About 40% of people over age 65 experience some memory loss. It is known as “age-associated memory impairment,” if there is no medical condition that causes this loss of memory. Then, it is considered part of normal aging. Alzheimer’s disease and other dementias are not part of normal aging.
Age-associated memory changes are often seen as:
The hippocampus is responsible for memory and shrinks with age. It’s deep inside each brain, near the ear. It links unrelated things into memory, like where you left your keys or your neighbor’s name. It’s vital for forming new memories about experienced events. When it’s not normal, spatial orientation falters; people get lost, a common symptom of amnesia.
At Northwestern University, researchers studied PEMFs to stimulate older adults’ brains to improve memory. Since the hippocampus is deep, they targeted the parietal lobe, closely linked to it. Stimulation of the parietal lobe is expected to boost hippocampus function.
The study had 16 adults, ages 64-80. They compared memory tests with a younger control group before stimulation. Older individuals were correct about 40% compared to the younger group, around 55%.
Stimulation was done using a high intensity PEMF at about 10 pulses per second for 20 minutes in each session, over five consecutive daily sessions to the left side of the head. Full intensity stimulation was compared to low intensity “sham” stimulation. This allowed the researchers to evaluate the changes in memory within the same individuals, a more realistic form of assessment, as would be seen in a clinical setting. At the end of the study. The researchers also used functional MRI (fMRI) of the brain to check brain function and the functional relationship of the parietal lobe with the hippocampus.
The results were as follows:
One of the lead authors said, “Older people’s memory got better up to the level that we could no longer tell them apart from younger people.”
This research also shows that stimulation of the parietal area of the brain impacts the memory associated with the hippocampus. The other words, the magnetic field penetrates deep enough into the brain through the parietal area into the hippocampal area to improve memory. The research also supports the idea that dysfunction of these connections increases with age, explaining the causes of memory loss as he will get older.
This research seems to indicate that the memory improvements do not last up to a week. It is not known whether longer episodes of stimulation would work better, whether stimulation beyond five sessions would work better, whether high intensity PEMF stimulation to other areas of the brain would produce similar or better results and whether stimulation with lower intensity PEMF systems would be as effective, and whether similar memory improvements could be seen in dementia or early-stage Alzheimer’s disease. Other high intensity brain stimulation research has already found benefits for Alzheimer’s disease. But, as is seen with many other conditions, the sooner treatment begins relative to memory loss the better the results. Waiting until Alzheimer’s disease has clearly been established is less likely to produce the same benefits as treating earlier age-related memory loss.
Nevertheless, these results are exciting, not only ensuring the safety of high intensity PEMF stimulation, but also that this PEMF therapy actually improves age-related memory decline.
Based on the results of this research I would recommend daily use of a home-based PEMF system, to encourage not only temporary improvement in memory but also to rebalance the tissues, hopefully age-reversing the age-related decreases in function of the hippocampal area. For convenience a portable PEMF unit may be likely to be used regularly, and certainly more affordable. Otherwise if someone already has a higher intensity PEMF system this can be used regularly to the parietal area of the brain, preferably daily.
Journal of Science and Medicine Abstract by William Pawluk discussing brain injuries
Read the full article in the Journal of Science and Medicine.
Traumatic brain injuries, or concussions, have challenged me as a doctor for over 40 years. Today’s solutions remain much as when I first learned about them in medical school. The key change is the growing recognition of mild TBI’s importance. In the past, serious brain injuries dominated attention, often requiring intensive care for coma patients. Now, we understand that even mild, especially recurrent cases, leave significant brain marks leading to major disability. Sports concussions have recently highlighted these consequences.
Therapies for mild to moderate TBI mainly focus on adaptation. New approaches are essential due to residual long-term brain effects, even after apparent recovery. Evidence suggests that early use of various pulsed electromagnetic fields can reduce brain inflammation, a major injury aspect. Inflammation disrupts brain function, causing both short-term and long-term symptoms like headaches, dizziness, depression, anxiety, and insomnia. These therapies can address the injury itself and many resulting symptoms, potentially healing the brain and reversing long-term damage.
Current medical management, often medication-based, mainly targets symptomatic relief for TBI consequences like depression, headaches, memory issues, and dizziness. It plays a limited role beyond symptom management and adaptation.
Evidence supports the use of pulsed magnetic fields, reaching deep into the brain without side effects. However, medical knowledge about PEMFs for concussion/TBI needs expansion, including establishing treatment protocols for different systems in terms of intensity, duration, frequency, and frequencies. High-intensity PEMFs used for extended periods appear to have no adverse brain effects and might even reduce cancer and Alzheimer’s/dementia risk.
Read the full article in the Journal of Science and Medicine.
Journal of Science and Medicine Abstract by William Pawluk about TBI
Read the full article in the Journal of Science and Medicine here…
This is a case report of a patient looking for a complementary approach to her chronic fatigue, and a mild partial complex, temporal lobe seizure disorder. Moreover, it is presumed the symptoms and seizure disorder were mostly attributed to her TBIs.
This report and discussion provide substantial support for the use of this specific 10 mT/100 Gauss pulsed magnetic field 10 Hz signal. This was for 2 hours daily to and only significantly improved clinical function. Also, it objectively produced positive neurological functional changes. Furthermore, it is still unknown whether 2 hours per day of this type of PEMF therapy is optimal. Clearly, in this patient, 2 hours/day of therapy made significant improvements in subjective and objective measures of function, and with internal validity, significant loss of benefit with cessation of therapy. Nonetheless, this loss of benefit with stopping treatment has been seen in other transcranial PEMF research. It remains to be seen whether durable, long-term benefits can be seen with longer-term PEMF therapy, whether other signal parameters could be optimized, including PEMF frequencies and intensities, and whether more permanent structural improvements in the injured brain may be found.
Further research is clearly needed on a larger sample of individuals with TBI. This is true whether complex or not, with different times after onset of injury. This would help to determine whether this approach is equally effective across various TBI scenarios. Along with this, whether any contraindications or limitations arise under different circumstances.
Read the full article in the Journal of Science and Medicine here…
Long-acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs) are in common use for pregnancy prevention. The percentages of use by age group are: ages 20–29 (13.7%), 30–39 (12.7%), 15–19 (5.8%) and 40–49 (6.6%).
Four IUDs are available in the United States, the copper-bearing IUD and three hormone releasing IUDs. Fewer than 1 woman out of 100 becomes pregnant in the first year of using IUDs (with typical use). IUDs are long-acting, can be removed, and can be used by women of all ages, regardless of history of pregnancy, and including adolescents.
A common question is whether using PEMFs in women with IUDs is safe. Three studies were found that looked at the question of the safety of doing MRI tests in the presence of IUDs. The only one that found any significant risk was for stainless steel -containing IUDs, which are not approved in the US.
Magnetic field interactions and potential adverse events were evaluated in 18 women using a questionnaire-based telephone survey. One woman reported a dislocation of the IUD after the MR test. All others had no signs of field interactions. The results were that MRI at 3.0-T can be used for women with copper-containing IUDs. (Berger-Kulemann) In another study, seven different types of copper IUDs were evaluated. Heating and dislocation of each IUD were investigated at two clinically relevant positions in 1.5 T and 3 T MR scanners. No significant heating of any tested IUD was detected during MR measurements. There was almost no temperature increase for all IUDs. No IUD movement was detected.
They concluded that there was no significant risk of possibly harming a woman was determined with an implanted copper IUD. (Neumann) the third study evaluated MRI safety of clinically used IUDs composed of copper/gold and stainless steel at 1.5T and 3.0T for displacement force, torque effects, and heating of IUDs composed of copper/gold (western IUDs) and stainless steel (China) on 1.5 and 3.0T MRI systems. They concluded that standard copper/gold IUDs can be considered as MR conditional for MR safety at 1.5 T and 3.0 T. The stainless steel IUDs, can be potentially harmful to during MRI due to high magnetic dislocation forces and torque. As a result, stainless steel IUDs (which are not available in the US or Canada) are considered MR unsafe. (Bussman)
Plastic IUDs would have no risk with PEMFs, since they do not contain metals. Drug-eluting IUDs have not been studied relative to MRI effects on the potential for enhanced drug release.
Therapeutic PEMFs, even high intensity systems, are not MRI machines. MRI devices contain both radiofrequency magnetic fields as well as high intensity static magnetic fields. High intensity radiofrequency are somewhat although minimally equivalent to pulsed magnetic fields. It can generally be assumed that even in women using high intensity PEMFs, that since they are MRI conditional, the safety/risk profiles can be considered acceptable. A major difference between MRI and PEMF treatment, is that PEMF treatment may be continued on a regular basis, whereas MRI is usually a relatively unusual, not frequently repeated. In this case we are particularly interested in the use of MRI in the pelvic area, and not other areas of the body.
Whether or not an MRI/high intensity PEMF is used, there is always the potential for dislocation of the IUD. Copper/gold metals are minimally magnetically attractable so there would be no torque on them to cause displacement. Very limited heating of the tissue when using a high intensity PEMF to the pelvic area is a possibility as the magnetic field bends around the metal, possibly somewhat increasing magnetic field intensity, in a very limited area around the IUD. The risk of this happening is the greatest with radiofrequency magnetic fields. However, these studies indicate this risk is almost nonexistent.
