Healing Bone Fractures, Part 2 of 5

This is the second in a series of posts in which I am documenting the process of treating a serious fracture of my right leg. In Part 1 I discussed the details behind the injury and the initial protocols that I used with the remedies I had available while I was still away. In this post I am going to explain the protocol that I implemented when I returned home.

I returned home on evening of Sunday February 3rd, four days after my injury and three days after my surgery. On Monday we picked up some additional supplements that I needed and then on Tuesday I made up a couple of new formulations specifically formulated to address my injury. This is the protocol that I implemented at that time:

Homeopathics: I am taking Arnica 200C, Hypericum 200C and Symphytum 200C individually, four pellets per dose alternated throughout the day. The dosage of each remedy varies over time according to the following protocol:

• Week 1: Arnica 4 doses per day; Hypericum 4 doses per day; Symphytum 4 doses per day.
• Week 2: Arnica 3 doses per day; Hypericum 3 doses per day; Symphytum 3 doses per day.
• Week 3: Arnica 2 doses per day; Hypericum 2 doses per day; Symphytum 3 doses per day.
• Week 4: Arnica 1 dose per day; Hypericum 1 dose per day; Symphytum 3 doses per day.
• Week 5 and onwards (until my bones are completely healed): Symphytum 3 doses per day.

Herbs: I created three new formulations to address my specific needs:

• A systemic herbal formulation prepared from 1:5 fresh herb tinctures containing turmeric rhizome (Curcuma longa) 18%, common horsetail herb (Equisetum arvense) 15%, boneset herb (Eupatorium perfoliatum) 15%, St. Johnswort herb (Hypericum perforatum) 15%, American plantain herb (Plantago rugelii) 15%, common comfrey herb (Symphytum officinale) 15%, wild ginger rhizome (Asarum canadense) 5%, white pine leaf/twig (Pinus strobus) 2%. This formulation is a specific for healing damaged tissues and blood vessels, bone, and improving general circulation. Boneset and turmeric also have a significant tonic action on the liver which will help address any stress on my liver from the medications and other aspects of my hospital experience, as well as protect my liver from any toxicity from the pyrrolizidine alkaloids in the comfrey, which is the best herb I know for healing bones and well worth the very slight risk of toxicity. Given that the comfrey will not exceed the 15-20% range in any of the formulations that I use and will be combined with herbs that can mitigate its potential toxicity, the likelihood of any toxicity is almost nil. Boneset and horsetail are also specifics for healing bone tissue. This formulation is taken in 6 ml doses three times per day on an empty stomach, 5-10 minutes before each meal.

Boneset (Eupatorium perfoliatum) is an excellent healing herb that is very effective for the healing of bone tissue.

• A systemic herbal sleep formulation prepared from 1:5 fresh herb tinctures containing English lavender flowering spike (Lavandula angustifolia) 20%, St. Johnswort herb (Hypericum perforatum) 20%, catnip herb (Nepeta cataria) 20%, American plantain herb (Plantago rugelii) 15%, hop strobilus (Humulus lupulus) 15%, turmeric rhizome (Curcuma longa) 9%, white pine leaf/twig (Pinus strobus) 1%. The dosage of this formulation is 6 ml immediately before bed and additional 3 ml doses through the night, as required. Getting sufficient sleep is one of my greatest challenges. I tend to be a light sleeper. I sleep on my sides and wake up four or five times a night feeling a bit stiff and change my position, flipping from side to side and then falling back to sleep fairly quickly. With my broken leg I can only sleep on my back. This is difficult for me because as a general rule I can't sleep on my back, and it also doesn't allow me to shift my position sufficiently. By half way through the night my lower back is very stiff and sore. Most nights I'm only getting five to six hours sleep, and that's with the sleep formulation. Occasionally I get a bit more. Getting sufficient sleep is critical to the healing process, so I made this formulation to help me sleep better. Notice that it contains a few of the herbs that are in my daytime formulation. This is to help continue to support the healing process through the night. It is also important that the overlapping herbs contribute to the sleep formulation. You will find few, if any, references to plantain having sedative properties, but it does. As a general rule, whenever someone is taking more than one herbal formulation concurrently, it is usually preferable if there is some overlap between the herbs in the different formulations. As in this case, the overlapping herbs must contribute to the desired actions of both formulations.
• A topical liniment made up of a base containing 1:5 fresh herb infused oils of pot marigold flower head (Calendula officinalis), Canada goldenrod leaf (Solidago canadensis), wild bergamot herb (Monarda fistulosa), coltsfoot leaf (Tussilago farfara), St. Johnswort herb (Hypericum perforatum), northern white pine leaf (Pinus strobus) and American plantain herb (Plantago rugelii). This infuse oil was prepared last year. The herbs are in descending order based on proportion as I am not certain of the exact percentages. To the base oil I added the following essential oils at an overall potency of two drops per ml of base oil: rosemary leaf (Rosmarinus officinalis) 25%, English lavender flower (Lavandula angustifolia) 25%, black spruce leaf/twig (Picea mariana) 15%, marjoram herb (Origanum majorana) 10%, eastern hemlock leaf/twig (Tsuga canadensis) 10%, Roman chamomile flower head (Chamaemelum nobile) 5%, yarrow herb (Achillea millefolium) 5% and eastern white cedar (Thuja occidentalis) 5%. I apply this twice a day, immediately upon waking and just before bed, to the lower thigh, knee and half of the foot of my injured leg as my leg below my knee and half of my foot are covered by a tensor bandage. I also apply it to the hip, knee and ankle of my left leg, and my wrists, as these areas are being stressed in unusual ways due to using crutches.

