As a medical practitioner specializing in the treatment of pain, chronic medical illness and neuro-endocrine disorders, Doctor David S. Klein began the office-based, community-oriented pain practice in 1983. At this time, physicians specializing in pain were rather few and far between, and nearly all practiced in the University Hospital setting.
In the short course of several years, Dr. Klein developed many new and innovative approaches to the treatment of pain, focusing on the imperative that an accurate diagnosis was essential to the effective treatment of any disease, disorder, or condition.
Much of the success in the treatment of pain and chronic illness is attributable to identication of hormonal imbalances, nutritional deficiencies and degenerative disorders with focused nutritional intervention and thoughtful, balanced supplementation.
In order to understand your needs, you first need to expand your understanding of how nutrition influences health & disease.
Dietary Source: pork, organ meats, wholegrain/enriched cereals, brown rice, wheat germ, bran, brewer’s yeast, blackstrap molasses.
Symptoms of Deficiency: decreased heart function, age-related cognitive decline, Alzheimer’s, fatigue.
Vitamin B2: Involved in carbohydrate metabolism; converts carbs to sugar, breaks down fat & protein, healthy digestion, nervous system, skin, hair, eyes, mouth, liver, antioxidant .
Riboflavin works as an antioxidant by scavenging free radicals. Riboflavin is an important nutrient in the prevention of headache and cataracts. By taking additional supplements of vitamins C, E, and B complex (particularly the B1, B2, B9 [folic acid], and B12 [cobalamin] there is further protection from the development of cataracts.
Dietary Source: brewer’s yeast, almonds, organ meats, whole grains, wheat germ, mushrooms, soy, dairy, eggs, green vegetables.
Symptoms of Deficiency: poor iron absorption/anemia, decreased free radical protection, cataracts, poor thyroid function, B6 deficiency, fatigue, elevated homocysteine.
Symptoms of riboflavin deficiency include fatigue; slowed growth; digestive problems; cracks and sores around the corners of the mouth; swollen magenta tongue; eye fatigue; soreness of the lips, mouth and tongue; and sensitivity to light.
Low levels of riboflavin in the diet and/or riboflavin deficiency has been associated with rheumatoid arthritis, carpal tunnel syndrome, Crohn’s Disease, colon cancer, atherosclerotic heart disease, and Multiple Sclerosis.
Vitamin B3 niacin: energy, digestion, nervous system, skin, hair, eyes, mouth, liver, eliminates toxins, sex/stress hormone production, improves circulation and cholesterol.
Niacin is commonly used to lower elevated LDL (“bad”) cholesterol and triglyceride (fat) levels in the blood and is more effective in increasing HDL (“good”) levels than other cholesterol-lowering medications.
High doses of niacin medications are used to prevent development of atherosclerotic vascular changes (plaque along the blood vessels that cause blockage). Niacin can reduce recurrent heart attack and peripheral vascular disease (atherosclerosis of the blood vessels in the legs that can cause pain with walking, called intermittent claudication) in those with the condition.
B3, as niacinamide, may improve arthritis symptoms.
Supplemental B complex vitamins (including B12, B9, B3, B2, and B1) exert a protective effect against cataracts.
Dietary Source: beets, brewer’s yeast, organ meats, fish, seeds and nuts. brewer’s yeast, beef liver, beef kidney, pork, turkey, chicken, veal, sunflower seeds, and peanuts.
Symptoms of Deficiency: cracking, scaling skin, digestive problems, confusion, anxiety, fatigue, reduced endurance, cholesterol elevation. Alcoholism is the prime cause of Vitamin B3 deficiency in the US.
Symptoms of mild deficiency include indigestion, fatigue, canker sores, vomiting, and depression. Severe deficiency of both niacin and tryptophan can cause a condition known as pellagra. Pellagra presents with y cracked, scaly skin, dementia, and diarrhea.
Involved in cellular energy production, digestion, nervous system, skin, hair, eyes, mouth, liver, eliminates toxins, sex/stress hormone production, improves circulation and cholesterol.
Pantothenate RBC production, sex and stress-related hormones, immune function, healthy digestion. B-5 facilitates the function, or in other words, helps in the absorption or function of other vitamins.
Dietary Source: meat, vegetables, whole grains, brewer’s yeast, avocado, legumes, lentils, egg yolks, milk, sweet potatoes, seeds, nuts, wheat germ, salmon.
