Ottawa Naturopath – Graham Beaton BHSc, ND – Ottawa Doctor of Naturopathic Medicine

Archive for November, 2013

Physical Activity vs Prescription Medications – Which is Better for Health?

Nov 18

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It is well documented that physical activity has many positive effects on health (reference). In general, people who are physically active have a higher quality of life and are at a reduced risk of developing many chronic diseases (such as arthritis, cancer, diabetes, heart disease, respiratory illnesses) compared to individuals who are sedentary.

A question that now arises, is does physical activity have a greater effect on health compared to medications? A recent journal article in BMJ (published on October 1st, 2013) looked to address this question.

What did the researchers do?
To determine if physical activity had a greater impact on health compared to taking medications, the researchers pooled the results of 16 separate meta-analyses (four of which were on exercise and 12 on medications), where a meta-analysis is a statistical method of combining the results of similar studies to increase the number of participants who received an intervention. Health was examined by determining mortality rates associated with 4 diseases:

  • Coronary heart disease
  • Diabetes
  • Stroke
  • Heart failure

What did they find?

  • Coronary heart disease: Physical activity and medications were equally effective in reducing mortality.
  • Diabetes: Physical activity and medications were equally ineffective in reducing mortality.
  • Stroke: Physical activity was more effective than medications for reducing mortality risk.
  • Heart failure: Certain medications (diuretics) were superior to physical activity in reducing occurrences of heart failure.

Are there limitations to this study?
Yes, unfortunately there were a number of limitations to this study, making it difficult to reach a definitive conclusion.

  • There are a limited number of randomized clinical trials (RCT) looking at the effectiveness of exercise/physical activity on mortality. The majority of studies looking at the health effects of physical activity are observational, which are not as strong in predicting cause and effect as an RCT
  • The authors correctly commented that they had relied on information from previously completed meta-analyses, and that several larger RCTs had been completed but were not “pooled” in with their data. It is possible that these new RCTs could have affected the results.
  • It is unclear if the appropriate amount/type of physical activity was chosen in the original studies to reach a conclusion. This is important issue as some studies underestimate the amount of activity required to reach a desired outcome. An example of this would be how much exercise is required to lose weight? If a study has selected 30 minutes as the amount of time one is required to exercise in order to lose weight, it might be insufficient (more time might be required). As well, the study may not account for what an individual is doing for the remainder of the day with regards to being physically active. So, if a person is exercising 30 minutes per day, and he/she is sedentary for the rest of the day, the 30 minutes spent exercising would be insufficient to have an impact on weight loss or on other possible health outcomes.
  • In addition to the above point, while it is known what direct effect a medication has on an outcome (e.g. dose x will result in x% decrease of blood pressure), the same is not always known for exercise (e.g. how much and what type of exercise should be done to achieve a certain outcome, etc).

What is the take home message?
The take home message is that physical activity has equivalent or better outcomes in the treatment of certain health conditions. Specifically, being physically active will reduce the mortality risk of coronary heart disease, diabetes, and stroke. Does this mean that if you suffer from certain conditions you should stop using your prescribed medications? Absolutely not. The findings from this article reinforce the fact that physical activity is vital to health, and being physically active can reduce one’s risk of mortality from certain diseases.

If you suffer from a chronic disease, or if you are at risk of developing a chronic disease, can physical activity help you? Yes. But before starting on a new exercise routine, talk to your health care provider about what type of activity is both safe and effective for you.

In practice, I council my patients on increasing their level of physical activity, taking into account their health condition(s), possible medications and level of physical fitness. If you have questions about a chronic health concern, physical activity or how Naturopathic Medicine can help you, please give me a call at 613-290-6115.

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Breast Cancer and Promoting Breast Health

Nov 18

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Each year 5000 Canadian women will die because of breast cancer and another 24000 women will be diagnosed with breast cancer1. Breast cancer is a significant health concern for Canadian women. This article will discuss what breast cancer is, risk factors for the development of breast cancer, and steps that can be taken to attempt to minimize one’s risk of developing breast cancer.

