Neuromyelitis optica (NMO) is an uncommon disease syndrome of the central nervous system (CNS). It affects the optic nerves and spinal cord. Individuals with NMO develop optic neuritis, that is inflammation of the optic nerve. This causes pain in the eye and vision loss. It also causes transverse myelitis, which is inflammation of the spinal cord. This can lead to weakness, numbness, and sometimes paralysis of the arms and legs. Furthermore, one can experience sensory disturbances and loss of bladder and bowel control.
NMO leads to loss of myelin, which is a fatty substance that surrounds nerve fibers and helps nerve signals move from cell to cell. The syndrome can also damage nerve fibers and leave areas of broken-down tissue. In NMO, immune system cells and antibodies attack and destroy myelin cells in the optic nerves and the spinal cord. In some ways NMO acts like MS, but is more severe and acute, typically. As with many other conditions, PEMFs are not likely to cure the condition but may be very useful in a supportive role to decrease complications and support the tissues. Nutrition and use of supplements specific for inflammation and the nervous system are also necessary to enhance the value of PEMFs.
PEMFs would be expected to reduce inflammation. They’d improve the capacity of the cells to absorb nutrients and supplements. Furthermore, they’ll even potentially to help recover nerve cell damage. There were two studies on MS reported in my book, Magnetic therapy in Eastern Europe. All treatments produced some benefit but two treatment courses with PEMF exposures from shoulders to legs, in 3 regions, for 10 minutes each exposure, were better than any other treatment option at a statistically very significant level. The author concluded that magnetic therapy was always well tolerated and because this method is simple, it is useful in the outpatient care of MS patients, in both improving subjective and objective functional use of muscles. Similar results were seen with another study in improvements in ambulation. Because NMO and MS are similar in several ways clinically, the benefits seen with MS patients may be reasonably expected with NMO.
Multiple sclerosis (MS) is a chronic, complex, and often disabling disease of the central nervous system (CNS) with a variable clinical course. There are two basic forms of MS – relapsing/remitting and progressive. There is significant overlap between these two forms. Patients with MS have inflammation, demyelination, scarring of brain tissue, nerve cell degeneration, and dysfunction resulting from dysfunction of the immune system. Inflammation causing demyelination predominates in the relapsing remitting phase of the disease and is seen as recurrent episodes of worsening and improvement (exacerbation and remission). Neurodegeneratiion, leading to extensive brain nerve cell (neuronal) damage, occurs at the same time as the inflammatory process in progressive stages of the disease.
MS affects more than 2.1 million people worldwide and over 400,000 individuals in the United States, with about 200 new patients diagnosed every week. Although it can affect individuals at any age, MS is usually diagnosed between the ages of 20-40 years and is approximately 3 times more common in women than in men. As a leading cause of disability in young adults, MS substantially affects an individual’s quality of life and can cause a major financial and functional burden on the patient, family, and health care system.
The main symptoms of MS can vary by patient and may change or fluctuate over time. For many years MS has been considered a white matter disease (i.e., involving sensory and motor findings). Magnetic resonance imaging (MRI) has allowed us to see that MS lesions occur in grey matter too (i.e., involves cognitive behavior), leading to a wider range of complex neurologic symptoms.
Some of the more common symptoms may include varying degrees of vision problems, fatigue, paresthesia, bladder/bowel/sexual dysfunction, gait problems, spasticity, dizziness/ vertigo, pain, depression, and cognitive dysfunction. Less common symptoms may include headache, hearing loss, seizures, tremors, incoordination, and speech and swallowing difficulties. These symptoms may lead to additional secondary complications, e.g., urinary tract infections, loss of muscle tone, decreased bone density, shallow breathing, pressure sores, and tertiary, e.g., social, vocational, and psychological complications, which create their own challenges to effectively treat and manage.
Because MS is diagnosed at a relatively young age (20 to 40 years), and continues to evolve over time, it causes a greater economic burden than many other chronic diseases over the lifespan of the individual and has a huge impact on health, quality of life, productivity, and employment over many years.
No one knows what causes MS. It is influenced by multiple interacting genetic, environmental, nutritional, hormonal, and viral factors. It is also correlated with geophysical parameters, such as sunshine exposure and variations in the Earth’s magnetic field, both of which are a function of location and seasonal influences.
Treatment of MS has advanced significantly over the past several decades. Historically, MS treatment was mostly supportive in decreasing the severity of exacerbations (MS attacks), relying on short-courses of powerful steroids. In the 1990s disease-modifying therapies (DMTs) began to be used for long-term treatment, to proactively manage and retard disease progression. While DMTs have benefits in reducing the occurrence of relapses and future disability, they can have important side effects. Despite their popularity and heavy reliance with doctors, they do not work equally well in everybody, reducing relapse rates only by only about 30%.
There is no consensus as to which DMT should be used for what type of MS patient. There are no studies that have evaluated which therapies are most appropriate for a particular MS patient group. The benefits of typical DMTs happen over long periods of time, typically beyond 4 years. This is another reason why new options for shorter term therapies are necessary for the comprehensive and total management of MS.
Generally, treatment with traditional therapy is considered relatively safe. The most frequently adverse effects include: injection-site reactions, flu-like symptoms, fatigue, muscle pains, elevation of liver enzymes, blood abnormalities, fat atrophy, infections, post-infusion reactions, and progressive multifocal encephalopathy (PML)- an often fatal demyelinating disease of the central nervous system. PML has been confirmed among 104,300 patients treated with natalizumab, 62 being fatal. Mitoxantrone may cause therapy-related acute leukemia and cardiotoxicity.
Fingolimod can lead to cardiac abnormalities such as slow heart rate and heart block, hypertension, liver and respiratory changes, infections, and macular edema. Teriflunomide and leflunomide may cause diarrhea, elevated liver enzymes, nausea, flu-like symptoms, and thinning or loss of hair, embryo-lethal effects in some animals. BG-12 has been associated with flushing (30%-40%) and gastrointestinal symptoms (e.g., diarrhea, nausea/vomiting, abdominal pain; about 20%). Alemtuzumab may cause hyperthyroidism and auto-immune thrombocytopenic purpura (ITP), and increased risk for super-infections and cancers.
So, given all these limitations of current approaches to managing MS, this is yet another reason that new approaches are needed.
In the search for other therapies to help manage MS, I have become aware of the potential for pulsed electromagnetic fields (PEMFs) to impact neurological tissue at a fundamental level. While there is little evidence at this time to suggest that PEMFs may actually be able to reduce plaque size, there is some suggestion that there is a possibility that PEMFs may be able to reduce recurrences and perhaps delay progression of MS as well.
Research suggests that PEMFs – although not a cure – can alleviate many of the major symptoms of MS, including spasticity, fatigue, cognitive function, mood changes and other impaired physiologic functions. This is because PEMFs act at such basic cellular and physiologic levels. They improve the function of all cells of the body, even those impaired by any specific disease process, such as MS. As such, PEMFs can substantially enhance the quality of life of individuals with MS without the side effects associated with pharmaceutical approaches.
Because every molecule, cell, organ in our body emits and is sensitive to electromagnetic fields, our biochemistry is influenced by our electromagnetic nature. As such, efforts to develop new therapies based solely on dysfunctional biochemistry without considering this nature ultimately will be limited. It is like replacing worn auto tires without aligning the wheels that caused the tires to get worn in the first place, i.e., you need to tackle both problems, so they don’t recur.
Although there is no tissue in which our electromagnetic nature is more evident than MS-attacked nervous tissue, most therapeutic efforts have emphasized the disease’s overt physical symptoms associated with demyelination. They also minimized, until recently, the role of its less understood, underlying electromagnetic dynamics.
Electromagnetic fields influence many biochemical and physiological processes. Although the specific mechanisms by which such fields alleviate MS symptoms remain undefined, many possibilities exist. For example, through influencing the flow of charged ions through membrane-transversing, protein channels, electromagnetic fields may enhance signal conduction in dysfunctional neurons. In another example, magnetic fields alter our neuro- and immunochemistry, both of which are affected by MS.
Electromagnetic fields influence the levels of various MS-altered hormones. Dr. R. Sandyk (Touro College, NY) has intriguingly suggested that a key player in the disease’s etiology is the brain’s all-important, magnetically and light-sensitive pineal gland, which secretes hormones (e.g., melatonin) that affect the entire body (J. Alternative & Complementary Medicine, 1997; 3(3): pp 267-290).
The epidemiology, pathogenesis, clinical manifestations, and disease course of MS can all be correlated with the pineal gland. For example, most individuals with MS have calcified (i.e., dysfunctional) pineal glands. If MS demyelination is a secondary consequence of pineal dysfunction, Sandyk believes research efforts should focus on therapeutic interventions, such as magnetic therapy, that enhance pineal functioning. [Interestingly, quadriplegics, but not paraplegics, also have dysfunctional pineal glands (Zeitzer JM et al. J. Clinical Endocrinology & Metabolism, 2000; 85(6): pp 2189 –2196)]
Magnetic field therapeutic interventions reviewed below use PEMFs in which an electromagnet is turned on and off at a defined frequency. For example, a field that is pulsed 25 times per second has a frequency of 25 cycles/second or Hertz.
Field strength is defined by gauss. For reference, the Earth’s magnetic field is about 0.5 gauss, a refrigerator magnet is about 10 gauss, and some medical applications, such as MRIs, can exceed 10,000 gauss. However, because size counts, the Earth’s low intensity, large size, field profoundly influences life, including MS expression. The following studies use weak electromagnetic fields, which scientists believe can initiate physiological responses that much stronger fields often cannot. These researchers have postulated a “window effect,” in which these responses may only be initiated at a unique combination of frequency, intensity, and polarity relative to the Earth’s magnetic field.
But despite the theories, is there evidence that PEMFs affect brain function? Behavioral and neurophysiological changes have been reported after exposure to extremely low frequency magnetic fields (ELF-MF) both in animals and in humans. Even in the nonliving human neuronal cultures exposed to extremely low frequency PEMFs show an increase in excitatory neurotransmission. Excitatory neurotransmitters turn functions on, and inhibitory neurotransmitters reduce functions.
Using transcranial brain stimulation, Capone studied noninvasively the effect of PEMFs on several measures of cortical excitability in 22 healthy volunteers, and in 14 sham field exposure was used. After 45 min of PEMF exposure, intracortical facilitation function related to cortical glutamatergic activity was significantly enhanced by about 20%, while other parameters of cortical excitability remained unchanged. Sham field exposure produced no effects. This study shows some indication that PEMFs can produce functional changes in human brain.
There is growing evidence in the literature of the beneficial effects of magnetic fields on different MS symptoms. Guseo reported that the technique can alleviate symptoms such as fatigue, bladder control, and spasticity, as well as improve quality of life. Richards et al. performed a double-blind study to measure the clinical and subclinical effects of a magnetic device on disease activity in MS and showed that a magnetic field improved the performance scale (PS) combined rating for bladder control, cognitive function, fatigue level, mobility, spasticity, and vision. Nielsen et al. showed in 38 MS subjects that magnetic stimulation on spasticity could improve self-score of ease of daily activities and clinical spasticity.
Regarding fatigue, commonly seen in MS, Sandyk proposed that depletion of neurotransmitter stores in damaged neurons may contribute significantly to the development of fatigue and showed that a picotesla PEMF in a small group of MS subjects improved fatigue. These results suggestedthat replenishment of neurotransmitter stores in neurons damaged by demyelination in the brainstem by periodic applications of picotesla PEMFs may lead to more effective impulse conduction and thus to improvement in fatigue.
Another possibly related way pulsed PEMFs might remediate MS fatigue is through electrophysiological effects. Richards et al. found that in MS patients, during a language task and after visual stimulation, EMFs increased the amount of brain alpha activity. G. Another study showed significan positive t differences in theta and beta band amplitudes between subjects exposed to real and sham 3 Hz magnetic fields (Heusser).
Sandyk (1998) found that transcranial applications of pico Tesla AC PEMFs produced rapid and sustained improvement of symptoms in patients with chronic progressive or secondary progressive MS, and evidence of normalization of electrophysiologic evoked potential responses. He further discovered recurrent episodes of uncontrollable yawning and body stretching, identical to those observed upon awakening from physiological sleep. This behavioral response has been observed exclusively in young female patients who are still fully ambulatory with a relapsing remitting course of the disease.