In this photograph we have common plantain (Plantago major), an alien species that has naturalized throughout

North America, on the left, and American plantain (P. rugelii), our native species, on the right. Notice the

reddish colour at the base of the petioles (leaf stalks) of American plantain. Most people

(including herbalists) don't realize that these are two different species.

Two weeks after my surgery I went to the hospital to have my stitches removed. There was a lot of pressure on my stitches due to the edema in my leg that occurs whenever I am moving around in an upright position. The blood and lymph tends to pool in my leg because I am not using my leg to walk, which is necessary to efficiently pump the fluids out of my leg against the force of gravity. As a result, the doctor decided to leave every second stitch in my lower, longer incision for another two weeks. In the mean time, beginning a couple of days after I got my stitches out I started poulticing the shorter incision from which all of the stitches were removed. I am applying a poultice twice per day for 30-45 minutes. The primary herbs that I am using are common comfrey leaf (Symphytum officinale), stinging nettle leaf (Urtica dioica), pot marigold petals (Calendula officinalis), purple loosestrife herb (Lythrum salicaria), and a bit of whole flax seed (Linum usitatissimum) to increase the mucilage content. I use these herbs in roughly equal proportions (except for the flax seed) and each time add a sixth herb in a similar proportion. I have a lot of "ends" which are small quantities of herbs that are left over from when I harvest herbs to make tinctures. I dry these remainders and use them when the opportunity arises. This is one of those opportunities. Each time I make a poultice I use a different sixth herb. Some of the herbs that I have used so far include elecampane leaf (Inula helenium), wood nettle leaf (Laportea canadensis), Canada goldenrod herb (Solidago canadensis), blueweed herb (Echium vulgare), blue vervain herb (Verbena hastata), wormwood herb (Artemisia absinthium), yarrow herb (Achillea millefolium), yellow bedstraw herb (Galium verum) and pearly everlasting herb (Anaphalis margaritacea).

Supplements: I was able to obtain the additional supplements that I need over the course of the first week that I was back so that since about a week and a half after my injury I have been on the full complement of supplements that I need to help heal my leg. These supplements are very important whenever there is significant tissue damage, but they are particularly important for healing damaged bone, cartilage, tendons and ligaments, regardless of the cause of damage. I use a similar supplement regimen for the treatment of osteoarthritis and osteoporosis. Although there are a number of supplements available that are formulated for building bone tissue that contain some of these nutrients, I chose not to use any of them because I didn't like any of the formulations. All of them were missing important nutrients, had way too much calcium relative to the other ingredients, and most of them were compromised in some way by using cheaper, low quality ingredients such as magnesium oxide. As a result, I had to put this supplement regimen together using a fair number of products. Nevertheless, the importance of using all of these nutrients in the right balance can not be over emphasized. I have listed them here by nutrient instead of by which ones I am taking with each meal, as I did in the first post of this series, so that it is more clear what I am taking. All of these are taken with meals:

• Vitamin A: 3,500 IU with breakfast; 3,500 IU with dinner.
• Beta-carotene: 750 IU with breakfast; 750 IU with dinner.
• Vitamin C (calcium and magnesium ascorbate): 1,485 mg with breakfast; 1,360 mg with lunch; 1,485 mg with dinner.
• Vitamin D: 1,200 IU with breakfast; 1,000 IU with lunch; 1,400 IU with dinner.
• Vitamin E (mixed tocopherols, acetate): 115 IU with breakfast; 40 IU with lunch; 315 IU with dinner.
• Vitamin K: 60 mcg with breakfast; 80 mcg with dinner.
• Calcium (citrate, ascorbate, malate): 150 mg with breakfast; 135 mg with lunch; 450 mg with dinner.
• Magnesium (citrate, ascorbate, malate): 60 mg with breakfast; 60 mg with lunch; 260 mg with dinner.
• Zinc (citrate): 5 mg with breakfast; 25 mg with dinner.
• Silicon (aqueous horsetail extract): 4.7 mg with breakfast; 4.7 mg with lunch; 4.7 mg with dinner.
• Manganese (chelate, citrate): 0.5 mg with breakfast; 5.5 mg with dinner.
• Copper (citrate): 0.5 mg with breakfast; 1.5 mg with dinner.
• Boron (chelate): 350 mcg with breakfast; 350 mcg with dinner.
• Selenium (chelate): 50 mcg with breakfast; 150 mcg with dinner.
• Polyphenol complexes (flavonoids, anthocyanidins, proanthocyanidins and catechins from extracts of berries, citrus, grape seed and green tea): 325 mg with breakfast; 225 mg with lunch; 325 mg with dinner.
• Quercetin: 100 mg with breakfast; 100 mg with lunch; 100 mg with dinner.
• Lutein: 0.5 mg with breakfast; 0.5 mg with dinner.

Blueberries (Vaccinium spp.) are a very rich source of anthocyanins and flavonoids, including quercetin.