Symptoms of Deficiency: reduced stress tolerance, poor wound healing, skin problems, fatigue
Dietary Source: milk, eggs, liver, fortified cereals, orange or green vegetables and fruits.
Symptoms of Deficiency: night blindness, poor immune function, zinc deficiency, fat malabsorption.
Used in 100 enzymes for protein metabolism, RBC production, reduce homocysteine, healthy nerve & muscle cells, DNA and RNA, B12 absorption, immune function. Healthy nerve cells, DNA/RNA, red blood cell production, iron function.
Dietary Source: fish, meat, poultry, eggs, milk, and milk products. poultry, tuna, salmon, shrimp, beef liver, lentils, soybeans, seeds, nuts, avocados, bananas, carrots, brown rice, bran, wheatgerm, whole-grain flour.
Symptoms of Deficiency: anemia, fatigue, weakness, constipation, loss of appetite, weight loss, numbness and tingling in the hands and feet, depression, confusion, dementia, poor memory, mouth or tongue soreness. Depression, sleep and skin problems, elevated homocysteine, increase in heart disease risk.
Vitamin B6 in the form of pyridoxal 5′-phosphate is a coenzyme for over 100 enzymes. Most of these enzymes are involved in amino acid metabolism and include aminotransferases (transaminases), decarboxylases. Pyridoxal 5′-phosphate is sometimes referred to as codecarboxylase, dehydratases and racemases. The basic chemistry accounting for the broad range of reactions of B6 is Schiff’s base formation. Schiff’s bases are reaction products of aldehyde and amino groups. In the resting state of the above enzymes, the aldehyde group of pyridoxal 5′-phosphate is covalently linked to the epsilon-amino group of a lysine residue at the active site of the enzyme. Upon binding of the amino acid substrate, the lysine is exchanged for the alpha-amino group of the substrate, forming a Schiff’s base with the aldehyde group of pyridoxal 5′-phosphate. A quinonoid intermediate follows the formation of the Schiff’s base, which in turn is followed by the formation of the reaction products. Schiff’s base chemistry is the mechanism of almost all of the reactions in which pyridoxal 5′-phosphate participates. One exception is the glycogen phosphorylase reaction. Glycogen phosphorylase catalyzes the breakdown of the storage polysaccharide glycogen to yield glucose 1-phosphate. Much of the total pyridoxal 5′-phosphate in the body is found in muscle bound to glycogen phosphorylase. In glycogen phosphorylase, the phosphate group of pyridoxal 5′-phosphate, rather than its aldehye group, participates in the catalytic role of the enzyme.
Vitamin B6 is involved in several key biological processes. Pyridoxal 5′-phosphate is the coenzyme for delta-aminolevulinate synthase, the first step in the synthesis of porphyrins. Heme is derived from protoporphyrin IX. Heme is the iron-containing prosthetic group that is an essential component of such proteins as hemoglobin, myoglobin and the cytochromes. Homocysteine is an intermediate in methionine metabolism and may undergo one of two metabolic fates, remethylation to L-methionine or further metabolism, leading to the synthesis of L-cysteine. The pathway leading to the synthesis of cysteine is known as the transsulfuration pathway. This pathway has two pyridoxal 5′-phosphate-dependent enzymes: cystathionine beta-synthase and cystathionase. The conversion of tryptophan to niacin also requires pyridoxal-5′-phosphate, this time as a cofactor for the pyridoxal 5′-phosphate-dependent enzyme kynureninase. And, via its role in transamination, pyridoxal 5′-phosphate is involved in the production of energy.
Decarboxylation of amino acids yields amines, including gamma-aminobutyrate, dopamine, norepinephrine, epinephrine and serotonin, which play important roles as neurotransmitters or hormones. The amino acid decarboxylases are also pyridoxal 5′-phosphate-dependent enzymes. Pyridoxal 5′-phosphate plays a role in the regulation of steroid hormone activity: Physiological levels of pyridoxal 5′-phosphate interact with glucocorticoid receptors to downregulate their activity. Pyridoxal 5′-phosphate has also been shown to negatively modulate steroid-dependent gene expression induced by progesterone, androgen and estrogen hormones. Finally, serine hydroxymethyltransferase is a pyridoxal 5′-phosphate-dependent enzyme which catalyzes the interconversion of serine and glycine, both of which are major sources of one-carbon units necessary for the de novo synthesis of purine nucleotides and thymidylate. Purine nucleotides are precursors of DNA and RNA, and thymidylate is a precursor of DNA.