This is a distinctly favorable therapeutic response to magnetic stimulation. This response is likely due to the production of adrenocorticotropic hormone (ACTH) stimulated by the PEMFs. There is support for this possibility in other research. Intracerebral administration of adrenocorticotropic hormone (ACTH) in experimental animals elicits yawning stretching behavior. A surge in plasma ACTH levels at night and just prior to awakening from sleep is also associated in humans with yawning and stretching behavior. In addition, ACTH is sometimes used to treat MS due to its immunomodulatory effects.
Sandyk (1997) describes the use of PEMFs in a woman with chronic progressive (CP) MS. A 40 year-old woman presented in December of 1992 with CP MS with symptoms of spastic paraplegia, loss of trunk control, marked weakness of the upper limbs with loss of fine and gross motor hand functions, severe fatigue, cognitive deficits, mental depression, and autonomic dysfunction with neurogenic bladder and bowel incontinence. Her symptoms began at the age of 18 with weakness of the right leg and fatigue with long distance walking and over the ensuing years she experienced steady deterioration of functions. In 1985 she became wheelchair dependent and it was anticipated that within 1-2 years she would become functionally quadriplegic. In December of 1992 she began experimental treatment with pico Tesla PEMFs.
While receiving regular weekly transcranial PEMF treatments over the next year, she experienced improvement in mental functions, return of strength in the upper extremities, and recovery of trunk control. During the second year she experienced the return of more hip functions and recovery of motor functions began in her legs. For the first time in years she could initiate flexion of her ankles and actively extend her knees voluntarily. Over the next year she started to show signs of redevelopment of gait. With enough function restored in her legs, she began learning to walk with a walker and was able to stand unassisted and maintain balance for a few minutes.
She also regained about 80% of the functions in her upper limbs and hands. Most remarkably, there was no further progression of the disease during the 4 year course of magnetic therapy. This patient’s clinical recovery cannot be explained on the basis of a spontaneous remission. He suggested that pulsed applications of PEMFs affect the neurobiological and immunological mechanisms underlying the pathogenesis of CP MS. but, these regenerative changes in the brain require a long course of treatment, possibly forever.
During his extensive experience in treating MS with PEMFs Sandyk also saw the resolution of sleep paralysis and diplopia, reversal of alexia, , improved bladder and the swallowing function, resolution of the Lhermitte’s sign, and reversal of abnormal evoked potentials, indicating improvement of electrophysiologic functions.
The best results appeared to occur in people who had the longest courses of care. There appeared to will be a lack of correlation between the extent of demyelinating plaques on MRI and the rate and extent of recovery in response to PEMFs. These results suggest that the dysfunction of brain cell connectivity due to neurotransmitter deficiencies contribute more significantly to the development of MS symptoms than the process of demyelination, which may clinically represent a side product of the disease.
Guseo has conducted a number of double blind controlled experiments using an 8 milliTesla PEMF device at 2 or 50 Hz for 20 minute treatments applied to either the head, trunk or thighs. All the treatment subjects experienced improvements in circulation. In a separate study, patients were given 15 daily treatments or sham-treatments in a reclining or sitting position by placing the coil on the upper and lower spine areas, then on the lower extremities. The applied magnetic waveform was a 300 Hz sine wave with repetition rates of 2-50 Hz. The peak applied magnetic field strength was 5-7 mT. In addition to the patients in the double-blind study, 104 patients were treated in an open series involving one or more groups of treatments, each grouping separated by 3 or more months, for up to 5 treatment series over a period of 18 months.
Patients in the placebo group of the double-blind study got an open series of treatments after 1 month and were termed a crossover treatment group. Double-blind results showed “well improved” or “improved” status for 7/10 PEMF-treated patients, and only 2/10 of the placebo group. In the open series, 83/104 were “well improved” or “improved”, as were 8/10 of the crossover group of former placebo patients. The improvement in most cases made everyday life easier: general weakness improved, walking longer distances or stepping on stairs became possible, and bladder incontinence improved in 26/50 patients with urinary incontinence. A notable effect of the PEMF was to reduce spasticity and pain.
Wieczorek, using the Guseo’s method, treated 126 MS patients, who mainly had spastic syndromes. 50-60% of the patients reported a favorable effect of the therapy with spasticity, vasomotor headache, and spinal pain.
Mix studied 10 patients with MS using a similar system. Treatments consisted of 20 daily exposures of low-frequency (10 Hz) PEMF for 15 min. Clinically, 30% of their MS patients had immediate subjective improvement.
Terlaki treated 97 patients with multiple sclerosis (MS) over a 3-yr period, 7 had MS with associated disorders. Most of the patients were treated while in the hospital. They received a total of 177 courses of PEMF therapy using the Gyuling-Bordacs (GB) magnetotherapy device. A typical course consisted of 10-25 treatments administered daily, 6 days/wk. Health status improved, worsened, or remained unchanged. 21% had no benefit . In 6% of the cases the condition deteriorated or treatment was interrupted for some reason. 73% showed some improvement. I 42 of 54 female MS patients (78%) and 25 of 43 male MS patients (58%) reported improvement after their treatment series.
Five MS patients with urinary incontinence reported improvement. In several patients, muscle spasticity decreased to such a degree that the dose of muscle relaxants could be reduced or even discontinued. Most of the other MS patients reported increases in muscle strength. No permanent adverse side effects of the treatments were seen. No precise data on how long the benefits from treatments lasted were available, but a few patients reported benefits lasting for 3-7 months. Full recovery was not seen with this short course of treatment in these more severe MS patients, as one might expect.
Another group (Brola) undertook a study using a low to medium intensity PEMF system. They included 76 patients with a long-term history of clinically confirmed MS, mean duration 8.5 years, and mean age of 37.8 years. The patients were divided into two groups: the study group and non-treated controls. Study group patients were exposed to sinusoidal PEMFs, 1-10 mT, 20-50 Hz. Standardized instruments of function were assessed on admission and after 21 days of stimulation.
No significant differences between the groups were found with motor impairment.Quality of life was found to be significantly better in the PEMF group than in the controls (p < 0.01). The most significant difference was seen in the mental state of the patients (alleviation of depression, elimination of anxiety, better emotional control), as well as decrease of muscle tone, altered sensations and pain. No side effects were seen . The authors concluded that PEMF therapy may supplement symptomatic treatment of patients with multiple sclerosis.
High intensity PEMFs, using rapid transcranial magnetic stimulation (rTMS), have been studied in MS. Using PEMF stimulation over the scalp, currents can be induced within the brain to excite the motor cortex, even to the extent that the brain would cause intended muscles to contract. Mills found that after a cortical stimulus spinal neurons controlling muscles are induced to fire by sending impulses over fast conducting spinal nerve fibers.
Nielsen used high intensity TMS on spasticity in 38 patients with multiple sclerosis in a double-blind placebo-controlled study. The maximum field intensity was 1.2 T, placed in the midline of the back of the chest with the bottom part of the coil placed over the 8th thoracic vertebra. One group was treated with intermittent repetitive magnetic stimulation (n = 21) for 25 minutes and the other group with sham stimulation (n = 17). Both groups were treated twice daily for 7 consecutive days. They evaluated changes in the patients’ self-score, clinical spasticity score, and in the stretch reflex threshold.
The clinical score improved by 18% [P= 0.003] after treatment and was unchanged in the sham group. The self-score of ease of daily day activities improved by 22% (P = 0.007) after treatment and by 29% (P = 0.004) after sham stimulation. The clinical spasticity score improved in treated patients and improved less or worsened with sham stimulation (P = 0.003). The stretch reflex threshold increased by 27% in treated patients and remained unchanged in the sham group. In the treatment group 50% of the patients improved their self score, 70% their clinical score and 50% their stretch reflex threshold. In the placebo group 59% improved their self score, 59% improved clinical scores and 29% improved the threshold of the ankle stretch reflex.
The effects lasted at the same level for 24 hours. 8 days after the end of treatment the stretch reflex remained improved by 27% in the treatment group as compared to baseline. After 16 days no statistically significant effect of treatment could be detected. The data presented in this study supports the idea that repetitive magnetic stimulation has an antispastic effect in multiple sclerosis. These results are comparable to the success rates of pharmacotherapy. Many MS patients who need to moderate spasticity cannot tolerate or refuse medication treatment because of side effects. TMS is well tolerated with no significant side effects. Transient dizziness was the primary side effect, thought to be due to blood pressure changes . The author recommended placement lower down on the spine than used in the study. TMS appears to be more tolerable than electrical stimulation since there is no induced pain or muscle contractions.
Spasticity in MS was also studied by a different group (Centonze). They used high-frequency (5 Hz) and low-frequency (1 Hz) rTMS protocols in 19 remitting patients with relapsing-remitting multiple sclerosis and lower limb spasticity. A single session of 1 Hz or 5 Hz rTMS over the leg primary motor cortex improved ankle stretch reflex. Single sessions did not induce any effect on spasticity. Improvements of lower limb spasticity were better when rTMS applications were repeated over a 2-week period. Clinical improvement was long-lasting (at least 7 days after the end of treatment) when the patients underwent 5 Hz rTMS treatment during a 2-week protocol. No effect was obtained after a 2-week sham stimulation.
With regard to safety of high intensity PEMFs, one study was done to evaluate the effects of rTMS on the permeability of the blood-brain barrier (BBB). In contrast to magnetic resonance imaging (MRI) in which the subject is exposed to static magnetic fields superimposed with small PEMFs , rTMS uses a large number of powerful, short duration pulses. MRI has been reported to increase the permeability of the BBB in rats. The rTMS treated rats received 50 stimulations a day for one week and compared to unexposed controls. Each stimulation session lasted 10 minutes, peak intensity of 1.9 T. BBB permeability was assessed in mid-frontal, mid-parietal and mid-occipital cortices, the cerebellum and the midbrain. The results revealed no significant differences in any of the five brain regions. The authors concluded that transcranial pulsed magnetic stimulation can be regarded as safe with regard to blood-brain barrier integrity.
Using rTMS 5-Hz over the motor cortex in people with multiple sclerosis (MS) with cerebellar symptoms appears to improve hand dexterity (n=8) but does not change dexterity in healthy subjects (n=7) (Koch).
Another group (Centonze ) tested the effects of 5-Hz rTMS over the motor cortex in individuals with MS complaining of lower urinary tract symptoms either in the filling or voiding phase. Motor cortex stimulation for five consecutive days over two weeks improved the voiding phase of the micturition cycle, suggesting that enhancing spinal excitability might be useful to improve bladder contraction and/or urethral sphincter relaxation in MS patients with bladder dysfunction.
While there is plenty of evidence to suggest that PEMFs may be very helpful in MS for a wide range of symptoms and functional limitations, there is at least one study demonstrating a lack of benefit for fatigue in MS. 50 MS subjects with primary fatigue were evaluated in a randomized double-blind cross-over trial (de Carvalho), recruited at a rehabilitation center, in Italy. Patients were randomized into two groups: magnetic field group and sham therapy group and evaluated with a fatigue impact scale, fatigue severity scale, VAS and 10 m walking test.
Each group received both sham therapy and magnetic field therapy for 24 min per session, three times per week, for 8 weeks with a wash-out period of 5 months. Patients had a statistically significant improvement in physical scores (p < 0.05). Using this particular PEMF system, the researchers found no significant benefits for fatigue, despite improvement in physical function. Lack of obvious benefits of PEMFs for fatigue in MS can be related to the particular PEMF system or the research design that incorporated this particular PEMF system. Often studies are not carried out long enough with devices that do not have a sufficient magnetic field intensity to produce results within the parameters of the study.
MS is a complex disorder for which there is no cure. Existing medical therapies delay the progression and severity of the condition. They do virtually nothing for the existing symptoms and damage caused to the nervous system. Because MS can be such a disabling condition, and because medical therapies are so focused on delaying progression, people suffering with symptoms from their condition have few helpful alternatives to their current state. As I have indicated many times before, PEMFs are not a panacea. People with various medical conditions require a teamwork approach to resolve their health issues.
Although the reviewed PEMF studies in MS demonstrate positive outcomes overall, they have somewhat varied outcomes individually, which could be due to the specific device, the study design, sample size (e.g., more subjects may statistically demonstrate subtler effects), treatment duration, type of MS, medication history, etc. Therefore, selecting an appropriate PEMF system will require some degree of expertise, preferably with the assistance of a medical professional very familiar with PEMF therapies.