Some of these are ingredients from a multivitamin that I am taking with breakfast and dinner. It is a good quality low potency multi with an excellent trace mineral content. It does not contain iron. I did not list all of the ingredients of the multivitamin, only those that are important for bone repair. However, the full range of nutrients in the multi are important to support healing in general. Mostly what I haven't listed are the B vitamins and some of the other trace minerals. In addition, I am also taking omega-3 fatty acids in the form of organic flax seed oil, 2-3 teaspoons taken throughout the day mixed in food (but not heated).

In addition to the above supplements that I am taking with meals, I am also taking the following on an empty stomach three times per day 30 minutes before each meal:

• Methylsulfonylmethane (MSM) 400 mg.
• Glucosamine hydrochloride 300 mg.
• Betaine 80 mg.
• Hyaluronic acid 10 mg.

Probiotics: Another one of the challenges that I am dealing with is constipation. It started with fasting from food and water for 16 hours before my surgery and was further aggravated by the intravenous hydromorphone and three courses of intravenous antibiotics that I was given through the night after my surgery. However, the ongoing issue is that I am spending a lot more time sitting and can't walk or run, which is important for good bowel tone. I am addressing this by taking a high potency probiotic supplement that contains 25 billion active cells of a combination of eight active strains of bacteria. I take this first thing in the morning in a glass of warm water with a tablespoon of whole organic flax seed. My bowel movements gradually returned to normal during the first week that I took this and I am continuing to take it on an ongoing basis.

Lactobacillus rhamnosus: An important probiotic species.

Exercise: This is another of my major challenges. The surgeon wants me to spend most of my day sitting or laying with my injured leg raised. This is not an option. It's bad enough that the muscles in my right leg are getting weaker. I'm not going to sit around and let my whole body atrophy. Plus, I have clients and students that depend on me and lots of work to be done. My life has definitely slowed down and there are many things that are too difficult or impossible for me to do, but I'm not out of commission completely. I have sit stations all over my house where I work, eat and rest consisting of a padded chair to sit on and a second chair with a pillow on it that I can put my leg up on. I have found that there is a delicate balance between sitting and moving around upright. If I do either for too long, the edema in my lower right leg gets worse.

Aside from the exercise I get moving around on crutches, every morning before breakfast I do an upper body workout with light weights and lots of stretching. I'm also working my injured leg as best I can. Whenever I'm sitting for periods of time I periodically massage my thigh and knee. I also wiggle my toes a lot and gently stretch the tendons and ligaments in my ankle and knee. In addition, I'm doing my best to work out my right knee and hip as best I can without being able to walk. To maintain some level of strength in these joints I do leg lifts from my hip raising my whole leg, and from my knee raising my lower leg several times per day for a few minutes. I also "pump" my leg while I'm walking on crutches by raising my leg and bending my knee on one step and then lowering my leg on alternate steps. As before I also continue to do deep breathing exercises in which I "feel" the life force or qi energy flowing into and out of my leg.

Diet: My diet is pretty good in general. It is almost completely organic and I get a lot of variety. My only concern is getting a bit more good quality protein. I have been a vegetarian for 33 years. Contrary to what some people believe, it is very easy for vegetarians to consume sufficient protein. Nevertheless, a good supply of high quality protein is necessary to heal bone tissue. Rather than bump up some of the typical high protein vegetarian foods such as beans or nuts which are harder on the digestive system, I have decided to increase my protein somewhat by eating one or two organic, free-range eggs most days. I have to strike a balance here and not eat too many eggs because for me eggs tend to be constipating.

So there you have it! This is the regimen I am following at this time. It is very intensive. I probably spend about 10% of my waking hours engaged in some aspect of this healing protocol. However, that's not bad considering I am still working at about 60% capacity instead of laying around like the surgeon advised me to. Also, with the exception of the intravenous hydromorphone and three courses of intravenous antibiotics that I was given through the night immediately after my surgery, I did not fill the prescription for painkillers that the surgeon gave me and only had to take a single dose of acetaminophen about 24 hours after my surgery. When I had the stitches removed, the surgeon prescribed another course of antibiotics and some anti-inflammatories. I didn't fill those prescriptions either. My intent is not only to stay relatively functional through this process, but also to make sure that my bones heal well and are strong enough to allow me to continue doing what I've always done. I'm also hoping to be able to start putting some weight on my leg a fair bit earlier than the three to four months that the surgeon predicted.

Overall, I have to say that the biggest challenge for me has been not being able to walk the land. In my normal life, every day I take my dogs out for about an hour and a half and walk the trails through the fields and forest where I live. Aside from the obvious benefits of the exercise and fresh air for the dogs and myself, it provides me with an opportunity to deepen my ongoing relationship with the land; to observe what changes are taking place; to stop periodically at one or more of my favorite sit spots and just be. I'm also missing the winter. Last year was the warmest winter I can remember. There was pretty much no snow. This year we are having a somewhat more "normal" winter. I am missing walking through the snow; breathing the cold, crisp air; feeling the wind on my face; the calls of the chickadees, goldfinches and nuthatches. At best a couple of times a week when the conditions are good I can put the spiky snow things on the bottom of my crutches, go out and sit behind my house by our fire pit and gaze out over the landscape. I really do appreciate those moments.

"The Land" in winter.