Another risk not discussed in the studies is the possibility of increased vaginal bleeding, due to the PEMF effect of decreasing platelet stickiness and increased fibrinolysis. Increased vaginal bleeding, especially around menses, is a natural consequence of an IUD in any event and may not necessarily be attributed to PEMF treatment. IUDs create additional risks of inflammation of the uterus and secondary infections in the fallopian tubes, ie, pelvic inflammatory disease (PID). PEMF stimulation may temporarily increase inflammation and potentially increase discomfort. However, PEMFs have been found useful in helping women with PID, along with antibiotic therapy.
If there is significant concern, especially with magnetic field intensities in excess of 7000 – 8000 Gauss, the duration of exposure to the PEMF may be reduced or the intensity kept to at least a 50% level.
Dislocation of an IUD is always a possibility even without MRI or PEMF exposure. However, if there is a concern or gynecologic issues develop, gynecologic examination would be recommended, particularly to see if there is dislocation.
There is almost no risk of using PEMFs in women with copper IUDs based on evidence from MRI studies. Usual risks associated wih the IUD are still present.
People are slowly beginning to understand the array of issues that PEMF therapy can address. I get a lot of questions about how to choose the best PEMF machine. It is confusing to know exactly what to look for, especially since PEMF therapy can benefit almost any health condition if you use the correct device.
From treating acute issues like sprains, fractures, and back pain to helping manage chronic conditions such as arthritis and autoimmune diseases, to improving circulation and cardiac function. PEMF therapy works. And any device will give the user some benefit. But if you may not have the right device for your specific problems. If you don’t use it in the proper way, PEMF therapy might not bring the results you desire.
When you’ve decided PEMF therapy is the route you want to take, and purchase the right PEMF machine for the condition you want to treat, there’s an added bonus. Not only can you use the machine later, for other conditions that may come up. Also, you can also share it with your family and friends. Particularly, if they have issues similar to the one that prompted the purchase in the first place!
Let me be really clear here: there is no one best machine that covers all conditions. Specific health problems require specific treatment. It’s essential to understand exactly what you are using the machine for.
Even when you have a specific diagnosis, there are probably multiple underlying issues that led to this diagnosis. You should discuss everything that’s going on with your health with a medical professional. Therefore, you can discover which system will work best for you.
If you’re focused on the science of PEMFs, I need to tell you that the machines used in research often aren’t available to the average consumer. And the machines that are readily available often haven’t been used, specifically, in research. But that doesn’t mean they can’t help you a great deal! It’s more about understanding the features of the machine, what you will use it for, and what the research says about those specific conditions and magnetic therapies that matters.
One thing that is crystal clear is that you can’t trust the marketing materials put out by a company that represents only one brand of device. The goal of these materials is to entice you to choose their product. Of course they’re going to tell you theirs is the best machine. That’s not about health care, that’s about sales. Manufacturers of specific devices won’t tell you what the machine can’t do. Anyone who tells you that their product is “the best” without knowing what condition you are trying to treat isn’t always looking out for your best interests.
I’ve personally tested dozens of different systems to see how they work. I have specific devices that I recommend because I know exactly which specific, unique conditions they are effective on. I also take into account how portable the device needs to be, as well as another essential aspect — personal budgets. My philosophy is that you should be able to get the best device available at that price.
Manufacturers each have their own philosophy on what PEMF parameters create the most change in the body. Sometimes, these make sense (ie, with frequency and intensity) and sometimes the features highlighted are pure bells and whistles with little actual impact. It’s imperative that the machine you select can actually do what you need it to do – that’s why knowing what to look for is so vital.
When you have a specific problem, you want targeted therapy. Some problems respond better to high intensities while others respond better to low intensities. Likewise, some conditions are best treated with low frequencies, some with high frequencies, and some need a range of frequencies available. The most important consideration when purchasing a PEMF device is will it effectively treat the problem or problems you are purchasing it for? Any additional benefits are just the cherry on top.
There are so many things to think about when you are in the market for a PEMF device. It’s no wonder people get confused – especially when relying on marketing materials rather than a medical professional who has tested numerous devices for different health issues.
Below, I’ve put together some answers to common questions that can help you know what to look for in order to get a machine that does what you are expecting it to do.
There’s a lot of talk about which frequencies are most effective, but the frequency you need depends on the condition you want to treat. In general, chronic issues need a higher frequency, because the problem tends to be rooted much deeper inside the body. Acute problems often respond well to lower frequencies. But because every individual situation is different there are exceptions to this rule — there are a lot of grey areas.
The ability to control frequency settings on a device is particularly important when thinking about the impact on the nervous system. If you plan to use the device for reducing stress and anxiety, pain management, as a sleep aid, or for chronic fatigue syndrome, fibromyalgia or treating the head, it can be very important that you can control the selection of the frequency.
Much of the time, if you have a specific issue, you’ll want to use medium or high intensity to get results. Of all the choices to make about a PEMF machine, intensity appears to matter most, most of the time. If your goal is health maintenance, a very low intensity (under 10 Gauss) system may be all that is needed. High intensity systems tend to work more quickly and effectively, with less time needed for treatment each day. Even they have health maintenance benefits.
No, not much. Some companies will play up waveform, which is why I’m mentioning it at all. There has been research on multiple waveforms, and all have been proven effective. That’s why I don’t spend much time thinking about this particular feature.
For problems that impact your entire body, such as osteopenia, osteoporosis, and arthritis (to name just a few), a whole body system is required. For localized problems, a smaller device that can target specific areas is often a better selection. It’s also important to consider your schedule and lifestyle. If you’re always on the move, and it’s difficult to find any time at all to lie on a whole body pad, a more portable device will be a better fit. On the other hand, if health maintenance is your goal, and you have ten minutes twice a day to devote solely to PEMF therapy, a whole body system might be best.
In some units, only one program is available, while others offer several programs based on specific conditions. Some use a “biorhythm clock” as a programming guideline, basing frequencies on the time of day. This is fine as long as you understand what each program does so you can choose the best one for your needs at that moment – especially if you need a higher frequency when the typical program would be a gentler, more relaxing frequency.
Typically, accessories are only an option with half-body or full-body systems. Accessories can be useful, depending on what condition you are treating with PEMF therapy, but PEMF machines can be just as effective without any accessories at all. I would advise against making a decision about a PEMF device solely based on what accessories are available.
The first thing to understand about the FDA is the difference between registration and approval. Registration simply means that the FDA is aware that the item is being imported into the US; it has nothing to do with safety.
Approval doesn’t come with a guarantee of safety either — just think of the number of FDA approved drugs that are later withdrawn from the market. The knowledge that the FDA has approved some PEMF devices does assure us somewhat that the FDA does not consider, in general, that PEMF therapy is unsafe or ineffective, however.
It’s also important to know that many manufacturers don’t even want to be FDA approved. The high cost of seeking FDA approval is one reason. Another is that FDA approval carries the requirement that the product be used only for specific-conditions. Since PEMF devices treat the body at the cellular level, they have a wide range of beneficial uses. Choosing to approve just one application or condition would not be advantageous to either the brand or the consumer.
Finally, remember that most PEMF machines are wellness devices, not medications or medical devices.
The old saying “you get what you pay for,” is true in many cases. If you want quality construction and quality service, the higher priced devices may be your best bet. However, there’s such a huge range in pricing – from $350 to $6,000 or more – that even if you can’t afford the top tier, you can certainly get a device that will benefit your health. Full body systems come at a higher price, but also treat more of the body at once. Generally, the higher intensity devices cost more.
That being said, you can absolutely still reap the benefits of PEMF therapy, even if you need to choose a less expensive unit. It’s just essential that you understand that treatment may take longer, and patience is necessary.
Therapy in a clinical practice setting can be inconvenient and expensive. For some problems, you may need an hour or two of treatment per day – more time than most people want to spend in a practice setting. And even after you feel better, the actual problem may need weeks or months of treatment to heal completely.
A quality PEMF machine is an investment in your health. When you own your own system, it’s available to treat you – and your whole family – in your own environment. When you think about how long a device will last, the price per day value is exceptional. It’s far less than you’d pay for office visits and prescription refills, especially when treating multiple family members.
Even with all the above information, making a decision on a piece of unfamiliar equipment can be confusing and difficult. I have spent years researching and testing machines so you don’t have to. If you need help selecting the right PEMF machine for your needs, call our medical office at (866) 455-7688. Or, visit our website at www.drpawluk.com/consult/ to schedule a consultation. There’s no need to guess. We can guide you to the best device for your needs.
The answer what Tony Robbins and I have in common is: quite a bit. One of those bits is NOT walking on hot coals! In my 50-year career as a Family doctor, a one-time “horse and buggy” style “Marcus Welby” doctor. This involved delivering babies, sewing ears back on, setting broken bones, piecing back together a “Spaghetti scalp”, stopping people from suicide, and just plain old holding hands at the end of life. I came to realize that all “establishments” deliver at least some benefits. Nobody gets everything they want.