The good thing about the above review, is that there is evidence to indicate that PEMFs of various intensities and designs may all facilitate various aspects of dysfunction and disability associated with MS. Low intensity PEMFs would generally be expected to produce their results over a longer period of time. High intensity PEMFs, with multiple courses of multiple treatments, can produce enduring results for variable periods of time beyond therapy, up to several weeks or months after treatment.
Because MS is a chronic, long-term, lifelong, progressive condition, it is normally recommended that individuals own a whole body home care therapeutic PEMF system of sufficient intensity, which can be used daily to regularly stimulate underlying neurological and physiologic functions in the whole body, all of which may be compromised by the MS process. It’s probably also advisable to periodically have access to a professional high intensity therapeutic system, if locally available.
It’s also likely that no one system is going to do everything that may be needed to help to control the spectrum of MS dysfunctions. For this reason, good nutrition, exercise, healthy lifestyle, supplements, herbs, acupuncture, chiropractic, guided imagery, mind-body approaches and other body therapies can still be very helpful , all used together.
Using PEMFs does not mean that DMT’s shouldn’t be tried. It is very probable that the combination will actually be much more effective, as is seen in the management of many health conditions. In addition, other immune therapies, such as low dose naltrexone (LDN) or even the cannabis-based therapies with high concentrations of cannabidiol [CBD], as they become available in various states in the United States, would also be complementary to the use of PEMFs, enhancing the effects of both.
Cumulatively, the studies reviewed here present support that electromagnetic PEMF therapy has considerable potential for expanding the healing spectrum of people with MS.
Painful periods [menses] affect almost 60% of women during adolescence and young adulthood, but may remain until age 50 or menopause. It occurs in 90% of adolescent girls and 50% of women. Most often it begins at the onset of menses or in the first year to 2 years following. Dysmenorrhea is a clustering of symptoms that occurs one to two days before menses, diminishing within two to four days into the flow. These symptoms can include nausea, diarrhea, vomiting, lethargy and headaches, dramatically interfering with daily life for several days a month.
There are 2 types of dysmenorrhea – primary and secondary.
Primary dysmenorrhea usually is caused by the production of natural inflammatory chemicals in the body called prostaglandins. Prostaglandins are made in the lining of the uterus.
Pain usually starts right before menstruation, as the level of progesterone decreases and prostaglandins increase in the lining of the uterus. On the first day of the menstrual period, the levels of prostaglandins are high. The prostaglandins stimulate strong uterine muscle contractions [cramps] which cause decreased blood flow to the uterus and increase pelvic nerve sensitivity that result in sudden increases in pain. As menstruation continues and the lining of the uterus is shed, the levels decrease. Pain usually decreases as the levels of prostaglandins decrease.
Secondary dysmenorrhea is caused by a disorder in the reproductive system. It usually begins later in life than primary dysmenorrhea. The pain tends to get worse, rather than better, over time. The pain of secondary dysmenorrhea often lasts longer than normal menstrual cramps. It may begin a few days before a menstrual period starts. The pain may get worse as the menstrual period continues and may not go away after it ends.
Some of the conditions that can cause secondary dysmenorrhea include the following:
Endometriosis—In this condition, tissue from the lining of the uterus is found outside the uterus, such as in the ovaries and fallopian tubes, behind the uterus, and on the bladder. Like the lining of the uterus, endometriosis tissue breaks down and bleeds in response to the changes in hormones that happen throughout the menstrual cycle. This bleeding can cause pain, especially right around menstruation. Scar tissue called adhesions may form inside the pelvis where the bleeding occurs. Adhesions can cause organs to stick together, resulting in pain.
Adenomyosis—Tissue that normally lines the uterus begins to grow in the muscle wall of the uterus.
Fibroids—Fibroids are growths that form on the outside, on the inside, or in the walls of the uterus (see the FAQ Uterine Fibroids). Fibroids located in the wall of the uterus can cause pain.
There can be some overlap in symptoms between dysmenorrhea and premenstrual syndrome.
Premenstrual syndrome (PMS) can overlap with dysmenorrhea. PMS symptoms happen between 2 and 12 days before the onset of a period, resolving within the first 24-48 hours of flow. PMS symptoms happen in the phase of the cycle after ovulation.
Treatment of dysmenorrhea most typically depends on the use of medications to relieve the pain. These medications, typically nonsteroidal anti-inflammatory drugs [NSAIDS] can cause liver, kidney, blood and gastrointestinal pain, along with nervous system toxicity. A woman taking the maximum dose of NSAIDs throughout her menstrual life increases the risk of kidney damage by 400%.
Hormonal medications, such as birth control pills, often are prescribed. TENS, heat, pelvic floor and aerobic exercises, and acupuncture have been found to have some benefit.
Some lifestyle changes also may help, such as exercise, getting enough sleep, and relaxation techniques. If medications do not relieve pain, treatment will focus on finding and removing the cause of the dysmenorrhea. Surgery may be necessary. In some cases, a mix of treatments works best.
Low level laser therapy [LLLT] can help with symptoms but requires administration by a trained practitioner. Pulsed high-intensity laser therapy [HILT] has also been found useful and needs to be administered professionally.
Efficacy of pulsed electromagnetic fields (PEMFs) in the treatment of primary dysmenorrhea was evaluated in several studies at the same Department of Physical Therapy at Cairo University.
Study 1. One study (El-Fatah) applied a 50 Hz, 60 gauss PEMF for one hour only one time on the first day of menstruation to 30 female students, ranging in age from 17 – 25 years. The PEMF was applied with one coil in the area above the upper edge of the pubic bone (suprapubic) and another coil at the same time over the upper lumbar area [T10 – L1]. The mean pain score on a scale from 0 – 4, was 1.77 before starting treatment and 0.27 after treatment. Before treatment 47% had mild pain, 37% moderate, 10% severe and 7% unbearable. After treatment 77% had no pain, 20% had mild pain and 3% had moderate pain. The percentage reduction of pain was 85% (p <.0001).
There was also a significant reduction in symptoms other than pain, from before treatment to after treatment, on the same day.
Again, these symptom improvements happened with only one hour of treatment on the first day of menses. More rapid resolution of the symptoms of dysmenorrhea would be expected with daily treatments in the home setting.
The researchers also measured prostaglandin blood levels before and after treatment. The mean levels before and after were 34 versus 13, for a 62% reduction in the blood levels. The reduction in prostaglandin levels even with one hour of stimulation is impressive and likely accounts for much of the benefits seen in reducing the symptoms of dysmenorrhea.
Study 2. Another study (El Refaye) evaluated 50 adult female university students. They compared use of PEMFs with the use of an NSAID (diclofenac). The PEMF was applied for 20 minutes to the pelvic area three times per cycle for three consecutive cycles. The applications were before the onset of menstrual flow, then the first and second days after flow began. For three consecutive cycles. The NSAID group received 50 mg of diclofenac once only at the onset of menstrual pain for three consecutive cycles. They had measurements of pain levels, physical and psychological symptoms and blood progesterone levels. The PEMF device was 60 Gauss at 50 Hz. As in the previous study the coils were applied to the suprapubic area and over the lumbar spine (T10-L1). Pain and progesterone levels were measured before treatment and after the third cycle.
Progesterone was measured because progesterone inhibits prostaglandin production in the uterus, blocks the action of prostaglandin and increases its inactivation rate. Therefore, increasing progesterone production or availability decreases uterine muscle contractions. This is also why many doctors prescribe progesterone pills to control dysmenorrhea.
From before to after treatment, in the PEMF group, the progesterone level increased by 184%, the pain level decreased by 67% and the menstrual symptom score improved by 41%. In the NSAID/diclofenac group, the progesterone level barely changed, the pain level only decreased by 50% and the menstrual symptom score improved only by 27%. When these results were compared between the groups statistically, the PEMF treatment group did significantly better than the diclofenac group.
Study 3. A third study (Thabet) compared the use of high intensity laser therapy (HILT) to PEMF therapy. Fifty-two women between ages 18 – 24 with primary dysmenorrhea were recruited to be evaluated. As with the other studies, the PEMF was 50 Hz and 60 gauss. The coils were applied to the suprapubic area and the lower back (L4-S3) for 30 minutes, three times per cycle for three consecutive cycles. The applications were done before the onset of menstrual flow, then the first and second days after flow began. In this study they measured current pain, pain relief and prostaglandin (PG) levels. Pain was measured before and right after the last – third treatment. The PG level was measured before and three months after treatment.
HILT was administered by a trained professional using a very expensive professional grade laser system. The laser was applied in three phases, to multiple locations, for over 15 minutes of application time, at each treatment session.
The before and after pain scores for the laser system were a mean of 3.2 vs 0.7 for a 78% improvement. The before and after pain scores for the PEMF system were 3.3 versus 1.2 for a 62% improvement. Statistically speaking, the laser treatment produced more benefit. The average pain relief scores for the laser group was 3.2 versus 2.7 for the PEMF group. As far as prostaglandin level changes, the mean difference for HILT was 19.4 versus 17.64 for PEMFs, with comparable 59% and 54% improvements, respectively.
Bottom line for this study is that both treatment methods have significant reductions in pain severity and prostaglandin levels. HILT therapy was somewhat more effective than the particular PEMF therapy used. The contrast is that HILT requires very expensive equipment, significant time and effort, including disrobing, professional treatment and all the associated costs. Neither treatment is anticipated to produce long-term benefits, so recurring treatments are likely necessary. PEMFs would be the most cost-effective.
Dysmenorrhea is a very burdensome problem that happens to women through their menstrual life, usually for years. There is still a great unmet need to reduce the personal burden of coping with days of disabling and disruptive symptoms, loss of productivity, psychological effects and the potential risks associated with treatments. Even a 60 Gauss magnetic field, applied for short periods of time can produce significant symptom reduction. The mechanisms for the benefit are multiple and at the very least include increasing progesterone levels and decreasing prostaglandin production, prostaglandins being the source of most of the symptoms.
While the research reviewed deals primarily with primary dysmenorrhea, PEMFs have been shown to be helpful for other forms of secondary dysmenorrhea, especially for endometriosis and also for pelvic pain issues in general, not to mention countless other uses.
It is recommended that women who have this issue should have for their personal use a portable battery-operated PEMF system that can be used just before a period begins and for the several days that symptoms last. Once owned, this type of PEMF system may be useful for many other symptoms and health issues for which PEMFs have been shown to be beneficial.
Higher intensity PEMF systems may be even more beneficial than the intensities used in the studies reviewed above. As a result, treatment times may be able to be shorter for any given treatment session and used for fewer days through a cycle. Dysmenorrhea includes significant inflammation and pain. There is more discussion about reducing inflammation and pain through effects on the adenosine receptor, which is also present in the uterus.
See the book Power Tools for Health: How Pulsed Magnetic Fields (PEMFs) Help You.
El Refaye GE, Botla AM, Hussein HAD, et al. Electromagnetic field versus diclofenac drugs on primary dysmenorrhea: A single-blind randomized controlled trial. J Clin Analytical Med. 2019 Mar;10(2): 202-206.
Thabet AAE, Elsodany AM, Battecha KH, et al. High-intensity laser therapy versus pulsed electromagnetic field in the treatment of primary dysmenorrhea. J Phys Ther Sci. 2017 Oct;29(10):1742-1748.
Most physicians don’t realize the following. “Fewer than half of the patients prescribed some of the most expensive drugs actually derived any benefit from them,”. This is according to GlaxoSmithKline Worldwide Vice President of Genetics Allen Roses. Dr. Roses, an academic geneticist from Duke University in North Carolina, spoke at a scientific meeting in London where he cited figures on how well different classes of medications work in real patients.
“Drugs for Alzheimer’s disease work in fewer than one in three patients, whereas those for cancer are only effective in a quarter of patients. Drugs for migraines, osteoporosis and arthritis work in about half of the patients,” Dr. Roses said. “Most drugs work in fewer than one in two patients mainly because the recipients carry genes that interfere in some way with the medicine.”
Until now, there was no way of knowing which medication would work best for which patient, and at what dose. Precision genetics will determine if the medication will work at all. Furthermore, as to what dose will best benefit the patient. Many physicians will recommend medications that have worked well for their other patients. However, they’re not realizing that for a particular patient, the medication won’t work at all.
