Bartonella Fw: News From Lymedoctor/ Vitamin D

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BorreliaMultipleInfectionsAndAutism Date: Monday, December 1, 2008, 6:27 PM

Lymedoctor Newsletter December 2008 - Vol 1, Issue 6

IN THIS ISSUE

The Miracle of Vitamin D (Part 3 of 3)

Stress and the Immune System

Bartonella, Rat, Flea Connection - the New Plague?

Sleep Update - Power Naps may be Really Good for You

Happy Holidays to You!

Quick Links

Lymedoctor.com

Nutritionessentials inc.com

WELCOME

Welcome to our sixth issue of the

Lyme Disease Solution Newsletter!

I certainly hope you find it useful.

Feel free to forward it to your friends.

You are able to access archived issues via my website:

www.lymedoctor. com

Dr. Singleton

The Miracle of Vitamin D - Part Three (of Three)

In this final discussion of vitamin D and Lyme disease I want to focus on three items: sunlight exposure/sunscreens , methods of improving vitamin D levels, and specifically how much to take and whether to use vitamin D2 vs. vitamin D3 for supplementation. Sunlight and Sunscreens The sun emits three types of ultraviolet radiation - UVA, UVB, UVC. UVA and UVB reach the earth and therefore impact us. UVC, while the most potent and potentially dangerous, does not penetrate the ozone layer of the atmosphere and therefore will not be discussed here. UVA - Although the weakest of the 3 UV's, overexposure to UVA in excess unfortunately results in skin aging and possibly skin cancer. Until the late 1990's most sunscreens did not filter out UVA. Rather those earlier sunscreens selectively filtered out UVB (to prevent sunburn). The result of this fact

is that people who used sunscreen from the 1960's to the 1990's blocked out UVB, but had often large amounts of UVA exposure. Could this overexposure to UVA be why we are seeing more skin cancer today in people at younger ages? No one knows for sure, but certainly today most dermatologists would say that virtually all sun exposure should be avoided, particularly by people with certain kinds of skin. The problem with doing this is that, while reducing skin cancer, it would also basically eliminate proper UVB sun exposure for vitamin D production. I think that there is a role for "prudent sun exposure" which I will discuss later. UVB - This form of UV is more powerful than UVA though not as powerful as UVC. Our exposure to UVB results in both vitamin D production and in sun-tanning (and unfortunately sun-burning and skin cancer if not properly done). The most intense time of exposure for UVB is

from about 11 am to 3 pm. UVB is absorbed by glass, doesn't get through, and therefore you cannot produce vitamin D from sun coming through glass. And, according to vitamin D expert Dr. Holick, even weak sunblocks and sunscreens (SPF of 8) can dramatically reduce the production of vitamin D by 95%. Parenthetically, although darker skin is not technically a "sunblock", people with darker complexions (ex. East Indian or African persons) require much more UVB exposure to generate vitamin D. On the other hand they are protected from premature skin aging. SUNSCREEN SELECTION - One word about selecting sunscreens - please be careful to make sure that the brand you use is both safe and effective. Is your sunscreen safe? Some sunscreens contain toxic ingredients that some experts suggest might actually harm the skin and possibly increase the risk for skin

cancer. An example of an ingredient to avoid would be "oxybenzone. " Is your sunscreen effective? Recent independent lab evaluations suggest that some of the most common brands do not deliver the SPF rating that the label suggests. The best thing is for you to do some homework. Best ways to obtain Vitamin D SUN - When one is exposed to the midday sun, the average person can produce anywhere from 10,000 IU to 50,000 IU of vitamin D in the course of a relatively short amount of time. As I stated above, it would take significantly longer for persons with darker complexions to produce those levels. If the skin overproduces vitamin D, the body will degrade the excess on the spot. Therefore, one can never have high or toxic blood levels caused by sun exposure alone. And remember, ALL of our ancestors got most of their vitamin D from the

sun. By the way, sun exposure increases the production of endorphins which make us feel better and strengthen our immune systems. So how do you accomplish "prudent sun exposure"? (Caution: This doesn't apply to you if you are taking doxycycline! Avoid sun exposure until off the medicine. Also if your skin is "Type I" or you have been told by your doctor "no sun", then skip this next section. In either case, be sure to get a vitamin D 25-OH blood test to see if you need to use diet and/or supplementation to obtain your vitamin D.) What I tell my patients to do is to plan on 10-30 minutes of sun exposure (preferably in a bathing suit for larger skin exposure) 3-4 times a week during summer months. The key thing to remember is that you should plan to stop the exposure when you begin to notice a slight "pinkening" of the skin. At the time you notice the pink, you can then apply sunscreen if