The vitamers comprising the vitamin B6 family are pyridine derivatives. Specifically, they are derivatives of 3-hydroxy-5-hydroxymethyl-2-methyl pyridine. The vitamers differ by the nature of the chemical group occupying the 4 position of the parent compound. In the case of pyridoxine, the 4 position is occupied by an hydroxymethyl group. Pyridoxine is also known as 5-hydroxy-6-methyl-3, 4-pyridinedimethanol, 2-methyl-3-hydroxy-4,5-bis(hydroxymethyl)pyridine and pyridoxol. Its molecular formula is C8H11NO3 and its molecular weight is 169.17 daltons. Pyridoxine hydrochloride is the principal form of vitamin B6 used in nutritional supplements and for food fortification.
Involved in metabolism of carbohydrate, fat, and amino acids (the building blocks of proteins.)
Dietary Source: meats, vegetables, unprocessed grains, brewer’s yeast, corn, cauliflower, kale, broccoli, tomatoes, avocado, legumes, lentils, egg yolks, milk, sweet potatoes, seeds, nuts, wheat germ, salmon.
Symptoms of Deficiency: depression, nervous system abnormalities, premature graying, hair loss, dry scaly skin, cracking in the corners of the mouth (cheilitis), swollen and painful tongue that is magenta in color (glossitis), dry eyes, loss of appetite, fatigue, insomnia, and depression. It may been seen in people who have been on long-term anticonvulsants, antibiotics, and sulfa therapy.
Folate can help reduce risk factors for heart disease and the harm that they cause, including cholesterol and homocysteine (both of which can damage blood vessels). Secondly, by diminishing this damage, studies suggest that not only can folate help prevent build up of atherosclerosis (plaque), it may also help the blood vessels function better, improve blood flow to the heart, prevent cardiac events such as chest pain (called angina) and heart attack, and reduce the risk of death.
Folic acid and vitamin B12 are critical to the health of the nervous system and to a process that clears homocysteine from the blood. As stated earlier, homocysteine may contribute to the development of certain illnesses such as heart disease, depression, and Alzheimer’s disease.
Studies suggest that vitamin B9 (folate) may be associated with depression more than any other nutrient, and may play a role in the high incidence of depression in the elderly.
Folic acid appears to protect against the development of some forms of cancer, particularly cancer of the colon, as well as breast, esophagus, and stomach.
Dietary Source: supplementation, fortified grains, tomato juice, green vegetables, black-eyed peas, lentils, beans.
Symptoms of Deficiency: anemia, impaired immune function, fatigue, insomnia, premature hair loss, high homocysteine, heart disease risk. Folic acid deficiency is the most common B vitamin deficiency.Folic acid deficiency can cause poor growth, tongue inflammation, gingivitis, loss of appetite, shortness of breath, diarrhea, irritability, forgetfulness, and mental sluggishness. People with ulcerative colitis and Crohn’s disease (both inflammatory bowel diseases) often have low levels of folic acid in their blood cells.
Dietary Source: milk, egg yolk, liver, fish.
Symptoms of Deficiency: osteoporosis, decreased calcium absorption, thyroid problems.
Vitamin E a-tocopherol: antioxidant, regulates oxidation reactions, stabilizes cell membrane, immune function, protects against cardiovascular disease, cataracts, macular degeneration.
Vitamin E blocks the conversion of cholesterol into the cholesterol, called plaque, that stick to blood vessel walls, and Vitamin E may reduce the risk of death from stroke in postmenopausal women.
Vitamin E supplementation improves cognitive performance in healthy individuals and in those with dementia from causes other than Alzheimer’s (for example, multiple strokes).
Vitamin E may reduce other long term risks associated with menopause such as Alzheimer’s, macular degeneration and cardiovascular disease.