“The vast majority of drugs – more than 90% – only work in 30-50% of the people,” Dr. Roses said. “Drugs out there on the market work, but they don’t work in everybody.”
To work, a medication has to be properly metabolized, absorbed and utilized. How you will respond to a medication is as unique as your fingerprints.
Only a test that tests how your genetics affects a medicine, called pharmacogenetics (PGx for short), can forecast how you will be affected by hundreds of medications. No other tests – not urine, blood or ancestry – or family history provides the needed information. The good news is it’s easy, painless and affordable. And, for all the medications that can be tested (with more being added as the scientific evidence is confirmed), you can know if a medicine will help you, do nothing for you, put you at higher than normal risk, or even kill you. The more medications you take, the greater the risk.
Even medications you have taken for years can put you at risk in the future. Now you can know in advance and consult with your prescribing physician to decide whether or not an alternative makes sense for you. Why not take advantage of this genetic testing opportunity to stay informed and protect yourself from a dangerous health risk?
Most people assume that because the medications their doctors prescribe are FDA approved, they will work and are safe for everyone. But because of the differences in people’s genetic profile and interactions with other medications, food, or alcohol, more than 125,000 people die annually, and 2,700,000 are hospitalized each year from ADRs.
It’s true! Words like “most” or “average” doesn’t necessarily apply to you. No matter the common side effects for any medications, and no matter the average statistics for encountering adverse drug reactions (ADRs) for a specific prescription medication, you may still have a dangerous or life-threatening reaction. Those people aren’t just statistics, and neither are you. You’re unique, and so is your risk.
Fortunately, today there is a way you can find out if you are at risk from your medications. This is done by getting a simple pharmacogenomics test (PGx) through a cheek swab. Much of the information in this piece is taken from the website parallelprofile.com. We have nothing to gain financially from this recommendation.
What I do want you to know is that medications can be vital in many circumstances and may not be able to be avoided. So, if you have to rely on medications, at least be safe.
I also know that PEMFs do not carry any of the genetic risks of medications. Based on my experience as an MD, they are much safer, less potentially toxic and can be as or more effective. In addition, PEMFs can frequently actually help to heal or strengthen the tissues that can cause the health problems. Most medications only control but do not heal. It’s import to have an appropriate PEMF device selection and professional guidance. Thus, you will get the best results without the risk of harm or even death, that can happen with medications.
For more advice about appropriate PEMF device selection go to DrPawluk.com or contact us at [email protected] or 866-455-7688.
Lyme disease is caused by the transmission of bacteria and viruses by the deer tick. Tick borne diseases are found throughout the world. The bacteria infection caused by the tick bite in the case of Lyme disease is a corkscrew type organism, called a spirochete. These are very hardy and reproduce very rapidly.
Lyme disease infection, called borreliosis, is a major health challenge. Is very tiny and is often hard to see and is frequently not seen before infection sets in. A classic sign of Lyme infection is the so-called target or bull’s-eye skin lesion. Many people who have Lyme disease never see a bull’s-eye lesion.
Lyme disease can cause a vast array of health problems. This depends on where the infection settles into the body. It can affect the brain, muscles and joints, the lungs, heart, the intestinal tract, and so on. The most common reactions are in the brain, muscles and joints and the heart. Most of the time it is treated early with antibiotics. Some people need long-term IV antibiotics to handle the infection. There is much controversy between conventional medicine and Lyme specialists on the best management of Lyme infection. Many people are treated shortly after a bull’s-eye rash and never seem to have a problem again. Many people show up with chronic severe ill-defined conditions. These, upon testing often months to years later, reveal the history of Lyme exposure.
Lyme disease often becomes chronic. I often tell my patients, that there are 4 aspects to Lyme disease. Number 1 is the actual active infection with the spirochete. The 2nd is the presence of the hidden, other morphological, hidden in the cell or intracellular forms of the organism. These tend to be chronic aspects of the infection. The 3rd form of reaction is an autoimmune reaction to the infection. This is also likely to be manifested and chronic long-term health conditions, not unlike rheumatoid arthritis or other connective tissue disorders. The 4th form of reaction is the actual damage caused by the infection. Acute Lyme infections, like any other infections, can settle in various tissues or organs of the body and create variable amounts damage, inflammation or scarring.
Obviously, Lyme disease needs to be treated with appropriate antibiotics, nutritional support, supplements and other therapeutic modalities, such as chiropractic and acupuncture. Some people need long-term IV antibiotics.
In the acute phase of the Lyme infection, antibiotics will usually suffice. In the chronic phases, it is very difficult to completely eradicate the infection or its consequences. This is where PEMFs come in.
Because PEMFs help with reducing inflammation, improving circulation, reducing pain and in general improving the value of other treatments, they should be part of any treatment program in any one with chronic Lyme related health problems.
A very common problem with Lyme disease is chronic pain. Many patients with Lyme disease become dependent on narcotics for their pain management. Unfortunately, narcotics can also be immunosuppressive and may in the long run be more harmful to the individual, besides the risk of addiction. PEMFs not only help with pain but also help to address the underlying causes of the pain in the body. This was spoken about very eloquently by Dr. Oz. PEMF therapy used at home on a daily basis is necessary to manage the pain of Lyme disease. Occasional treatments in a Dr.’s office will not do the job for somebody with chronic daily pain. Moreover, at the very least, these occasional treatments will only provide temporary relief. The major value of PEMFs, is that they can be purchased and used in the home setting at one’s convenience, at one’s own schedule.
One of the most important aspects of the use of PEMFs for Lyme disease management is to be able to uncover or expose the forms of the Lyme organism that hideout in the cell, hidden from detection by the natural immune system. Antibiotics have not been found very useful for attacking these hidden forms. PEMFs help to open cell membrane channels, allowing nutrients better access to the inside of the cell and also helping the cell to eliminate waste better. By balancing the energy of the cell membrane, the cell will be healthier and more resistant to the hidden forms of the Lyme disease in the cell.
Lyme disease in the brain, called neuro-borreliosis, is especially challenging to treat. Many medical treatments and nutritional approaches do not access the hidden Lyme organisms in brain tissue, due to not be able to get through the blood brain barrier. PEMFs have been shown to increase the diffuse-ability of the blood brain barrier, allowing better access of treatments, supplements, herbs and nutrients into the interior of the brain’s nerve cells.
Consequentially, because of the longer-term damage done by Lyme infection, ongoing daily home use of PEMFs, likely for a person’s lifetime, may be necessary to achieve the best results. I honestly cannot tell you that PEMFs will cure your Lyme disease. I should also say that there is very little hope of complete cure with any treatment. This is largely due to the autoimmune and chronic damage caused by the infection. In addition, the chronic use of multiple oral or intravenous antibiotics will clearly leave the body suffering from them as well. Using PEMFs along with antibiotics can make a big difference, in making them even more effective. I’ve had many patients who have reported that when they don’t use their magnetic systems daily, they feel worse.
Consequentially, Lyme disease can be such a stubborn and challenging condition to manage. Lastly, PEMFs can be dramatically helpful for many people, and I routinely recommend them to my Lyme patients.
The SARS-CoV-2 pandemic of 2019 – 21 is showing signs of waning as of June 2021. By now, worldwide, there have been 182,042,821 cases reported, with 3,942,207 deaths and 166,533,512 people who have recovered. On April 29, 2021, the total daily count amounted to 903,354. (www.worldometers.info/coronavirus).
While the clinical spectrum of those infected ranged from asymptomatic, to mild symptoms, to multiorgan failure and to death, the vast majority of individuals recover, to at least a reasonably functional level. The long-term outcomes of infection are remaining to be defined. But it is becoming clear that a substantial percentage of individuals continue to suffer long after their infections – called Long Hauler Syndrome (LHS). (Pavli)
It is common enough that The University of Cincinnati Medical Center has proposed 5 subtypes of LHS, based on initial symptoms, duration of symptoms, whether there is a quiet period and the timing of onset.
Long-term manifestations of coronavirus infections were seen in previous epidemics of SARS-CoV and MERS-CoV. Both epidemics left survivors with fatigue, persistent shortness of breath, reduced quality of life and significant mental health problems. (O’Sullivan) The difference with this current pandemic is the global extent and the length of time of involvement. So many more people have been affected and since it is lasting significantly longer, with the progressive development of variants, the number of people being left with residual and persistent symptoms has also grown exponentially. And, unfortunately, there are no definitive and effective treatments for LHS.
The pattern of continued and persistent symptoms is called by various names, including Long Hauler Syndrome (LHS) or Post-Covid Syndrome. LHS is estimated to affect 10 – 35% but could reach 85% in those who have been hospitalized. Persistent medical problems have a wide spectrum of symptoms and other manifestations. LHS is most probably a multisystem disease, even following mild acute infection. Causes of these reactions may include hormonal disturbances, immune system dysfunction, persistent subacute or super infections, and nervous system abnormalities
The major symptoms of LHS include fatigue, shortness of breath, chest pain, mental and cognitive disorders, and scent and taste dysfunctions.
Chronic fatigue syndrome/myalgic encephalomyelitis
The chronic fatigue looks much like chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), can persist up to or beyond 7 months after initial infection, and result in significant disability. LHS resembles other postinfectious syndromes that follow outbreaks of other viruses, and selected symptoms overlap with CFS/ME. It is triggered by infection and immune activation, resulting in a dysregulated autonomic nervous system (dysautonomia) and abnormal immune parameters. (Stanculescu)
Shortness of breath and/or poor exercise tolerance are more common in those who have been hospitalized and last up to 4 months after discharge. Shortness of breath may even occur for the first time even weeks after discharge, affecting between 43 – 66% of those hospitalized or in ICU. Chest pain could still be common in about 22% at 2 months. These problems are probably due to residual lung injury during the acute infection. Pre-existing COPD is more likely to result in more severe lung impairment and may increase the risk for progressive lung fibrosis over time.
Mental health symptoms include posttraumatic stress disorder (PTSD), depression, anxiety and cognitive impairment. There are many factors relating to the process of infection and hospitalization that contribute to the symptoms. Sleeping disorder is, anxiety and depression may affect up to 26%, even up to 6 months following initial SARS-CoV infection. PTSD may range from 6 – 20%. The rate of suicidal ideation is also increased. Psychological issues and sleep problems may also continue to persist and will need attention.
Neurological symptoms and cognitive dysfunction can result from multiple, interactive causes, especially direct damage by the virus to the brain and indirect effects due to the systemic nature of the infection. The psychological issues may have little to do with pre-existing conditions.
Neurological issues have occurred more often in males and include Guillain-Barré syndrome (GBS), often seen with other viral infections and widespread immunization campaigns.
Since SARS CoV2 infections are a neuro-inflammatory disorder, neurological syndromes are being seen more commonly. These include stroke, cerebral vasculitis and hemorrhage, altered mental status (from encephalitis, encephalopathy, seizure, spasticity), peripheral nervous system involvement (GBS, muscle inflammation, and neuropsychiatric symptoms. Opsoclonus-myoclonus syndrome (OMS) can also occur. OMS is rare and affects the nervous system resulting in rapid, multi-directional eye movements (opsoclonus), quick, involuntary muscle jerks (myoclonus), uncoordinated movement ( ataxia ), irritability, and sleep disturbance. Transverse myelitis has also been seen and may result in paralysis. It involves an inflammatory process of the spinal cord that they result in neuronal death or spinal cord lesions.
Taste and smell issues can affect up to 11% of individuals 6 months after hospital discharge. This likely happens due to damage to the nerves of smell in the nose or the front part of the brain. Gastrointestinal symptoms, in particular diarrhea and vomiting may be seen in up to one third of patients 2 months after hospital discharge.
Lung issues are also common and persistent. Long-term pulmonary problems may resolve significantly over the next 2 years, although evidence of previous infections shows that people can still be left with some level of pulmonary function issues. (O’Sullivan) Those with significant changes on their chest x-rays during hospitalization will likely need longer term care and follow-up testing should be done to evaluate the extent of inflammation not only in the lungs but also elsewhere in the body and various organs. These include evaluation for possible heart damage and risk of clotting.
