I watched about 50 minutes of the IOM's video of the new report's press release. I thought it was remarkable how sincere the scientists were: they truly do not understand a lot of things going on with these vitamins, they're upping the vitamin D required significantly for most population groups from a 200 IU adequate intake to a 600 IU Recommended Dietary Intake with a 4,000 IU tolerable upper limit. They ignore vitamin D from sunlight.
They say later that most people in the United States get about 200-300 IUs from the diet. They grudgingly admit that most people are going to have to take vitamin D supplements; later they discuss that people could specifically target fatty fish (e.g. salmon) or specific fortified foods. When asked about what they think about people taking 1,000 or 2,000 IU supplements just in case, they said it probably wouldn't increase risk, although one cautioned against it noting the beta carotene and vitamin E examples, which looked good in observational trials but proved unhelpful or even harmful in randomized trials.
It's rather sad that they've done all these randomized controlled trials on bone health, but they didn't collect all this other information on these trial patients (cancer, immune system, etc). Without the randomized trials, the IOM could not say anything, which I don't blame them for given the history of observational trials. I'll be taking a 2,000 IU supplement to be on the safe side, and I'll be upping it from the occasional couple times a week to a routine thing. I'm still partial to the idea that the seasonal flu is caused by vitamin D deficiency.
If you aren't looking for something then you'll never find it, which is why I'm constantly disappointed by people who seem to reject the idea that focusing on the nutritional basics (rather than taking a bunch of drugs) can effectively improve health. It's also rather sad that we still don't even understand how something as basic as vitamin D relates to immune function when we've expended enormous amounts of money on various drugs which were harmful dead ends.
I may add more thoughts on this later.
Showing posts with label medicine. Show all posts
Showing posts with label medicine. Show all posts
Sunday, December 12, 2010
Sunday, November 28, 2010
Back pain troubles, chiropractic, and the multifidus
I've had back pain for just about as long as I can remember, but it is usually mild and somewhat intermittent. Lately it's gotten worse. I know basically why I have back pain: I sit a lot - but at the same time, lots of people sit a lot without as much back pain. I also have bad posture.
The last time I had back pain this bad was a couple years ago, after driving straight for a couple days. I went to a chiropractor and he gave me a quick adjustment for cheap. He first applied heat, and then solidly cracked my bank (spinal manipulation) manually. I felt way better. I don't generally have faith in chiropractic, but I figured I should try it again. This time, the (new) chiropractor first made me go through a whole diagnosis session with an "Insight Subluxation Station", X-rays, and a lot of stretch "testing". Then chiropractor then gave me an adjustment with an "activator gun" which gave relatively little relief. The subluxation station apparently showed my back as registering all sorts of out of whack and out of balance electrical signals, and the X-rays showed evidence of compression in the past (big surprise) but not much else. I would have preferred to look at an MRI scan to see if I have any herniated discs, out of curiosity, but the x-ray is interesting too.
The subluxation station is essentially a surface electromyograph (see THE SCIENCE & VALIDITY BEHIND THE INSIGHT MILLENNIUM SUBLUXATION STATION). I'll try to scan the results and post them later. I'm a bit skeptical, but I'm willing to see how it goes. It does not surprise me that it showed messed up results. I was able to feel my muscles and legs twitching with spasms when I had the really bad pain. I'm guessing that's not uncommon when you have back pain as bad as mine. But now the twitching has basically disappeared and it seems likely that the readings would be a fair bit better - acute back pain is often transient and self-limited, like most infections. The chiropractor seems to want to test me again after doing a dozen or so more adustments, and I imagine the reading will be much better - unsurprisingly. He's also saying that he wants to keep going until my legs are equal length, which is something the activator gun wiki article (linked above) discusses as somewhat dubious. The chiropractor is now expecting me to be a long-term customer, which I'm not really interested in - but I'll play it out for a bit longer (cheap with insurance). In the picture below, the right is me and the left is a healthy control (balanced).
One of the reasons that I will no doubt feel much better is that I'm doing a lot of research and paying careful attention to posture. I've been aware of the Alexander technique, which had a very positive clinical trial published in the BMJ not too long ago. The easiest takeaway from that is to lay down on your back and lift your knees, which is a very relaxing and pain-relieving way to spend some time. I've also been reading through Dr. Jolie Bookspan's articles, and have been particularly intrigued by her article on hyperlordosis as a cause of lower back pain. My back pain is mainly from sitting (the article identifies hyperlordosis as related to standing) but I feel that my back is caused by hyperlordosis. I've tried to implement posture advice and it may have been partly counterproductive - I've been trying to arch my back too much, and every time I do it I can feel the pain and stress it causes. Ironically, in reviewing my x-ray results the chiropractor said I had too little curve and arch, which I think is completely wrong.
