Yet another study is reported today that casts doubt on the value of supplementing vitamin D. Subjects were given either 400 iu daily or 50,000 iu twice a week. No difference in outcome was seen. I am going to agree with them for one minute here: I would not use either one of these options.

However, it boggles the mind that we are still so unsophisticated in our analyses of vitamin D. I present here a summary of studies that DID find a benefit. Since randomized studies of supplementation have not found harm, it seems the choice is whether to take a risk (that appears very small so far) to get an advantage as detailed below.

MAIN TAKEAWAY POINTS:

• Vitamin D supplementation is beneficial in a number of conditions and especially for patients below the 20 ng/mL cutoff
• The dose of vitamin D is about 100 iu daily of vitamin D3 for each 1 ng/mL you want to increase the level by, double that for obese patient
• Toxicity is unusual, but possible with doses above 10,000 iu daily
• The ideal level to aim for may depend on the condition and the patient’s genetics; 50 ng/mL is reasonable, but levels up to 60-80 ng/mL or even 80-90 ng/mL have their supporters
  

For this review, I have focused on randomized controlled trials of vitamin D supplementation.

Vitamin D supplementation in general, without regard to condition or level, generally reduces all-cause mortality (Chowdhury et al, 2014) and improves pregnancy outcomes (Sablok, 2015).

The most obvious benefit of vitamin D supplementation is for people whose vitamin D is below 20 ng/mL. In my opinion, this group makes it worthwhile to screen everyone with a vitamin D level, as supplemented patients will experience fewer bone fractures, less injury from falls, better tooth retention, better sleep and well being, less overall pain, less cardiovascular disease, less asthma and COPD, less influenza, fewer colds, and less pneumonia (see Table 1).

If people already have certain medical conditions, raising vitamin D using supplements will help them to have better outcomes with Hepatitis C treatment, to have less joint pain (with rheumatoid arthritis), less neuropathy (with diabetes), less pain (with fibromyalgia), better glucose control (with gestational diabetes), lowered insulin resistance (teenagers with prediabetes), less eczema, and fewer episodes of otitis media (for children prone to otitis) (see Table 2).

One study compared gene expression in people with low vs. normal vitamin D levels. They found 66 genes expressing differently between the two groups. In vitamin D deficient subject, supplementation corrected the expression of these genes (Hossein-nezhad et al, 2014).

The expression of several immunological markers was improved in a group of patients with multiple sclerosis supplemented to a average level of 50 ng/mL (Terrier  et al, 2012).

In many cases, research has not shown a benefit to attaining levels above 35 ng/mL, and there are concerns that there may be adverse consequences of excessive vitamin D supplementation. However, it is hard to draw firm conclusions in that regard. Few research subjects attain levels much above 35 ng/mL, making it difficult to find statistically significant differences above that level. The studies showing associations between high vitamin D levels and certain illnesses do not involve a randomized controlled comparison of people taking different doses of vitamin D. This introduces the possibility that there are other reasons people with high vitamin D levels sometimes have higher fracture risk (Bleicher et al, 2014), more Type 1 diabetes (Gorham et al, 2012) or higher risk of cardiovascular disease.

For certain conditions, a vitamin D level above 40 ng/mL is the most beneficial (Munger et al, 2006). In fibromyalgia, maximum benefit was found when patients were supplemented to levels exceeding 48 ng/mL (Wepner et al, 2014). Some neurologists (Gominak et al, 2012) claim that it is necessary to supplement patients to levels of 60-80 ng/mL to correct sleep problems, including sleep apnea, and levels above 80 ng/mL may offer additional advantages in autism (Cannell, personal communication; Perlmutter—in his book, Grain Brain).

Some people have genetics that result in lower vitamin D levels (Wang et al, 2011). These variants are near genes involved in cholesterol synthesis, hydroxylation and vitamin D transport. There are also inborn errors of vitamin D metabolism, some of which can be overcome with vitamin D supplementation (Malloy et al, 2010).

Some people also have genetics that impair the hydroxylation of 25 OH vitamin D to the active form 1, 25 OH vitamin D. It is tempting to hypothesize that these are the patients who get more benefit from very high levels. Mitochondria are involved in this conversion, raising the possibility that mitochondrial dysfunction also impacts need for high levels of 25 OH vitamin D (See Perfect Health Diet website).

Vitamin D supplementation as a single 300,000 iu dose can also be used to treat primary dysmenorrhea (Lasco et al, 2012).