Chronic inflammation and musculoskeletal complaints
In one study (Karaarslan) following up on people who had been hospitalized, it was found that at 1-month after hospitalization, 72.0% reported one or more symptoms, with 56% had musculoskeletal symptoms, 51% had any other SARS-COV-2 symptom. The musculoskeletal symptoms were fatigue/weakness (44%), back pain (23%), joint pains (22%), muscle aches (21%), low back pain (16%), and neck pain (10%).
Another serious postinfectious condition has been found that can occur 2–6 weeks after SARS-CoV-2 infection is a multisystem inflammatory syndrome (MIS). (Brodin) It has been seen in children (MIS-C) and in young adults (MIS-A). Disease severity in SARS-COV-2 correlates with the neutrophil-to-lymphocyte ratio (NLR). NLR is a marker of systemic inflammation. The NLR ratio is indicative of low-grade inflammation, ‘inflammaging’ and obesity-associated inflammation, and is a poor prognostic factor in SARS-COV-2.
Other than prolonged symptoms, LHS does not seem to have further complications or fatal outcomes. Since there is no “cure” for LHS, management of the problems of those with LHS have to be practical and serve most to help with symptoms. New developing symptoms may indicate further delayed consequences of infection. Those with significant changes on their chest x-rays will likely need longer term care and testing should be done to evaluate the extent of inflammation in the body and various organs. These include evaluation for possible heart damage and risk of clotting.
Since PEMFs have been shown to have numerous health benefits and impact so many physiological functions they should strongly be considered to help in the management and support of those with LHS. (Pawluk) In particular, appropriate PEMFs will help with inflammation, immune function, circulation, the coagulation system, brain and spinal cord function, pulmonary function, fatigue, sleep, PTSD/anxiety and depression. Daily home use would be expected to help the most with many of the symptoms and should facilitate tissue repair and regeneration. Treatment may be needed for years to achieve optimal and stable results. Fortunately, PEMFs are extraordinarily safe and may be combined with other therapies for best results. PEMFs may reduce or eliminate the need for pharmaceutical anti-inflammatory treatments.
The right intensity PEMF, whole body PEMF with local applicator/s is necessary to achieve optimal results, in both the short-term and long-term See here.
To determine which PEMF system would be best for your circumstances, a consultation is recommended. Apply here.
Learning about and choosing a PEMF (Pulsed Electromagnetic Field) system can be very confusing. There is a huge amount of information now available on the Internet about various kinds of pulsed magnetic field therapy systems. Much of it is conflicting. Poorly informed individuals post opinions. Manufacturers post opinions. Even professionals post opinions, which vary from professionals. Discover these myths today.
If you are doing your own research and considering getting a PEMF device, or starting PEMF therapy, always make sure that you are getting your information from a reputable source. Always make sure that they are able to cite independent research and studies to back up their conclusions. Below are some of the most common misconceptions and lies that I hear repeated about PEMFs along with everything you need to be confident of the truth.
The people who make this claim have completely ignored the scientific literature. There is a large amount of research supporting the use of high intensity PEMFs for a vast range of problems. In fact, research looking at high intensity PEMFs to the brain supports their safety as well. Check out our posts on the topic here and here for more specific information.
There are those who also claim that high intensity PEMFs are the only kinds of PEMFs that work. They also ignore a large amount of research demonstrating that lower intensity, medium strength PEMFs are extraordinarily effective across a vast range of health problems. Learn how different intensities affect your body here.
While low intensity PEMFs, under 5 gauss (500 uT), have not been found to be very effective in research for specific health conditions, many people experience benefits. Very low intensity PEMFs may be most effective for health maintenance, for people with significant electrical or EMF sensitivity, and for improving circulation among other benefits.
While many devices use specific waveforms, the waveform is likely less important than the amount of charge it can induce in the body. Almost any waveform can be designed in such a way as to maximize the amount of charge produced for the amount of voltage required to produce that charge. That means that some waveforms may be more efficient for charge production but not exclusive. You can learn more about different PEMF waveforms in our education center.
A vast range of frequencies have been tested in research to treat a wide range of health conditions. Numerous frequencies have been found to be effective for many individual conditions. There is no specific frequency that will solve all problems or help every health condition. On the other hand, almost any frequency will help almost any problem, especially frequencies under 100 kHz. There are specific frequencies that have been tested for specific problems and have appeared to produce benefits. Again, however, they are not likely to be exclusive in their benefits. The post linked above about waveforms, also contains a lot of information about frequencies, so check it out for more detailed information.
A number of manufacturers claim that their systems are more effective because they use “earth-based” versus other types of frequencies. Most of the time these earth-based frequencies are not defined. The fact is that the earth itself naturally includes a vast range of frequencies. These include those in the ionosphere, the so-called Schumann resonances, ranging from 1 – 100 Hz, as well as those entering the polar regions from space, those emitted from natural materials, the rays of the sun, colors around us, and many others. Even the static magnetic field of the earth varies, not only day-to-day but also around the planet. Even the so-called 7.8 Hz Schumann resonance is not the only Schumann resonance. All of the Schumann resonances are important to human functioning. Each 1 producing different effects and having different benefits.
A number of magnetic systems promote the use of 8-minute treatment times. There is no solid evidence to support this claim. A large number of studies have used various treatment times with great benefit. Studies are often limited by very practical considerations and optimal treatment times are hard to define. Ultimately, the individual determines the amount of treatment time to which to commit. Some PEMF systems are actually used upwards of 12 hours per day with no untoward effects and with dramatic benefits. The treatment period that will be best for you will depend on the condition being treated, your system and many other factors, so it is always best to consult with a PEMF physician prior to starting PEMF Therapy.
Many PEMF systems advise a maximum treatment time per day. Often this is based on the practical limitations of the engineering of the PEMF system. As with many other treatment modalities, treatment times may need to be longer and more frequent at the beginning of use for specific problems. As improvement is seen, treatment time and how often they are done can be stretched out until finally periodic maintenance treatments are all that is necessary. The amount of treatment time and how often treatment should be performed will be person and problem dependent. Some problems need more time. Often professional guidance is useful to determine the best course of therapy. If a PEMF device has significant research support, this will often provide the best guidance.
There are many manufacturers of PEMF systems. Each manufacturer makes their own claims. Doing independent research and educating yourself about your options is always going to be the best way to determine which is the most useful system for your particular needs, budget and circumstances. I frequently talk to people who were introduced to PEMF therapy without getting adequately informed about PEMFs or doing adequate research before making a purchasing decision.
Often, clinicians or professionals make recommendations based on their experience with a particular PEMF system. Unfortunately, many of these professionals have not themselves had adequate training or exposure to different PEMF systems to make the best recommendations. If you have received such a recommendation, ask about why that system is being recommended over others and don’t be afraid to get a second opinion if your doctor is not able to give you good answers.
Unfortunately, there is very little information provided to most doctors, through their regular educational and information channels. This includes almost any discipline, including medical, surgical, chiropractic, acupuncture, etc., about magnetic field therapies. Some doctors will admit they know nothing about this and will support their patients in exploring the use of this technology. Other doctors will say that it’s bogus and there’s no merit or science behind it. In this case, the doctor is uninformed, is not going to be supportive and can’t be relied on for advice. As with so many other things outside conventional practice, the individual seeking help needs to become informed on her/his own.
People frequently extrapolate results from research on unique and specific individual PEMF systems, claiming these results as applicable to their own system. This may or may not be true. In research literature you will frequently see reviews of the research on various signals, intensities, actions, and conditions. Reviewers will make note of similarities and differences, where gaps in knowledge exist and future research needs. I have seen this significantly in the past with people who have worked with static magnets.
They will often claim or believe that what happens with the static magnet will happen with a PEMF system. While many actions of PEMFs signals are common across many types of signals, they are not all necessarily exactly equivalent. Ultimately, one has to apply the signal most likely to be useful for a specific set of circumstances. While the research database PEMFs is already very extensive, it is by no means complete. There is no cookbook for what is best in a specific set of circumstances. So unfortunately, extrapolation is necessary, but should be considered with discrimination, relying on an extensive knowledge base.
All PEMFs improves circulation. Even a locally applied PEMF stimulator will, by reflexive action on the nervous system and chemical components of the blood, improve circulation throughout the body. Circulation enhancement will be greatest in the area of the applicator. Whole body application of a PEMF stimulator will improve circulation in a larger area of the body. Because of the natural drop-off of intensity of the PEMF signal from one area of the body to another, even whole-body stimulation will not cause evenly improved circulation.
Some manufacturers have documented improvements in circulation with their specific device, but this doesn’t mean that others will not have the same action and benefit. Circulation improvements need to be put into perspective as well, given all the other actions and benefits of PEMFs, and should be considered only one component of the benefits, not infrequently the least important. Ultimately it is the body that decides which particular action of a PEMF signal it will produce. Over time all the various actions of the PEMF signal combined are likely needed to produce the best, most durable and most effective outcomes.
Practitioners of other modalities may say that you can’t combine PEMFs with their modality. This is patently untrue. In fact, PEMFs, often improve the benefits of other modalities. The combination of the use of modalities produces better results than either modality alone. The reason for this is that each modality has unique ways of action and providing health benefits. Health conditions almost always have multiple components as a cause or as part of their development. Any individual modality will provide benefit to a certain point by addressing specific actions particular to that modality. Therefore, addressing or treating conditions with multiple modalities provides the most likely, more complete benefit. Specific examples include, combining PEMFs with acupuncture, physical therapy, nutrition, ozone, or medications, among others.
While there have been numerous studies that have found a particular PEMF signal to work well for a particular condition, it is not usual to find research that compares different PEMF signals for the same condition. In fact, even when different PEMF signals are used to study the same condition, the research design is often different enough to make the comparison of results challenging. The research does seem to indicate that many different PEMF systems can benefit the same conditions. This is why I often say that whatever PEMF system you use, it will often be of benefit regardless of condition. Even if it doesn’t affect the condition specifically, it helps the body generally, which indirectly helps the body to cope with the condition.
Even in circumstances where a particular signal is very effective for a given condition, a conclusion is often reached saying that a particular intensity or a particular frequency is the best. But, when one looks at the research carefully one can often see that variations in the parameters, frequency or intensity, still produce results. They may not be optimal but benefits can still be seen. Be wary of anybody saying there is only one frequency, one intensity or one device that is effective for a given condition. One of the reasons for this is that any given condition, diabetes, for example, varies significantly from person to person. In ideal circumstances, the PEMF parameters would be adjusted for the individual and also for changes in a condition in an individual over time.
FDA approval is based on safety and effectiveness. Device manufacturers have to select very specific circumstances (indications) to obtain FDA approval. They also have to spend huge amounts of money to do the research necessary to obtain approval. This barrier would limit the availability of this unique, safe, effective and diverse technology. Companies will seek FDA approval for specific uses when there is a large potential for recovering costs and creating profit. Since PEMFs work for so many different conditions, it is very difficult, and possibly morally inappropriate, to get FDA approval for a technology that has so many uses and so much value. Unlike for medications, which have relatively unlimited “off label” uses, the FDA controls and limits the uses of devices much more strictly. Off label use is very difficult to achieve. Society would lose the full benefit of this technology using FDA approval.
Combining PEMFs with systems that incorporate crystals is becoming more popular. As has been said many times before combining modalities can often produce better results than either one alone. However, most systems combining crystals with PEMFs have very low magnetic field intensities. So, these crystal/PEMF systems can be quite useful for health maintenance and general frequency “tuning” of the body. My general experience is that these types of systems do not work well or adequately for significant or serious health problems, because of the very low intensity PEMFs.
Research shows that low intensity PEMF systems do not provide much benefit for common health problems such as arthritis, vascular disease, cardiac disease, neurological diseases, bone disorders, etc. It is not known to what extent these types of systems can significantly impact aging. Because of the effects of higher intensity PEMF systems on tissues throughout the body, they would have a greater impact in slowing aging, other than superficially or cosmetically. Exercising on PEMF mats, with or without crystals, will have relatively limited effectiveness because of the loss of intensity of a magnetic and/or crystal field as the body is farther from the field.
Electrical stimulation has been available longer than PEMFs. Clinicians and researchers have more familiarity with electrostimulation and a better understanding of that modality. Electrostimulation can be applied not only in the home setting but also in other professional settings. Electrostimulation is the direct application of current to the body, using electrodes and conducting gels or liquids. Electrostimulation is often less expensive than PEMFs. The major downside of electrostimulation is the limit of its penetration into the body.
