Feeling depressed? It’s all in your… gut

Naturopathic medicine has long espoused the connection between digestive health and overall wellness.  The  interior ‘terrain’ of the body affecting susceptibility to illness and the general state of health as described by traditional Naturopathic physicians is all about the ecosystem of the gut.  Terms like ‘dysbiosis’ and ‘toxemia’ refer to imbalance of this internal ecosystem, affecting microflora and chemical signaling having far-reaching effects from digestive function to mood and neurological disorders.

A growing body of evidence is demonstrating the mechanisms behind the environment in the gut and physical and psychological ailments.  The gut has long been referred to as the ‘second brain’ because it is rich with its own nerve supply called the enteric nervous system.  This intricate nervous system responds to changes in neurotransmitters like serotonin, a chemical that affects mood and sleep.  Although serotonin affects the mind, and is targeted by drugs like anti-depressants, the majority of circulating serotonin is produced in the gut and is essential for digestive function.  Hormones like cortisol, which generates a stress response, also affect the gut.

A naturopathic approach to any health concern, whether physical, mental or emotional, should include attention to nutrition and digestive health.  For many patients experiencing depression and anxiety, making dietary modifications and treating the health of the gut can make a profound impact on their mood.  Assessing digestive function, addressing overgrowth of unfavorable organisms in the gut, reinoculating with beneficial probiotic flora, and repairing damage to the gut mucosa are all components of healing the gut.

Evaluation of digestive function and the microbiology of the gut may be part of an assessment, using digestive stool analysis.  Such functional medicine tests are unique from routine colonoscopy or stool tests, and are available from Naturopathic physicians and other holistic doctors.  With this information, an individualized plan can be made to remove unfavorable organisms, such as overgrowth of unfriendly bacteria or yeast like Candida albicans — traditionally called ‘dysbiosis.’  Next, supplementation of high-potency, multi-strain probiotics containing Lactobaccili and Bifidobacterium replenish the presence of protective gut flora.  These organisms have many roles, from maintaining proper digestion and elimination to regulating immune function.  Addressing digestive impairments and modifying the diet to remove food sensitivities is crucial in the gut recovery process, and may require several months of strict avoidance of gut irritants like wheat and other gluten-containing grains.  Finally, repair of the gut lining using herbs and nutrients that rebuild the protective mucous membrane is the final phase of gut recovery.

Whether you suffer from depression and anxiety, digestive complaints, other chronic illness or simply want to improve your overall health, treating the gut is the foundation of wellness.  For more information, call Hygeia Center for Healing Arts at (734) 769-4981.

More info: A Gut Check For Many Ailments, Shirley Wang

Mind-Altering Microbes: Probiotic Bacteria May Lessen Anxiety and Depression, Science Daily

The Gut and Psychology Syndrome Diet

 

Seasonal Affective Disorder: Strategies to Beat the Winter Blues

Seasonal Affective Disorder, or SAD, affects roughly 6% of adults in the US.  Defined as annual depression occuring the winter months and lifting with seasonal change, SAD is a more severe form of the “winter blues.”  Over 25% of Americans report some sensitivity to the decrease in light during the fall and winter.

The specific cause of SAD is not fully understood, but it is believed to be caused by a confluence of factors including: age, gender, genetics and individual brain chemistry.   SAD is more common in women, and in young adults to mid-life.  It is also more common in those living in northern states with reduced sunlight exposure in the fall and winter months.

The symptoms of SAD are due to a chemical imbalance marked by a decline in serotonin, a neurotransmitter that governs mood, and melatonin, the hormone responsible for sleep/wake cycles.  Production of both melatonin and serotonin depends on exposure to UV light, and the absense of light exposure is a key factor in the decline of levels.

The symptoms of SAD may include:

• Mild to moderate depression in the fall and winter
• Fear, worry, anxiety
• Loss of energy
• Social withdrawl
• Oversleeping
• Aggravation in the afternoon
• Pain – fibromyalgia, TMJ, migraines
• Difficulty concentrating
• Appetite changes, cravings for sweets and carbs, especially in the afternoon and evening
• Weight gain
• Sleep problems, insomnia
• If untreated can lead to serious problems including suicidal thoughts and behavior, school or work problems, social withdrawal and substance abuse

The most common treatment for SAD is light therapy with full-spectrum light bulbs or lightboxes.  Full-spectrum lightboxes come in a variety of designs, the Ott light and the Verilux products are two quality brands with affordable lamp options.  Medical research typically cites results from light therapy with 30 minutes of exposure to 10,000 lux daily.  Lux is a standard measurement of luminescence; on a typical overcast day one would be exposed to 10,000 -25,000 lux.