One of the things that Tony Robbins and I share is an interest in the value of PEMF therapy. In his new book “Life Force,” Tony discusses strategies he’s learned. These come from interviewing more than 100 of the world’s top medical pioneers. Much of the impetus for doing the book stems from his own health challenges. Similarly, it comes from search to help with his own healing.
He talks about a personal snowboarding accident leaving him with an excruciatingly painful torn rotator cuff. This led to the discovery that he also had severe spinal stenosis. PRP, platelet rich plasma, helped only a small amount. Serendipitously, at a conference a spinal surgeon recommended PEMF therapy to him. His first experience with 20 minutes of PEMF therapy reduced pain from 9 out of 10 to 4.5. He absolutely benefited from the PEMF therapy. However, he ended up getting stem cell therapy to further help to heal his shoulder. But he continues to use PEMF therapy regularly to boost energy and concentration, improve sleep and overall daily function.
Regarding stem cell therapy, I often tell people “you can’t grow garden in a swamp.” Research shows that PEMF therapy helps to reduce/clear “the swamp,” that is, to decrease the swelling and inflammation associated with many of the health issues for which stem cell therapy is used. The research also shows that PEMF therapy not only increases the body’s own natural proliferation of stem cells, and it also helps them to turn from undifferentiated into the differentiated cells needed for the intended tissue repair and regeneration. And PEMFs also help to maintain the injected stem cells and the regenerating tissues longer term. Based on science and experience, It’s my view that, given the cost and hassles in getting and doing stem cell therapy, more support is needed to give more confidence that that it will work as well as hoped. Adequate intensity and proper use of PEMF’s provide that assurance.
As Tony mentions, research on PEMF therapy is extensive. it shows dramatic results in reducing pain, swelling, inflammation and improving cellular metabolism and energy. Much of this is discussed in my two books, Power Tools for Health and Supercharge Your Health With PEMF Therapy.
Tony further goes on to describe how he used it successfully for his 83-year-old aunt. She suffered a bad fall, and for the professional athletes he coaches. He combines multiple other therapies including hyperbaric oxygen [HBOT] and cryotherapy. His PEMF is a high intensity, very high cost PEMF system normally only sold to health professionals. I also recommend combining PEMF with other therapies to provide maximum benefits. This gets very expensive.
However, PEMF therapy often will stand extremely well on its own and may be the best value of any other therapy, when one considers costs, time needed to use it, convenience, limitations of the benefits of these various other therapies, or their usefulness across a myriad of health conditions. The usefulness of PEMFs is described in my Supercharge Your Health with PEMF Therapy book across 80 health conditions and the ability to use PEMFs in the convenience of the home setting.
One can certainly use PEMF therapy in the professional setting with holistic practitioners, physical therapists, chiropractors, acupuncturists, trainers, etc., but, because of the cost and convenience issues, getting an appropriate PEMF system for home use, as Tony has done, is likely to help the most in the long run. So, home PEMF therapy may be used not only for helping with specific health issues but will also have the add-on value, amazingly so, for long-term daily general health maintenance. Who doesn’t need health maintenance, even beyond any specific health issues?
In his book, Tony says “I personally recommend that you get yourself an experience with one, and you’ll be sold on its power and impact. Most people will do three sessions of twenty to 60 minutes and see significant positive changes. But I felt the impact, and many do, after just the first session, and I’m willing to bet you’ll notice a positive change. PEMF devotees affectionately call it “lightning in a box,” and just may be the right way for you to decrease both acute and chronic pain, increase circulation, and boost your overall energy while recharging your health.”*
Tony has tended it call his PEMF therapy system “lightning in a box”. Furthermore, we have very few returns. Follow-up consultations with those who have purchased devices indicates that they are very pleased with all the benefits they feel. They can’t thank me enough for steering them the right way. In some cases, this is even after the have purchased a less effective system on their own. As a result, with ongoing consultations and support from DrPawluk.com, most people who make the recommended PEMF purchasing decision, have no regrets and freely share their experiences with myriads of other people.
To order a PEMF system go to DrPawluk.com. For help in deciding which PEMF system to get, go to https://www.drpawluk.com/consult/, complete and submit the form.
*Excerpted from “Life Force: how breakthroughs in precision medicine can transform the quality of your life of those you love.” Tony Robbins, Peter Diamandis, MD & Robert Hariri, MD, PhD. Simon & Schuster, 2022.
Marijuana has become legal recreationally in many states in America and throughout Canada. Many people land pro and con about the risks and benefits of recreational marijuana. However, the medical uses of marijuana [cannabis] are increasingly recognized and accepted, and as a result, medical marijuana is now legally available in a very controlled fashion in an increasing number of states as well.
As the science and understanding of the actions and effects of marijuana have exploded, it is now known to act throughout the body on tissue and cell receptors called the endocannabinoid system (ECS). Moreover, the research described below is now showing us that PEMFs, in addition to all the other actions of PEMFs, act on the ECS too. This is what marijuana and PEMFs have in common. So, some of the common actions of marijuana/cannabis are also seen with PEMFs.
n the 1940s, marijuana/cannabis plants were discovered to have receptors called cannabinoids, which helped the plants ward off predatory insects while attracting pollinators, as well as helping them survive the harsh environmental conditions, including frost, heat, and dehydration. Additionally, from 1988 on, researchers began to discover cannabinoid receptors in animals. They also found that these receptors outnumbered all other receptors in the animal brains. Therefore, since these receptors were inside the body, they came to be called endocannabinoids. Notably, endocannabinoids are found in all animals except insects. Nonetheless, these receptors are found throughout animal bodies, with the locations being unique to each species.
What this research indicates is that the ECS may be activated or enhanced both by acting internally on endocannabinoid receptors already active in the body and also through the intake or application of cannabinoids from without the body, including cannabis and hemp-derived CBD. Furthermore, cannabis/marijuana contains both THC and CBD, the most active components, among many other compounds.
Hemp plants contain more CBD, and cannabis plants contain more tetrahydrocannabinol (THC), a compound that causes the ‘high’ that people associate with cannabis use. Consequently, hemp-derived CBD products with less than 0.3% THC are legal federally. Interestingly, the benefits of CBD do not depend on whether it is cannabis-derived CBD or hemp-derived CBD. Common side effects, such as an upset stomach, feeling tired, or feeling on edge, remain the same. This is because the chemical make-up of CBD does not depend on which plant it comes from. It is generally thought that THC acts mostly on the nervous system, whereas CBD also acts more commonly on the rest of the body.
The receptor is like a lock. The lock has to be opened or activated, usually by a molecule, to create its actions. There are 2 basic types endocannabinoid receptors, CB1 and CB2. Cb1 receptors are found mostly in the brain and spinal cord. CB2 receptors are everywhere else throughout the body.
The 1st receptor activating molecule was discovered in 1992 and called anandamide (AEA), and Ananda being the Sanskrit root word for bliss. Years later another important activating molecule called 2-AG was found that activated both CB1 and CB2 receptors. There are many other endocannabinoids with lower levels of activity, primarily acting to boost the activity of the main endocannabinoids.
The body produces endocannabinoids as needed. Lipid molecules normally in the cell membrane are converted into the endocannabinoid receptors.
The ECS helps maintain functional balance in the body (homeostasis). So, the ECS is vital to maintaining health at all levels. This includes actions on sleep, mood, memory, appetite, physical activity, pain perception, and even immune function. An adequately functioning ECS helps us to be energetic, focused and healthy. A dysfunctional ECS, whether it’s due to problems with producing ECS receptors or their proper functioning, many problems begin to surface.
Memory – THC may impair short-term memory; extinction of old memories; neural growth in the hippocampus involved in declarative and spatial memories; inhibit neuronal excitability.
Appetite – CB1 receptors increase appetite; leptin levels in the blood correlate with endocannabinoids, with lower levels increasing appetite; endocannabinoids affect taste perception; increased neural signaling when sweets are taken.
Energy balance and metabolism – homeostatic role for energy storage and nutrient transport; modulates insulin sensitivity; resulting benefits for obesity, diabetes and atherosclerosis.
Stress response – increased endocannabinoids after repeated stress reduce the adrenal stress response, particularly to non-threatening stimuli
Anxiety – reduce aggression, anxiety reduction, reduce excessive arousal.
Immune system – stimulate macrophages, neutrophils, bone marrow cells, B cell migration and regulate IgM levels.
Female reproduction – affects timing of embryo implantation; likelihood of miscarriage increases if uterine AEA is too high or too low; exogenous cannabinoids may decrease likelihood of pregnancy if natural AEA levels are too high and can increase likelihood of pregnancy if natural AEA levels are too low.
Autonomic nervous system – CB 1 receptors are in the muscle neurons of organs; reduced noradrenaline from sympathetic nervous system nerves; inhibit bowel neuronal activity – helping with excessive bowel motility.
Analgesia – cannabinoids suppress pain in the spinal cord; one mechanism for analgesia by acetaminophen; ECS involved in placebo responses.
Temperature regulation – affects temperature regulation by causing vasodilatation. Capsaicin, which causes sweating, is similar to endocannabinoids.
