psoriatic plaques and leave them covered for 6 hours overnight under an occlusive dressing. The treatment was repeated daily for a 4-week period. Fish oil proved highly effective in reducing scaling (severity of scaling went from an average rating of 2.91 to 0.32 on a scale from 0 to 4), plaque thickness (from a rating of 2.21 to 0.52), and skin redness (from a rating of 2.71 to 0.90). Itching was not relieved by the fish oil treatment. The 4-week liquid paraffin treatment was also effective in reducing skin redness, but was significantly inferior to the fish oil treatment in reducing scaling and had no significant effect on itching or plaque thickness. Both treatments were well accepted by the patients and the researchers concluded that they are both clinically effective with the fish oil treatment being superior to the paraffin treatment (Escobar 1992).

ADHD

Attention-deficit hyperactivity disorder (ADHD) is a growing problem among adolescents in the western world. Estimates of prevalence vary between 5 and 10% with most victims being boys. The main symptoms of ADHD are cognitive problems (problems with thinking, learning and remembering), hyperactivity, anxiousness, shyness, perfectionism, opposition, social problems, excessive talkativeness, restlessness and noisiness. According to Canadian researchers who performed a meta-analysis of 62 randomized trials of Ritalin, there is no evidence that this drug is effective beyond 4 weeks and there is considerable evidence of its many adverse effects including decreased appetite, insomnia, headaches, stomach aches, drowsiness, anxiety, irritability, and dizziness (Schachter 2001). Therefore, alternative treatments are needed. Considerable evidence has mounted suggesting that ADHD is linked to a fatty acid deficiency and imbalance, specifically a lack of DHA and EPA and an excess of the omega-6 fatty acid, arachidonic acid (AA). Clinicians at the University of Milan decided to explore this issue further and found that supplementation with fish oils is effective in correcting the fatty acid imbalance while helping to improve the symptoms of ADHD. Their study involved 16 adolescents between the ages of 3.5 and 16 years who had been diagnosed with ADHD. The study participants received a fish oil supplement at a dose of 250 mg/day/kg with a ratio of EPA to DHA of 2:1 for 8 weeks. Before supplementation, the average AA:EPA ratio was 41 in the subjects compared to 28 in a group of matched children without ADHD. At the end of the 8-week study period, the ratio in the fish oil group dropped to 4.1. Before supplementation, the average inattention score was 19 and the hyperactivity score was 20 and these values dropped to 13.9 and 15.5, respectively, after supplementation. The researchers speculated that ADHD involves a modification in cell membrane fluidity and architecture caused by an unfavorable AA:EPA ratio, and that fish oil supplementation helps correct this (Germano 2007). Another study involved 6 boys and 3 girls who had been diagnosed with ADHD and were under the care of a psychiatrist. All study participants were instructed to take 2 tablespoons (30 mL) of a liquid concentrate of EPA and DHA supplying a total of 10.8 grams EPA and 5.4 grams of DHA a day. The median AA:EPA ratio 20 at the start of the study and after 8 weeks, it was 1.7. Along with the change in the AA:EPA ratio, a highly significant reduction in ADHD symptoms was observed by both the psychiatrist and parents. Inattention score fell from 18 to 10, hyperactivity score from 11 to 5, oppositional/defiant score from 10 to 5, and conduct disorder score from 5 to 1. The researchers concluded that high-dose EPA+DHA supplementation was effective in reducing the AA:EPA ratio, while markedly reducing the most common symptoms of ADHD (Sorgi 2007).

Menstrual Cramps

Menstrual cramping (or dysmenorrhea) is the most common gynecologic complaint and the leading cause of short-term absenteeism among adolescent schoolgirls. This cramping is believed to be associated with an elevated level of PG2 prostaglandins, which are pro-inflammatory molecules. PG2 prostaglandins are synthesized from the omega-6 fatty acid, arachidonic acid. Researchers at the University of Cincinnati Medical Center reasoned that interventions decreasing the level of these inflammatory molecules would be beneficial in reducing menstrual pain. Since it is known that EPA and DHA compete with arachidonic acid for the enzymes needed to produce these inflammatory molecules, the researchers carried out a clinical trial involving 42 girls between the ages of 15 and 18 years who experienced significant menstrual pain during their periods. The extent of pain was evaluated using the Cox Menstrual Symptom Scale at entry into the study and after 2 months of daily supplementation with a placebo or 1080 mg of EPA and 720 mg of DHA daily. At the end of the study the Cox rating had decreased from an average of 69.9 to an average of 44.0 in the fish oil group and no change was observed in the placebo group. The amount of painkiller (ibuprofen) tablets consumed during the menstrual periods dropped by more than 50% during the fish oil treatment as compared to the placebo treatment (Harel 1996). These results provide compelling evidence that fish oil supplementation has a beneficial effect on menstrual cramps in adolescents.

Alzheimers

DHA is an absolute requirement for the development of the human central nervous system and the continuous maintenance of brain cell function. DHA is an important part of the plasma membranes of nerve cells and is essential in the maintenance of their fluidity and integrity.