you wish to continue in the sun, or simply come out of the sun. DIET - Although not the ideal way to get all of your vitamin D, certainly the right foods could be helpful. In fact, in the Scandinavian countries, apparently most people get their summer vitamin D from the sun and their winter vitamin D from wild caught oily fish. Therefore, fish such as salmon and mackerel would be very good sources of vitamin D and other excellent nutrients such as omega 3 oils. Another potential source is cod liver oil. A teaspoon of cod liver oil contains about 400 IU of vitamin D, and it is believed that this fact resulted in the government's establishment of 400 IU as the recommended amount of daily intake of vitamin D. However, we now believe that 400 IU is woefully too low a recommendation for vitamin D. One caution concerning the extensive use of cod liver oil is the fact that it contains

significant amounts of vitamin A. High doses of vitamin A may have an adverse effect on the bones of some people. Therefore, I recommend using some cod liver oil, but not making it a major source of vitamin D for most people. Perhaps the poorest dietary source is milk and for several reasons. First of all, the amount of vitamin D in milk is inconsistent and is often not natural vitamin D3, rather most often synthetic, non-human vitamin D2 is used. Secondly, there is not enough in the average glass of milk to do the job, yet people are lulled into a sense of complacency thinking that that is all they need. Third of all, the majority of the world is lactose intolerant and therefore avoids milk. So if you plan to get some of your vitamin D from milk, don't count on too much from that source. Like cod liver oil, get some vitamin D from milk if you can, but most dietary vitamin D should come from fish

sources. Vitamin D Supplementation The preferred form of vitamin D is human vitamin D, which is also known as vitamin D3 (cholecalciferol) . This is the form of vitamin D formed in the skin when exposed to UVB radiation. A synthetic form is also available called vitamin D2 (ergocalciferol) . I don't recommend vitamin D2 unless there is no choice except D2 because D2 is only 25-30% as effective as vitamin D3. Before embarking on a vitamin D supplementation program, the first rule is that you need to know your vitamin D 25-OH level. As I have stated before, most experts do not recommend the 1,25-OH as a marker for vitamin D status. Dr. Cannell, Executive Director of the Vitamin D Council, states: "Calcitriol [Vitamin D 1,25-OH] levels should never be used to determine if you are deficient in

vitamin D." If your level is mildly low - 30 to 40 ng/ml - consider supplementation with vitamin D3 at an amount of 1,000 to 2,000 IU per day. When levels are moderately low - 20 to 30 ng/ml - consider using vitamin D3 2,000 to 3,000 IU per day. If levels are very low - 15 to 20 ng/ml - consider using 3,000 to 4,000 IU per day of vitamin D3. Extremely low levels are less than 15 ng/ml, and this situation I suggest supplementation with prescription 50,000 IU of vitamin D3 weekly for 4-8 weeks, followed by 4-5,000 IU of vitamin D3 daily. By the way, most prescriptions of 50,000 IU of vitamin D are in the form of vitamin D2. You may need to seek out and use a compounding pharmacy in order to get prescription 50,000 IU vitamin D3. It is available but you may have to look for it. In extremely low

levels, I routinely follow blood levels every 2-3 months until levels are stable. All others, I check levels 2-4 times per year. Adjustment in dosages should be made based on blood levels.

Stress and the Immune System

A few months ago I caught a nasty cold. (Yes, contrary to popular belief, even doctors get sick!) In the final phase of recovery from that virus, something very upsetting happened to me, and I remember feeling very angry and hurt. Within minutes, or so it seemed, my cold symptoms relapsed back to the beginning, as if I had never improved. I actually had to go through another course of recovery for several more days because my reaction to my external emotional stressor had negatively impacted my immune system. As frustrating to me as that was, it reinforced something that I have known about and have been trying to teach my patients about for years: the mind, emotions, spirit, and body are all intricately connected, and what happens to one component affects all other human components. Anything that stresses one component will definitely affect the other components as well. Often patients will

misinterpret this "whole person" approach as the doctor saying that "it's all psychological. " Nothing could be further from the truth. What the doctor is rightly saying is that what is going on in the body cannot be so neatly separated from what is going on in the head. It is all connected in ways only the Creator completely understands. The truth is that our beliefs, thoughts, reactions to life events, and past emotional and physical traumas all contribute to our overall state of health and our ability to recover from disease. This fascinating field of mind-body medicine may be worth your time and exploration. There are many excellent books that are available for lay persons. Some of my favorite authors are: Dr. Bernie Siegel, Dr. Lawrence LeShan, Dr. O. Carl Simonton, Dr. Sarno, Dr. Wayne Dyer, etc., to name just a few. These authors, along with the Bible,