I would love to find research support for an ideal level being in the 50ng/mL, or the 70-80+ range. This is frequently recommended in functional medicine, but does not appear well supported, and certainly not by randomized controlled studies of supplementation.

Please comment if you have studies to support aiming for such a high level!

 

REFERENCES

Al-Shaar L1, Nabulsi M, Maalouf J, El-Rassi R, Vieth R, Beck TJ, El-Hajj Fuleihan G.
Bone. 2013 Oct;56(2):296-303. Effect of vitamin D replacement on hip structural geometry in adolescents: a randomized controlled trial.

Amestejani M, Salehi BS, Vasigh M, Sobhkhiz A, Karami M, Alinia H, Kamrava SK, Shamspour N, Ghalehbaghi B, Behzadi AH. J Drugs Dermatol. 2012 Mar;11(3):327-30.
Vitamin D supplementation in the treatment of atopic dermatitis: a clinical trial study.

Arregbesola et al. J Epidemiol Community Health Serum 25-hydroxyvitamin D3 and the risk of pneumonia in an ageing general population. (huge connection with deficiency; when sufficient, no added benefit).

Asemi Z & Maryam Karamali &Ahmad Esmaillzadeh .Diabetologia 2014 Effects of calcium–vitamin D co-supplementation on glycaemic control, inflammation and oxidative stress in gestational diabetes:a randomised placebo-controlled trial

Belenchia AM, Tosh AK, Hillman LS, Peterson CA.; Am J Clin Nutr. 2013 Apr;97(4):774-81. Correcting vitamin D insufficiency improves insulin sensitivity in obese adolescents: a randomized controlled trial.

Bleicher K1, Cumming RG, Naganathan V, Blyth FM, Le Couteur DG, Handelsman DJ, Waite LM, Seibel MJ. J Bone Miner Res. 2014 Sep;29(9):2024-31.
U-shaped association between serum 25-hydroxyvitamin D and fracture risk in older men: results from the prospective population-based CHAMP study.

Bitetto D1, Fabris C, Fornasiere E, Pipan C, Fumolo E, Cussigh A, Bignulin S, Cmet S, Fontanini E, Falleti E, Martinella R, Pirisi M, Toniutto P. Transpl Int. 2011 Jan;24(1):43-50. Vitamin D supplementation improves response to antiviral treatment for recurrent hepatitis C.

Camargo CA Jr, Ganmaa D, Frazier AL, Kirchberg FF, Stuart JJ, Kleinman K, Sumberzul N, Rich-Edwards JW. Pediatrics. 2012 Sep;130(3):e561-7.  Randomized trial of vitamin D supplementation and risk of acute respiratory infection in Mongolia.

Chowdhury Rajiv, Kunutsor Setor, Vitezova Anna, Oliver Williams Clare, Chowdhury Susmita, Kiefte-de-Jong Jessica C et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies BMJ 2014

Columbo M, Reynold A Panettieri2 and Albert S Rohr1Allergy, Ashtma and Clinical Immunology 2014 Asthma in the elderly: a study of the role of vitamin D;

Forman JP1, Scott JB, Ng K, Drake BF, Suarez EG, Hayden DL, Bennett GG, Chandler PD, Hollis BW, Emmons KM, Giovannucci EL, Fuchs CS, Chan AT
Hypertension. 2013 Apr;61(4):779-85.
Effect of vitamin D supplementation on blood pressure in blacks.

Gominak SC1, Stumpf WE.
Med Hypotheses. 2012 Aug;79(2):132-5. doi: 10.1016/j.mehy.2012.03.031. Epub 2012 May 13. The world epidemic of sleep disorders is linked to vitamin D deficiency.

Gorham, ED & C. F. Garland & A. A. Burgi & S. B. Mohr & K. Zeng & H. Hofflich & J. J. Kim & C. Ricordi. Diabetologia 2012 Lower prediagnostic serum 25-hydroxyvitamin D concentration is associated with higher risk of insulin-requiring diabetes: a nested case–control study (another U shaped curve, T1DM)

Greene DA1, Naughton GA. Osteoporos Int. 2011 Feb;22(2):489-98.  Calcium and vitamin-D supplementation on bone structural properties in peripubertal female identical twins: a randomised controlled trial.

Hossein-nezhad A, Spira A, Holick MF. PLoS One. 2013;8(3):e58725.  Influence of vitamin D status and vitamin D3 supplementation on genome wide expression of white blood cells: a randomized double-blind clinical trial.