To penetrate the body deeply, invasive techniques often are necessary to place electrodes deep in the body, such as in the brain or the spinal cord. Estim is often painful or very uncomfortable. Estim also requires the skin or tissue to be exposed. PEMFs do not have these disadvantages. Application of PEMFs can be done without exposing the skin and directly exposing the body to electric currents. There is no risk of burning with PEMFs.
Most of the time there is no sensation from PEMFs. In addition, PEMFs will go through clothing and through all the tissues of the body without being absorbed, used up or blocked by the body. As a result, PEMFs produce a much deeper penetration and benefit within the body. Estim often masks pain but does not heal the underlying cause. A major use of estim is to stimulate muscle contractions. Estim can do this with less expense than PEMFs. However, PEMFs used for muscle stimulation purposes have been found in research to produce much better muscle contractions than estim with almost no discomfort.
Neither is better than the other. All modalities have limitations and unique benefits. Acupuncture has been used for much longer in human history than PEMFs. There is no doubt about its value and use. However, there are many circumstances in which acupuncture has limited effectiveness. There are also many circumstances, supported by research, where PEMFs combined with acupuncture produce better results, than with acupuncture alone. The major benefit of PEMFs compared to acupuncture, is the ability of PEMFs to heal the tissues directly. Acupuncture’s benefits come from stimulating the acupuncture meridians which indirectly fortify the tissues of the body and regulate bodily functions. Acupuncture treatment requires the skills of an acupuncturist. PEMFs are mostly applied by individuals in their own home setting.
Doctors often say that PEMFs should not be used medications. Usually this is due to a lack of understanding of how PEMFs work and the significant amount of research available about the actions and benefits of PEMFs. PEMFs can improve absorption and utilization of medication. In rare situations, PEMFs may increase the absorption of medications that often cause toxicity and need to be used very carefully. These can include but are not limited to anti-arrhythmia medications and antiseizure medications.
If absorption is increased in these kinds of medications, they may become over effective resulting in potentially excessive levels. PEMFs are not contraindicated in these circumstances would need to be used with caution and under the watchful eye of the prescribing physician. It is often worth attempting use of PEMFs in the circumstances requiring these medications because the PEMFs can benefit the causes of the underlying problems, which medications often do not. A good example is the use of PEMFs with atrial fibrillation.
PEMFs should not be considered as a sole treatment for cancer. There is research to indicate that PEMFs can be very helpful as an adjunctive therapy in cancer treatment. People using PEMFs prior to receiving a diagnosis of cancer have often found significant benefits in reduction of side effects and improvements of benefits from their conventional cancer therapies. Because PEMFs help to condition the body to optimize its general health, recovery from cancer therapy can be made easier and smoother.
People sometimes lump therapeutic PEMFs with environmental EMFs, this is due to a fundamental misunderstanding of these designations. You can learn more about it in our dedicated post on the differences between EMF and PEMF. PEMFs have a long history of use, over 70 years or more, by millions of people. Even very high intensity PEMFs, such as MRIs and more recently FDA approved high intensity PEMFs applied across the brain, have been shown to be extraordinarily safe. 1 of the concerns about PEMFs is that they may cause cancer.
However, PEMFs have even been found to be valuable as part of cancer treatment programs. The most common contraindication for using PEMFs is in pregnancy. This is not to say that PEMFs are harmful in pregnancy, it’s just that they have not been formally studied. Many women have used PEMFs throughout their pregnancies without problems, in fact, experiencing a smoother pregnancy process. Women working in MRI environments throughout their pregnancies have not been found to have significant health risks.
There is still considerable debate about what the risks of environmental EMFs are. Some research has shown that people exposed to fairly high intensity PEMFs in the work environment for hours a day over extended periods of time, may actually be healthier than a comparably selected nonexposed population. Environmental EMFs, produced by cell phone, microwaves, Wi-Fi and dirty electricity are a very different kind of PEMF. Most of these are not known to nature and are not specifically designed for therapeutic purposes. Therapeutic PEMFs are very low frequency under 1000 Hz. The frequencies in the microwave range, which is what most environmental frequencies are today, are absorbed by the body and create heating and inflammation. These are considered to be the reasons that environmental EMFs have the risk of harm but not therapeutic PEMFs.
To give perspective, therapeutic PEMFs have been studied in hundreds of thousands of individuals across thousands of studies, with almost all studies concluding that there are no significant side effects or risks of harm. If people follow appropriate application and consideration of precautions and contraindications, the risk of harm is dramatically outweighed by the potential benefits.
I frequently see people purchasing less expensive PEMFs because they want to limit how much they spend. This is especially true if they are not convinced that PEMFs work. Often these individuals have not done enough evaluation of how PEMFs work to know what the likely value will be of any particular PEMF system. It is generally true that the higher the intensity of the PEMF system, the larger the applicators, both in area and magnetic field intensity, the higher the cost will be.
Most inexpensive PEMF systems have very low magnetic field intensities and are usually only useful for very local applications. They are often not designed for ease-of-use and durability. The important issue in selecting a PEMF system should not be cost, it should be selected considering the intended uses and the likely value. The risk in inappropriately selecting a less expensive PEMFs system is that the person may conclude that PEMFs don’t work. The appropriate conclusion would be that this particular PEMF doesn’t happen to work for this particular need. Nevertheless, because of low cost, a trial with a low cost PEMF system may be worth determining whether there is any value at all. If there is at least some benefit a better PEMF system may be considered.
Many scientifically oriented people have a hard time understanding how magnets might help any health problems. Because static or permanent magnets are not dynamic it is expected that they should not affect tissue. Most people understand that magnets will affect metals or other magnets, but that tissue is not magnetic. This is also misconception because tissues have minerals and charge. All magnetic fields, whether from static magnets or PEMFs, interact with minerals and charges, even if they happen to be in the tissues of a body.
There is significant, but not extensive, research literature that has found that static magnets do help various health conditions. Sometimes static magnets are more practical and usually less expensive than PEMFs. So, once one understands the circumstances in which they would be effective, they can be a practical solution. Their primary value comes from stimulating acupuncture points and treating fairly superficial tissue problems.
There are people who primarily work with static or permanent magnets. As Abraham Maslow said, “if your only tool is a hammer you will see every problem as a nail.” In these circumstances magnets will be attempted for almost every problem. Early in my journey with working with magnetic fields I was working to develop familiarity with this technology and discover its benefits and limitations. It wasn’t long before I realized, by understanding the physical nature of magnets, that they could be useful to a certain extent, but not for all the different kinds of problems I would normally encounter as a physician. Bottom line, static permanent magnets are effective but they have a limited range of usefulness. Their primary value comes from stimulating acupuncture points and treating fairly superficial tissue problems. You can learn more about why this is, and the mechanisms behind it here.
While it is certainly useful to have as much research as possible, for practical reasons often this cannot happen. In any event, there is almost never enough research. There can always be more. Once the specifications, applicators and signal characteristics of the PEMF system are understood, it is relatively easy to extrapolate the likely benefits for a given person and condition. The person and circumstances need to be understood and appropriate expectations set, since PEMFs are not a panacea even with the best research. Some of the best researched PEMF systems never become available commercially. While a PEMF system may not be a panacea for all possible circumstances, almost all individuals see some benefit, if the PEMF system is appropriately selected and applied.
Lastly, this website is designed to give you all the tools you need to research and understand PEMF machines and how they can help both personal health issues and be used beneficially in everything from Chiropractic Practices to Urgent Care facilities. Check out our PEMF Education Center for scientific articles about every aspect of PEMF therapy, or call us today to talk about what PEMF system may be right for you.
The last 20-30 years have witnessed a marked increase in total joint replacement procedures with excellent results. Total or partial hip and knee replacements are the most common. There are more than 1 million Americans having one of these procedures each year. The main complication is aseptic (noninfectious) loosening. It is the cause of more than 70% of hip revisions and more than 40% of knee revisions.
Cementless hip replacement will fail in as many as 25% of young patients after 10 years. Significant bone loss is seen in up to 14% of individuals during the first 3 months after an initial total hip replacement. Pain is a common finding after loosening occurs, on average becoming a problem after 12 months.
Revision prostheses have poorer outcomes compared with primary joint replacement. This is because the quality of the bone tissue where the new prosthesis is to be implanted is poor. It has loss of bone mass and osteoporosis of the surrounding bone. Furthermore, there is breakdown of bone around the implant, bone loss, and poor natural bone healing capability. These are the main problems in reconstructive hip surgery and reduce the lifespan of revision implants. Inflammation produces enzymes that degrade tissue at the bone implant interface.
PEMF therapy has been shown to improve bone mass, decrease harmful inflammation, and stimulate circulation. Therefore, it has been studied in conjunction with joint replacements with much success.
In one randomized double-blind study, 30 patients undergoing hip revision were treated for 6 hours per day for 90 days after surgery. Subjective improvement was higher in those receiving the PEMF treatments compared to the placebo. Patients whose bone density measurements (DXA) improved more than 3.5% were considered responders. Various “bone zones” were tested; some results were the same in the PEMF and placebo groups. In two of the zones (corresponding to the inside of the bone lining), researchers found that 40% of patients were responders in the control/placebo group, compared to up to between 66% and 93% responders in the PEMF group. This study shows a positive clinical correlation between PEMF therapy and bone stock restoration after surgery.
Researchers have studied a variety of new approaches to improving the bone-implant interface. Some of these include other types of implant surfaces, locally-applied osteoporosis medications (bisphosphonates), and locally-applied growth factors, platelet-rich plasma, and stem cells. However, costs, safety issues, complexity of administration, optimal dosing, and lack of long-term studies limit these options.
Surgeons doing an original joint replacement or implant often encourage the patient to wait until they are older to get the procedure done because of the very real possibility that in 10 to 15 years the procedure will have to be redone. Redone procedures are more complex and challenging, and have an increased risk of breakdown.
New, noninvasive strategies are needed to enhance the success of the implantation procedure by increasing bone formation around the prosthesis and lowering local inflammation, especially in cementless implants. PEMF stimulation is ideal for this. The effectiveness of PEMFs in enhancing endogenous bone repair and reducing inflammatory processes has been shown in multiple studies.
PEMFs have been studied for the ability of various materials to integrate with bone. Almost all the studies of shown that PEMF stimulation can be applied locally and can significantly enhance the integration of implant materials, including titanium, stainless steel and ceramic implants. Even nails or rods implanted into the bone marrow of long bones, such as the femur, which were movable or unstable, as would happen with surgery for fractures, improved and were integrated into the bone better.
I had an experience myself with a titanium dental implant, where the implant was integrated better into a bone graft because I was using PEMF stimulation. Even the dental surgeon was pleased, surprised, and amazed. He had apparently only seen this type of integration one other time in his 17 years of practice.
PEMFs have been studied for the osteointegration of joint replacement prostheses. There are 2 aspects to this: the treatment of loosened prostheses and the use of PEMFs after a revision.
In the first scenario (treatment of loosened prostheses) the intention is to reduce the need for a revision. In one study, 132 patients had PEMF therapy for advanced loosening of their prosthesis. Treatment was done 2-3 times a day for 40 minutes each time, for 20 weeks. Follow up was done over the course of 5 years. A revision procedure was no longer deemed necessary in 70% of patients.
In an extension of this research, PEMF therapy was administered to more than 1,000 patients with loosened artificial hips. The PEMF signal used was 30 gauss with frequencies ranging from 2 to 20 Hz. The treatment lasted for either 6 months, or until patients reported complete relief from pain and discomfort, whichever came first. Treatment was successful in 70% of the patients. Before treatment, 76% used crutches; this was reduced to 48% after the study. In more than 65% of the patients, further surgery could be avoided within a follow-up of 10 years. The treatment took an average of 16 weeks. Before treatment, 54% of the patients suffered from permanent pain; this was reduced down to 6.5% afterwards. Before PEMF treatment, 36% of patients used analgesics and after treatment only 2% did. Researchers concluded that PEMFs are best considered for patients at an early stage of aseptic loosening.
In another double-blind study using PEMFs for loosened cement hip prostheses, 37 patients completed 6 months of treatment (either active or placebo). Success was determined clinically using a Harris hip score greater than or equal to 80 points. Ten of the 19 active patients (53%) were considered successes, compared to two of the 18 placebo patients. This is a statistically significant and clinically relevant result. A 60% relapse rate among the active successes was seen at 14 months after stimulation, and despite maintenance therapy of one hour per day, the relapse rate increased to 90% at three years. These data suggest that for loosened cemented hip prostheses, use of PEMFs is a treatment option only to delay revision hip surgery.