Cognitive decline (memory loss and a decline in awareness and the ability to think, learn and judge) is often part of the aging process and precedes Alzheimer’s disease and dementia. Dutch researchers report that cognitive decline is substantially less among elderly men consuming a diet rich in EPA and DHA. Their study involved 210 men between the ages of 70 and 89 years who completed food frequency questionnaires and were tested with the Mini-Mental State Examination (MMSE) scale at enrolment and 5 years later. After 5 years the MMSE score had declined by 1.2 points among the men who never consumed fish as compared to a decline of only 0.3 points in the fish consumers (a higher MMSE score indicates better cognitive functioning). The researchers also compared the rate of cognitive decline to the calculated daily intake of EPA and DHA. They found that men with an intake of about 400 mg/day actually improved their MMSE score by 0.2 points over the 5-year evaluation period, while men who consumed only about 20 mg/day experienced an average decline of 0.9 points (van Gelder 2007). Another study conducted by researchers at the Rush-Presbyterian-St. Luke's Medical Center found that participants who consumed fish just once a week had a 60% lower risk of developing Alzheimers than did those who rarely or never ate fish. They also observed that participants whose daily intake of DHA was about 100 mg/day had an incidence of Alzherimers which was 70% lower than those with an intake of 30 mg/day or less (Morris 2003).

Researchers at Tufts University report that a low blood plasma level of DHA also increases the risk of developing Alzheimers. Their study included 899 men and women free of dementia when entering the study. The median age of the participants was 76 years and they were followed up for an average of 9 years. Analysis of blood samples showed that those with high levels of DHA in their blood had a 47% lower risk of developing dementia and a 39% lower risk of developing Alzheimers than did the participants with lower levels. The researchers estimated that the intake of DHA among participants with high plasma levels was about 180 mg/day (Schaefer 2006, Morris 2006). It is important to point out, however, that researchers at the Karolinska Institute report that supplementation with DHA-rich fish oil, while effective at slowing the progression of milder forms of the disease, is not effective in the treatment of moderate existing Alzheimers (Freund-Levi 2006).

Depression

Depression is becoming increasingly prevalent in Western society. Some researchers believe that part of the reason for this can be traced to major dietary changes that have taken place over the past century. During this time there has been a large increase in the intake of saturated fats and omega 6 vegetable oils at the expense of omega 3-rich foods such as fish and wild game. Researchers at the Royal Melbourne Institute of Technology report that the severity of depression is directly associated with the ratio of omega 6: omega 3 fats in the blood (Adams 1996). Another study reported an inverse relationship between the severity of depression and dietary intake of omega 3’s (Edwards 1998). The annual incidence of major depression per 100 people in nine countries was compared with the consumption of fish and a high incidence of depression was found in countries with low fish consumption. New Zealand with an annual fish consumption of only 40 lbs had an annual incidence rate of depression of 5.8% while Korea with a fish consumption of more than 100 lbs/year had an annual incidence rate of only 2.3%. Japan with a fish consumption of almost 150 lbs/year had the lowest incidence of major depression at 0.12% (Hibbeln 1998). Another study found that people who consume fish twice a week or more have a 37% lower risk of being depressed and a 43% lower risk of having thoughts of harming themselves (suicidal tendencies) (Tanskanen 2001). Research also reveals that fish oil supplementation is effective in relieving childhood depression. Nemets (2006) conducted a randomized, placebo-controlled clinical trial involving 20 children (15 boys and 5 girls) between the ages of 8 and 12 years. The study participants were assigned to receive capsules containing either fish oil (providing 400 mg/day of EPA and 200 mg/day of DHA) or a placebo for a total of 16 weeks.
After the first 4 weeks of supplementation the researchers noted that the children on fish oil had significantly improved their rating on the Childhood Depression Rating Scale (CDRS) with 7 out of 10 showing an improvement of greater than 50%. None of the children in the placebo group experienced a 50% or better improvement. Four of the 10 children in the fish oil group were classified as being no longer depressed whereas none of the children in the placebo group achieved this goal. Therefore, fish oils may have significant therapeutic benefits in childhood depression.

Pregnancy

Omega 3 fatty acids are extremely important for having a healthy pregnancy. Please refer to my separate blog post where I cover this topic (under the “Pregnancy” section).

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Introduction

Omega 3 fatty acids are extremely important for having a healthy pregnancy. Omega 3s are a type of polyunsaturated fatty acid that are considered essential, and are often referred to as “essential fatty acids” or EFAs.

Types of Omega 3s

There are three main types of Omega 3 fatty acids. Your body can use all three of these Omega 3s to help perform different functions.

• Eicosapentaenoic acid (EPA): EPA is found primarily in fish and fish oil.
• Docosahexanoic Acid (DHA): DHA is especially important to your body, and is also found primarily in fish.
• Alpha-Linolenic Acid (ALA): ALA is found mostly in seeds, vegetable oils, and leafy green vegetables. It is converted into EPA and then into DHA in your body.

Benefits of Omega 3s During Pregnancy

Omega-3s are critical for your baby’s growth and development, playing a crucial role in brain and eye development, since 70% of brain cell development takes place during gestation and is passed from mother to fetus via the placenta. DHA is especially important during pregnancy and lactation because it is the major omega 3 in the central nervous system and retina (O’Brien 1964, Anderson 1975). Supplementation with fish oil during pregnancy results in improved DHA status in infants at birth, thus, your DHA status plays a role in your baby’s DHA status. Birth outcomes seem to be improved in mothers with higher DHA status, with longer gestation and reduced risk of preterm birth (Jacobson 2008, Olsen 2000), improved birth weight (Olsen 1990), and the prevention of neonatal brain injury (Suganuma 2010)

A number of studies link higher maternal DHA status or intake to more mature or favorable behaviors in infants and children, such as:

➢ Accelerated attentional functions (Colombo 1991, Colombo 2004, Willatts 2003)
➢ More mature sleep behavior in newborns (Cheruku 2002)
➢ Higher problem solving (Judge 2007a, 2007b)
➢ Higher visual acuity (Jacobson 2008, Innis 2001, Judge 2007a, Judge 2007b, Williams 2001)
➢ Better discrimination of native from foreign sounds (Innis 2001)
➢ Improved immune system (Prescott 2007, Denburg 2005)
➢ Improved cognitive function in childhood (Oken 2008, Hibbeln 2007)
➢ Better hand-eye coordination at 1 year of age (Dunstan 2008)
➢ Lower blood pressure at 6 years of age (Forsyth 2003)
➢ Improved motor function at 7 years of age (Bakker 2009)

Omega 3s are also necessary for your own health and wellbeing during pregnancy. Women with higher levels of DHA have been shown to be less likely to develop postpartum depression (Hibbeln 2002, Sontrop 2006, Freeman 2006).