Hong Q, Xu J, Xu S, Lian L, Zhang M, Ding C. Rheumatology (Oxford). 2014 Nov;53(11):1994-2001. Associations between serum 25-hydroxyvitamin D and disease activity, inflammatory cytokines and bone loss in patients with rheumatoid arthritis.

Huang W1, Shah S, Long Q, Crankshaw AK, Tangpricha V. Clin J Pain. 2013 Apr;29(4):341-7. Improvement of pain, sleep, and quality of life in chronic pain patients with vitamin D supplementation.

Krall EA, Wehler C, Garcia RI, Harris SS, Dawson-Hughes B.Am J Med. 2001 Oct 15;111(6):452-6. Calcium and vitamin D supplements reduce tooth loss in the elderly.

Lasco A, Catalano A, Benvenga S. Improvement of Primary Dysmenorrhea Caused by a Single Oral Dose of Vitamin D: Results of a Randomized, Double-blind, Placebo-Controlled Study. Arch Intern Med.2012;172(4):366-367. 

Malloy PJ, Feldman D. Genetic Disorders and Defects in Vitamin D Action.Endocrinology and metabolism clinics of North America. 2010;39(2):333-346

Marchisio P1, Consonni D, Baggi E, Zampiero A, Bianchini S, Terranova L, Tirelli S, Esposito S, Principi N.Pediatr Infect Dis J. 2013 Oct;32(10):1055-60.
Vitamin D supplementation reduces the risk of acute otitis media in otitis-prone children.  (took kids over 30ng/dl, using 1000 iu vitamin D, to prevent ear infections)

Martineau AR  et al.  Lancet Respiratory Medicine 2014. Vitamin D3 supplementation in patients with chronic obstructive pulmonary disease (ViDiCO): a multicentre, double-blind, randomised controlled trial (only people who start out deficient improve, about 2000 iu daily is enough; they attain about 35 ng at most by the time they are done)

Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. 
JAMA. 2006 Dec 20;296(23):2832-8.
Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis.


Shehab D.a · Al-Jarallah K.a · Abdella N.a · Mojiminiyi O.A.b · Al Mohamedy H. Medical Principles and Practice 2015 Prospective Evaluation of the Effect of Short-Term Oral Vitamin D Supplementation on Peripheral Neuropathy in Type 2 Diabetes

Rizzoli R, Boonen S, Brandi ML, Bruyère O, Cooper C, Kanis JA, Kaufman JM, Ringe JD, Weryha G, Reginster JY. Curr Med Res Opin. 2013 Apr;29(4):305-13.
Vitamin D supplementation in elderly or postmenopausal women: a 2013 update of the 2008 recommendations from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).

Sablok A1, Batra A, Thariani K, Batra A, Bharti R, Aggarwal AR, Kabi BC, Chellani H.
Clin Endocrinol (Oxf). 2015 Feb 14.  Supplementation of vitamin D in pregnancy and its correlation with feto-maternal outcome.

Terrier B, Derian N, Schoindre Y, Chaara W, Geri G, Zahr N, Mariampillai K, Rosenzwajg M, Carpentier W, Musset L, Piette JC, Six A, Klatzmann D, Saadoun D,Patrice C, Costedoat-Chalumeau N. Arthritis Res Ther. 2012 Oct 17;14(5):R221.
Restoration of regulatory and effector T cell balance and B cell homeostasis in systemic lupus erythematosus patients through vitamin D supplementation.

Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H.
Am J Clin Nutr. 2010 May;91(5):1255-60.  Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren.

Uusi-Rasi K, Patil R, Karinkanta S, et al. Exercise and Vitamin D in Fall Prevention Among Older Women: A Randomized Clinical Trial. JAMA Intern Med. Published online March 23, 2015. 

Wang et al (very large group). Lancet. 2010 Jul 17;376(9736):180-8.
Common genetic determinants of vitamin D insufficiency: a genome-wide association study.

Wepner F, Raphael Scheuer, Birgit Schuetz-Wieser, Peter Machacek, Elisabeth Pieler-Bruha, Heide S. Cross, Julia Hahne, Martin Friedrich Pain 2014  Effects of vitamin D on patients with fibromyalgia syndrome: A randomized placebo-controlled trial (this group attained a level of 48 ng or more; pain resumed 6m after supplementation stopped)

Wepner F, Raphael Scheuer, Birgit Schuetz-Wieser, Peter Machacek, Elisabeth Pieler-Bruha, Heide S. Cross, Julia Hahne, Martin Friedrich
Arthritis Research and Therapy 2012. Effects of vitamin D on patients with fibromyalgia syndrome: A randomized placebo-controlled trial.