Vitamin E is an essential fat-soluble vitamin that includes eight naturally occurring compounds in two classes designated as tocopherols and tocotrienols. Each of these compounds exhibits different biological activities. d-a-Tocopherol has the highest biological activity and is the most widely available form of vitamin E in food. The other isomers ( beta, delta, gamma), some of which are more abundant in a typical Western diet, are less biologically active than d-a-tocopherol. The commercially available synthetic forms of vitamin E are comprised of approximately an equal mixture of eight stereoisomeric forms of a-tocopherol, usually in the esterified form such as acetate or succinate. For practical purposes, 1 International Unit (IU) of vitamin E represents 1 mg of the synthetic form, racemic a-tocopherol acetate, while the natural form of d-a-tocopherol has a biopotency of vitamin E equal to at least 1.49 IU, if not more. The most widely accepted biological function of vitamin E is its antioxidant properties. Vitamin E is the most effective chain-breaking, lipid-soluble antioxidant in biological membranes, where it contributes to membrane stability. It protects critical cellular structures against damage from oxygen free radicals and reactive products of lipid peroxidation.
Absorption of vitamin E is dependent upon the digestion and absorption of fat. Free tocopherols are absorbed by a non-saturable, passive process into the lymphatic circulation along with fat. About 45% of an ordinary dose is absorbed into the lymph.
Dietary Source: wheat germ, liver, eggs, nuts, seeds, cold-pressed vegetable oils, dark leafy greens, sweet potatoes, avocado, asparagus .
Symptoms of Deficiency: dry skin and hair, rupturing of red blood cells, anemia, easy bruising, PMS, hot flashes, eczema, psoriasis, cataracts, poor wound healing, muscle weakness, sterility. Symptoms of deficiency include muscle weakness, loss of muscle mass, abnormal eye movements, impaired vision, and unsteady gait. Kidney and liver functional deterioration may develop. Severe vitamin E deficiency can be associated with serial miscarriages and premature delivery. The main signs of severe deficiency in animals are reproductive failure, nutritional “muscular dystrophy,” hemolytic anemia, and neurological and immunological abnormalities. The last three processes also have been identified in humans. However, vitamin E deficiency occurs rarely in humans, having been reported in only two situations: premature infants with very low birth weight and patients who fail to absorb fat.
Diet recommendations: The Recommended Dietary Allowance (RDA) for vitamin E is based primarily on customary intakes from US food sources. The current RDA for males is 10 mg and 8 mg for females. However, the requirement for vitamin E increases with higher intakes of polyunsaturated fatty acids (PUFA). The recommended ratio of E/PUFA is 0.4 mg d-a-tocopherol per gram of PUFA. In defining the ideal intake, factors to consider are intake of other antioxidants, age, environmental pollutants, and physical activity.
Calcium: bones and teeth, helps heart, nerves, muscles, and other body systems work properly, needs other nutrients to function.
Dietary Source: dairy, wheat/soy flour, molasses, brewer’s yeast, Brazil nuts, broccoli, cabbage, dark leafy greens, hazelnuts, oysters, sardines, canned salmon.
Symptoms of Deficiency: osteoporosis, osteomalacia, osteoarthritis, muscle cramps, irritability, acute anxiety, colon cancer risk.
Chromium: an important trace mineral. Dietary deficiencies are common, and 90% of Americans suffer from diets that are low in chromium.
Low chromium levels can increase blood sugar, triglycerides and cholesterol levels. Low chromium will increase the risk for diabetes and heart disease.
Chromium has demonstrated the ability to lower total and LDL (“bad”) cholesterol levels and raise HDL (“good”) cholesterol levels in the blood. Chromium may improve lean body mass and reduce body fat.
Antacids, particularly those containing calcium carbonate, may reduce the body’s ability to absorb chromium.
Dietary sources: include brewer’s yeast, lean meats, cheeses, pork kidney, whole-grain breads and cereals, molasses, spices, and some bran cereals, organ meats, mushroom, oatmeal, prunes, nuts, asparagus, and whole grains.
Signs of deficiency: Diabetes, obesity, elevated cholesterol. Glucose-tolerance test failure.
Subclinical manifestions often include ‘easy brusing’ and purplish discoloration under the skin of the forearm and nails. Never take copper alone. Balance of copper to zinc must be maintained or a series of serious problems can result from treating what is otherwise a cosmetic problem.
The most common symptom or disorder that results from sub-clinical copper deficiency is osteo-arthritis.
Dietary Source: green vegetables, beans and peas, nuts, seeds, and whole, unprocessed grains.
Symptoms of Deficiency: loss of appetite, nausea, vomiting, fatigue, weakness, numbness, tingling, cramps, seizures, personality changes, abnormal heart rhythms, heart spasms.
Manganese is a component of the antioxidant enzyme manganese superoxide dismutase (MnSOD).