Bookspan's research led me to research which has identified more fatiguable trunk muscles in those with lower back pai (see, e.g., Chok et al 1999). Daneels et al (2000) found that only the multifidus was smaller in those with chronic low back pain, and in 2002 Daneels et al found that those with chronic low back pain weren't activating their multifidus. The Musculoskeletal Consumer Review suggests feeling for the multifidus and then exercising it mentally to help activate it, but I can't seem to do that. Suggestions at the SlowTwitch forum include the "pointer dog" exercise, which I imagine looks like the following. There's also the The Multifidus Back Pain Solution: Simple Exercises That Target the Muscles That Count book, which I'll probably buy. The "activation" problem is mentioned by one of the reviewers. The reviewer recommends Spinal Stabilization instead, but interestingly enough the first reviewer of that book similarly complains that there's no real discussion on how to activate these muscles or know if they are activating properly. This article describes how to activate these muscles, and apparently the practice also does real-time ultrasound imaging (RTUS) tests to confirm the activation (unfortunately not in my area). It's so mysterious that I don't know whether I'm activating them or not, and thus I can't blame a couple physical therapists at a forum for ranting a bit about the newest "fad" (although they still annoy me). UPDATE: This is called the motor control exercise in the literature, and a systematic review was published not long ago.
The last time I had back pain this bad was a couple years ago, after driving straight for a couple days. I went to a chiropractor and he gave me a quick adjustment for cheap. He first applied heat, and then solidly cracked my bank (spinal manipulation) manually. I felt way better. I don't generally have faith in chiropractic, but I figured I should try it again. This time, the (new) chiropractor first made me go through a whole diagnosis session with an "Insight Subluxation Station", X-rays, and a lot of stretch "testing". Then chiropractor then gave me an adjustment with an "activator gun" which gave relatively little relief. The subluxation station apparently showed my back as registering all sorts of out of whack and out of balance electrical signals, and the X-rays showed evidence of compression in the past (big surprise) but not much else. I would have preferred to look at an MRI scan to see if I have any herniated discs, out of curiosity, but the x-ray is interesting too.
The subluxation station is essentially a surface electromyograph (see THE SCIENCE & VALIDITY BEHIND THE INSIGHT MILLENNIUM SUBLUXATION STATION). I'll try to scan the results and post them later. I'm a bit skeptical, but I'm willing to see how it goes. It does not surprise me that it showed messed up results. I was able to feel my muscles and legs twitching with spasms when I had the really bad pain. I'm guessing that's not uncommon when you have back pain as bad as mine. But now the twitching has basically disappeared and it seems likely that the readings would be a fair bit better - acute back pain is often transient and self-limited, like most infections. The chiropractor seems to want to test me again after doing a dozen or so more adustments, and I imagine the reading will be much better - unsurprisingly. He's also saying that he wants to keep going until my legs are equal length, which is something the activator gun wiki article (linked above) discusses as somewhat dubious. The chiropractor is now expecting me to be a long-term customer, which I'm not really interested in - but I'll play it out for a bit longer (cheap with insurance). In the picture below, the right is me and the left is a healthy control (balanced).
One of the reasons that I will no doubt feel much better is that I'm doing a lot of research and paying careful attention to posture. I've been aware of the Alexander technique, which had a very positive clinical trial published in the BMJ not too long ago. The easiest takeaway from that is to lay down on your back and lift your knees, which is a very relaxing and pain-relieving way to spend some time. I've also been reading through Dr. Jolie Bookspan's articles, and have been particularly intrigued by her article on hyperlordosis as a cause of lower back pain. My back pain is mainly from sitting (the article identifies hyperlordosis as related to standing) but I feel that my back is caused by hyperlordosis. I've tried to implement posture advice and it may have been partly counterproductive - I've been trying to arch my back too much, and every time I do it I can feel the pain and stress it causes. Ironically, in reviewing my x-ray results the chiropractor said I had too little curve and arch, which I think is completely wrong.
Bookspan's research led me to research which has identified more fatiguable trunk muscles in those with lower back pai (see, e.g., Chok et al 1999). Daneels et al (2000) found that only the multifidus was smaller in those with chronic low back pain, and in 2002 Daneels et al found that those with chronic low back pain weren't activating their multifidus. The Musculoskeletal Consumer Review suggests feeling for the multifidus and then exercising it mentally to help activate it, but I can't seem to do that. Suggestions at the SlowTwitch forum include the "pointer dog" exercise, which I imagine looks like the following. There's also the The Multifidus Back Pain Solution: Simple Exercises That Target the Muscles That Count book, which I'll probably buy. The "activation" problem is mentioned by one of the reviewers. The reviewer recommends Spinal Stabilization instead, but interestingly enough the first reviewer of that book similarly complains that there's no real discussion on how to activate these muscles or know if they are activating properly. This article describes how to activate these muscles, and apparently the practice also does real-time ultrasound imaging (RTUS) tests to confirm the activation (unfortunately not in my area). It's so mysterious that I don't know whether I'm activating them or not, and thus I can't blame a couple physical therapists at a forum for ranting a bit about the newest "fad" (although they still annoy me). UPDATE: This is called the motor control exercise in the literature, and a systematic review was published not long ago.
Monday, March 23, 2009
What I've been doing
Since I got a cushy government job several months ago after graduating from college, I've been living stress-free and catching up on leisure reading in both fiction and nonfiction. I've been learning a lot, and most of it is highly bloggable. Why, then, haven't I been blogging?