Sleep – increased ECS activity in the central nervous system is sleep inducing; increases slow wave and REM sleep; increases adenosine which promotes sleep and suppresses arousal; ECS activity is circadian, with higher levels with light.
Physical exercise – higher ECS levels during physical activity generate exercise-induced euphoria, the so-called “runner’s high”; cannabinoids cross the blood brain barrier.
Every state that supports the use of medical marijuana has different conditions for which it can be recommended. In Maryland, the following are the qualifying conditions.
Many of these conditions have been shown to be benefited by PEMFs, whether through other mechanisms or through the ECS.
People with a number of different conditions have deficient cannabinoid number or function. Common ones include aero bowel syndrome, fibromyalgia, and migraines. Furthermore, nervous system inflammatory conditions are being studied to see if cannabinoids can help slow or stop them. (Saito) These include Parkinson’s, Alzheimer’s, multiple sclerosis, and Huntington’s disease. Additionally, even depression and PTSD are thought to have an endocannabinoid deficiency aspect.
Some cancers have higher levels of cannabinoid receptors, meaning that they are seeking more of the activating molecules, AEA and 2-AG. Research shows that supplying the body with cannabinoids or stimulating their production cannot only help with symptom management in individuals with cancer, such as pain, sleep, anxiety, and nausea, but can also help with the side effects of chemotherapy and directly attack cancer cells. (Hermanson)
In terms of the brain, the ECS also has a very important role in memory. Notably, the development of plaque in the brains of those with Alzheimer’s may be caused by blocking endocannabinoids in the brain. (Stanford news) Furthermore, one of the best-known effects of cannabis is to help with fear, anxiety, and depression. Inhibiting CB1 receptors in mice causes them to have increased anxiety and fear behaviors as well as physiological stress levels. (Jenniches)
The ECS helps energy production, storage and expenditure. It may be useful to deal with metabolic disorders, such as obesity, diabetes and cardiovascular disease. The low-grade inflammation and insulin resistance that go along with these conditions have been associated with overactivity of the endocannabinoid system. In obese patients with type-2 diabetes, a CB1 blocking drug has been found to help decrease blood glucose levels and lower inflammation beyond what weight loss alone could do. (Hollander; Scheen) On the other hand CB1 blockade can cause significant psychiatric problems.
In my book Power Tools for Health, published in 2018, (Pawluk) I outline 25 mechanisms of actions of PEMFs, with no mention of the ECS. The research on PEMFs goes back into the late 1960s. The 1st book I published in 1998, Magnetic Field Therapy in Eastern Europe: a review of 30 years of research, had no mention of endocannabinoid receptors. Therefore, as a result, there is very little research yet on the impact of PEMFs on the endocannabinoid system. However, since the ECS is so important and extensive in the human body, it is hard to imagine that PEMFs don’t have some effect on these ECS receptors.
I was encouraged when I saw the paper “Repetitive high-frequency transcranial magnetic stimulation reverses depressive-like behaviors and protein expression at hippocampal synapses in chronic unpredictable stress-treated rats by enhancing endocannabinoid signaling.” (Xue) This research article tells us that PEMFs certainly have an effect on the ECS receptors in the brain. If that’s true, they will almost certainly have an impact on ECS receptors and actions throughout the body. This makes a lot of biologic sense given the vast range of actions of PEMFs on human function and physiology. This means that PEMFs can have actions on many different types of receptors, not just in the ECS, and with a lot of overlap of action among them.
A specific form of PEMFs, called repetitive transcranial magnetic stimulation (rTMS) is FDA approved for the management of treatment-resistant depression. Additionally, TMS is being studied for a large range of different types of neurological and other health conditions. This study was done to evaluate the impact of rTMS on the ECS of the brain related to the management of depression. Concurrently, chronic stress in both humans and in animals increases the risk of depression. Much of the effects of chronic stress impacts the hippocampus of the brain. The hippocampus regulates emotion and susceptibility to chronic stress through its connections with the amygdala and limbic hypothalamic-pituitary-adrenal axis.
Previous research has definitely shown the involvement of the ECS in depression. The major findings of this study were as follows: (1) rTMS improved depression-like behaviors induced by chronic stress; (2) the expression of various ECS enhancing receptors increased in the hippocampus following rTMS treatment; on the other hand, the amount of enzymes that break down endocannabinoids decreased after rTMS treatment, thus showing a dual action of rTMS; (3) rTMS elevated the amount of CB1 in hippocampal astrocytes and neurons. Consequently, these data together indicate that the activation of the ECS in the hippocampus is involved in the antidepressant effects of rTMS treatment.
In addition to rTMS affecting the ECS, another study found that longer-term use of lower intensity PEMFs also affect the ECS, especially neural brain cells. Glutamate is an excitatory neurotransmitter in the brain. Moreover, glutamate-induced neural overstimulation (excitotoxicity) is a common cause of many neurological diseases. Therefore, the role of PEMF in glutamate-induced excitotoxicity was evaluated in relation to the ECS. (Li) Notably, PEMF exposure of mouse hippocampus neural cells (HT22 cells) in cultures was a 15 Hz, 9.6 Gauss peak magnetic field for 4 hours in 2 protocols plus 20 and 24 hours of glutamate treatment, and, in another protocol, PEMF was for 4 hours followed 10 hours later by another 4 hours plus 24 hours of glutamate treatment. Consequently, the most significant effects were seen in the extended PEMF exposure of a total of 8 hours.
The PEMF stimulation improved the lifespan of mouse hippocampus neural cells (HT22 cells) and reduced cell death after the induction of excitotoxicity. A CB1 receptor-specific inhibitor suppressed the protective effects of PEMF exposure. Furthermore, AEA and 2-AG were elevated following PEMF exposure, showing that the neuroprotective effects of the PEMF were related to modulation of the ECS. Consequently, these results suggest that PEMF exposure leads to neuroprotective effects against excitotoxicity by acting on the ECS. The ECS can regulate glutamatergic synaptic transmission and neural plasticity. Activation of ECS signaling inhibits excitotoxicity and therefore plays an important role in neuroprotection against ischemic stroke or traumatic brain injury.
The encouraging aspect of these studies using different intensities of PEMFs is the strong probability that PEMFs applied anywhere in the body are likely to have impacts on ECS receptors anywhere in the body. Furthermore, there is also a strong probability that PEMFs can work synergistically with the intake of cannabinoids, whether cannabis/marijuana or hemp-derived CBD. Consequently, this could also mean that dosing with cannabis and/or hemp CBD may be able to be reduced when combined with PEMFs. It could also mean that PEMFs may be able to reduce the side effects of cannabis/CBD when used in combination.
While the above studies specifically focused on rTMS and the brain and depression and neural cell excitotoxicity, we have other examples of PEMFs acting not only on other parts of the body but also in many other conditions, as shown in the Power Tools for Health book.
Weight loss is a complex issue with no quick-fixes or easy answers. Commercial weight-loss programs are a huge industry. However, quite often these programs only work short-term, if at all. Obesity is a growing epidemic. Researchers are looking for answers to both what causes obesity and what the most effective treatments might be. PEMFs for weight loss are a dramatically underutilized tool and in this article we’ll talk about how they can best be used.
Medical treatments for obesity currently include prescription medications, devices such as gastric balloons, bariatric surgery, and altering nutrition and physical activity choices. Medication and surgery carry their own set of risks, with potential side effects that could exacerbate health issues.
Nutrition and exercise are important components of a healthy lifestyle, but weight loss can be slow with these interventions alone, making them harder to stick with. With many programs, even when a significant amount of weight is lost initially, it’s often regained when the intervention ends. That’s why I think it’s worth exploring the effectiveness of PEMFs for weight loss.
Your body has many built in processes that regulate fat burning – and fat storage. These processes ultimately have an impact on how easy it is to lose weight.
Your metabolic rate determines how quickly you will burn calories. Calories are burned while at rest, in everyday activities, and through intentional exercise. You basal metabolic rate (BMR) is the number of calories burned simply to keep your body functioning while at rest. This rate is primarily determined by your genetics, meaning there isn’t a lot you can do to change it. But you can impact calories burned through daily activities and exercise, so metabolism isn’t as static as you might believe.
If you have a “high” metabolism, you’ll burn more calories both at rest and during activity. If your metabolism is “low” you’ll burn fewer calories – which means you’ll need to eat less in order to maintain a healthy weight. With a slow metabolism, gaining weight is easy, and losing it can be very difficult – so you’re hit from both sides!
Quite often, there are stubborn areas where fat deposits build up no matter what you’re doing to lose weight. You may see great results from other treatments in terms of overall weight, but fat in those problem areas just doesn’t budge. Poor circulation is the reason these areas seem to hold on to fat.
When blood flow is poor, fat loss is difficult. That’s why these areas – abdomen and “love handles” in men; hips, thighs, and abdomen in women – are so troublesome. When circulation is poor, fatty acids released cannot make it to the bloodstream to be burned as energy. Instead, they land right back where they came from. Spot reduction exercises don’t work well, because they do nothing to improve blood flow to the area. That’s where PEMFs can help.