Because Vitamin D is produced in the skin cells upon contact with sunlight, many people in northern climates can be deficient or insufficient in Vitamin D and require supplementation.  This important nutrient helps maintain mood, immune function, and hormone balance.  Because Vitamin D is a fat-soluble nutrient that can accumulate in the body, it is recommended that one test blood levels of Vitamin D (a test known as 25-hydroxy-vitamin D) prior to supplementation.  This can help determine what dosage of supplementation would be ideal; in some cases of extreme deficiency, your doctor may recommend weekly megadoses to help bring the level up to the optimal range, then switch to a lower maintenance dose.

Other natural treatments for SAD are aimed at increasing serotonin and melatonin levels.  One option is the herb St. Johnswort, which has been extensively studied for the treatment of mild to moderate depression, and is useful for SAD.  St. Johnswort should not be used by patients who are already taking anti-depressants, as it works similarly to the medications and can potentiate their effects.  Another option might be 5HTP, a natural substance which is a precursor to both serotonin and melatonin.  This can help naturally increase serotonin levels and boost mood.

Lifestyle modification is also an important part of coping with SAD or other forms of depression.  Counseling or psychotherapy, stress management and mind-body techniques may all be helpful.  Additionally, a balanced whole-food diet high in vegetables, fruit, whole grains, beans, nuts, seeds and fish is optimal for maintaining overall health.  Avoiding sugar, alcohol and caffeine is key as these substances can aggravate a depressed mood.

Finally, exercise and time spent in nature are important ways to elevate mood and promote health.  Exercise naturally raises serotonin levels, helps improve sleep and maintains physical health.  Many studies demonstrate that time in nature also brings a sense of well-being, in addition to some sunlight exposure even during the winter months.  Dressing warmly and taking a brisk walk every day can help beat the winter blues.

For more information please see the following resources:

WebMD – Seasonal Affective Disorder

Mayo Clinic – Seasonal Affective Disorder

Dr. Julia Ross’ book The Mood Cure

Holiday Craft and Artisan Bizarre December 11th 12-4

Safe Summer Fun: Non-Toxic Sunscreens

The Environmental Working Group (EWG) has recently shed light on the dangers of sunscreen.  Most commercially available sunscreens contain two major toxic chemicals; Oxybenzone, a hormone-disrupting chemical, and retinyl palmitate, a form of vitamin A that has been shown to accelerate the growth of skin tumors.  The EWG recommends that consumers avoid sunscreens with vitamin A (look for “retinyl palmitate” or “retinol” on the label).  Unfortunately, many of the safer sunscreens recommended by EWG contain forms of zinc and titanium, which can have their own health risks in high doses. Most of the non-toxic sunscreens are all-natural or organic. 

Ultimately,  the EWG states that the best protection from the harmful UVA rays of the sun is a physical barrier  such as clothing or shade.

Below is a list of EWG-recommended sunscreen brands.  For the complete list of specific products and ratings visit the EWG website at: www.ewg.org/2010sunscreen.

Safe Sunscreens:	Avoid These:
Badger	Coppertone
California Baby	Hawaiian Tropic
Jason	Kiss My Face
Loving Naturals	Neutrogena
Soleo Organics	No-Ad

Thanks to Anna Weaverdyk and Rachel Hasse for their contribution to this article.

Upcoming Events

Parenting Workshop:

Naturopathic Women’s HealthCare welcomes Sonja Knighton and her creative parenting workshops.  Sonja is a preschool teacher, and has dedicated fourteen years to crafting her own mothering and working with children and families professionally.  The Mother Wit perspective provides a medium for re-skilling in the art of creating family.

 Sunday July 18th, 3-5 pm

 Wit & Wisdom

During this workshop you will explore how developing the intuitive aspect of your parenting allows you to cultivate parenting tools that are uniquely aligned with your family’s needs.