I've begun to seriously worry about my digital identity. It's apparent from several comments that there are people who know who I am, and I don't know who they are. Some people might wonder why this might be a problem. The problem is that this site was intended to be a place where I could truly speak my mind and voice controversial opinions. In many cases these opinions will not be correct, and sometimes they may sound absurd. I'm an intensely private and self-conscious person and I can't stand to have my mistakes archived in the Wayback Machine for all to see for the rest of my life. I've played fast and loose with my identity on this site, and at some point I plan to cultivate a new internet identity more carefully. Statements signed by my real name will ideally be carefully-researched and screened for neutral wording.
In my last post I mentioned that I was reading The Skeptical Environmental, a book which is overwhelmingly researched. While I can't say that I've fact-checked it thoroughly, on the surface it appears accurate to call it, as one Amazon reviewer says, a tour de force in environmental science. It's admittedly shaken my "ecowarrior" philosophy to the core. Prior to reading it I read a Worldwatch State of the World book, which I found disappointing. Lomborg heavily criticizes the Worldwatch books and exposes in some cases what appears to be scientific dishonesty on the part of environmentalists, even global warming theorists. My thoughts on the issue are still developing, but while my convictions were shaken, I still disagree with Lomborg on his major conclusions and remain concerned about biodiversity, global warming, persistent pollutants, farming, and water. Yet I highly recommend the book for the one of the best available monographs on the statistics and theory behind environmental issues.
I'll skip some of my other reading aside from mentioning that it relates to medicine, scientific controversy, and corporate conflicts of interest (eg Marcia Angell's The Truth About the Drug Companies). Today I saw a section (p. 145) in The Money Culture (a humorous book on Wall Street) which related my thoughts on some of these issues:
Ultimately, I'm not right-leaning. I probably rate high on the psychological "openness" score. However, I try to be rational. I'm willing to investigate implausible claims before writing them off. That's perhaps wasted a lot of my time, but it's also helped me learn a lot. Ultimately I've tentatively concluded that fringe scientists and theorists are more likely to engage in scientific dishonesty. But they don't have a monopoly on such improprieties, and rationally one cannot come to firm conclusions without investigation and empirical evidence. There are, for example, ways to make a lot of money trading stocks. It's not nonsense. But it doesn't have anything to do with Elliot Wave theory -- which, I'll admit, I haven't investigated and have little regard for.
I've begun to seriously worry about my digital identity. It's apparent from several comments that there are people who know who I am, and I don't know who they are. Some people might wonder why this might be a problem. The problem is that this site was intended to be a place where I could truly speak my mind and voice controversial opinions. In many cases these opinions will not be correct, and sometimes they may sound absurd. I'm an intensely private and self-conscious person and I can't stand to have my mistakes archived in the Wayback Machine for all to see for the rest of my life. I've played fast and loose with my identity on this site, and at some point I plan to cultivate a new internet identity more carefully. Statements signed by my real name will ideally be carefully-researched and screened for neutral wording.
In my last post I mentioned that I was reading The Skeptical Environmental, a book which is overwhelmingly researched. While I can't say that I've fact-checked it thoroughly, on the surface it appears accurate to call it, as one Amazon reviewer says, a tour de force in environmental science. It's admittedly shaken my "ecowarrior" philosophy to the core. Prior to reading it I read a Worldwatch State of the World book, which I found disappointing. Lomborg heavily criticizes the Worldwatch books and exposes in some cases what appears to be scientific dishonesty on the part of environmentalists, even global warming theorists. My thoughts on the issue are still developing, but while my convictions were shaken, I still disagree with Lomborg on his major conclusions and remain concerned about biodiversity, global warming, persistent pollutants, farming, and water. Yet I highly recommend the book for the one of the best available monographs on the statistics and theory behind environmental issues.
I'll skip some of my other reading aside from mentioning that it relates to medicine, scientific controversy, and corporate conflicts of interest (eg Marcia Angell's The Truth About the Drug Companies). Today I saw a section (p. 145) in The Money Culture (a humorous book on Wall Street) which related my thoughts on some of these issues:
Like about half of America, my father believes he can systematically beat the stock market ... shallow pretenders ... bother him ... it pleases him to see Rukeyser embarrass the various hemline theorists, 75-year cyclists, Elliot Wavers, and druids ... he watches Louis Rukeyser for the same reason every right-thinking, sexually repressed, country club Episcopalian lingered long and hard over the delicious defrockings of Jimmy Swaggart and Jim Bakker. It confirms his skepticism about alternative forms of belief. (emphasis mine)
Ultimately, I'm not right-leaning. I probably rate high on the psychological "openness" score. However, I try to be rational. I'm willing to investigate implausible claims before writing them off. That's perhaps wasted a lot of my time, but it's also helped me learn a lot. Ultimately I've tentatively concluded that fringe scientists and theorists are more likely to engage in scientific dishonesty. But they don't have a monopoly on such improprieties, and rationally one cannot come to firm conclusions without investigation and empirical evidence. There are, for example, ways to make a lot of money trading stocks. It's not nonsense. But it doesn't have anything to do with Elliot Wave theory -- which, I'll admit, I haven't investigated and have little regard for.
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