Recommended Dosage of Omega 3s

The position of the American Dietetic Association and Dietitians of Canada is that adults should consume a combined intake of 500 mg per day of DHA and EPA, based on an intake of 2000 kcal per day (Kris-Etherton 2007). Specific recommendations for DHA intakes during pregnancy for North Americans are limited to those made by the International Society for the Study of Fatty Acids and Lipids working group, which recommend a minimum of 300 mg per day (Simopoulos 1999) and the Institute of Medicine, which recommends 200-300 mg per day (Nesheim 2007).

Current Consumption of Omega 3s

Pregnant women are reducing their intake of DHA in North America, largely due to the concern expressed regarding the heavy metal toxicity of fish. This is reflected in lower breast-milk DHA concentrations. For example, in US women, milk DHA concentration is 0.2% of total fatty acids, whereas in some Chinese women it is 2.8% of fatty acids (Carlson 2009). In fact, the mean DHA intake in Canadian women is 82 mg per day with 90% of women consuming less than the recommended 300 mg per day during pregnancy (Denomme 2005).

Maternal DHA Status Declines Throughout Pregnancy

Overall maternal essential fatty acid status declines steadily during pregnancy. For example, a study of 110 pregnant women found a temporary increase in DHA status until 20 weeks, but then a steady decline thereafter. This pattern was associated with a progressive DHA deficiency in maternal blood throughout pregnancy and resulted in a sub-optimal neonatal DHA status (Al 1995).

When To Take Omega 3s

Expectant mothers should begin to include essential fatty acids in their diets in early pregnancy to ensure that DHA is passed on to the baby's tissues during the gestational period. The susceptible window during which dietary DHA may be needed to optimize brain development is a relatively long one and extends from mid-pregnancy (Helland 2003) into the first year of life (Jensen 2005). The most rapid rates of brain DHA accumulation in fetal brain occur during the third trimester and the first year of life (Carlson 2009). Because we are not sure whether postnatal supplementation can correct fully for prenatal deficiency, it also seems appropriate to assure an adequate maternal intake throughout pregnancy and lactation. Two strategies could make more DHA available for brain development: maternal diet could include more fish and, where that is not possible, a supplement could be provided.

Good Omega 3 Sources

Fish is definitely the best source of EFAs and it has the added bonus of being an excellent source of protein. However, given that fish can contain high levels of mercury, certain recommendations regarding fish consumption during pregnancy have been fairly well established, including:
1. Do not eat shark, swordfish, king mackerel, or tilefish;
2. Twelve ounces or less per week of fish and shellfish lower in mercury, such as shrimp, canned light tuna, salmon, pollock, and catfish is considered safe;
3. Limit albacore (“white”) tuna to 6 oz or less per week since this type of tuna contains more mercury than canned light tuna.

Fish oil supplements are available but you must check to make sure that your supplements are not made from fish livers (ie. cod liver oil). The liver can contain high amounts of vitamin A, which has been linked to birth defects. Omega-3 supplements not derived from fish livers but rather from the body of the fish are less likely to contain this type of vitamin A.

Food companies have also responded to all of the scientific and consumer interest in essential fatty acids by adding them into commonly consumed foods. For example:
➢ each 100 gram serving of Danino yogurt from Danone contains 40 mg of DHA and 25 mg of EPA;
➢ each Omega Pro egg provides 125 mg of DHA;
➢ each 50 mL serving of Break-Free Omega-3 liquid eggs provides 125 mg of DHA and 125 mg of EPA;
➢ each 250 mL of Nielson Dairy Oh 1%, 2%, and chocolate milks provide 10 mg of DHA and the homogenized milk provides 20 mg DHA.

The plant-derived omega 3 fatty acid (ALA) acid can be found in such foods as flax, canola oil, and walnuts. Below, I have listed the percentage of ALA by weight of some plant foods:

- Flaxseed: 22%
- Flax oil: 50.8%
- Hemp: very trivial
- Canola oil: 9.3% HOWEVER, these foods have NO EPA and DHA
- Soy oil: 7.0%
- Nuts: 0.2 – 0.4%
- Walnuts: 6.8%

Some of these foods are quite high in ALA. In fact, about 2000 mg of ALA is typically consumed daily in North America. However, DHA and EPA are NOT present in the plant sources of ALA – instead, a metabolic conversion has to occur to convert ALA into DHA and EPA. And what most people don’t realize is that humans have a very poor ability to convert these plants sources of ALA into DHA and EPA. The exact conversion rate of ALA to DHA in humans is controversial, but just to give you an idea of how inefficient this conversion is, it ranges from <0.2% (Pawlosky 2001, 2003) to 3.8% (Emken 1994). Therefore, you have to eat a lot of flax or walnuts to get a good dosage of DHA and EPA.

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Introduction

Many people visit Naturopathic Doctors with concerns regarding the Canadian childhood vaccination schedule. Vaccinating or not vaccinating your child is a very personal decision and there seems to be a lot of controversy regarding the subject. After having my daughter in August, I decided that it was time to explore the issue further so that I could make an informed decision on what route I was going to take with her. After learning more, I decided to compile some information for a blog post.