To register email Sonja at momwit@gmail.com

 

Office Closure August 3-22

Naturopathic Women’s HealthCare will be closed from August 3rd through 22nd and will reopen on Monday August 23rd.  For supplement refills, please contact the office by Friday July 30th. 

Dr. Christoff Quinn will be out of contact by phone or email for the first week of August, and will periodically check messages prior to returning on August 23rd.  For urgent matters, her colleague Dr. Hallie Armstrong will be taking patient calls through Beaumont Integrative Medicine in Troy, at (248) 964-9200.  Extended telephone consultations with Dr. Armstrong will be billed at $35 for 15 minutes and $75 for 30 minutes.

In addition to a remote camping trip and family reunion, Dr. Christoff Quinn will be attending the annual convention of the American Association of Naturopathic Physicians in Portland, Oregon.   She looks forward to returning to the office with the latest updates in naturopathic medicine at the end of August.

In Defense of Food Sensitivities

Yesterday’s article in the New York Times on food allergies presents an opportunity to clarify the distinction between food allergies and food intolerances.  The article cites Dr. Marc Riedl, allergist and immunologist at UCLA who was recently commissioned to author a report on food allergies for the federal government.  Dr. Riedl accurately comments on the fairly low prevalence of true food allergy – roughly 5% for adults and 8% for children. 

By true food allergy is meant a Type I, acute immune hypersensitivity reaction mediated by a type of antibody called immunoglobulin E, or IgE.  Evaluation by allergy and immunology specialists for IgE food reactions are typically conducted via blood testing for IgE antibodies or by performing skin prick tests for food reactions.  True IgE-mediated food allergies are the type of hypersensitivity to foods causing severe responses including anaphylaxis and death.  This type of food allergy is relatively rare, and occasionally false-positive reactions to foods can occur on testing.

Other types of reactions to food, frequently mislabeled “food allergies,” are in fact food sensitivities.  These reactions may also present with an immunological reaction to foods and are mediated by immunoglobulins type A and G.  The presence of IgG or IgA antibodies to foods correlate to delayed hypersensitivity reactions and commonly present as chronic symptoms such as digestive complaints and skin rashes.  Evaluating for food sensitivities can be done by testing saliva or blood, or by performing an Elimination/Challenge diet.  Studies that assess testing methodology have demonstrated inconsistencies with salivary IgA and serum IgA and IgG testing, with unclear sensitivity and specificity and a good deal of variability between laboratories.  Today the “gold standard” for evaluating food sensitivities is considered to be the Elimination/Challenge Diet, in which select foods are eliminated for a minimum of three weeks and gradually reintroduced one at a time.  The findings of this test are empirical and subjective, and certainly more challenging for a patient that simply getting a blood test.  However, the clinical relevance of how much better one feels after eliminating reactive foods, confirmed with a return of the symptoms when the food is reintroduced, is significant. 

An important clarification regarding the Elimination/Challenge diet is that this assessment is appropriate for identifying food sensitivities, not food allergies.  It would be inappropriate and dangerous to attempt a “challenge” of foods suspected of causing acute hypersensitivity reactions, such as a peanut allergy, which can be life-threatening.  Unlike the incidence of true food allergy, the incidence of food sensitivities is very common.  As mentioned in the article, as much as 30% of the population believe that they have a food allergy  – a misnomer for food sensitivity or intolerance.  The actual prevalence of food sensitivity may be even higher than 30%, given the widespread use of prescribed and over the counter antacid medications for reflux and indigestion.

Which brings me to the most important point from a Naturopathic perspective of Identify and Treat the Cause: the food sensitivity, although often a hidden or overlooked aggravator of many chronic health problems, may be in fact merely a symptom of underlying maldigestion and not the causal factor itself.  The prevalence of food sensitivities correlates with rising incidence of GERD, maldigestion associated with greater consumption of refined food, a low-fiber diet, overeating, eating too quickly, elevated stress levels, and impaired digestive function.  While identifying and eliminating food sensitivities can greatly improve a patient’s chronic symptoms, digestive health must be addressed to fully resolve the underlying cause and prevent further sensitivities and greater dietary restrictions.

More information on food sensitivities can be found at Alletess, a laboratory specializing in food sensitivities (despite the incorrect usage of the term “food allergies” on their website), and from the following resources:

The Anti-Inflammation Diet and Recipe Book by Jessica Black, ND

Coping With Food Intolerances by Dick Thom, ND

New Parenting Workshop Series with Sonja Knighton

Naturopathic Women’s HealthCare is pleased to present a new series of parenting workshops with Sonja Knighton. 