Most of the details relating to the protocols that I am using have been covered in these first two parts of this series. From Part 3 of this series onwards I will discuss any changes that I make to these protocols and provide updates on how things are progressing.

Healing Bone Fractures, Part 1 of 5

Things have really slowed down in my life and I haven't been able to post anything for a few weeks. That's because on January 30th I badly broke my lower right leg! Even though I'm an outdoorsy kind of person, I figured if I made it this far in my life without breaking any bones, maybe I never will. Well, it turns out I was wrong!

The Niagara Escarpment along the east side of the Saugeen (Bruce) Peninsula not far from where we were hiking.

We were hiking along a trail near the Niagara Escarpment on the Saugeen (Bruce) Peninsula. This area is characterized by lots of dolomite rock outcroppings. Normally we would have been snowshoeing, but we got a couple of days of unseasonably warm weather and it rained a lot. The amount of snow went from 45 cm (1.5 feet) down to about 5 cm (2 inches), making it much more easy to walk in boots. While we were hiking, I stepped with my left foot into a crevice in the rock that I couldn't see because it was covered in snow. It was quite deep. I never hit bottom and all of my weight came down on my right shin on the rock. I have a clean break in my fibula just below my knee, but my tibia was shattered just above my ankle. I'll spare you the details of how we got out of there, but it was quite a trip! Had there still been enough snow to snowshoe, my foot wouldn't have fit into that crevice.

This is more like the terrain where we were hiking (and the right season!).

Because of the severity of the fracture, I needed surgery. They weren't able to get me into surgery until the following day. The injury occurred around noon on the 30th and I didn't get into surgery until around 4:30 pm on the 31st. I had to have a 25 cm (10 inch) plate screwed into my tibia to hold the pieces together. I have no cast because I need to be able to move and stretch the tendons and ligaments in my ankle and knee so they don't tighten up too much while I'm off my leg.

Here are a couple of x-ray views of my leg with the plate taken the morning after my surgery.

It's a pretty messy affair and I suspect that I will need to have surgery again at some point to remove it.

According to the surgeon, this kind of fracture takes about four months to heal. If I'm lucky, three months at the absolute minimum. During this time my leg can't bear any weight. Once it is strong enough to bear weight, I will require a month or two of physiotherapy to get the strength back in my leg. So, he's predicting that this process is going to take 4-6 months.

What the surgeon doesn't know, because it's outside his paradigm, is that I have tools available to me to accelerate the healing of my leg. I have a basic protocol for treating bone fractures that I have used to help heal other people. This is the first time I'm going to be using it on myself!

I am going to use this as an opportunity to provide an example of how to heal a bone fracture. I will provide details of exactly how I am treating this on an ongoing basis, and updates as to how my healing is progressing. The important thing to keep in mind is, although I am following a basic protocol, it needs to be fine-tuned for each specific situation. If four different people came to me with similar fractures, I would treat each person slightly different depending on their specific needs, constitution, history, etc. What I am describing is how I have adapted this protocol to my own specific needs. Nevertheless, it will provide a good example of how I treat this kind of injury.

The protocol that I use is very complex. It requires five different components all of which are important: herbal treatment, both systemic and local; homeopathic treatment; supplements that help our body heal tissue damage and rebuild bone tissue; physical therapy; and dietary adjustments to support the healing of this type of injury.

I am going to begin by providing details of what I used in the interim when I didn't have everything available to me to complete the protocol. Then I will document what I am using and my progress in a continuing series of posts.

In the early evening on the day of the fracture, when it became apparent that the surgery wasn't going to happen that day, I had myself checked out and we went back to the cottage we were renting where I knew I would be more comfortable and be able to eat some good food and make use of whatever herbs and supplements I had on hand. My partner, Monika, tried to find some of the additional remedies I needed but was only able to obtain homeopathic Arnica in a 30C potency. Homeopathic Arnica is an essential remedy for any kind of sudden traumatic injury. It reduces swelling, bruising and pain, and supports the healing process. While we were still there and through the evening I took it every hour. I didn't sleep very well and took it every couple of hours through the night as well, and continued taking it every hour the next day up until my surgery. I resumed it when I awoke on Friday.

Mountain arnica (Arnica montana) is mostly used topically by herbalists because it is very irritating and mildly toxic when taken systemically.
It should only be used systemically by experienced herbalists. In homeopathic potencies this is not an issue.

Homeopaths rarely use homeopathic remedies in combination with other modalities. Although I am not a homeopath, I have a good understanding of the system and sometimes use homeopathic remedies in combination with herbs, especially for the treatment of acute conditions. In order to treat a situation holistically, I have found that it is best if we address it on as many different levels and in as many different ways as possible. The more severe the injury or illness, the more important it is to do this.

At the cottage I also had available to me a general herbal tonic formulation containing 1:5 fresh herb tinctures that provided some benefit in terms of reducing inflammation and pain, increasing circulation and supporting the healing process. It also contained some liver herbs that would help protect me from the side-effects of all the medications I was going to have to take before and after the surgery. I upped the dose from 3 ml into the acute dosage range at 6 ml. Because I was going to have to fast the following day before my surgery, I only had one dose before my dinner, but I resumed it as soon as I returned from the hospital after my surgery. I also had some supplements including vitamins C (calcium ascorbate), D and E, zinc, polyphenols, and a good quality low potency multivitamin with a very good trace mineral complex. I took one of everything and two vitamin C with my dinner, and resumed these when I returned after my surgery as well. The last thing I had is a herbal sedative which I travel with because sometimes I have difficulty sleeping when I'm in an unfamiliar environment. I took this before bed and a couple more doses through the night. I didn't sleep very well that night, mostly because I had to sleep on my back which I never do, but it did help me sleep a bit and reduce the pain and inflammation.