Information for this handout has been gathered from numerous sources, including a course entitled “Vaccine Balancing Act” by Hilary Andrews and Heather Zwickey, the Centers for Disease Control, the World Health Organization, various medical sites, and pharmaceutical company monographs of specific vaccines.

This handout has not been designed to dissuade you from vaccinating your child. Its sole purpose is to provide education on this matter and let you know that alternative vaccination schedules can be recommended if you decide to take an alternative route like myself.

Vaccine Successes

Immunizations are recognized as one of the greatest public health achievements of the 20th century. The widespread use of immunization is responsible for dramatic reductions in, and in some cases the elimination of, specific diseases. To see the comparison between 20th century annual morbidity and current morbidity from vaccine-preventable diseases (United States figures), see the following table:

	Twentieth-century annual cases	2004 cases	% Decreases
Smallpox	48164	0	100.00
Diphtheria	175885	0	100.00
Tetanus	1314	26	98.02
Pertussis	147271	18957	87.13
Polio (paralytic)	16316	0	100.00
H. influenzae, type B and unknown (<5 years)	20000	172	99.14
Measles	503282	37	99.99
Mumps	152209	236	99.85
Rubella	47745	12	99.97
Congenital rubella syndrome	823	0	100.00

More Infectious Diseases Have Vaccines

In 1974, children were routinely vaccinated against SEVEN diseases (Diphtheria, Tetanus, Pertussis, Polio, Measles, Mumps, and Rubella). Currently in Canada, children are routinely vaccinated against THIRTEEN diseases (all of the above plus Haemophilus influenzae type B [Hib], Pneumococcal Disease, Varicella, Meningococcal Disease, Hepatitis B, and Influenza).

Testing of Vaccinations

Vaccines are studied in a 2-step process: testing of vaccines before licensing and monitoring of vaccines after licensing.

Before licensing, vaccines are tested mainly to make sure they raise titer levels (ie. improve immunity) to the infectious disease they are meant to protect. These studies are too small to detect many potential dangerous events. “It is almost never possible to do pre-licensing studies that are large enough to find rare events with great certainty,” says Robert Lowell David MD, a professor of pediatrics at the University of Washington and a vaccine safety researcher at the Group Health Cooperative, Immunization Studies Program. It is thought that a study to detect potentially dangerous events would require too many participants, and would cost the vaccine manufacturer too much.

For monitoring of vaccines after licensing, a post-marketing safety surveillance system called VAERS (Vaccine Adverse Effects Reporting System) has been established to collect information about adverse events (possible side effects) that occur after administration of vaccines. In other words, once a vaccine has been approved for use, the studies for safety in children really begin.

One thing that is important to point out is that in the clinical trials that have been conducted on childhood vaccinations, only healthy infants have been enrolled. There are no studies where sick or “slightly sick” infants are vaccinated. In addition, ages are not adjusted if the infant is premature. In other words, age-correcting does not take place, meaning that the vaccination schedule is the same for infants born 1 month early as a full-term baby even though their development is different.

The Vaccine Schedule

The vaccine schedule has been determined because it is linked to pediatric wellness visits. “In order to eliminate disease in a society through vaccinations, the majority, if not all of the people must be vaccinated. The only time we see people in the healthcare system often enough to complete the primary series of vaccinations is in the first year of life. From a public health standpoint, it makes absolutely the most sense to give as many vaccines as early as we can, and as many at the same time as we can. This provides the greatest chance to immunize the greatest proportion of the population,” says Anne Montgomery MD, FAAFP, FABM, IBCLC (head of La Leche League).

In other words, the schedule is not determined by: individual risk factors, immune system development, and neurological system development.


Canadian Childhood Vaccination Schedule

	DTaP-IPV	Hib	Pneu-C-7	MMR	Var	Men	HepB
2 months	X	X	X
4 months	X	X	X				Infancy 3 doses or pre-teen/teen 2-3 doses
6 months	X	X	X
12 months				X		X
15 months			X		X
18 months	X	X		X
4-6 years	X

Canadian Childhood Vaccinations





This combination vaccine contains 4 vaccines combined into 1 vial (and at months 2, 4, and 6, it also contains the Hib vaccine). Thus, the combination vaccine tends to have the same effects as the individual components. Most studies have been done with the individual vaccines and not the combination.

Diphtheria
- Description: Diphtheria is a serious bacterial infection. You can catch it from a person who has the infection and coughs or sneezes. It usually affects the nose and throat and causes a bad sore throat, swollen glands, fever and chills. But if it is not properly diagnosed and treated, it produces a poison in the body that can cause serious complications, such as heart failure or paralysis.
- Risk Factors: crowded or unsanitary conditions, malnourished, compromised immune system.
- Efficacy of Vaccine: 87-96%

Tetanus
- Description: Tetanus is a serious illness caused by tetanus bacteria. The bacteria live in soil, saliva, dust and manure. The bacteria usually enter the body through a deep cut, like those you might get from cutting yourself with a knife or stepping on a nail. The infection causes painful tightening of the muscles, usually all over the body. It can lead to "locking" of the jaw, which makes it impossible to open your mouth or swallow. If this happens, you could die of suffocation.
- Risk Factors: Age over 50 years (due to decreased circulation), diseases that decrease circulation, and trauma to the skin since the bacteria enters through a contaminated wound (ie. skin injury, burns, intravenous drug abuse, skin ulcers, surgical wounds).
- Efficacy of Vaccine: >90% but immunization does not confer immunity (therefore a booster is required every 10 years).