Sunday May 16th, 3:00-5:00 pm

“After the Snow Forts & Tea Parties.”  

In this workshop you will discover how to participate in play with your child(ren) in ways that nurture parent-child intimacy and reconnect you with the experience of whole hearted joy. 

Sunday  June 6th, 3:00-5:00 pm

“Shake It Off”

During this workshop you will learn to recognize opportunities to disengage funky energy & create a pool of strategies to help your family in challenging moments and difficult situations.

Sonja Knighton has dedicated fourteen years to crafting her own mothering and working with children and families professionally.  The Mother Wit perspective provides a medium for re-skilling in the art of creating family.   For more information or to register, email Sonja at: motherwit@selfaware.com

Have a Healthy Heart This Valentine’s Day: Eat Chocolate, Drink Wine

Chocolate l photo by ParsecTraveller

February is Heart Health Awareness Month, a great opportunity to explore preventive measures for maintaining cardiovascular health.  While hereditary risk factors are not modifiable in preventing heart disease, many lifestyle and nutritional choices have been shown to reduce risk and to strengthen the heart.  Fortunately, many of these options don’t require self-denial, and in fact some can be rather indulgent and may fit in well with your plans this Valentine’s Day: dark chocolate, red wine, and loving relationships.

Chocolate is cardioprotective is due to antioxidant, anti-inflammatory, and anti-atherogenic  compounds called polyphenols in cocoa .  Polyphenols in dark chocolate have been shown to reduce LDL cholesterol, the “bad” form that causes the cholesterol deposits in blood vessels and leads to atherosclerosis, and increase the “good” HDL cholesterol.  Chocolate was also found in one small study to inhibit platelet activity, reducing blood clotting.  It also appears to help lower high blood pressure by triggering the release of nitrous oxide in the blood, which relaxes blood vessels. 

The tradition use of cocoa originates in Mayan and Aztec culture in the form of a blended drink of fermented and crushed cocoa beans called xocoatl, which lacked the saturated fat and refined sugars of modern chocolate products that may do more harm than good.  The amount of cocoa used in clinical trials is roughly 100 g, which is a fairly high daily dose even for chocoholics.  The downside of obtaining this amount of cocoa daily is of course the increased caloric intake that comes from consuming chocolate bars containing sugar and cocoa butter, between 200-400 extra calories daily and containing over 1/3 of the daily recommended limit for saturated fat.  The “darkness” of the chocolate or cacao content doesn’t necessarily reflect the polyphenol content, although dark chocolate may have less added sugar and saturated fat than milk chocolate. 

Antioxidant polyphenols are found in many foods besides chocolate, of course, which brings me to our next indulgence, red wine.  The benefits of red wine have been known for quite some time and have been written about extensively in both medical literature and books on diet and health.  An 8 oz glass of red wine contains over 600 mcg of resveratrol, a potent antioxidant that supports blood vessel health.  The alcohol content of red wine is an unnecessary element of the beverage for conferring the health benefit, and many people choose to obtain the beneficial constituent resveratrol in supplement form rather than imbibe daily.  Alcohol can have an unfavorable effect on blood sugar, and again there are the extra calories.  Like chocolate, the benefit of red wine is probably best as an occasional indulgence.  Fortunately, many other foods that we can consume every day contain polyphenols and other beneficial nutrients, such as tea and fresh, brightly colored vegetables and fruits. 

Finally, an essential way to care for your heart is by managing stress and maintaining healthy relationships.  Many studies document the impact of stress on cardiovascular risk factors like high blood pressure and cholesterol.  Dr. Dean Ornish, a physician specializing in the reduction of coronary heart disease risk through lifestyle modification, emphasizes the need for love and intimacy in our lives. In his book Love and Survival, he writes: “I am not aware of any other factor in medicine – not diet, not smoking, not exercise, not stress, not genetics, not drugs, not surgery – that has a greater impact on our quality of life, incidence of illness, and premature death from all causes.”