were important sources of information and inspiration as I wrote Chapter 9 of my book, The Lyme Disease Solution. Let's take a moment and illustrate this mind-body connection with some interesting medical research out of UCLA that was reported recently. This study specifically addresses the connection between the brain and gastrointestinal tract. It turns out that we not only have a brain in our heads, but we also have a brain in our guts (the "enteric brain") which work hand-in-hand together. These 2 brains can work independently. They even have the same neurotransmitters, such as serotonin. (Incidentally, the best book on this topic is The Second Brain, by Dr. Gershon.) In fact, irritable bowel syndrome (IBS), which affects about 20% of Americans is now being called a "brain-gut disorder" and not just a gut disorder by the UCLA

researchers. The authors go on to say that there is a clear correlation between stress, anxiety, and depression and the symptoms of IBS. They recommend a comprehensive strategy that includes stress management as a major component. Why? Because both brains respond to stress in a maladaptive way leading to neurological gut symptoms called IBS. So what is the Lyme disease connection? Here is what my medical experience (and personal Lyme experience) tells me. It is a fact that three fourths (3/4) or more of the body's immune system is located in the gut. This is in addition to the gut containing a "second brain" that we have just discussed. It is extremely likely that stress, anxiety, and depression will have a similar unhealthy effect on the immune system which is located in the gut as these psychological states have on the "second brain" also located in the gut. Almost

invariably when a Lyme patient takes time off to take a vacation, or gets away from the everyday stressors, or gets connected to a good therapist, they feel better. Is that your experience too? If so, that should be telling you something important about stress and your immune system. Here are some simple recommendations for you to consider: (1) Do an inventory of your life stressors and consider developing a support team to help you manage those stressors - family, pastors, trained counselors (I highly recommend this resource), and healthy friends (who are leading well-functioning lives themselves). Don't resist temporary medication (especially for sleep) if your Lyme doc recommends it for you.(2) Decide to look at the events of life from the standpoint of gratitude, generosity, and kindness rather than anger, frustration, and hopelessness. Believe it or not, you do have a choice in how you respond

to any event occurring in your life. Did you know that kindness brings health and healing to the giver, to the receiver, and to the observer of an act of kindness? You can be an observer of kindness by watching movies where acts of kindness are featured. Or consider volunteering at a homeless shelter this holiday season. Kindness, like laughter, is good medicine.(3) Get regular exercise which will act as a natural stress absorber and boost your endorphins (which support your immune system). Regular diet and sleep are also important keys.(4) Take a regular "Sabbath rest" away from all of the struggles of life. Take one day a week where you just decide that you are not going to let the worries and stresses of life onto your agenda. Guess what - the world is not going to come to an end! And, while I know these are challenging economic times, take regular vacations.(5) Read good inspirational books on

a regular basis. I recommend Osteen's books if you don't have any others in mind.

Bartonella, Rat, Flea Connection - the New Plague?

There is fascinating research concerning the "brown rat" (AKA Norwegian rat) that just came out this month that you should know about. The brown rat (Rattus norvegicus) is the hardiest mammal on earth, next to the human. They live everywhere on the planet except Antarctica. Research done by Professor Chao-Chin Chang suggests that brown rats may be carrying several species of Bartonella bacteria that can cause serious illnesses in humans. More than 20 species of Bartonella bacteria have been discovered since the early 1990's, and at least eight are known to be pathogenic to humans.In the study, the researchers took samples from 58 rodents, including 53 brown rats, 2 mice, and 3 black rats. Results showed that 10.3% of the rodents were carrying Bartonella bacteria, and 80% of those carriers were brown rats. Most were carrying B. elizabethae, which can cause heart disease (endocarditis) in humans. The

researchers also identified a species of Bartonella that had not previously been identified in rodents. Further tests showed that the species was closely related to B. rochalimae, which is known to be pathogenic to humans. Exactly how the bacteria are being spread to humans in uncertain, however the researchers are confident that, just like the plague, infections are spread by fleas. Clinically, this might help explain why so many Bartonella/BLO patients have no clear history of tick bites, but do have history of other "insect bites" where the insect was never actually seen by the patient. And who knows what other vector(s) might be able to pass this on in addition to fleas. In conclusion, Professor Chang states: "Several different Bartonella bacteria are surely transmitted by rodents. These results raise concerns about the existence of other reservoirs and vectors for this emerging infection. This

certainly warrants further investigation." As many of us in Lyme medicine well know, Bartonella truly qualifies as an "emerging infection" which represents a real challenge to patients and Lyme doctors alike. Testing is not particularly good at this point in our history, making clinical recognition the most important method of diagnosis. And then there are other pathogens which can, in some cases, look somewhat similar to Bartonella including Q fever (which is carried by brown rats also, by the way), mycoplasma, toxoplasmosis, tularemia, brucellosis, and so forth, to name just a few.It is very gratifying to see the medical research world attempting to explore and better understand the complexity of vector-borne diseases. Interestingly, the veterinary research world is well ahead of us in this arena. But, as the old saying goes: "better late than never."Reference:

Lin JW, Chen CY, Chen WC, Chome BB, Chang CC. Isolation of Bartonella species from rodents in Taiwan including a strain closely related to 'Bartonella rochalimae' from Rattus norvegicus. J Med Microbiol. 2008;57:1496- 150.