Knowing what we do about the relationships between metabolism, circulation and weight loss, as well as how PEMF therapy works, it’s clear to see that there is potential for PEMFs to help with fat reduction and weight loss.
Your cells are powered by energy, and when that energy level dips, these cells cluster together, slowing metabolism. PEMF therapy stimulates cells directly to make more energy, helping give metabolism a boost.
PEMF therapy also promotes the release of fatty acids from fat cells, and improves circulation to those areas where stubborn fat deposits linger, which allows the fatty acids to make it to the bloodstream where they can be processed as energy.
PEMFs increase circulation through three mechanisms. First, PEMFs increase nitric oxide, which helps widen blood vessels, allowing for better blood flow. They also improve separation of red blood cells, breaking up cell clusters. Only one red blood cell can enter the capillaries at a time, so if cells are bunched together, circulation will suffer.
PEMFs also lower the viscosity (density) of water, which helps to emulsify fat. The fat is broken into smaller molecules that can more easily flow into the bloodstream, allowing it to travel to where it can be burned as energy.
PEMF therapy also has potential to impact weight through stimulation of the reward centers in the brain (much like it helps with smoking cessation). A small nine-week study of obese individuals treated with either brain (transcranial) magnetic stimulation (TMS) or a sham treatment suggested that the TMS may help drop pounds and reduce cravings.
Individuals who were given high-intensity TMS lost about ten pounds in five weeks, and cravings had reduced by 34% – both significantly greater than those in the sham group. By the end of the nine weeks, the high-intensity TMS group had lost 3.2% of their initial weight. It is expected that with stimulation beyond 9 weeks even more weight loss would occur, until goal weight is achieved.
Other research has demonstrated the impact of TMS on the balance of bacteria in the gut. When the balance of beneficial to harmful bacteria is off, the messages carried to the brain about appetite and satiety can be altered. Using PEMFs for weight loss by changing the balance of bacteria is a promising new avenue of treatment.
There are no quick-fix solutions, and lifestyle changes are the most likely to both promote and maintain weight loss. Lifestyle interventions also don’t come with adverse side effects. It can be difficult to change your dietary and exercise habits. However, and PEMF therapy might provide the extra boost to weight loss that keeps people motivated.
All participants in the study looking at reward centers were also given advice by both a physical trainer and a nutritionist every two weeks, and with this intervention, the sham control group also lost weight – 1.8% of their baseline. These results show that PEMF could be an effective addition to lifestyle interventions in combating obesity and stimulating weight loss.
PEMF therapy directly impacts the cells. You may experience other secondary benefits, even when the primary intent is weight reduction. PEMFs can rev up your metabolism, by improving thyroid function. Thyroid imbalances can be behind many uncomfortable symptoms, including fatigue, mood problems, and weight gain. This is something I discuss in a lot of detail in the bonus course currently available for power tools for health.
PEMFs also help remove toxins from your body, which not only improves bowel function but also helps burn cellulite. When excess waste and cellulite is removed, weight loss often results.
PEMF therapy can improve chronic pain conditions, especially in the joints. PEMFs help your body heal from injury and boosts energy – which in turn may help you exercise more regularly, thus stimulating faster weight loss.
PEMFs also promote high quality sleep and reduce stress. Both poor sleep and high stress are connected with weight gain – among other issues.
That’s a lot of good reasons to give PEMFs a try. If you’d like to explore the benefits of PEMFs for weight loss, call our office to speak to a member of my team. We can help you find the product that best suits your health needs and budget. We are here to help you take steps towards your weight loss goals – starting now!
I was on the telephone today with a professional singer. He has a chronic complaint of problems with his vocal cords. Many things upset his ability to carry the pure notes that he needs as a singer. Singers, especially professional singers, are very preoccupied with the health of their vocal cords. This is completely understandable, since this is the basis of their livelihoods often.
So what causes the problems with the vocal cords for singers? There are many. Clearly, singing often involves a tremendous range of demand on the vocal cords, with the intensity of the sound produced, the pitch needed and the frequencies to be produced. This requires an incredible decision of a very sensitive apparatus, the vocal cords.
Vocal cords are very sensitive to inflammation and irritation. Inflammation can be caused by acid reflux, for example with hiatal hernias, allergies – with postnasal discharge, respiratory infections, such as colds, autoimmune problems, asthma, chronic bronchitis, toxic air – for example singing in a smoky environment, etc. The list of potential causes of vocal cord inflammation and irritation is very long.
It is not always possible to eliminate all of these causes. So, are there ways to prevent vocal cord damage and problems with vocal cord control?
In the case of the person I consulted with, he had had surgery for his shoulder. As a consequence, he was placed on Celebrex, which suppressed his immune system, leading to a cold, which required various antibiotics. The antibiotics then messed with his gut which probably aggravated a previously dormant gastric reflux problem. All of these led to a significant problem with his vocal cord control. So, from the above example we can see that it doesn’t take a whole lot to upset the delicate balance of vocal cord control.
After dealing with the consequences of all of these issues, my bottom-line recommendation is that he needed to be on PEMF therapy for the vocal cords. We know from other research, that muscles, which are the delicate instruments to control vocal cords too, do much better with PEMF stimulation. PEMFs stimulate myosin phosphorylation. Myosin phosphorylation is what makes energy for muscles to be able to do their work. The Eastern Europeans discovered long ago that treating muscles with PEMFs before competition, in the case of the Olympics for example, allowed the muscles to be worked longer, to work harder and to recover faster. Vocal cord muscles are no different. However they are more subject to the need for precise control. The muscles of vision are similar.
So, for my patient, I recommended treatment with a portable PEMF system, the SomaPulse, prior to any singing engagement, or even practice, and immediately afterwards. By doing this on a regular basis he would decrease the inflammation caused by the potential overwork situation of singing. Decreasing any swelling present prior to singing [and often this would not even be appreciated], would allow much more precision of the vocal cord apparatus. Treating the vocal cords after singing would decrease any inflammation and swelling of the vocal cords that would happen at that time. Daily use of the PEMFs would preserve the vocal cords over an extended period of time, often, nullifying any other potential causes of inflammation of the vocal cords.
PEMFs can dramatically extend the life and function of the vocal cords, and therefore the vitality and career of the singer. Specifically, I recommend the SomaPulse system, although other PEMF systems may also be very helpful. The SomaPulse system offers the value of portability and flexibility, being battery-operated. Additionally, the SomaPulse signal has been proven in NASA research to stimulate stem cells and tissue regeneration factors. So it is impossible for fairly significantly damaged vocal cords to be able to recover a significant degree of function. No matter, I would recommend daily treatment of the vocal cord apparatus. This will maintain the health of the vocal cords, regardless of damage or dysfunction. In addition, PEMFs can help the body in a lot of other ways. The vocal cords react to other health issues in the body. Therefore, treating the whole body is also very beneficial in preserving vocal cord function.
Bottom line, I strongly recommend PEMF therapy for any singer, not only for whole body health, but also to preserve vocal cord function. Could we have saved Adele from a lot of grief with PEMF therapies?
I have been a family physician for more than 40 years. I have helped hundreds of women with life-limiting and embarrassing incontinence and OAB issues. Most of the time, treatment was frustrating and only partially successful. I have always looked for alternative approaches that were not invasive to help with this condition. Even these did not often work successfully.
I have worked with PEMFs for a vast range of health issues for a long time. I have encountered interesting responses from patients, particularly females, who have had improvements in their urinary incontinence issues from the use of PEMFs.
Because of these observations, I decided to do a review of the scientific literature on the use of PEMFs for this problem. I was pleasantly surprised to see a reasonably significant number of articles describing research being done on urinary incontinence and overactive bladder. This research is very promising and ranges from the use of high intensity PEMF systems in the professional office setting to the use of much lower intensity PEMF systems in the home setting. My experience has been that high intensity PEMF systems can often get good results in a short time, but often the results don’t last.
This is because high-intensity PEMF systems do not always create a physical change in the tissue in the short time in which they are used. This means that they will require multiple courses of treatment over the years. On the other hand, using a home-based, battery-operated PEMF system, worn over the bladder area, many hours a day, possibly even overnight, seems to be very effective, and possibly over the long run even more effective. This is true because of the need to change the physical characteristics of the bladder itself in terms of the inflammation, bladder muscle irritability, and reduce the number of overactive nerve cells contributing to the problem. PEMFs lend themselves extraordinarily well to this complex set of changes that happen in the bladder over time to create an overactive bladder, leading to incontinence.
Better solutions than the current medical solutions (typically medications, procedures or surgeries) are necessary. Electrical stimulation, as noted in a recent study, is not anywhere as effective as PEMF therapy (and nowhere near as comfortable). But, electrostimulation is in the domain of the practitioner and healthcare facility, and that is what they are going to recommend, because that is the only tool they have. We know now as well that pelvic exercises don’t work over time.
Certainly pelvic exercises do make any kind of other external stimulation approach work even better. Many women begin to actually recognize contractions of their pelvic muscles after using high-intensity PEMFs. Then, they can go home with a home-based PEMF stimulation system to finish the job. But, using high-intensity PEMFs to begin a course of treatment is not necessary, since home-based PEMF systems will work well over time anyway, and Kegel exercises may not be necessary.