Loosening in the absence of infection (aseptic) is the most common problem of hip replacements, limiting their long-term success. There was a study of PEMF treatment in 24 patients with this complication. At the end of treatment, six months and one year later, pain and hip movements improved significantly. Both bone scans and ultrasonography improved significantly, but not in plain X-ray. The decreased pain and improved function suggest that PEMF is effective in improving symptoms of patients with loose hip replacement, supported by objective improvements in bone scan and ultrasound. No improvement, however, can be expected in patients with severe pain due to gross loosening.
Another group of 30 patients undergoing hip revision with a replacement prosthesis were treated with a 20 gauss PEMF signal for 6 hours per day, starting from the 7th through 90th days after revision in a double-blind study. PEMF-treated individuals were functionally better. Postoperative bone mineral density (BMD) was 66–93% versus 40% in controls, or more than double the improvement, even at 90 days after surgery. In addition, the PEMF group had a reduction in pain of 77% compared to 40% in the control, even as far out as 90 days after the procedure. The treatment was not associated with any negative side effects; nevertheless, it must be noted that the use of the electromagnetic stimulation at the hip required considerable patient commitment. Still, this important study showed that PEMF treatment aids clinical recovery and bone restoration.
In another study, 45 patients were studied using a 75 Hz, 20 gauss PEMF stimulator for 60 days, at a minimum of 6 hours per day. Of those, 76% had good or excellent results. The more treatment that was done, the better the results were, with 80% of those who used it for more than 30 days reporting good results. But, of those who used it for more than 60 days with at least 360 hours of exposure, 92% had good results. There appears to be a dose-related effect which is possibly cumulative. No side effects of stimulation were seen.
In addition to the benefits seen with PEMFs in the treatment of loosened implants, the therapy has also been studied immediately following joint replacement surgery, with the long-term goal being extended life of the implant and prevention of loosening in the first place.
During the healing process, bone cells first proliferate, then mature, and finally deposit minerals. In the active growth phase, osteoblasts have elevated production of extracellular matrix (ECM) genes such as type I collagen (COL I). When cells enter the maturation phase, cell growth slows down and the expression of matrix formation proteins such as COL I and alkaline phosphatase (ALP) increase. The last stage involves adding minerals to the area of the injured soft tissue. Since inflammation can hinder bone repair, it is important to know whether PEMF could stimulate bone repair under conditions of inflammation. Bone implants themselves lead to inflammation, which can hinder the progress of bone repair.
Conditions of bone repair were studied in experiments simulating implant placement. On day 7, the PEMF-exposed bone culture released more nitric oxide (NO) than the control. PEMFs resulted in a significant increase in NO release. PEMF-induced NO production in macrophages takes on an oscillating pattern and peaks at 7 days. The survival of osteoblasts in a control group decreased from days 0 to 7. The PEMF-exposed osteoblasts had significantly higher survival on day 7. Osteoblasts stimulated by PEMF began to synthesize internal NO and probably developed their own protective mechanisms such as intracellular detoxifying agents and heat-shock proteins to prevent NO from damaging themselves. NO subsequently promoted osteoblastic activities such as growth, viability and collagen expression.
As a result of increased collagen synthesis in the ECM, the cells produced elevated alkaline phosphatase (ALP) activity. Higher ALP activity eventually leads to more mineral deposition and superior bone repair. The high osteoblast proliferation stimulated by PEMF is the primary determinant of the rate of bone formation.
The above studies show a strong correlation between PEMF therapy and successful treatment and longevity of joint replacement implants. There appears to be a dosing effect where longer treatment times or treatments at higher intensities have higher long-term success than shorter treatment times or lower intensity treatments.
Heart failure (HF) affects 6.2 million people in the United States of America, with close to 500,000 new people diagnosed each year. 50% of those with HF are readmitted to the hospital within 6 months after treatment. In 2017, HF accounted for 80,480 deaths. 75% of those with HF have pre-existing hypertension. Given that HF is a progressive disorder, about 50% of those with HF will die within 5 years. Conventional medical treatments slow progression but are not a cure or reverse the condition. Nonconventional treatment approaches are clearly needed.
Research in the last 10 years has provided a better understanding of the underlying heart mechanisms involved in the development and progression of HF. This information reveals the opportunity for newer treatment approaches. When HF is associated with reduced output from the heart, that is, the ejection fraction, the processes that contribute to this are due to poor heart muscle contractions, general heart muscle health, increased sympathetic nervous system activity in the body, imbalanced neuroendocrine reactions, reduced nitric oxide sensitivity, ATP depletion, increased reactive oxygen species, cardiac scarring (fibrosis) and elevated heart cell death rate.
Some of these mechanisms include reduction of ATP production, poor intracellular calcium levels, dependence on glucose versus fatty metabolism, reduced cardiovascular supply, increased inflammation, aging of the vascular lining (endothelium) and fibrosis of the heart muscle. Pulsed electromagnetic fields (PEMFs) are known to safely impact all of these mechanisms and can be used to augment the benefits of conventional therapies.
Ideally, all individuals should be using PEMFs for preventive health maintenance throughout their lives, thus reducing the likelihood of development of heart failure through its various causes. However, once there is evidence of cardiac stress and heart tissue restructuring (remodeling), but before the diagnosis of HF is made, PEMFs are likely to have the most impact in reversing or slowing the progression of the subsequent, almost inevitable, development of HF.
The potential for PEMF therapy to help with heart failure (HF) was brought home to me about 20 years ago when I saw a woman who was previously very active and an avid golfer, confined to a wheelchair by her late-stage heart failure. Through a colleague, she received around 12 hours a day of therapy with a high intensity static magnetic therapy device over about two weeks. At the end of that treatment time, she was not only able to walk, but actually went out and played golf again. In the 30 years I had been a medical doctor at that time, I had never seen such dramatic recovery without the heavy-duty use of medications.
Heart failure syndrome is the inability of the heart to deliver adequate blood to the body to meet metabolic needs and oxygenation of the body at rest or during mild exercise. Heart muscle (myocardial) dysfunction can be systolic, diastolic or both; acute or chronic; compensated or uncompensated; or involve one or both ventricles.
Several mechanisms in the body are activated to counter heart failure, depending on how long the heart failure has been present. These include neuroendocrine changes involving the sympathetic nervous system, renin-angiotensin hormones, the kidneys and other alterations that try to restore both the output of the heart and tissue circulation. The left ventricle can’t eject an adequate volume of blood (ejection fraction). The right ventricle cannot fill adequately due to stiffness. Left ventricular heart failure is the dominant picture of Heart Failure Syndrome, but the right heart can develop isolated failure as well. When both ventricles fail that is usually an indicator of an end-stage clinical situation of the heart failure syndrome.
HF is a progressive disease with a major impact on quality of life. Except for situations where the HF may be caused by treatments that can reverse the condition, HF usually worsens with time. Although some people survive many years, progression has an annual mortality rate of 10%. Overall, 80% of men and 70% of women with heart failure under 65 years of age can be expected to die within 8 years of the diagnosis. The rate of mortality in those over 65 with HF is even higher and occurs sooner.
HF is largely a condition of older people. Less than 10% of the population between 60 – 79 has HF, whereas, of those over age 80, between 10.8 – 13.5% have it. It is estimated that the prevalence of HF will increase 46% from 2012 to 2030, resulting in >8 million people ≥18 years of age with HF in the United States.
The most common causes of HF are ischemic heart disease (blocked coronary arteries), hypertensive heart disease, cardiomyopathy, rheumatic heart disease and other causes. Hypertension is the cause in 60% of those with heart failure over age 50. The percentage of increased risk of death in those with HF with atrial fibrillation (A Fib) is 340%; with pulmonary hypertension, 210%; and poor kidney function with low creatinine clearance, 98%. HF from blocked coronary arteries has been shown to be associated with higher likelihood of death compared to HF from other cardiac diseases.
Starting therapy for HF may lead to some control of the clinical condition – the stability phase. Months to years following the stability phase, function may decline leading to multiple hospitalizations. Eventually the condition may not respond to treatment when relatively permanent physical changes in the heart ventricles set in. The longer it takes for treatment to be started from the onset of symptoms and the initial HF diagnosis, the worse the outcomes, with the cutoff being 18 months. So, there is urgency to start aggressive early management of the HF.
Once refractory, heart failure is medically managed by continuous adjustments of pharmaceuticals and may end up with the use of left ventricular assist devices (LVADs) and cardiac transplantation. Unfortunately, not everybody is a candidate for these invasive end-stage treatments. LVADs are generally considered a bridge to eventual heart transplantation.
The most common terms used to describe heart failure include:
The four stages of heart failure
A – pre-heart failure: Firstly, having a family history of heart failure or several predisposing cardiac conditions
B – asymptomatic or silent heart failure: Secondly, systolic left ventricular dysfunction with an ejection fraction* (EF) of <=40% –
C – signs or symptoms of heart failure: Thirdly, shortness of breath, fatigue, reduced exercise tolerance and swelling of the feet, ankles, lower legs, and/or abdomen
D – advanced symptoms that don’t get better with treatment: Lastly, the final stage of heart failure, NYHA class III-IV, symptoms on mild or minimal exertion or at rest
*Ejection fraction (EF) is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction. Normal range: 52–72%. Severely abnormal: <30%.
The New York Heart Association (NYHA) Classification provides a simple way of classifying the extent of heart failure and is different from the above stages A-D. It classifies those with HF into one of four categories based on their limitations during physical activity; the limitations/symptoms relate to normal breathing and varying degrees of shortness of breath and/or angina pain.
NYHA Classification – Stages of Heart Failure:
There is a further classification of heart failure based on the ability of the heart to pump out blood. This is called the ejection fraction (EF). The two forms of HF related to the EF are heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrHF).
The terms congestive heart failure (CHF) and heart failure (HF) have been used synonymously. However, with CHF, the heart’s capacity to pump blood cannot keep up with the body’s needs. As the heart weakens, blood begins to back up and force liquid through the capillary walls. The term “congestive” refers to the resulting buildup of fluid in the ankles and feet, arms, lungs, and throughout other body organs, including the belly and the brain. CHF would normally be considered starting in stage C or NYHA class III. So, not all individuals with HF would be considered to have CHF.
Heart failure is caused by abnormal function of different parts of the heart including the lining around the heart (pericardium), the heart muscle itself (myocardium), heart muscle cells (cardiomyocytes), the lining of the chambers of the heart (endocardium), the heart valves and the blood vessels – large (macro) and small (micro). Problems with any of the parts of the heart individually can lead to HF.
In HF there is a lower amount blood pumped out of the heart (cardiac output) but not necessarily decreased EF. Symptoms are due to a decreased output of blood into the rest of the body (forward blood flow), with resulting backup into the lungs. The body tries to compensate for the low output by physiological responses that increase the amount of blood coming into the heart (preload) and going out into the rest of the body (afterload). Preload and afterload problems are in a vicious cycle. These compensation actions lead to worsening of heart malfunction and increased HF symptoms.
Reduced function of the heart muscle can result from decreased ability of the heart muscles to contract properly and/or due to stiffening of the muscle walls (fibrosis). This means that the heart chambers cannot get rid of all the blood inside them with every contraction and relaxation (reduced EF), resulting in the backup of blood in the body or the lungs. The pressure in the blood vessels from the backup leads to leakage of fluid into the lungs and throughout the body, hence, congestion. Commonly in HF the heart enlarges (cardiomegaly) as it attempts to function better in the face of the causes and consequences of the HF. This can be further affected by the proper flow of electrolytes in/out of heart muscle, essential to preserve cardiac function.
The endothelium is a very thin lining of metabolically active cells inside the blood vessel wall. A common cause of HF is impaired cardiac blood vessel endothelial function, which is related to, not only local, but also systemic microvascular inflammation. This is due to underlying coexisting conditions such as hypertension, obesity, ischemia, diabetes, metabolic syndrome, lung disease, smoking, and iron deficiency.
When HF is associated with a reduced ejection fraction (EF), the processes that contribute to this are due to poor muscle contractions, general heart muscle health, increased sympathetic activity in the body, neuroendocrine reactions, reduced nitric oxide sensitivity, ATP depletion, increased reactive oxygen species, and elevated heart cell death rate.