Up to this point, except for the insane pain when I actually broke my leg, as long as my leg didn't get banged or twisted the pain wasn't that bad. The Arnica was definitely a factor in this.

After the surgery, the doctor wanted me to stay another night to make sure I didn't end up with a kind of serious swelling that can occur with this kind of injury, or an infection, and that my pain was under control. However, I was determined to get out of there as quickly as possible so that I could get onto the remedies that I needed. I stopped dosing myself with the intravenous hydromorphone (a semi-synthetic derivative of morphine) as soon as I woke up so that they would see that I was managing the pain and asked to be disconnected from everything. The surgeon saw I was doing OK and I managed to get out by 1 pm. He gave me a prescription for a drug containing 300 mg of acetaminophen and 30 mg of codeine phosphate. I didn't fill the prescription. We did pick up a product containing 500 mg of acetaminophen without the codeine. I took one tablet on Friday evening shortly before bed when the pain in my leg got pretty intense for a few hours. That was all I used.

It is important to note that we should not use non-steroidal anti-inflammatory drugs (NSAIDs), such as acetylsalicylic acid, ibuprofen and naproxen, to treat the pain and inflammation associated with bone fractures as these drugs interfere with bone formation. Drinking alcohol also interferes somewhat with bone formation. This is mainly a concern for moderate to heavy drinkers, nevertheless, it is best drink very little or not at all. Smoking has a more pronounced negative impact on bone formation than alcohol.

We went back to the cottage and stayed for the next three days. Some friends were coming up for the weekend and we asked them to bring me some additional homeopathic remedies. At this point my interim protocol was as follows:

Homeopathics: Arnica 200C, Hypericum 200C and Symphytum 200C taken individually, four pellets per dose alternated throughout the day every 1-2 hours so that I was taking each remedy 4 times per day. Hypericum is a specific for nerve damage and nerve pain. Although I did not have any numbness or tingling, indicating that there probably wasn't any nerve damage from the original injury, there was a risk of nerve damage resulting from the surgery. Symphytum is a specific for healing bones. I tend to use Hypericum and Symphytum both in homeopathic form and in crude tincture form as you will see later. The two forms taken together are very synergistic, working much better than either the tincture or homeopathic individually.

Common comfrey (Symphytum officinale) is a specific for bone fractures, both in herbal and homeopathic forms.

Crude herb preparations must be used carefully as it contains pyrrolizidine alkaloids, which are liver toxins.

This is not an issue when taken in homeopathic potencies.

Herbs: I continued taking the tincture formulation I had with me at a higher dose until I was able to get home and formulate something specific for my injury. I took 6 ml in a bit of water on an empty stomach 10-15 minutes before each meal. I also continued to take the sedative formulation, 6 ml before bed and additional 3 ml doses through the night, if necessary.

Supplements: Making the best use of the supplements that I had available, I took the following (these are the doses of the nutrients that are particularly important for bone repair as provided by the individual products I had available to me):

• With breakfast: Vitamin A 3,500 IU, beta-carotene 7,500 mg, vitamin C 1,325 mg (from calcium ascorbate), vitamin D2 200 IU, vitamin D3 1,000 IU, vitamin K1 50 mcg, vitamin K2 10 mcg, calcium 152 mg (ascorbate), copper 0.5 mg (citrate), manganese 0.5 mg (citrate), zinc 5 mg (citrate), selenium 50 mcg (chelate), boron 0.35 mg (chelate), lutein 0.5 mg, bioflavonoids 100 mg (citrus extract), quercetin 100 mg, anthocyanidin 100 mg (mixed berry extract).
• With lunch: Vitamin C 1,200 mg (from calcium ascorbate), vitamin D3 1,000 IU, calcium 137 mg (ascorbate), quercetin 100 mg, anthocyanidin 100 mg (mixed berry extract).
• With dinner: Vitamin A 3,500 IU, beta-carotene 7,500 mg, vitamin C 1,325 mg (from calcium ascorbate), vitamin D2 200 IU, vitamin D3 1,000 IU, vitamin E 200 IU (mixed tocopherols), vitamin K1 50 mcg, vitamin K2 10 mcg, calcium 152 mg (ascorbate), copper 0.5 mg (citrate), manganese 0.5 mg (citrate), zinc 20 mg (citrate), selenium 50 mcg (chelate), boron 0.35 mg (chelate), lutein 0.5 mg, bioflavonoids 100 mg (citrus extract), quercetin 100 mg, anthocyanidin 100 mg (mixed berry extract).

Some of these are ingredients from a multivitamin that I took with breakfast and dinner. It is a good quality low potency multi with an excellent trace mineral content. It does not contain iron, calcium or magnesium because iron should only be taken when absolutely necessary and the amount of calcium and magnesium that can be included in a multivitamin is too low to be relevant. I did not list all of the ingredients of the multivitamin, only those that are important for bone repair. However, the full range of nutrients in the multi are important to support healing in general. In addition, I was also taking omega-3 fatty acids in the form of organic flax seed oil, 2-3 teaspoons taken throughout the day mixed in food (but not heated).