In my review of the science, it’s clear that high intensity PEMFs do improve OAB and urinary incontinence significantly, including positively changing the underlying causes of the incontinence in the bladder tissue itself. At the same time, research is showing that even very low intensity magnetic fields, worn throughout the day for upwards of 2 months at a time also produce improvement. Some of the studies at the lower intensities used 10 Hz and 18.5 Hz, both producing positive results.
Higher intensity systems are typically limited to much lower frequencies, or repetition rates, usually less than 10 Hz. But from all of this research, there is still no certainty as to which frequency or intensity works best. From my experience, it’s probably much more important to be using PEMF therapies of whatever kind, on a consistent basis, over the bladder or pelvic area, daily, for an extended period of time. In the long run, this is going to create the physical changes in the bladder that are necessary to reverse the tissue changes causing the bladder overactivity problem. The body has its own pace of healing and we need to acknowledge and respect that.
So, from this review I’m optimistic that we can offer significant relief to millions of women suffering from overactive bladder and urinary incontinence unnecessarily, given the inexpensive, comfortable home-based PEMF solutions available. These are expected to produce much better long-term results than current therapies, with a lot less risk.
As an aside, while most of this review is focused on female urinary incontinence, a number of the studies within included males in their research. Males often had similar results to females in the improvement of their OAB and urinary incontinence. So, ladies, if you have male partners, family members or friends who suffer from incontinence, this technology are likely to benefit them as well.
Over the years of practicing medicine, I have worked with hundreds of women with urinary incontinence. Most of the time these were women who had delivered babies. It’s commonly accepted that women who delivered babies naturally would be expected to have stress urinary incontinence down the road. That was the old thinking. It made sense at the time. However, as we have learned more and more about this common and very stressful problem, we have discovered that it is not as simple as the stretching of the tissues of the birth canal with the birth process.
We were all taught that women needed to do pelvic exercises to strengthen the muscles of the pelvis [Kegel exercises] to reduce the symptoms of stress incontinence. Again, that was a very simplistic approach in hindsight. A whole new concept of what is going on with urinary incontinence (UI) has emerged as science has evolved.
At minimum, 11 to 16 million women in the United States cope on a daily basis with symptoms that include sudden strong urges to urinate, difficulty delaying urges to urinate, frequent trips to the bathroom, and in many cases involuntary loss of urine when urgency strikes. They may wear pads or adult diapers for accidents, plan ahead for access to bathrooms, and modify their social and work lives to accommodate their symptoms. Some are very distressed by the symptoms, whether mild or severe, and others find mechanisms to adapt, reporting little trouble with symptoms or interference with normal routines.
Others report their symptoms negatively influence quality of life factors, including: loss of self-esteem, attractiveness, and sexual function. The majority of women believe that some amount of urinary incontinence is inevitable with aging. Women with these symptoms tend to not talk with their health care providers concerning their bladder dysfunction, and providers may not routinely inquire. As a result, a small minority receive treatment.
Between 10-40% of women have UI (possibly even more), and the percentage increases with age. There are 3 basic types of UI: stress, urge, and mixed. Overall, about half have stress incontinence, a smaller proportion have mixed, and the smallest is urge. Since women often have mixed incontinence [MI], the more commonly used term today is overactive bladder [OAB]. OAB with urge incontinence happens in 10% of women 18+ years of age (less than 5% in the age group 18–44 and up to 19% in the 65+ age group).
The severity of the symptoms is critical to determining treatment approaches and the likelihood of success of treatment, and severity increases with age. Significant incontinence is present in 9-13% of women over 55. Remission or improvement in UI is seen particularly in stress incontinence and primarily because women develop coping strategies that decrease the reported frequency of episodes of UI. Not so with OAB, which typically can get worse with time or age.
Urinary incontinence is an important health problem to the individual sufferer and to health services. Risk factors for UI include age, pregnancy and childbirth, menopause, hysterectomy, obesity, lower urinary tract symptoms, functional or cognitive impairment, occupational risks, family history, genetics, and a host of other factors, including diabetes, use of diuretics, cigarette smoking, dementia, etc.
Treatments include prescription medications or patches, surgeries and procedures (including sacral neuromodulation and botulinum injections), behavioral interventions such as bladder training, and complementary and alternative medicine options such as acupuncture and reflexology.
All these treatments, of course, have varying success rates.
All drug treatments are effective at improving one or more overactive bladder [OAB] symptoms when compared to placebo. Reductions ranged from 0.9 to 4.6 incontinence episodes per day across all drug treatments and from 0.7 to 4.2 in voids per day. No one drug is clearly better than others. Extended release formulations taken once a day reduce urge urinary incontinence [UUI] by about 2 episodes per day, and total urinations by 2 per day. Immediate release forms taken twice or more a day reduce UUI episodes by 1 per day, and urinations by 2 per day. Of note, placebo reduces UUI by 1 and voids by 1 per day. Even with these small results on symptoms, drug treatments increase quality of life and reduce distress, compared to no treatment.
Procedures and surgical treatments include sacral or peripheral neuromodulation, bladder instillation or injection of drugs, bladder distention, and cutting nerves to the bladder. The strength of the evidence for managing OAB with procedural and surgical treatment is weak outcomes of this care.
Stress incontinence is more often managed by surgery due to advances in surgical techniques. While not well proven for its value, most clinicians use invasive urodynamic testing (IUT) to prove stress incontinence before offering surgery. IUT is expensive, embarrassing and uncomfortable for women.
Behavioral interventions include bladder training and more complicated behavioral training (with or without biofeedback), pelvic muscle exercises, vaginal electrical stimulation, and caffeine reduction. Managing OAB with behavioral treatment approaches alone gets moderate to weak short term benefits and weak benefits in the long term. Still, overall, behavioral approaches can reduce episodes of incontinence and daily voids at least somewhat. Complex approaches are close to drug treatment in getting modest improvements, reducing leakages by up to 1.9 per day, and emptying’s per day up to about four. Behavioral approaches do not enhance drug therapy for reducing episodes of incontinence or voiding.
These treatment options include acupuncture, foot reflexology, and hypnotherapy. The evidence for complementary and alternative approaches to managing OAB is weak. Acupuncture may decrease frequency of voiding and symptoms of urgency, with objective evidence from bladder measurements [cystometrics]. Women felt they were improved in the bother associated with incontinence and the quality of life. The results may be similar to the use of drugs. Reflexology needs more evidence know the benefit. Hypnotherapy, or hypnosis, is likely not to be very useful. Given the big role belief plays in OAB treatment, it has been difficult to prove the value of hypnosis.
Total direct health care costs for women with OAB in 2000 were estimated at $6.9 billion, of which $1.1 billion were for drug treatment and $550 million for surgical treatment. Medication costs for OAB with the two most commonly used drugs ranged from $56 to $360 over a twelve month period for newly diagnosed patients. And, these drugs do not cure the problem, only control it. So, these costs will be lifetime.
The research seems to indicate that the evidence is not strong to support the current treatments for OAB. Medications can provide symptom relief which is often not complete, but suffering women see these as better than nothing, and they are convenient. Because benefits of current treatments are only modest, there is a need to consider the value of combinations of types of treatments.
One of the fundamental causes of the relatively poor performance of current treatments may well be due to a previous lack of understanding of the fundamental mechanisms involved in UI. As a result of this new information, it appears that one potentially very valuable set of tools for managing incontinence would include magnetic field therapies, particularly PEMFs.
Overactive bladder syndrome (OAB) typically includes the lower urinary tract symptoms of frequency, urgency, and varying severities of urgency urinary incontinence. It is specifically defined as “urgency, with or without urge incontinence, usually with frequency and nocturia”.
Other than some of the obvious causes listed above, there is now emerging a better understanding of the tissue changes involved in the bladder to produce OAB. Three hypotheses exist to explain this.
The myogenic hypothesis states that the smooth muscle cells of the overactive bladder are more susceptible to contraction, and smooth muscle bundles contract in groups, allowing for the possibility that physical changes in the muscle fibers allow local activity to spread to the rest of the bladder, making it more susceptible to spontaneous contractions.
The peripheral autonomous hypothesis states that bladder overactivity is due to enhanced coordination of muscle activity by bladder wall nerves. An imbalance of stimulation and relaxation increases autonomous activity, possibly resulting in increased bladder sensation as well as bladder overactivity.
The neurogenic hypothesis states that some nerve fibers are generally quiet during normal bladder voiding. These fibers can form new pathways, and then may be responsible for bladder pain and overactivity, carrying urinary impulses to the spinal cord.
Neurogenic theories suggest that bladder overactivity arises from generalized nerve excitation of the bladder muscle. The main trigger for changes in transmission of nerve signals from the bladder to the central nervous system may be nerve growth factor (NGF), which is elevated in OAB. Blockade of NGF by antibodies against NGF prevents frequent urination, bladder contractions, urination urge activity, and swelling of spinal cord neurons. Based on these findings, NGF plays a critical role in the pathophysiology of OAB.