The dictionary defines “germophobe” as “a person who fears physical contact with germs and is therefore obsessed with cleanliness”.

Given what we know now about the fact that there are 10 bacterial cells to each human cell in our bodies, this seems like strange behavior indeed. How can you even focus on the germs outside when there are so many germs inside? Yet, germophobes are very common. A recent entertaining blog contrasted “germophile” and “germophobe”, insisting that one was not better than the other.

But should we choose consciously? Is one better than the other? What would “better” mean in this case? Of course from my point of view as a functional medicine physician, “better” means free of illness, and full of vitality and a sense of well-being.

If that is the goal, I think “germophile” wins.

WE SPREAD GERMS INSTINCTIVELY
The thing that I find most relevant to thinking about this question, is how many of our automatic and most treasured behaviors involve maximizing the transfer and spreading of germs. From the first moment of life, which, if we are lucky, involves a short trip down the birth canal, it’s all about getting as many germs as we possibly can. Breast milk is full not only of germs, but of germ “landing docks”, that allow germs to take residence in the baby’s intestine. Breast milk is also full of certain substances the baby cannot digest. They are solely for feeding the bugs that begin to inhabit the baby—letting them go hungry would be a disaster!

Of course that is just the start. For some reason, I was overwhelmingly driven to kiss my babies over and over again. I touched them a lot and I have to say, I didn’t bathe them daily because they just didn’t seem dirty to me.

Many of our other behaviors (kissing in general, shaking hands, touching, hugging) also seem aimed at sampling the environment and each other, and becoming maximally colonized with germs. Babies are notorious at mouthing everything within their reach. Is this really because the mouth is another “sense organ” to them, or is it because they are busily and systematically putting together an extensive germ collection? Read just a bit of the latest science on the gut-brain connection and you will learn that gut bacteria impact brain development and our responses to stress later in life. Even certain parasites are favorable to the brain. I am becoming a bigger and bigger fan of germs. To be honest, I am in awe of what they do for us.

WE RELY ON BACTERIA
DNA in the human cell comprises about 20,000 genes. Each gene is the blueprint for a protein that will then carry out a function within the cell or in another part of the body. However, the human organism requires about 500,000 to a million different proteins to function. Where do they come from? Some have hypothesized that the 20,000 human genes mix and match and combine bits of each other to become half a million different proteins. Others have argued that this is not the case: we get the vast majority of our cellular-level tools from bacteria.

Each bacteria only has a few thousand genes. So the goal, clearly, is to collect as many different bacterial strains as possible as quickly as you can. Babies are especially well-suited for this. They have a “weak” immune system, so as not to kill off germs right away: the germs get the benefit of the doubt. As we get older, we still have a compulsion (or brilliant adaptation) to keep sampling: we touch things, then touch our face or somehow put fingers in the mouth. There could be a way that this helps us cope with what our environment requires of us: detoxification, absorption or manufacture of vitamins, immune system training and performance, connection with other human beings. We know bacteria influence or perform these functions. There could be more: we could be adapting to different threats: savanna vs. forest, tide pools vs. mountaintops. I’m deeply intrigued.

And in turn, we impact our environment bacteriologically in exquisitely specific ways: each finger has its specific bacterial signature. What purpose does that serve?

GUT BIOME DIVERSITY
Now that we are measuring the gut biome (collection of all bacterial DNA within a human being), we know that within the body, about 99 genes are of bacterial origin for each 1 human gene. This is due to the large variety of bacteria we possess. The diversity of bacterial species within the gut is reported as a measure of robust gut health.

When we observe indigenous cultures, we find that they do outrageously “germy” things, like let a carcass fester in the sun before consuming certain animals. All traditional cultures have a typical fermented food. Some will only consume certain foods if they have been fermented. We also notice that their rates of allergies, asthma, autoimmune disease, obesity, diabetes and most cancers are or were lower than ours. We think this is all related to gut biome diversity.

Our laboratory animals may also be too sterile and may not represent how life really means to proceed. Rat cages are routinely sterilized, and their food, if you think about it, is typically entirely processed. Perhaps they represent what it would be like for us if we lived like that.