Other: From the moment I was able to stand after my injury I spent a lot of time wiggling my toes to help with circulation and to keep my feet as flexible as possible. Most other forms of movement were not possible until a few days after my surgery due to the severe swelling of my leg. Whenever I was sitting (always with my leg up to reduce swelling), a periodically massaged my knee and lower thigh to help prevent them from tightening up as much as possible. I was also doing deep breathing exercises in which I focused on "feeling" the life force energy or qi circulating through my body, particularly in my leg.

This is the end of my first post on the ongoing saga of my leg. In Part 2 I will provide the details of the complete protocol that I put myself on once I returned home.

The Pros and Cons of Vitamin Supplementation, Part 3 of 3

This is the third of three posts on this topic. Part 1 was posted on November 20th, Part 2 on November 22nd.

I would like to begin here by first clarifying some of the statements that I made in Parts 1 and 2 concerning manufacturers and retailers of natural health products. I referred to certain aspects of their formulating strategies as marketing gimmicks and also suggested that in some cases manufacturers were engaging in deceptive practices concerning the quality and forms of the ingredients in their products. Sadly, this is sometimes the case and it can be very difficult for consumers to discern the relative quality of products and information that are out there.

Before looking at some of the challenges for consumers who are looking for quality information and products, I would like to put this into a broader context. Natural healing practitioners and the natural health products industry have long been innovators in terms of challenging the status quo, developing effective therapeutic protocols, and making many excellent products available. Many of these very effective therapies and products have been ignored by mainstream medicine and often challenged as ineffective or even harmful. It is true that in some cases they were, but these challenges from reductionistic medical practitioners and scientists were largely based on a perspective that anything that is not backed up by clinical studies doesn't exist. The fact that a significant proportion of mainstream medical practices and uses of drugs are not supported by clinical studies doesn't seem to matter. What matters is that many proponents of mainstream medicine will attack anything that challenges their paradigm. Nevertheless, many of the medicines and methodologies that have been used by traditional peoples or developed by practitioners of natural healing have since been scientifically verified. When they are, the scientists who do the research often claim to have "discovered" these new treatments and don't acknowledge their origins or that they once vehemently denied their efficacy and the credibility of those who used them. That being said, just like any aspect of society where there is money to be made and ego gratification to be obtained, not everything out there in the natural healing and health products world is necessarily good for us.

Varro Tyler was a respected scientist considered to be one of the worlds leading authorities on medicinal plants. He once wrote that
mad-dog scullcap (Scutellaria lateriflora) is "a nearly worthless and essentially inactive plant". Recent research has begun to verify its
traditional uses. Any experienced herbalist that has ever used this herb knows that, stuck in his reductionistic, materialistic world view,
Tyler might have known a bit about the chemical constituents of plants, but he knew very little about medicinal herbs.

Back in the 60s and 70s, the natural foods and health products industry was largely made up of grassroots idealists who believed in what they were doing and tried their best to live it. Sure, there was still some questionable information and products out there, but most of it was pretty basic and sound. If we were to take a tour of the typical health food store at that time we would have found mostly staples, the essentials of a good diet: lots of unprocessed or minimally processed whole foods. The selection of supplements was for the most part pretty basic and uninteresting. What was sometimes lacking was a good variety of organic produce, meats and dairy products. Fortunately, organic agriculture has grown significantly since then and this is no longer the case.

In the late 70s and early 80s things began to change. The industry started growing at an incredible rate and the diversity of products increased similarly. On the food end, the shelves started filling with products that looked very similar to those on the shelves of regular supermarkets. On the positive side, this was an important indicator that natural products and healing modalities were becoming more mainstream and a growing segment of the population was starting to take their health more seriously. These products provided a lot more diversity and choices for consumers and they formed a very important bridge for people who were starting to change their diet, enabling them to purchase healthier products that were very similar to what they were already consuming. However, the downside was that the shelves of health food stores and eventually mainstream supermarkets as the momentum continued through the 90s were mostly filling up with slightly more natural and healthy junk foods. Although these products are better than their mainstream counterparts because they don't contain numerous additives and are usually made from mostly whole food ingredients, often organically grown, most of them are still for the most part processed foods. They are a healthier alternative but they are not whole, natural, unprocessed foods, which is ideally what our diet should consist of. You will find most of the real health foods in the bulk foods and produce departments of these stores, which of late tend to be taking up a smaller and smaller proportion of the floor space. I'm not saying that these products don't have any value. They are a step in the right direction and have lots of benefits over mainstream food products including those I mentioned above. I even eat some of them myself and recommend them to my clients to help them transition to a healthier diet. What I am saying is that many of these foods are not as "natural" as people tend to think they are.