Pertussis
- Description: Whooping cough is an infectious bacterial disease caused by Bordetella pertussis that leads to uncontrollable coughing. The name comes from the noise you make when you take a breath after you cough. You may have choking spells or may cough so hard that you vomit. Anyone can get whooping cough, but it is more common in infants and children. It is especially dangerous in infants because the coughing spells can be so bad that it is hard for infants to eat, drink or breathe.
- Risk Factors: Anyone can get whooping cough, but the health effects are usually much worse for children less than a year old. It is highly contagious with up to 90% of susceptible household contacts developing the disease following exposure. Coughing adolescents and adults (usually not recognized as having pertussis) are the major reservoir for Bordetella pertussis and are the usual sources for the initial case in infants and children.
- Efficacy of Vaccine: 35%-96%

Polio
- Description: Polio is an infectious disease caused by a virus that attacks your nervous system. The disease most commonly affects young children. Poliovirus spreads in human waste and people usually get it from contaminated food or water. Symptoms include fever, tiredness, vomiting, neck stiffness, and leg and arm pain (most infected people never have symptoms). In rare cases, however, polio infection can cause paralysis and there is no treatment for this. Some people who have had polio develop post-polio syndrome (PPS) years later and symptoms include tiredness, new muscle weakness and muscle and joint pain. There is no way to prevent or cure PPS. Polio vaccination will protect most people for life and most countries eradicated polio decades ago, except for rare cases.
- Risk Factors: Travel to an area where polio is common or that has recently experienced an outbreak, living with or caring for someone who may be shedding poliovirus, handling laboratory specimens that contain live poliovirus, a compromised immune system.
- Efficacy of Vaccine: >90% immune after 2 doses and >99% immune after 3 doses.
- Extra Notes: The mother’s immune system passes immune molecules called antibodies through the placenta to the fetus and these antibodies provide protection to the baby for as long as they remain in the baby’s body. A different immune molecule (called IgA) is found in the breast milk and is transferred to the gut of the infant during breastfeeding until the newborn can synthesize his/her own antibodies. Therefore, a phenomenon called passive immunity protects the breast fed baby from polio for up to 6 months of age. A healthy gut may play the most important role in preventing polio so a healthy child with good gut flora and a healthy digestive tract need not be vaccinated. However, in Canada, the polio vaccine is part of the DTaP vaccine so if you want your child to receive the DTaP vaccination, then he/she will also be vaccinated against polio.

Vaccine Additives: aluminum phosphate, 2-phenoxyethanol, polysorbate, bovine serum albumin, trace amounts of formaldehyde, and trace amounts of polymyxin B and neomycin may be present from the cell growth medium.

Adverse Reactions: localized symptoms from the injection (ie. redness and tenderness at injection site, painful swelling from shoulder to elbow), hives, anaphylaxis, or neurological complications.

Contraindications or Precautions: severe allergic reaction (ie. anaphylaxis) after a previous vaccine dose or to a vaccine component, encephalopathy (ie. coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of previous dose of DTaP, moderate or severe acute illness with or without fever, Guillain-Barré syndrome within 6 weeks after a previous dose of DTaP, history of arthritis-type reaction following a previous dose of DTaP, progressive or unstable neurologic disorder, uncontrolled seizures or progressive encephalopathy, pregnancy.





Hib Disease
- Description: Haemophilus influenzae type b disease, also called Hib disease, is an illness that can cause a potentially fatal brain infection in young children. Hib disease is caused by the bacteria, Haemophilus influenzae serotype b. The Hib bacterium is widespread in humans. Along with other bacteria, it usually lives in the throat and nose without causing illness. In some cases, though, the bacterium breaks through the body's defenses and causes disease. Hib disease is spread through contact with discharges or droplets from the nose or throat of an infected person and can spread from person to person through sneezing, coughing, or speaking closely with an infected person. A person does not have to have symptoms to spread the bacterium. The most common and severe manifestation of Hib disease is meningitis (inflammation and swelling in the coverings of the brain and spinal cord). Symptoms of meningitis include fever, weakness, vomiting, and a stiff neck. Hib can also cause infection of the lungs, blood, joints, bones, throat, and covering of the heart and can result in such serious diseases as epiglottitis (inflammation of the epiglottis – the flap that sits at the base of your throat), pneumonia, arthritis, and cellulitis (inflammation of the connective tissue). Hib is resistant to a number of antibiotics so treatment of an infection is often unsuccessful. The most striking feature of Hib disease is age-dependent susceptibility.
- Risk Factors: lack of breastfeeding, smokers in the household, age, daycare, greater than 4 in a household, race and ethnicity (higher in Native American and African American), low income, low socioeconomic status, school-aged children, and chronic disease.
- Efficacy of Vaccine: Clinical efficacy has been estimated at 95-100%. Invasive Hib disease in a completely vaccinated child is very rare. Before the introduction of Hib vaccines, an estimated 20 000 cases of invasive disease occurred annually (in the US) in children younger than 5 years, including meningitis (12 000 cases) and pneumonia (7500 cases). By 1999, just 2 years after the introduction of the Hib vaccine, there was a 95% reduction in the incidence of this disease in kids younger than 5 years, with only approximately 250 cases reported in 1999. In 2002, there were 34 cases of Hib disease
- Extra Notes: Passive immunity protects the breast fed baby from Hib for up to 6 months of age (as with Polio). Therefore, Hib is rarely seen in infants less than 6 months. Attack rates generally occur at 6-7 months of age and decline thereafter while the disease is not common beyond 5 years of age.