Although the cause has been divided into neurogenic and non-neurogenic types, there has also been investigation into the role of inflammation in the development of bladder overactivity.
In rats with OAB, injection of COX-2 anti-inflammatories into the bladder reduced inflammatory molecules in bladder tissue and improved bladder contraction. In experimental cystitis, treatment with a peptide that inhibits inflammatory markers reduced inflammation and nerve factors such as NGF, improving symptoms of OAB. Therefore, we can conclude that interaction among other inflammatory disorders in the body, pro-inflammatory molecules, and the peripheral and central nervous system are responsible for the development of OAB.
At one level, anti-inflammatory drugs aid in the treatment of OAB symptoms by reducing inflammatory responses. Also, there is evidence to show that OAB may be improved by using various electromagnetic stimulation strategies.
There are 3 basic approaches studied using magnetic fields to stimulate the bladder to reduce the symptoms of OAB and stress incontinence. These include static magnets, direct stimulation of the bladder, and stimulation of the nerves controlling bladder function. Stimulation of the nerves that control bladder function includes stimulation of spinal nerves, the pelvic pudendal nerve and the tibial nerve in the leg. Sacral nerve stimulation involves invasively stimulating the pelvic pudendal nerve and the sacral spinal nerve roots.
Pelvic floor muscle electrical stimulation is an alternative treatment for urinary frequency and urge incontinence with a success rate from between 45% and 91%. There are various approaches for delivering electrical pulses. Use of electrical stimulation is still not commonly accepted, primarily because of discomfort and invasiveness.
Electrical sacral nerve stimulation via an implant for medication resistant OAB treatment has been studied. Sacral nerve stimulation is an increasing alternative gaining some use.
With regard to the use of static magnetic stimulation of the pelvic floor, compared to placebo, the use of 15 static magnets of 800-1200 Gauss, in undergarments to the front, back, and underneath the pelvis for at least 12 hours a day for three months was studied. This study found no evidence that static magnets cure or decrease the symptoms of urinary incontinence.
Magnetic stimulation is a new technique for stimulating the nervous system noninvasively. It can activate deep neural structures by induced electric currents with much less or no pain.
We have mentioned many times before in other updates that a major aspect of the benefit or value of PEMFs is to reduce inflammation. In addition, there is the expectation that PEMFs should also reduce nerve cell firing (the neurogenic theory). Plus, there is evidence to show that PEMFs can also reduce muscle irritability or spasticity (the myogenic theory). Recent research showed that activating sacral bladder nerve roots by magnetic stimulation suppressed OAB contractions in patients.
Neuromodulation has revolutionized the management of OAB and is now well established as a safe and effective treatment for those who don’t respond to conservative medication treatments. Most of this involves uncomfortable and surgically implanted electrical stimulation. PEMFs have been discovered to have similar actions without the discomfort, cost or harm.
Treatment of OAB should progress from the least to most invasive modality, and neuromodulation is a more attractive option owing to it being a minimally invasive approach, tolerable, having positive outcomes, and being reversible.
Multiple neuroanatomical pathways have been described for sacral neuromodulation including the sacral S3 nerve root, pudendal nerve and tibial nerve. The S3 nerve root is currently the main treatment target and has the most long-term data on safety and efficacy to support its use. However, studies on neuromodulation at the pudendal nerve or posterior tibial nerve have been positive and their role in treatment continues to evolve. Most urologists who are experienced in voiding dysfunction can become proficient in each technique. Patient selection, surgical techniques and postoperative management differ slightly between approaches and urologists should familiarize themselves with these differences.
Neuromodulation has been reported to be effective for the treatment of stress and urgency urinary incontinence. The cure and improvement rates of pelvic floor neuromodulation in urinary incontinence are 30-50% and 60-90%, respectively. In clinical practice, vaginal, anal and surface electrodes are used for external, short-term stimulation, and sacral nerve stimulation for internal, chronic (long-term) stimulation.
The effectiveness of neuromodulation has been verified in a randomized, placebo-controlled study. However, the superiority to other conservative treatments, such as pelvic floor muscle training has not been confirmed. A long-term effect has also been reported. In conclusion, pelvic floor exercise with adjunctive neuromodulation is the mainstay of conservative management for the treatment of stress incontinence. For urgency and mixed stress plus urgency incontinence, neuromodulation may therefore be the treatment of choice as an alternative to drug therapy. (Yamanishi, 2008)
Percutaneous tibial nerve stimulation (PTNS) has been proposed for the treatment of overactive bladder syndrome (OAB), non-obstructive urinary retention (NOUR), neurogenic bladder, paediatric voiding dysfunction and chronic pelvic pain/painful bladder syndrome (CPP/PBS). (Gaziev) Electrical stimulation of the posterior tibial nerve (PTN) has become an established therapy option for the treatment of OAB that failed medical therapy. An implant is surgically placed near the PTN and activated by an external pulse generator. When you have the PTNS treatment a very fine needle (just like an acupuncture needle) is inserted into the lower leg, slightly above the inside of the ankle. This is the area where the tibial nerve runs.
A small pad is stuck to the skin on the bottom of the foot on the same leg. This is a bit like the pads that get stuck on your chest if you have an ECG test. These two electrodes (one needle, one skin-pad) are then connected to the pulse generator which delivers an electrical signal that travels along the tibial nerve up to the sacral nerve plexus in the pelvis. One of the functions of the sacral nerve plexus is to control bladder and pelvic floor function.
When women’s responses to PTNS are compared to standard medication as the only therapy, there are no significant differences in results. Urine leakage associated with a feeling of urgency and loss of stool or gas from the rectum beyond patient’s control became significantly different after treatment in both groups about equally well. (Eftekhar) PTNS was also studied in patients with OAB persisting after 2.5 years of using first-line anticholinergic drugs.
The patients did daily PTNS at home. PTNS was successful following 1 month of treatment in 53% patients. After follow-up at about 10.8 months, 49% continued PTNS. Bladder function scores stayed lower than before treatment. PTNS was considered a second therapeutic option before surgical treatment. (Ammi) Since PTNS is equivalent to medication in its effects, and it is invasive and expensive, it is considered to be 2nd line therapy only, in those who fail medical therapies.
A small number of patients were followed for 9 yrs. Six of the seven patients still had sensory and muscle responses on stimulation at 9-year follow-up. Three of four patients who had a successful treatment response at 1 year, still use the device 9 years later. After 9 years of clinical experience the implant was found to be a safe therapy for OAB.
OAB occurs in patients with other medical conditions. In these situations therapies are much more limited than in the general patient with OAB. When PTNS is compared to pelvic floor muscle training with biofeedback in multiple sclerosis (MS) patients with mild disability, both approaches improve symptoms related to urgency to the same extent. (Gaspard) Pelvic floor muscle training is very time-consuming, expensive and the benefits do not last without continuing some kind of muscle training indefinitely. PTNS was also found to be very helpful in neurogenic OAB after stroke, reducing urinary frequency and urgency.
The long-term efficacy and safety of PTNS for OAB after 3 years from the start of an ongoing course of therapy was established for a particular stimulation system. Patients completed a 36-month program getting 1 treatment per month after an initial 14-week treatment program. 77% maintained moderate or marked improvement in OAB symptoms at 3 years. Voids per day decreased from 12 to 8, nighttime voids decreased from 2.7 to 1.7 and urge incontinence episodes decreased from 3.3 to 0.3 per day. All quality of life parameters remained markedly improved from baseline through 3 years. So, when PTNS is initiated the patient has to commit to long-term therapy with an implanted invasive, electric stimulator.
Another form of stimulation for OAB is another less acceptable invasive approach, vaginal electrical stimulation (ES). ES and PTNS have been compared. ES was applied for 20 min, three times per week for 6-8 weeks with pulses of 10-50 Hz square waves or with 5-10 Hz frequency,. PTNS was applied for 30 min once a week for 12 weeks. Objective tests after both treatments decreased significantly almost to the same extent in each group, but the decrease in the ES group was somewhat greater. The number of patients who describe themselves as cured was higher in the ES group.
The costs and cost-effectiveness of PTNS and sacral nerve stimulation (SNS) have been evaluated. SNS is a more invasive procedure, requiring the insertion of electrodes into the inside of the pelvis. The costs of initial therapy were $1,773 for 12 weekly PTNS treatments. SNS requires an initial evaluation test at $1,857. For ongoing therapy the cost of the SNS surgical implant was $22,970. 2-year maintenance costs were $3,850 for PTNS and $14,160 for SNS, including those who discontinued therapy.
Only 48% and 49%, respectively, remain on therapy at 2 years. PTNS had substantially lower overall cost. Because of the slightly higher rate of success with SNS, an additional 1% of patients would remain on therapy at 2 years if SNS were used rather than PTNS, but the lifetime average cost per patient would be more than $500,000. (Martinson) So, because of concerns about insurance coverage, with a high risk of these costs being mostly borne by the individual patient, there need to be other less expensive alternative therapies available to these very expensive and invasive procedures.
PEMFs may be an ideal neuromodulation alternative to help treat OAB, without the high costs and the need to endure procedures, including tolerating long standing electrical implants in the body.