The Normal Breast and Breast Cancer
The breast is composed of several different types of tissues, including fat and connective tissue, blood and lymph vessels, specialized glands (called lobules) that produce milk after a woman has given birth and ducts that transport milk. The tissues of the breast are controlled by various hormones and other growth factors that allow the breast to mature (during puberty), produce milk, and that allow for the normal repair and replacement of cells of the breast. Like all cells of the body, the cells of the breast have a normal life cycle, where they grow, die and are replaced with new cells, and this process occurs in a regulated manner. In cancer, this normal regulated cell growth is lost, and abnormal cells are allowed to continue to replicate, resulting in cancer. Specifically, breast cancer arises when there is abnormal growth in the cells of the lobules and their associated ducts.

Why Does Breast Cancer Occur?
Unfortunately it is not known why breast cancer occurs. While there are several risk factors for the development of breast cancer, it appears as though the onset of cancer might be influenced by a combination of risk factors occurring at once. For instance, one common risk factor is a genetic mutation in a specific gene, the BRCA1 gene. Normally, the BRCA1 gene works to produce proteins that fix errors in DNA synthesis during the production of new cells. When the genetic mutation exists, the DNA repair proteins are not produced, allowing cancerous cells to arise. Now, amongst women who carry the gene, approximately 55 to 65% go on to develop breast cancer by the age of 70 – which indicates that additional cancer promoting factors might need to be present for a woman to develop breast cancer2.

Additional risk factors for the development of breast cancer include: a woman’s age, personal and family history of breast cancer, early menstruation and late menopause, exposure to hormones (birth control pills, hormone replacement therapy), pregnancy and breast feeding, etc. Three additional modifiable risk factors include obesity, physical activity and alcohol use, which are discussed below.

Obesity and Physical Activity
Obesity is an established risk factor for the development of postmenopausal breast cancer. One reason for this is that fat tissue, especially fat around the waist, produces estrogen. The estrogen produced enters into circulation, where it may stimulate the cells of the breast, increasing both the risk that abnormal cancerous cells can arise, and/or stimulates the growth of breast cancer that is already present3.

Obesity has also been shown to influence several other cellular mechanisms that can increase the risk of developing breast cancer. These include increasing inflammatory factors present in the breast (which can cause damage to cellular DNA of the breast, potentially leading to the presence of abnormal/cancerous cells) and increasing the production of other cellular growth factors (e.g. insulin-like growth factor 1 (IGF-1)), which would increase the chance that abnormal (cancerous) cells are produced and/or stimulate existing cancer cells to grow/reproduce2-3.

In addition to one’s weight influencing her risk of developing breast cancer, one’s level of physical activity has also been linked to breast cancer2. Specifically, it has been shown that amongst postmenopausal women, those who are physically inactive have higher levels of estrogen in circulation. Again, this can increase the risk of cancer cells arising and can promote the growth of existing cancer of the breast. As well, physical activity has been shown to influence one’s level of the cellular growth factors, including IGF-1, such that a lack of physical activity is associated with higher levels of IGF-1 in circulation, and a subsequent increased risk of developing cancer4.

Alcohol and Breast Cancer Risk
Alcohol has consistently been shown to be associated with an increased risk of developing breast cancer. It was previously believed that alcohol contributed to breast cancer risk by increasing the levels of estrogen in circulation5. It appears now that this might not be the case as several studies have shown that alcohol ingestion does not have an effect on estrogen levels. Newer studies are now focusing on how alcohol may initiate the formation of cancerous cells by altering how DNA is replicated, how alcohol might affect the invasiveness of breast cancer cells and how alcohol might affect other hormones that can then be converted in to estrogen within breast tissue5.

In summary, while it is currently unknown why certain women will develop breast cancer, it is possible to reduce the risk of developing breast cancer by maintaining a healthy weight, being physically active and moderating alcohol use.
Graham Beaton is a Naturopathic Doctor in practice at Ottawa Collaborative Care Centres. If you are concerned about developing breast cancer, or if you have breast cancer and you would like to know how naturopathic medicine can help, please contact Graham at 613-290-6115.
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Concussions and Return to School

Nov 5

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Lately there has been a lot of attention in the media about the long term health effects of concussions in both adolescents and professional athletes. The attention is due to the growing amount of evidence that concussions can have a long term impact on the structure and subsequent function of the brain – affecting mood, memory, cognitive abilities, and motor function. Over the short term, concussions can cause several challenges that can persist for months, including headaches, difficulty concentrating, problems with short term memory, etc.