Vaccine Additives: aluminum phosphate, 2-phenoxyethanol, polysorbate, bovine serum albumin, trace amounts of formaldehyde, and trace amounts of polymyxin B and neomycin may be present from the cell growth medium.

Adverse Reactions: inflammation at the site of injection, Guillain-Barre, seizures, renal failure, and possible link with Type 1 Diabetes.

Contraindications or Precautions: severe allergic reaction to a vaccine component or following prior dose, moderate or severe acute illness, < 6 weeks of age.




Pneumococcal Disease
- Description: Pneumococcal disease is a leading cause of serious illness in children and adults throughout the world. The disease is caused by a common bacterium, Streptococcus pneumoniae, which can attack different parts of the body. When bacteria invade the lungs, they cause the most common form of community-acquired bacterial pneumonia; when bacteria invade the bloodstream, they cause bacteremia; and when they invade the covering of the brain, they cause meningitis (it is actually now the #1 cause of pediatric meningitis). Pneumococci may also cause otitis media (middle ear infection) and sinusitis. Currently there are more than 90 known pneumococcal types; the ten most common types account for approximately 62% of invasive disease worldwide. Antibiotics are effective for the disease forms but resistance to antibiotics is becoming more common.
- Risk Factors: smoking, recent Influenza infection, daycare, poor nutrition, lack of breastfeeding, recent antibiotic use, race (African American, Native American, Alaskan Native have double to quadruple the risk), genetic susceptibility, COPD (chronic obstructive pulmonary disorder), alcoholism, congestive heart failure, diabetes, renal failure, lack of a spleen.
- Efficacy of Vaccine: The currently licensed pneumococcal vaccine is based on the 23 most common serotypes of pneumococcus, against which the vaccine has an overall protective efficacy of about 60%–70%. Children under 2 years of age, and persons suffering from various states of a compromised immune system (ie. HIV infection) do not consistently develop immunity following vaccination, thus reducing the protective value of the vaccine in some major target groups for pneumococcal disease.
- Extra Notes: Colonization of the bacteria does not occur before 6 months of age because of maternal antibodies acquired in utero (ie. passive immunity, as seen in Polio and Hib). Therefore, infection before 6 months of age is unlikely.

Vaccine Additives: Sodium Chloride, succinic Acid, polysorbate 80, water for injection.

Adverse Reactions: irritability, decreased appetite, drowsiness, diarrhea, vomiting, rash, seizures, fever, tenderness at injection site.

Contraindications or Precautions: severe allergic reaction to vaccine component or following prior dose, moderate or severe acute illness with or without fever, thrombocytopenia (low platelet count) or any coagulation disorder.





This combination vaccine contains 3 vaccines combined into 1 vial. Thus, the combination vaccine tends to have the same effects as the individual components. Most studies have been done with the individual vaccines and not the combination.

Measles
- Description: Measles is an infectious disease caused by a virus. It spreads easily from person to person. The main symptom of measles is an itchy skin rash. The rash often starts on the head and moves down the body. Other symptoms include: fever, cough, runny nose, and conjunctivitis (pink eye). Measles can sometimes lead to serious problems.
- Risk Factors: overcrowding, international travel, weakened immune system (especially vitamin A deficiency), winter and spring months.
- Efficacy of Vaccine: 90%-95%
- Extra Notes: The occurrence of measles before the age of 6 months is relatively uncommon because of passively acquired maternal antibodies from the immune mother.

Mumps
- Description: Mumps is an illness caused by the mumps virus. Mumps causes the following symptoms: fever, headache, muscle aches, tiredness, loss of appetite, and swelling of the salivary glands follows these symptoms. Swelling of the glands near the jaw line below the ears may give you "chipmunk cheeks.” Serious problems from mumps are rare, but can include deafness, swelling (of the brain, spinal cord, testicles, breasts or ovaries), and pregnancy loss.
- Risk Factors: overcrowding, ages 2 – 12, international travel, weakened immune system, winter and spring.
- Efficacy of Vaccine: 90%-98%
- Extra Notes: A primary immune response to the first vaccine dose provides long-term protection. Second doses of MMR are given because of the measles component (not because of the mumps or rubella component).

Rubella
- Description: Rubella is an illness with flu-like symptoms followed by a rash. It is usually mild and you may get it and not even know it. However, adults who get rubella often feel sicker than children do. The biggest danger of rubella is if a woman gets it during the first 20 weeks of pregnancy. She may lose the baby, or the virus could cause problems to her unborn baby. Those problems could include cataracts, deafness or damage to the heart or brain. Other common symptoms of Rubella infection include: low-grade fever, headache, runny nose, red eyes, and muscle or joint pain.
- Risk Factors: pregnancy (severe complications arise in the unborn children of women who get rubella during the first 3 months of their pregnancy). Infants infected before birth are rubella carriers and they excrete the virus and expose hospital staff, and pregnant women to the disease. In fact, these little babies can shed the virus for up to one year after birth.
- Efficacy of Vaccine: >95%
- Extra Notes: A primary immune response to the first vaccine dose provides long-term protection. Second doses of MMR are given because of the measles component (not because of the mumps or rubella component). In addition, the vaccine virus is communicable during breastfeeding so breastfeeding is a contraindication for vaccination.

Vaccine Additives: sorbitol, hydrolyzed gelatin, medium 199 with Hank's salts, sodium phosphate monobasic, sodium phosphate dibasic (anhydrous), sucrose, sodium bicarbonate, potassium phosphate dibasic (anhydrous), neomycin, monosodium L-glutamate monohydrate, potassium phosphate monobasic, phenol red, water for injection, recombinant human albumin, fetal bovine serum.