GUT AND PSYCHOLOGY
The most exciting findings recently are in psychobacteriology (I made that up, I don’t think they have a name yet). Most of our nervous system is in the gut. Most of our immune system is there too. It is where the action is, clearly. Bacteria make substances that are recognized by our nervous system. Researchers have found that bacteria in the gut communicate with our brains using the vagus nerve, that links the intestinal area with the brain. They help us be calm, resourceful and connect better with others. They may control appetite and food choices. In turn, all of the above influences our immune system function.

I’m starting to think that germs make us better people—healthier, more connected with each other, more adaptable, and more relaxed. I think the vast majority of bacteria are helpful, and we should re-examine each one of our assumptions about killing them. There is a minimum of sanitation that prevents important infectious illnesses but by and large, we have gone overboard. So I am a germophile.

VIDEO VERSION here:

This past month has seen an onslaught of highly damning research results on the most fundamental tools of conventional medicine. It has left me wondering what is left for doctors to do that will help more than harm?
 
ANTACIDS ARE NOT SAFE
Medscape, a highly read conventional medical newsfeed, reports that the most popular article of the month among readers was the one reporting that proton pump inhibitors (PPIs) were linked to a rise in heart attacks. PPIs are medications like omeprazole (Prilosec), pantoprazole (Protonix), dexlansoprazole (Dexilant), esomeprazole (Nexium) and lansoprazole (Prevacid). They are prescribed for a variety of complaints, especially acid reflux and indigestion. Millions of people are on these medications, sometimes for decades. It can be very hard to stop these medications, because stopping them may cause rebound heartburn (though I have my tricks).
 
How do PPIs cause heart attacks? Scientists are not sure, but it could be because we need the acid in the stomach for a number of reasons, and one of them is to use a substance made by mouth bacteria and turn it into a very important substance called nitric oxide, that protects blood vessels.
 
Far fetched, but, it’s only a start.
 
IBUPROFEN IS NOT SAFE
Today the FDA put out a warning that NSAIDs, well-loved drug category reducing pain and inflammation, also likely increase heart attacks and strokes. This category includes ibuprofen (Advil, Nuprin, Motrin), naproxen (Aleve, Naprosyn), and many others. Almost everyone has at least tried something from this category, or taken it for a week or more to manage an injury, and millions take it most days to manage chronic pain. So what are doctors supposed to do with patients’ pain?
 
Interestingly, the regular use of NSAIDs can cause heartburn, and I have often seen patients started on PPIs because of their NSAID, sometimes preventatively. I am not looking forward to the study about what the combination does to your heart attack risk.
 
In case you thought you would turn to acetaminophen (Tylenol), remember that it worsens asthma and impairs detoxification by reducing your levels of glutathione. It has also been connected to asthma development in babies and to ADHD in the children born to women who used it during pregnancy. All of these are associations, but they are not reassuring.
 
STATINS ARE NOT SAFE
What about statins? Everyone should be on one, right? Well they cause diabetes. They were thought to cause a little diabetes, but it turns out they cause more diabetes than originally thought. So how is it that they can still be beneficial? After all, another study this month tells us that a significant number of patients have a sudden decline in cognitive function after starting statins. Researchers are not sure if this is a real effect of the drug or some sort of research distortion, but it sure could be real.
 
DIABETES IS WORSE THAN WE THOUGHT, EVEN WELL-TREATED
Yesterday saw the publication of a study showing that diabetics have an accelerated decline in cognitive function, even when treated. So maybe those people who had heart attacks and were placed on statins are living longer but living with cognitive decline?
 
AND LET’S NOT FORGET
This month the Cochrane Collaboration, a highly respected European group that reviews research on therapy and prevention, declared that there was no good evidence that water fluoridation prevents dental caries.
This is the same group that pointed out that influenza vaccination is probably not worthwhile for the vast majority of people.
And more recent research suggest that whooping cough vaccination (not lack of vaccination) is a cause of disease resurgence.
 
Does this leave anything for the average doctor to do that will actually work, and won’t make the patient worse? How about preventative tests that aim to detect cancer?
 
CANCER IS NOT AS WE THOUGHT
This week, we also had the report on an enormous study comparing breast cancer incidence and mortality across US counties with high and low mammography rates. If mammography saves lives then the counties with high mammography rates would have had fewer breast cancer deaths, and fewer larger tumors. But that is not the case. Mammograms do find many more small cancers, but these may not be cancers that would have become noticeable over time. We know this because counties with a high rate of mammography did not have a lower rate of large tumors. Therefore mammograms do not prevent small tumors from turning into large tumors.
 