Neuromodulation also happens with PEMFs, since these magnetic fields reach deep into the body and pelvis non-invasively. Therapeutic electric fields do not go deep into the body. This is why electrical stimulation usually has to be done right on the nerve or muscle being stimulated. That’s also why the stimulators have to be surgically implanted.
PEMFs also have varying abilities to penetrate deep into the body or act on specific nerves or tissues. The deeper in the body the tissue is that needs stimulating the stronger the magnetic field often needs to be. High intensity PEMFs are usually required to do sacral nerve stimulation. High intensity repetitive 15 Hz magnetic stimulation (rMS) was evaluated in women with stress incontinence. rMS of the sacral nerve roots (S2-S4) was applied for 15 mins, 3 days a week for 2 weeks (6 times in all). At 1 week after treatment ended patients in the active stimulation group showed improvement in health perception, social limitation, sleep/energy performance and incontinence severity.
These results were not seen in the sham stimulation group. Also, these results were no longer seen at 1 month after the end of treatment. So, rMS of the sacral roots has a short-term benefit on the quality of life of patients. This is also true as well for electrical stimulation. And, these results are comparable to those seen in short-term treatment programs for pain management using rMS, suggesting that longer-term courses of treatment are necessary. (Manganotti) While this research group did not find significant physical changes with short-term high intensity magnetic stimulation, another group (Fujishiro 2000, Fujishiro 2002) found that with only 30 minutes of treatment with rMS, the number of leaks and amount of urine loss on a pad test significantly decreased with only one treatment session. They also found that there was a 74% improvement in quality of life.
A group of Japanese researchers has worked for years on developing techniques of using magnetic stimulation as part of neuromodulation. They devised a continuous magnetic stimulator allowing longer-term, in office magnetic stimulation, using a magnetic chair type device. They wanted to see if continuous magnetic stimulation would result in strengthening the closing of the urethra when under pressure and inhibition of bladder contractions in dogs. The stimulating coil was placed underneath the pelvis to stimulate the pudendal nerve at 10 Hz. Urethral pressure was increased by more than double and bladder contraction was inhibited. (Yamanishi, 1999) In effect OAB was improved.
In addition to doing neuromodulation, PEMFs may also be able to work on muscle, addressing the myogenic theory and helping with the muscles of the bladder and pelvis itself. In Kegel’s exercises the goal is to stimulate the muscles to contract to reduce incontinence secondary to the lack of muscle strength in the pelvic muscles, affected by the stretching of the tissues during labor, which maintain the position of the bladder in relation to the urethra. When this position is disrupted stress incontinence happens. Kegel exercises frequently fail, for many reasons. As noted above, even stress incontinence can be associated with urge incontinence, partly due to bladder muscle irritability. PEMFs not only strengthen pelvic muscles but also work on the irritable bladder muscles to relax.
An early clinical trial in a small number of women found that magnetic stimulation of the pelvic floor muscles may be effective for urge incontinence, too. (Suzuki) Patients with urge incontinence, who failed pelvic floor muscle training, were given high intensity 10-week PEMF treatments with a continuous 10Hz chair device at about 1100 gauss. They had a number of tests conducted at the end of the 10 week cycle of treatments. This group was compared to another group receiving sham treatments. Magnetic stimulation was found to be effective in reducing urge incontinence in both physical and subjective measures.
In another study by the same group, using 20 Hz 15-minute (with 1-minute on/30-second off cycles) stimulation twice a week for 5 weeks, they studied women with stress incontinence and another group with urge incontinence with magnetic stimulation. In that study, 86% of patients with stress incontinence and 75% with urge incontinence were improved.
The ability of the urethra to control pressure from the bladder to urinate is important in reducing incontinence, to allow some degree of voluntary control, that is, delaying the urge to urinate. In earlier work done by the same Japanese group, they studied the use of a magnetic coil underneath the pelvis in the area from the anus to the pubic bone, called the perineum. They confirmed that urethral pressure increased, suggesting that magnetic stimulation can be effective as a urinary incontinence therapy. (Ishikawa, 1998)
In another study they then looked at the ability of PEMFs to control urethral pressure. An active PEMF treatment group received high intensity functional PEMF stimulation. The stimulating intensity was gradually increased to the tolerable limit. (This is a common approach that we use in the office setting, since individual tolerances tend to vary.) A 15-minute, 20Hz single session was carried out using an on-off cycle of PEMF stimulation. In the active PEMF treatment group, the maximum urethral closure pressure increased significantly after stimulation. In the sham group, no changes were seen. All women tolerated the functional continuous magnetic stimulation well, and none experienced any adverse effect. (Yamanishi, 1999)
In a much larger study to evaluate the efficacy and safety of magnetic stimulation for the treatment of urinary incontinence in women with overactive bladder, a larger group of women with urge incontinence were randomized to active stimulation or sham stimulation. An armchair-type magnetic stimulator was used for 25-minute magnetic stimulation twice a week for 6 weeks, with a magnetic field intensity of 560 mT (5600 gauss) peak at 10 Hz. The sham device only delivered a maximum intensity of 20.4% at 1 Hz.
The number of leaks per week, number of voids/urgency per 24 hours, mean and maximum voided volume, and the quality of life assessment were measured. The active treatment group experienced about half the number of leaks/week and number of urgency sensations/24 hours and a large increase in the amount of urine voided. As for safety, except for rare diarrhea and constipation, no patients experienced any device-related adverse event. (Yamanishi, 2014)
As the above study found, very few adverse events are typically found with PEMF stimulation, even with high intensity PEMFs. To verify this, another group evaluated whether there were any obvious tissue or cycle changes in rats receiving continuous stimulation to their genital organs (uterus and ovaries). The rats underwent 36 sessions of 25-minute PEMF stimulation with 10Hz at a maximum output level of 560 mT (5600 gauss) once per day, 5 days per week. No adverse effects of long-term pulsed magnetic stimulation were noted. Rats are much more sensitive to PEMFs than humans, and because of their high metabolic rate, tend to show adverse effects results sooner than would be seen in humans. So, these results are reassuring to the potential risks to humans of frequent treatment to their pelvic organs with PEMFs to improve OAB and incontinence.
While high intensity PEMFs may be very useful to produce short-term benefit for OAB and incontinence, there is always the concern that recurrent courses of treatment may be necessary, potentially for the rest of a woman’s life. As a result, it is useful to know whether lower intensity home-based PEMF systems may be able to produce comparable results.
In one research study, investigators at the University of Maribor in Slovenia, Department of Urogynecology, used a portable magnetic therapy device worn in a garment over the bladder continuously all day. Women with urinary incontinence receiving active device treatment were compared to a group of women who used a non-active sham device. The treatment device had a pulsating magnetic field 10 microTesla and 10Hz frequency, which was worn day and night for 2 months.
Compared with the sham device, the number of pads used was significantly lower, as was the pad weight, and a significant improvement in the power and duration of pelvic floor muscle contractions. Active magnetic stimulation produced a 56% improvement in urinary incontinence symptoms compared with 26% improvement in the sham group. This form of magnetic stimulation is efficient and safe, can be used at home, and because of its small size, wearing the device is not annoying for patients.
In a different study, this group used a similar portable device with 18.5 Hz in women with mixed incontinence and using more objective measures of bladder function. The device was similarly applied: day and night for 2 months. After 2 months of magnetic stimulation there were significant decreases in voiding frequency, nighttime urination and pad use. First sensation of bladder filling and maximum bladder capacity increased significantly before and after stimulation only in the active stimulation group. 78% reported improvement in symptoms after magnetic stimulation with an average success rate 42% versus the sham group at 23%.
The same group looked at the use of this same type of PEMF stimulation in young females with enuresis, or nighttime bedwetting. This relates to women with incontinence, because frequent nighttime urination is a common distress with OAB. Females, mean age 10.8 years, range 6-14 years, were randomly assigned to either active 18.5 Hz magnetic stimulation or sham stimulation.
As above, they wore their stimulators continuously day and night for 2 months. In the active treatment group, the number of weekly enuresis episodes decreased significantly compared to sham, from 3.1 to 1.3 per week. Three girls from the active group were completely dry and four were significantly improved. Also, in the PEMF group there was a significant increase in bladder volume at the time of a strong desire to void as well as an increase in bladder volume at that void.
As mentioned earlier, much research has been conducted using electrical stimulation as neuromodulation for reducing symptoms of OAB. The challenges with this form stimulation are that it typically is invasive and very uncomfortable and does not allow for home use.
One study was done specifically to compare the two modalities. In that study, an armchair-type device with a local stimulation coil at 10 Hz was applied continuously. Objective measures of improvement were collected. The bladder capacity at the first desire to void and the maximum measured bladder capacity increased significantly during stimulation compared with pre-stimulation levels.
The measured maximum bladder capacity increased significantly more in the magnetic stimulation group by 106% compared with the pretreatment level than that in the electrical stimulation group, which had an increase of only 16%. This is a huge difference. Bladder overactivity was abolished in 3 patients in the magnetic stimulation group but not in any patient in the electrical stimulation group. Although both treatments were effective at some level, the inhibition of bladder overactivity was far greater in the magnetic stimulation group.