Wishing you a heart-healthy Valentine’s Day,

Diana Christoff Quinn, ND

Seasonal Affective Disorder: Strategies to Beat the Winter Blues

Seasonal Affective Disorder, or SAD, affects roughly 6% of adults in the US.  Defined as annual depression occuring the winter months and lifting with seasonal change, SAD is a more severe form of the “winter blues.”  Over 25% of Americans report some sensitivity to the decrease in light during the fall and winter.

The specific cause of SAD is not fully understood, but it is believed to be caused by a confluence of factors including: age, gender, genetics and individual brain chemistry.   SAD is more common in women, and in young adults to mid-life.  It is also more common in those living in northern states with reduced sunlight exposure in the fall and winter months.

The symptoms of SAD are due to a chemical imbalance marked by a decline in serotonin, a neurotransmitter that governs mood, and melatonin, the hormone responsible for sleep/wake cycles.  Production of both melatonin and serotonin depends on exposure to UV light, and the absense of light exposure is a key factor in the decline of levels.

The symptoms of SAD may include:

• Mild to moderate depression in the fall and winter
• Fear, worry, anxiety
• Loss of energy
• Social withdrawl
• Oversleeping
• Aggravation in the afternoon
• Pain – fibromyalgia, TMJ, migraines
• Difficulty concentrating
• Appetite changes, cravings for sweets and carbs, especially in the afternoon and evening
• Weight gain
• Sleep problems, insomnia
• If untreated can lead to serious problems including suicidal thoughts and behavior, school or work problems, social withdrawal and substance abuse

The most common treatment for SAD is light therapy with full-spectrum light bulbs or lightboxes.  Full-spectrum lightboxes come in a variety of designs, the Ott light and the Verilux products are two quality brands with affordable lamp options.  Medical research typically cites results from light therapy with 30 minutes of exposure to 10,000 lux daily.  Lux is a standard measurement of luminescence; on a typical overcast day one would be exposed to 10,000 -25,000 lux.

Because Vitamin D is produced in the skin cells upon contact with sunlight, many people in northern climates can be deficient or insufficient in Vitamin D and require supplementation.  This important nutrient helps maintain mood, immune function, and hormone balance.  Because Vitamin D is a fat-soluble nutrient that can accumulate in the body, it is recommended that one test blood levels of Vitamin D (a test known as 25-hydroxy-vitamin D) prior to supplementation.  This can help determine what dosage of supplementation would be ideal; in some cases of extreme deficiency, your doctor may recommend weekly megadoses to help bring the level up to the optimal range, then switch to a lower maintenance dose.

Other natural treatments for SAD are aimed at increasing serotonin and melatonin levels.  One option is the herb St. Johnswort, which has been extensively studied for the treatment of mild to moderate depression, and is useful for SAD.  St. Johnswort should not be used by patients who are already taking anti-depressants, as it works similarly to the medications and can potentiate their effects.  Another option might be 5HTP, a natural substance which is a precursor to both serotonin and melatonin.  This can help naturally increase serotonin levels and boost mood.

Lifestyle modification is also an important part of coping with SAD or other forms of depression.  Counseling or psychotherapy, stress management and mind-body techniques may all be helpful.  Additionally, a balanced whole-food diet high in vegetables, fruit, whole grains, beans, nuts, seeds and fish is optimal for maintaining overall health.  Avoiding sugar, alcohol and caffeine is key as these substances can aggravate a depressed mood.

Finally, exercise and time spent in nature are important ways to elevate mood and promote health.  Exercise naturally raises serotonin levels, helps improve sleep and maintains physical health.  Many studies demonstrate that time in nature also brings a sense of well-being, in addition to some sunlight exposure even during the winter months.  Dressing warmly and taking a brisk walk every day can help beat the winter blues.

For more information please see the following resources:

WebMD – Seasonal Affective Disorder

Mayo Clinic – Seasonal Affective Disorder

Dr. Julia Ross’ book The Mood Cure

Flu Prevention and Wellness

A Naturopathic Perspective on the H1N1 Flu

By Dr. Diana Christoff Quinn

The H1N1 virus, also called the swine flu, is of great concern to many as we enter the early stages of cold and flu season. The swine flu is a strain of the influenza A virus that typically causes flu-like symptoms including fever, cough, runny nose, sore throat, headache, muscle aches, and sometimes nausea, vomiting and diarrhea.  The swine flu is a composite of four different flu viruses – North American swine, Eurasian swine, North American avian, and human[i].