Nor did counties with high mammography rates have lower breast cancer mortality. So mammograms do not save lives.
 
But these counties did have higher breast cancer incidence rates. So really all mammography does is cause more women to have to undergo cancer treatment. Overall, lives are not saved.  I am NOT talking about false positive scares. This is full-fledged chemotherapy, lumpectomy or mastectomy and/or radiotherapy; and then more medications like tamoxifen; and long-term side effects like heart failure and cognitive decline from chemo and immune system anomalies from radiotherapy.
 
THE PRICE TO PAY FOR PEACE OF MIND
It appears that what really happened is that some women gained reassurance at the expense of other women going through a diagnosis of breast cancer (either invasive breast cancer or DCIS), and undergoing dangerous chemotherapy and disfiguring and painful removal of a body part. Women that were going to die, died anyways (the mortality didn’t change). UNLESS-- what we are seeing is a lot more real breast cancer than before—but no one is admitting to that.
 
The following concept is now gaining favor: that cancer does not always proceed from small to large in predictable fashion. I know it makes no sense but it is true: cancer sometimes starts small and explodes very fast. Sometimes it starts small and regresses back to nothing. Sometimes it progresses the way we used to think, from small to large to widespread.

HERE’S WHAT I THINK
The concept of better living through chemistry is backfiring. Chronic disease prevention through surgery will also not work. There’s that devil once again, in the details. The idea that you could continue with your previous lifestyle, the one that brought on the heartburn, joint pain or headache, high cholesterol (which may not even be harmful cholesterol) or high glucose, or maybe even cancer—the idea that a pill could make it just fine to continue with that lifestyle—that has turned out to be WRONG. Doctors can’t save you from a symptom without giving you a disease, which may be worse.
 
What we need to do is to find and fix the underlying cause.
 
For some people, it’s not a choice they made. The underlying cause is toxins, or immune dysfunction, or multigenerational trauma. Help may be available for them too. There are worthwhile trade-offs to be found, there is trauma therapy, and immune support.
 
But for others who have space to improve their lifestyle, to eat healthier, sleep more, exercise more, stress less, focus more on meaning, purpose, community, love, and service, it will actually NOT be very hard to sidestep antacids, anti-inflammatories, statins, and whatever is on those rows and rows of shelves at the drugstore—and diabetes, strokes and heart attacks, and in many cases even cancer.
 
The work we do to resolve heartburn or reflux, joint pains, headache, cholesterol and glucose issues is the same work that studies suggest leads to a long and healthy life.
 
INDEED, ALL CAUSE MORTALITY IS SHARPLY REDUCED WITH FRUITS, VEGETABLES, EXERCISE and MEDITATION.
A study from 2012 shows an 8-fold reduction in all-cause mortality in the participants who ate more than 5 portions of fruit and vegetables daily and who were in the fittest subset. A separate study showed a 40% reduction in all-cause mortality with meditation. I would love to see the study that combines diet, exercise and meditation. And the study that further measures the effect of having a strong sense of mission, and a good close-knit group of family or friends.
 
The skills and practice of functional medicine have helped me squarely focus on the promotion of wellness. My goal is to continue to learn efficient and effective ways to guide my patients to optimal health through natural means.

 

 

REFERENCES FOR THE SKEPTIC—bring to your physician and have a conversation!
 
Proton Pump Inhibitors and Cardiovascular health

http://www.scientificamerican.com/article/certain-heartburn-drugs-linked-to-increased-risk-of-heart-attack/
 
NSAIDS and cardiovascular health
http://www.fda.gov/Drugs/DrugSafety/ucm451800.htm#collapseSix
 
Statins risk for diabetes—March 2015

http://www.sciencedaily.com/releases/2015/05/150507145328.htm
 
Statins affect memory
http://www.ncbi.nlm.nih.gov/pubmed/26054031
 
Water fluoridation not proven to prevent cavities
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010856.pub2/abstract
 
Influenza shots probably not worthwhile in most people
http://www.cochrane.org/CD001269/ARI_vaccines-to-prevent-influenza-in-healthy-adults
 
Whooping cough vaccination spreads disease
http://www.sciencedaily.com/releases/2015/06/150624071018.htm
 
Mammography and cancer rates in US counties
http://archinte.jamanetwork.com/article.aspx?articleid=2363025
 
Fruit and vegetable intake, physical activity, and mortality in older community-dwelling women.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3639003/