Adverse Reactions: fever is the most common adverse reaction following MMR vaccination. The measles component of MMR vaccine is most often associated with this adverse reaction. Febrile seizures have been noted but are rare. Rashes, usually appearing 7-10 days after MMR have been reported in approximately 5% of vaccinees. Thrombocytopenia (low platelet count) has occurred within 2 months of vaccination in 1 in 30 000 vaccinees. Allergic reactions following the administration of MMR or any of its component vaccines are rare.

Most of the adverse events reported are attributable to the measles or rubella components. Parotitis (inflammation of the parotid glands), fever, orchitis (inflammation of the testes), and rare cases of central nervous system dysfunction (ie. deafness) have been reported rarely from the mumps component of the vaccine.

The most common complaints from the rubella component are fever, lymphadenopathy (enlargement of the lymph nodes), and arthralgia (joint pain) but these adverse reactions only occur in susceptible persons and are more common in adults, especially women. Transient peripheral neuritis complaints (ie. pain in the arms and legs) have been reported and generally begin 1-3 weeks after vaccination with the rubella component, persist for 1 day to 3 weeks, and rarely recur. As for chronic arthritis, data from studies in the US have not supported an association between the rubella component of MMR and chronic arthritis.

Concern has been raised about a possible relation between the MMR vaccine and autism by some parents of children with autism. Two groups, the Institute of Medicine and the American Academy of Pediatrics have reviewed the evidence regarding a potential link between autism and MMR. Both groups independently concluded that the available evidence doesn’t support an association. However, a 2002 study in Utah found that 75 out of 125 children (60%) with autism were positive for antibodies to the MMR vaccine and 70 out of 125 (56%) autistic children had myelin basic protein (MBP) autoantibodies. In 90% of children with MMR antibodies, MPB autoantibodies were also found. None of the 95 blood samples taken from children who did not have autism showed evidence of either the MMR antibody of the MBP autoantibody

Contraindications or Precautions: Severe allergic reaction (e.g., anaphylaxis) after a previous vaccine dose or to a vaccine component, pregnancy, known severe immunodeficiency (e.g., hematologic and solid tumors; receiving chemotherapy; congenital immunodeficiency; long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised), moderate or severe acute illness with or without fever, recent (within 11 months) receipt of antibody-containing blood product, history of thrombocytopenia or thrombocytopenic purpura, breastfeeding, gelatin or egg allergies.





Chickenpox
- Description: Chickenpox is an infectious disease caused by the varicella virus. Most cases occur in children under age 15 but older children and adults can get it. It spreads very easily from one child to another. Symptoms include an uncomfortable, itchy rash, fever and headache. The rash is like blisters and usually appears on the face, scalp or trunk. The disease is usually mild and lasts 5 to 10 days, but it sometimes causes serious problems. Adults and older children tend to get sicker from it.
- Risk Factors: no previous chickenpox infection, working in or attending a school or child care facility, living with children, primary and acquired immunodeficiency states, active untreated tuberculosis, fever > 38.5°C, pregnancy.
- Efficacy of Vaccine: 70-85%
- Extra Notes: Duration of immunity after vaccination is thought to be about 7 years or more. Therefore, the vaccine might prevent childhood chickenpox. But because its immunity is believed to be short-lived, a vaccinated child leaves him- or herself vulnerable to the dangers of adult chickenpox. In addition, the risk of chickenpox is 2.5x higher if the varicella vaccine is administered less than 30 days following MMR whereas there is no increased risk if varicella vaccine is given simultaneously or more than 30 days after MMR.

Vaccine Additives: Sucrose, hydrolyzed gelatin, urea, sodium chloride, monosodium L-glutamate, sodium phosphate dibasic, potassium phosphate monobasic, potassium chloride, water for injection.

Adverse Reactions: pain and redness at the injection site and varicella-like rash, fever, upper respiratory illness, cough, irritability/nervousness, fatigue, disturbed sleep, diarrhea, loss of appetite, vomiting, otitis, diaper rash/contact rash, headache, teething, malaise, abdominal pain, other rash, nausea, eye complaints, chills, lymphadenopathy, myalgia, lower respiratory illness, allergic reactions (including allergic rash, hives), stiff neck, heat rash/prickly heat, insect bites, arthralgia, eczema/dry skin/dermatitis, constipation, itching, rare pneumonitis, and rare febrile seizures.

Contraindications or Precautions: Severe allergic reaction (e.g., anaphylaxis) after a previous vaccine dose or to a vaccine component, substantial suppression of cellular immunity, pregnancy, moderate or severe acute illness with or without fever, recent (within 11 months) receipt of antibody-containing blood product, receipt of specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination.




Meningococcal Disease
- Description: Meningococcal infection is caused by a bacterium known as meningococcus. Many people (approximately 10% of the population) carry meningococci bacteria at the back of the throat or nose without any ill effects. In rare instances, meningococci overcome the body's natural defenses and cause serious diseases, including meningitis (infection of the lining of the brain) and meningococcemia (a widespread infection involving the blood and multiple organs). Meningitis symptoms commonly include high fever, headache, stiff neck, vomiting and drowsiness. Other symptoms include nausea, vomiting, dislike of bright lights (photophobia), confusion, drowsiness or a small purplish skin rash. In young children, the most noticeable symptoms may be marked behavioural change, such as drowsiness, irritability or excessive crying. These symptoms can develop over several hours or they may take 1 to 2 days. In people with meningococcemia without meningitis, the headache, neck stiffness and photophobia may be absent but the rash may be extensive, and may be associated with bleeding. The meningococcal infection is spread from one person to another through a transfer of secretions from the throat or nose during close contact. Kissing, sharing eating utensils, drinking glasses, water bottles, cigarettes or sharing of lipstick can spread the disease. Most people exposed to the bacteria do not easily become infected, and even if infected, the majority does not develop any disease or symptoms.
- Risk Factors: age (< 5 years), living in a community setting, compromised immune system, active smoking and second-hand smoke.
- Efficacy of Vaccine: 94%

Vaccine Additives: sodium chloride, aluminum phosphate, water for injection.