The swine flu is transmitted by respiratory droplets in the air, from coughs and sneezes.  Transmission requires fairly close contact to the sick person, as the virus can’t travel more than 6 feet and does not remain airborne for long.  The typical incubation period for the virus is 1-7 days after exposure, but more likely 1-4 days.  People infected with the flu are contagious at least one day prior to the outbreak of symptoms and up to five days after.

How serious is the swine flu?

At this time, the World Health Organization considers the overall severity of the influenza pandemic to be moderate.  The moderate assessment reflects that:

• Most people recover from infection without the need for hospitalization or medical care.
• Overall, national levels of severe illness from Influenza A (H1N1) appear similar to levels seen during local seasonal influenza periods, although high levels of disease have occurred in some local areas and institutions.”[ii]
• According to the CDC, there have been roughly 400 deaths in the US reported to date attributable to the H1N1 flu; many estimate a million cases of infection or more are probable, given that mild cases are not reported and routine testing is no longer being performed.

Are there ways to prevent the flu?

Using basic hygiene is often our best defense. Everyone is advised to wash their hands regularly, use a tissue to cover mouth and nose during a cough or sneeze, and stay home if they are ill.  Getting adequate rest and nutrition are also very important for maintaining good immune defenses.  For hand washing, consider using essential oil antimicrobial hand sanitizers such as CleanWell[iii].  This product does not contain alcohol, and is therefore gentler on hands while still being 99.9% effective in killing germs.

Natural remedies to help with prevention include probiotics, healthy gut bacteria including Lactobacilus acidophilus.  A recently published study in the journal Pediatrics demonstrated that “daily dietary probiotic supplementation for 6 months was a safe and effective way to reduce fever, rhinorrhea, and cough incidence and duration and antibiotic prescription incidence, as well as the number of missed school days attributable to illness, for children ages 3 to 5.”[iv]

Who is at risk of complications from the flu?

Most people will not experience severe symptoms or complications from the flu.  Those who may be at higher risk of complications and hospitalization include:

• Children less than 5 years old
• Persons aged 65 years or older
• Children and adolescents under 18 who are receiving long-term aspirin therapy and who might be at risk for Reye syndrome after influenza virus infection
• Pregnant women
• Adults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders
• Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV)
• Residents of nursing homes and other chronic-care facilities.[v]

When is it important to get medical attention?

Emergency warning signs in children:

• Rapid or difficult breathing
• Fever with a rash and/ or bluish skin
• Lack of thirst resulting in not drinking enough fluids
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and a worsened cough

In adults, emergency warning signs requiring urgent medical attention include:

• Difficulty breathing or shortness of breath

• Sudden dizziness or confusion

• Severe or persistent vomiting

Are there natural remedies to help treat the flu?

It is important with the treatment of the flu to keep hydrated and to rest.  Because the flu is a virus, antibiotics are not an effective treatment.  Many holistic doctors recommend using the homeopathic remedy Oscillococcinum[vi] at the first sign of symptoms.  This remedy has been shown to shorten the duration and severity of flu symptoms.  Additionally, one study of Elderberry syrup demonstrated its efficacy for shortening the duration of the flu.[vii]

The H1N1 virus was initially thought to be very dangerous, but now the severity has been updated to moderate.  With basic hygiene and self-care the flu virus may be prevented, and common natural remedies can help decrease the symptoms and duration of a flu infection.

Dr. Diana Christoff Quinn, ND is a licensed Naturopathic doctor specializing in women’s health and chronic illness.  She maintains a private practice in Ann Arbor as well as in Beaumont Hospital’s Integrative Medicine clinic in Royal Oak.  For more information or to schedule an appointment call (734) 769-4981.

---

[i] http://www.infectiousdiseasenews.com/article/39389.aspx

 

[ii] http://www.who.int/csr/disease/swineflu

[iii] http://www.cleanwelltoday.com/

[iv] http://pediatrics.aappublications.org/cgi/content/abstract/124/2/e172

[v] http://www.cdc.gov/h1n1flu/identifyingpatients.htm

[vi] http://www.oscillo.com/

[vii]http://www.ncbi.nlm.nih.gov/pubmed/15080016?ordinalpos =13&itool=EntrezSystem2.PEntrez.Pubmed.PubmedResultsPanel.Pubmed_ DefaultReportPanel.Pubmed_RVDocSum