Natural foods and health products are not on the fringe any more. They are mainstream and they are big business! In this industry it is almost impossible for small grassroots companies to survive these days. Most of the smaller companies have been swallowed up by medium sized companies or gone out of business. A growing number of the medium sized companies are being purchased by mega corporations. A significant portion of the industry is now owned by major food and pharmaceutical companies. This shouldn't surprise anyone because it is the same pattern that is unfolding throughout the global economy. These corporations aren't stupid. Natural foods and health products have been one of the fastest growing sectors and they want a piece of the pie, or all of it if they can get it! To this end, it's much easier to acquire an established company than to start from scratch. What this means is that natural foods and health products have arrived. They have been legitimized. In many ways this is a good thing, but what it means for this industry is that it is now infused with corporate values. Although many people that work in this industry still have a lot of the idealism that was characteristic of the past, a growing number of them aren't there because they believe in it. They are there because it's a good business.

With the infusion of corporate values into the natural foods and health products industry comes a lot of sophisticated strategies aimed at increasing the bottom line. Sometimes this translates into cutting corners on product quality. It has also resulted in some unscrupulous marketing strategies such as greenwashing.

One of the things that tends to characterize people who are interested in improving their health is their hunger for information. Companies in this sector have used this to their advantage by flooding the market with information on various dietary strategies, nutrients, herbs, and other related topics and products. It is not an exaggeration to say that most health-related information that is available in magazines and a significant amount in books is essentially advertorial of one kind or another. Some of the information might still be useful, but it is very difficult to determine what is good quality information when most of it is at best very biased, and sometimes completely inaccurate. To make matters worse, the people who consumers rely on for information, natural health product retailers, typically get most of their information from sales representatives, product literature, and a lot of those magazines that are publishing advertorials. I'm sure the majority of the people working in health food stores sincerely want to help their customers, but most of the information that they have access to is dubious and they usually don't have the necessary training to be able to filter out the good stuff from the bad stuff. Even natural healing practitioners often buy into a lot of the inaccurate information that is out there. This is particularly true of practitioners who sell natural health products because they are obtaining a lot of their information from product literature as well.

Once more I want to emphasize that I am not suggesting that most natural health products are poor quality or that manufacturers, distributors and retailers are deliberately trying to deceive consumers. Although it is true that a lot of the dubious information out there ultimately comes from someone who is attempting to manipulate consumers in order to increase their profits, most of the people down the line really believe that this information is accurate and helpful to people – and some of it is! The challenge is that most people don't have the tools to be able to assess the quality of the information. As an herbalist, I can honestly say that most of the information out there on herbs is inadequate and often inaccurate. However, unless you are an experienced herbalist you aren't going to be able to recognize this. Everyone can't be an herbalist. That is why one of the most important roles of herbalists is as educators. We need to get good quality information out there to help people to be able to make informed choices.

Now let's get back to the original point. It can be very difficult to determine what constitutes a good supplement regimen. On the one hand, we have extreme supplement advocates who, whether for business or ideological reasons or both, would have everyone popping hundreds of pills per day. At the other end of the spectrum we have old school reductionists and food purists who believe that supplementation is unnecessary unless a deficiency is confirmed. In between we have just about every other possible opinion.

In considering a person's nutrient requirements there are basically four different ways of looking at it:

1. Based on the minimum amounts required to prevent a deficiency disease. This perspective used to be common among medical doctors and dietitians. It is less so today as it is now clear that there are other negative health consequences that can be demonstrated when a person's intake of a particular nutrient is low well before the point where the symptoms of a deficiency disease will manifest.
2. Based on the amounts that occur in a "normal" diet of a "healthy" population. This is more typical of medical doctors and dietitians today. It is problematic because what is average is not necessarily what is natural or ideal. What is currently considered "healthy" by practitioners and advocates of mainstream medicine is probably not as healthy as they would like to believe.
3. Based on optimum requirements for overall level of health and well-being. This is difficult to determine and could vary considerably between different people.
4. Based on therapeutic doses. This is not something that should be advocated for daily consumption. When the dose of an individual nutrient is increased beyond the range that it is utilized for nutritional purposes, its action becomes less nutrient-like and more drug-like. Taking nutrients in therapeutic doses can be an effective element of an overall treatment protocol, but it is not nutrition.

Many medicinal herbs and spices, such as rosemary (Rosmarinus officinalis), are loaded with nutrients and antioxidants.

In my clinical practice I have found that what works best is to strive for optimum nutrient requirements. This should primarily be accomplished through eating a good diet as I discussed in the first part of this series. In particular, it means eating lots of vegetables and moderate amounts of fruit. However, for reasons that I stated previously, namely variations in individual requirements and the high levels of stress and toxicity that are endemic in contemporary Western society, I have also found that some level of supplementation is preferred if one wants to achieve some level of optimum health and well-being. The basic regimen that I recommend is as follows:

1. A low potency multivitamin and mineral supplement as I discussed in part 2 of this series, taken once a day with breakfast. This helps to ensure that we are getting what we need on a daily basis. The higher levels of B complex vitamins and certain minerals also help to address increased nutritional requirements due to stress, as well as provide some level of support for immune function.
2. To help protect our body from the harmful affects of toxicity and support immune function, I recommend some degree of supplementation with antioxidants. I primarily recommend vitamin C, 400-600 mg once or twice a day. If only taken once a day it should be taken with dinner to separate it from the vitamin C taken at breakfast as a component of the multivitamin. It is best to take vitamin C in the form of mineral ascorbates rather than ascorbic acid because the diet of most people in our society tends to be acidic and ascorbic acid will increase our acid load. Mineral ascorbates are not acidic. Calcium, magnesium or mixed mineral ascorbates are best. Sodium ascorbate is not recommended because we already tend to consume way more sodium than is good for us. It is also important that a vitamin C supplement contain a decent dose of antioxidant polyphenols, such as flavonoids, anthocyanins and proanthocyanidins. These are mutually synergistic with vitamin C. I also recommend vitamin E. 200 IU is sufficient for most people. It should be natural vitamin E, preferably in the form of mixed tocopherols. Vitamin E works best if taken together with 50-100 mcg of the mineral selenium. The vitamin E and selenium are best taken once per day with dinner. They must be taken with a meal that contains fat.
3. For people who live in the temperate regions of the northern and southern hemisphere, I recommend supplementation of vitamin D. Typically, I recommend 2,000 IU per day from October to March (April to September in the southern hemisphere), and 1,000 IU in April and September (March and October in the southern hemisphere). Anyone who does not spend much time outdoors should take 1,000 IU in the summer as well. However, anyone who wants to implement a healthy lifestyle should try to spend as much time as possible being active outdoors – in a natural setting as much as possible. For vitamin D production and many other reasons, it is best not to wear sunglasses all of the time when outdoors during the summer. Sunglasses aren't good for our eyes anyway. Of course, these recommendations are reversed for people living in the southern hemisphere where the seasons are opposite. Also, keep in mind that requirements of vitamin D supplementation is going to be lower at high altitudes and higher for darker skinned people. It's also going to be lower for people who traditionally eat foods that are high in vitamin D such as fish liver.
4. In the contemporary Western diet, the fat content of our diet tends to be high in saturated fats of animal origin and plant-based oils that are high in omega-6 fatty acids. Ideally we need to reduce these and increase the proportion of monounsaturated and omega-3 fatty acids. Traditionally, animal fats in our diet came from seafood or wild game and livestock that ate a natural grass-based diet. Today, livestock are primarily fed an unnatural diet designed to speed up their growth rate and fatten them up. They are also a lot less active. The result is that their tissue contains more fat and it is primarily saturated with very little omega-3. Consumption of large amounts of fish and wild game is no longer recommended due to environmental contamination and ecological issues. As a result, the easiest way to increase omega-3 consumption is through the use of plant-based vegetable oils. By far the best source is organically grown, raw flax seed oil that has been processed without exposure to heat or oxygen, stored in dark bottles and refrigerated. Other plant sources tend to have lower levels of omega-3 relative to omega-6, monounsaturated and saturated oils. Consuming nuts and other foods that contain them is still good in moderation. Olive oil, which is a mostly monounsaturated oil, has been found to have many health-promoting benefits as well. Nevertheless, we still need to increase the omega-3 oils in our diet and flax seed oil is the best option. I don't recommend fish oils because they are subject to environmental contamination and because of the way they are processed they tend to be rancid. Although the negative health consequences of consuming rancid oils has been given less attention than trans-fats and animal source saturated fats, it is almost certain that rancid oils pose almost as much of a health threat as trans-fats. The other issue with fish oils is that several major studies that have looked at the amount of fish and other marine animals that are being harvested from the ocean have unanimously concluded that commercial fishing at anything close to current levels is completely unsustainable. The omega-3 issue has been given a lot of attention in recent years and many foods are now claiming to be "fortified" with omega-3 oils. This is another marketing gimmick. Omega-3 oils are extremely unstable in the presence of light, heat and oxygen, and adding them to various processed foods means that they will be rancid. As a result, I recommend a dietary supplement of 1-2 teaspoons of good quality flax seed oil per day. This should never be cooked but can be added to cooked foods on our plate as long as they are consumed right away. It is important to recognize that consumption of polyunsaturated oils increases our daily requirements for vitamin E and selenium.

This is the basic supplement regimen that I recommend. In my life and my practice I have found it to be a very useful adjunct to a good diet and healthy lifestyle. It is not going to meet everyone's needs exactly, and I sometimes recommend additional supplements or higher doses for specific issues. For example, anyone suffering from chronic auto-immune or inflammatory conditions will benefit from higher doses of vitamin D and antioxidants, especially ascorbate and polyphenols.

Blueberries are a very rich source of polyphenols such as anthocyanins.

We can also increase the antioxidant content of our diet by increasing consumption of leafy green vegetables, and fruits and vegetables that have a deep orange, red, blue or purple colour. It is not necessary to consume exotic "superfoods". This is also a marketing gimmick. All plants are anti-oxidant to some degree. It's true that some are considerably more antioxidant than others, but pretty much no matter where we live their are fruits and vegetables that are very high sources of antioxidants. For instance, it doesn't get much better than dark blue and purple berries like black raspberries, blackberries, blueberries and bilberries, which grow and are cultivated throughout the temperate regions of the northern hemisphere. It doesn't make sense to consume exotic plants from foreign countries where we don't know for sure whether they are destroying the environment when growing or wild-harvesting them, they must be transported long distances, and they are usually a lot more expensive.

That is my take on supplementation. It's not going to be perfect for everyone, but it's a good basic template which we can work with and fine-tune in order to meet our individual needs. Of course, there are lots of other opinions out there. All I can say is that these recommendations are supported by the limited research that is available, and more importantly, I have found that they work in my life and my practice.