Sleep Update - Power Naps may be Really Good for You

In the past, the emphasis of the medical community regarding sleep primarily focused on how much sleep. Namely, it was assumed that if you could get 7-8 hours per night, not much else mattered. We now know differently - the quality of sleep may be just as important as the length of sleep in many cases. For instance, fragmented sleep (multiple awakenings), which occurs as we get older, can result in inadequate deep or "slow wave" sleep (Stage 3 and 4) and inadequate REM sleep. Additionally, sleep apnea is much more common than we think. It can lead to a host of medical problems. In fact, sleep apnea was the apparent cause of death for football Hall-of-Famer, Reggie White, in his 40's. I was intrigued by a recent statement from a cognitive neuroscientist from City University of New York. "Not only do we need to remember to sleep, but most certainly we sleep to

remember" according to Dr. Fishbein. The clinical study of "sleep intensity" looks at the quality of sleep and the role of sleep for proper brain function, including memory. It turns out that deep sleep is critical for memory, especially for processing of information recently learned. This deep sleep occurs very early at night and precedes REM (dreaming) sleep. When deep sleep is interrupted or inadequate, memory is affected. The aging process definitely has been shown to result in reduced time in the stages of deep sleep. When I had active Lyme, I am certain that the interruption of my deep sleep was a major contributor to my "brain fog". Likewise, many of my patients have the same problem. And it is difficult to separate out how much of the cognitive impairment (brain fog) is actually due to Lyme in the brain versus due to deep sleep disruption caused by Lyme. A

study by Dr. Fishbein may help sort this out to some extent. In this very interesting study, he took English-speaking students and taught them certain Chinese words. Half of the students were allowed to take a nap after being taught these words and the other half were not allowed to nap. By the way, the slow wave naps were 12 to 90 minutes in length, but the students were not allowed to go in REM sleep. The results showed not only a significant improvement in the retention and processing of the words by the students who were allowed to take a short "deep wave sleep" power nap, but it further seemed that their brains kept working during that time to solve problems and to even come up with new ideas. "The nap group has essentially teased out what's going on," Fishbein concluded. Therefore, fragmented sleep, which can occur with aging, sleep apnea, or, in my experience Lyme disease, can

be a contributor to brain function impairment. It can even suppress the generation of new brain cells in the hippocampus, where memory-making begins. Finally, it can even hinder learning weeks after sleep returns to normal according UCLA's sleep expert, Dr. Dennis McGinty. So what is the role for power napping in the Lyme setting? I believe that it may play an important role especially early in the course of Lyme disease treatment for those with cognitive impairment, especially if there is clearly fragmented sleep resulting in inadequate deep sleep. If possible, a short siesta of 15 minutes during lunchtime might just be exactly what the doctor ordered. Doing this was certainly helpful to me during my first bout with Lyme. As my sleep quality improved during the course of antibiotics, I seemed to need the naps less and less over time. Remember, of course, it is always

important to consider the need to rule out sleep apnea and babesiosis, both of which can cause excessive daytime sleepiness. Consult your Lyme doctor about the need to evaluate these or other disorders for sleep abnormalities. If your Lyme doctor has no objections, and you can afford to do it, enjoy your power naps without guilt! Reference: n Neergaard, AP Medical Writer

Happy Holidays to you!

This year has been one of tremendous blessing to my family and me. Not that it hasn't been without great trial and challenge, but there is just so much to be thankful for. I wish you and your loved ones a wonderful Christmas (or Hanukkah) season and a prosperous and blessed New Year. Don't forget to give The Lyme Disease Solution as a gift this season to a friend or a doctor that could use some Lyme info. Also don't forget about our friends at Nutrition Essentials, Inc. at www.nutritionessent ialsinc.com I understand they are having a December 20% off sale for selected Nutres label products. You might want to take advantage of this chance to try the products I use in

my office. I am told that you should enter the following code to get the 20% discount: promo20

I haven't completely decided on the topics that will be covered in the next Newsletter. The next issue should arrive in late January, 2009. Can you believe it, 2009!! Be Blessed, Dr. Singleton

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