Adverse Reactions: irritability, injection site redness, injection site swelling, injection site pain/tenderness, fever, crying, drowsiness, impaired sleeping, vomiting, diarrhea, anorexia

Contraindications or Precautions: Severe allergic reaction (e.g., anaphylaxis) after a previous vaccine dose or to a vaccine component, moderate or severe acute illness with or without fever.





Hepatitis B
- Description: Hepatitis B is a virus that attacks the liver. It can cause serious disease including permanent liver damage (cirrhosis). Hepatitis B is also the main cause of liver cancer, which can be fatal. The disease is spread from one infected person to another by contact with blood or body fluids. The virus may also be spread by using items that have blood on them, such as a toothbrush, razor, or needles used for drugs, and by having unprotected sex with someone infected with the virus. Mothers who are infected with hepatitis B virus can pass the virus to their newborn babies during delivery. When infants get infected with hepatitis B virus, they often do not have symptoms but most will stay infected for life.
- Risk Factors: Having unprotected sex with more than one partner, having unprotected sex with someone who's infected with HBV, having a sexually transmitted disease such as gonorrhea or Chlamydia, being a man who has sexual contact with other men, sharing needles during intravenous (IV) drug use, sharing a household with someone who has a chronic HBV infection, having a job that exposes you to human blood, receiving hemodialysis for end-stage kidney (renal) disease, traveling to regions with high infection rates of HBV (ie. Africa, Central and Southeast Asia, and Eastern Europe).
- Efficacy of Vaccine: 95-100%

Vaccine Additives: Aluminum (as amorphous aluminum hydroxyphosphate), sodium chloride, sodium borate, water for injection.

Adverse Reactions: injection site reactions (ie. local pain, soreness and tenderness, itching, redness, bruising, swelling, warmth, nodule formation), fatigue, malaise, fever, nausea, diarrhea, headache, sore throat, upper respiratory infection.

Contraindications or Precautions: Severe allergic reaction (ie. anaphylaxis) after a previous vaccine dose or to a vaccine component, moderate or severe acute illness with or without fever, infant weighing less than 2000 grams (4 lbs, 6.4 oz).


A Note About Autism and Vaccinations

In an April 1999 report, the Department of Developmental Services in California found a 273% increase between 1987 and 1998 in the numbers of new children entering the California developmental services system with a professional diagnosis of autism. The report concluded that “the number of persons with autism grew markedly faster than the number of persons with other developmental disabilities (cerebral palsy, epilepsy and mental retardation)” and “compared to characteristics 11 years ago, the present population of persons with autism are younger (and) have a greater chance of exhibiting no or milder forms of mental retardation…”. They also concluded that the increase could not be explained as a result of improved diagnostic techniques and case-finding.

The connection between vaccination and autistic behaviour was first reported in a book called DPT: A Shot in the Dark (Coulter & Fisher, 1985). However, the association between vaccinations and autism is generally thought to be more in relation to MMR (not DTaP). In 1998, gastroenterologist and researcher named Andrew Wakefield suggested a link between autism and the measles vaccination and this was published in the well-known medical journal called the Lancet. On February 2, 2010 the Lancet retracted his 1998 publication, noting that elements of the manuscript had been falsified. It is important to note, however, that his findings have never been disputed – it was just his research tactics that were questionable.

A concerning ingredient in vaccinations was something called thimerosal (a mercury product). In February 1999, a researcher at the Centers for Disease Control (CDC) named Thomas Verstraeten conducted an unpublished analysis of CDC Vaccine Safety Datalink records and found a relative risk of 7.6 for autism in children receiving thimerosal-containing vaccines. A relative risk of 7.6 might not mean much to most people but take this into consideration - generally a relative risk of 3.0 is considered the threshold to demonstrate causality and that the relative risk for a government-sponsored study of second-hand smoke as a cause of cancer is 2.69, which people take as “conclusive”. In June 2000, Verstraeten disclosed his analysis to vaccine advisory committee members at a meeting and he was told to reanalyze his results. This first reanalysis yielded a relative risk of 2.48 after which he was asked to reanalyze again and the relative risk dropped to 1.69.

In July 1999, public health officials announced that thimerosal was going to be phased out of vaccines as a precautionary measure. Currently, thimerosal is NOT found in any of the childhood vaccinations.


What is the Alternative?

An alternative schedule of vaccinations takes into account your child’s risk factors for getting the disease, immunological and neurological development, and the reduction of vaccine doses whenever possible. Administering vaccines to a child at a point when the immune system can mount the most appropriate response and the neurological system is the least vulnerable is the key to proper timing of vaccinations.

Several organizations, including the Institutes of Medicine and the World Health Organizations are concerned about an increased risk for autoimmune disease with vaccination. Vaccinating late, when the immune system is fully developed (and perhaps taxed from poor lifestyle choices) may increase the risk of autoimmune disease and vaccinating early when the immune system is not fully developed may increase the risk of allergies, autoimmune disease, and neurological disorders.

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Hi everyone,

I wanted to share our exciting news - we welcomed Isla Jane Donald into our family on August 22. Our family is doing really well and Isla is a happy and healthy baby. A lot of people have been asking about her name. It's pronounced "eye-la", has Scottish origins, and means island.

Angela