In practice I have seen several adolescents who have suffered from concussions due to their participation in different sports (e.g., football, rugby, hockey, water skiing, downhill skiing, cycling, speed skating). Each of these children had various symptoms following the concussion, influencing their ability to return to sport and more importantly, influencing their return to normal daily activities including schooling at a level pre-concussion. There are a lot of questions concerning how to know when children/adolescents is ready to return back to normal activity and what steps can be taken to facilitate one’s return. A recent journal article has been published exploring these questions.

In the journal Pediatrics published on Oct 27, 2013, a review titled “Returning to learning following a concussion” gives guidance on how to safely transition a child/adolescent back to school after suffering a concussion. This is important as not only can concussions affect one’s ability to learn, but taxing a concussed brain can worsen symptoms and slow recovery.

Before summarizing the review, it is important to be able to recognize if a person has suffered a concussion. The signs (something that can be seen by another individual) or symptoms (something that is felt by the affected individual) can vary, and may not even be present for a few days following the incident. These signs and symptoms include:

  • Headaches
  • Confusion or feeling as if in a fog
  • Amnesia following event
  • Seeing stars
  • Temporary loss of consciousness
  • Ringing in ears
  • Nausea or vomiting
  • Fatigue
  • Speech difficulty
  • Difficulty concentrating
  • Irritability or other personality changes
  • Sensitivity to light and noise
  • Sensitivity to motion or difficulty with balance
  • Sleep disturbances

In a learning environment, many of the above symptoms can both affect the ability to learn and can be triggered by a child’s surroundings following a concussion. For instance:

  • Headaches can distract a student: Can be triggered by noise in classroom, by lighting, and the child focusing on tasks.
  • Dizziness: Can be brought on by walking or standing.
  • Light sensitivity, double vision or blurry vision: Can affect attention and can be brought on by using computers and/or a tablet, lighting, etc.
  • Sleep disturbances: Excess fatigue can affect attention, memory, learning, and can affect recovery. Excessive sleeping while trying to recover can affect one’s sleep cycle, further impacting on sleep.

Reintroducing a child back to a learning environment first requires having the student detail what symptoms are present and their severity. If the child’s symptoms are sufficient enough to affect his/her ability to concentrate or tolerate stimulation (noise, lights, movement) for up to 30 minutes, then the child should remain at home. While at home, it is recommended that only light mental activities be done (light reading, interacting with family, limited television watching are allowed as long as symptoms are not triggered), and activities including video games, computer and tablet use, and texting should be kept to a minimum.

When the child/adolescent is able to manage 30 to 45 minutes of stimulation comfortably, then they are free to return to a modified learning environment (school or tutoring). Modifications include taking a 15 minute break for every 30 minutes of instruction time and a reduction in course work. It is important to continue to check in with the student to see if his or her symptoms are persisting or are made worse by studying. If the symptoms are not present, the workload can be gradually increased back to normal levels.

There are several strategies that can also be implemented to reduce signs/symptoms experienced following a concussion. For example, to reduce:
Headaches:

  • Take frequent breaks
  • Identify triggers for headaches (noise, light, etc) and reduce exposure

Dizziness

  • Lie head down if symptoms present
  • Avoid crowded areas in school (hallways)

Visual symptoms:

  • Reduce brightness or exposure to computers, smart boards, videos
  • Wear hat, visor or sunglasses if light sensitive
  • Avoid fluorescent lighting

Noise sensitivity:

  • Avoid noisy areas and take breaks in quiet areas
  • Consider earplugs
  • Avoid busy hallways at school

    • Difficulty concentrating or with memory:

  • Delay, reschedule or have extra time provided for major tests and assignments

Fatigue

  • Take rest breaks
  • Shorten school and study time

There are many factors to consider in helping a child/adolescent to recover from a concussion. It is important for them to not only limit physical activity, but also mental activity as it can affect recovery time. By implementing the above, the majority of children/adolescents are back to their normal routine within 3 weeks of suffering from the concussion.

If your child has suffered from a head injury or concussion, please seek immediate medical care. In addition, consult with a health care provider about the child’s return to normal daily activities, including school and sport.

If you have any questions about concussions, returning to activities or sport following a concussion, or on naturopathic medicine, please contact Graham Beaton at 613-290-6115.

Graham Beaton is a naturopathic doctor practicing in the Centretown neighbourhood of downtown Ottawa.

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