Autoimmune diseases may also contribute to systemic inflammation that leads to endothelial inflammation and dysfunction. By itself, nitric oxide leads to smooth muscle relaxation and decreased thickening of the blood vessel wall. ATP, of course, is necessary for muscles to beat and contract adequately and regularly. Also, cardiac muscle cells under stress are more prone to premature death (apoptosis).
So, the longer HF has been in place, the more rapid the decline. All the effects of HF are cumulative and increasingly irreversible as the heart remodels itself, despite optimized medical treatments. Those with a longer duration of HF are older and more likely to have multiple coexisting conditions (e.g., A Fib, renal dysfunction) or HF-related physiological changes. Longer HF duration is independently associated with more advanced irreversible myocardial damage. (Sugiura)
Multiple factors, whether acting individually or synergistically, contribute to the development and progression of HF. These can include: reduced energy supply (ATP), tissue calcium imbalance, poor tissue metabolism, cardiac and peripheral vascular changes, inflammation, gastrointestinal blood supply, endothelial dysfunction, and scarring or fibrosis of cardiac tissue. Enlargement of the heart or cardiac hypertrophy is a key aspect of HF.
ATP (adenosine triphosphate) and the Heart
Every action in every cell, anywhere in the body, directly or indirectly, requires ATP. ATP is the fundamental “currency” supplying energy for
The majority (~95%) of the ATP used by the heart comes from the metabolism of oxygen in the mitochondria. Mitochondria are the “powerhouses” of the cell. Mitochondria inside each cell take up about 40% of the volume of heart muscle cells (cardiomyocytes). By contrast, in liver cells they only take up about 20-25% of their cell volume. Each ATP molecule is recycled 1000-1500 times per day. Therefore, the human body turns over its weight in ATP daily, or about 65 Kg/day in a resting adult. (Zimmerman) Only about 80-100 grams of ATP are stored in the body at one time. This is enough energy for 5-8 seconds of all-out effort.
During high-intensity exercise, the heart uses more than 90% of its maximal oxidative capacity, meaning there is minimal extra capacity over what is being used for the exercise. Oxygen consumption and cardiac work need a constant, readily available supply of ATP. (Ventura-Clapier) The bioenergetics of the heart is tightly controlled. In HF, there is an imbalance between the work the heart must do and the energy it makes to fulfill its needs. The failing heart has energy starvation.
The requirement for ATP is absolute.
The human heart contains ~0.7 grams of ATP. But, to maintain normal electrical action and continuous contractions, it uses ~6000 grams (6 Kg) of ATP a day! This is about 10% of the total body need for ATP per day. All ATP in a normal heart needs to be renewed every ≈ 20 seconds. If ATP production suddenly stopped in a healthy human heart, the stored ATP would only be able to keep the heart beating for a few seconds. So, the rate of ATP use must be continually matched with the rate of ATP production – on a beat-to-beat basis! The heart is considered a ‘metabolic omnivore’ and can use multiple sources to produce ATP. (Zhou)
Many metabolic pathways must be controlled and integrated to supply the ATP needed for energy in cell processes including ion transport, muscle contraction, nerve impulses, phosphorylation, and making the biochemicals needed for repair and survival. (Dunn) So, heart muscle cells need ATP to maintain normal heart rates, pump blood and support increased work demands, i.e., to recruit its contractile reserve.
Based on all the above, ATP plays a critical role when there is a lack of blood supply to the heart (ischemia) and in the development and maintenance of heart enlargement (hypertrophy) and subsequent HF. Ischemia and HF, in a vicious cycle, fail to integrate to maintain normal and constant levels of production of ATP.
Cardiac hypertrophy
Enlargement of the heart (cardiac hypertrophy) is an early indicator of the risk of developing HF. Cardiac hypertrophy is abnormal or pathologic heart tissue restructuring (remodeling). Pathologic remodeling increases energy demand because of unfavorable heart shape, increased neurohormonal stimulation, and impaired calcium function. (Zhou) Together, these changes upset the balance (homeostasis) between energy supply and demand, resulting in cardiac energy management stress, hence, an energy starved heart. One way to reduce energy demand on the heart is through standard medical therapy (such as vasodilators and beta blockers), which improve survival in heart failure. These treatments effectively reduce energy consumption by improving cardiac function. Nevertheless, conventional medical approaches do not increase the supply of ATP, hence the continuing, inevitable downward spiral of HF.
However, there is an ATP paradox in HF. The ATP content in a failing heart is largely maintained until the end stage, despite a mismatch between energy supply and demand. The stressed heart continues on a downward spiral to failure despite relatively stable ATP. The mitochondria play a role during cardiac remodeling to keep energy balance, but adequate ATP supply alone can’t stop the other non-energy-dependent processes in HF from leading to the vicious cycles of heart failure. (Zhou)
Intracellular calcium
Abnormal calcium ion (Ca2+) imbalance is a hallmark of HF. Ca2+ movement is impaired in failing hearts and results in reduced energy charge during cardiac electrical activity. Mitochondria act as a Ca2+ sink under pathological conditions, resulting in Ca2+ overload that contributes to mitochondrial dysfunction. Ca2+ is an important regulator of mitochondrial function and involved in the development of HF. But, uptake of Ca2+ into mitochondria is reduced in failing hearts. (Zhou) PEMFs appear to increase intracellular Ca2+ (Barbier), providing yet another possible mechanism of PEMFs aiding HF.
Fatty acid metabolism
Beat-to-beat cardiac ATP production happens by oxidative metabolism in mitochondria using fatty acids as the primary fuel. (Zhou) During pathological heart remodeling, cardiac metabolism shifts toward glucose; and fatty acid oxidation and fatty acid metabolism decrease. ATP generated from the use of glucose alone is less than 5% of the total ATP used in a normal adult heart. The capacity for glucose-derived ATP production is limited in adult hearts. The increased reliance on glucose reduces the efficiency of ATP production and makes pathological remodeling worse. Since fatty acid metabolism is not as efficient, lower fatty acid oxidation increases accumulation of more damaging incompletely oxidized fatty acids. This mismatch between fatty acid supply and oxidation is seen early in HF.
Vasculature and HF
There is much more awareness of the large coronary arteries (macrovascular circulation) that feed the heart muscle and get stented or bypassed when blocked. The macrovascular blood supply feeds the smaller, capillary blood vessels. It is the tiny capillary blood vessels (microvascular circulation) that do most of the work to supply circulation to the heart, down to the cellular level. The number of capillaries in a given area of tissue (capillary density) is critical for the supply of blood at the tissue level. Both lower capillary density and obstructed vascular flow in capillaries can impact cardiac muscle function.
Furthermore, heart failure (HF) patients can have body wide, macrovascular or microvascular, constriction and reduced peripheral blood supply. The benefits from improving blood flow in HF have been known for a long time. (Luxán) For example, nitroglycerine and other nitrates/nitrites, which release nitric oxide (NO), have been used in heart disease since 1847 (Lee) because of their vasodilating benefits. Angiotensin-converting enzyme inhibitor drugs, called ACE inhibitors, commonly used in treating HF, stimulate NO release. PEMFs have been found to increase the activity of ACE inhibitors. (Sadeghzadeh)
Moreover, chronically reduced blood supply can lead to chronically ischemic HF. Ischemic HF has reduced capillary density and inflamed endothelium. There is also significant chronic heart muscle cell (cardiomyocyte) death plus compensatory enlargement of the heart. As a result, surviving heart muscle cells have a compensatory increase in size followed by enlargement of the heart chambers, reduced numbers of capillaries and inflamed endothelium, scarring and increased numbers of inflammatory macrophage white blood cells. This is the classic situation in HF with preserved ejection fraction (HFpEF). So, HFpEF has scarring (interstitial fibrosis), sporadic cardiomyocyte death, and hypertrophy. On the other hand, HF with reduced EF (HFrEF) is associated with impaired coronary flow reserve and microvascular perfusion.
Macrovascular narrowing or occlusion of the coronary arteries leads to reduced blood supply to the myocardium. This leads to secondary microvascular problems. But microvascular dysfunction can occur in the absence of coronary artery occlusion. Metabolic syndromes and diabetes, as well as hypertension, affect the coronary microcirculation. Maladaptive hypertrophy is also associated with reduced vessel density. Fewer capillaries lead to decreased oxygen supply to the enlarged heart muscle.
Blood vessels of the heart not only regulate local blood flow but also control cardiac cell metabolism. The metabolic requirements of the heart to fulfill its pumping function are immense. The vasculature is essential for regulating cardiac metabolism and protecting against HF.
In HfrEF from coronary artery disease, there is also an increase in reactive oxygen species (ROS), reduction of NO and inflammatory activation in the microvasculature. These then lead to reduced microvascular circulation and endothelial dysfunction. The endothelium then may start shedding itself. Restoring endothelial function is expected to restore vascular flow and oxygen supply and rescue dysfunctional cardiomyocytes.
Recovering microvascular function is especially important for those who have a stunned or hibernating myocardium. A stunned myocardium results when the coronary blood supply is improved after prolonged postischemic dysfunction, such as in heart ischemia episodes or myocardial infarction. Hibernating myocardium is chronically ischemic myocardium supplied by a narrowed coronary artery in which ischemic cells haven’t died but contraction is chronically depressed.
Preserved EF HF (HFpEF) is becoming the predominant form of HF in aging societies. There is an important link between coronary microcirculatory dysfunction and HFpEF. HFpEF involves all the muscular structures of the heart. Cardiac microvascular endothelial cells regulate the relaxation of cardiomyocytes, especially through NO activity. Heart muscle cells don’t relax properly when endothelial cells are inflamed. This leads to increased stiffness (fibrosis) of the left ventricle with diastolic dysfunction. There is some evidence that PEMFs induce NO in various circumstances, contributing to increased microvascular blood flow and secondarily to reduced development of hypertrophy. (McKay)
Inflammation in HF
It has long been known that heart failure (HF) is associated with measures of systemic inflammation. (Murphy) However, even though the association between inflammation and HF severity and prognosis is well known, clinical trials of conventional anti-inflammatory therapies have not been successful. Targeted anti-inflammatory therapies with non-conventional approaches may be better to improve prognosis in HF. Inflammation in the heart is seen in all HF, but there is more inflammation in those with HFpEF. This is because HFpEF is more associated with diabetes, hypertension, chronic obstructive pulmonary disease, obesity, and chronic kidney disease, all conditions with high levels of inflammation. So, the therapeutic target in HFpEF, should be the reduction of systemic inflammation, not just cardiac inflammation.
57% of HF patients enrolled in one study (Redfield) had elevated serum C-reactive protein (CRP), a common measure of systemic inflammation. Those in stable chronic HF with reduced and preserved EF had a median elevated high sensitivity CRP (hsCRP) between 6.6 mg/l and 8.5 mg/l, with optimal levels being less than 1. (Watanabe) Systemic inflammation is even greater in acute HF, with hsCRP concentrations of 12.6 mg/l.
Other markers of inflammation are also elevated in HF. These include tumor necrosis factor (TNF)-a, IL-1b, IL-6, and galectin-3. TNF-a is associated with both impaired systolic and diastolic function, and adverse cardiac remodeling. Any cardiac cell injury leads to increased interleukin (IL)-1. IL-1b reduces energy production and myocardial contractility through direct effects on mitochondria. IL-1 also impairs diastolic function by affecting intracellular calcium reuptake which inhibits cardiomyocyte relaxation. Nuclear factor kappa B (NFkB) is decreased. It is needed to reduce inflammation, cell death (apoptosis), extracellular matrix remodeling, mitochondrial dysfunction and induces antioxidant effects.
Targeting these inflammatory factors is important in managing HF. Anti-IL-1 therapy has been evaluated in those with recently decompensated HF (Murphy). The death or hospitalization rate for HF after therapy was lower with longer-term therapy. Anti-inflammatory therapies may take longer to have benefit than the shorter acting benefit seen with conventional medical therapies with heart action-altering mechanisms.
Reducing IL-12 and IL-23 can also be helpful. IL-12 may induce autoimmune myocarditis and microvascular endothelial dysfunction. IL-23 increases myocardial remodeling and decreases survival post–myocardial infarction (MI) in animals. Reducing IL-6 and the important N-terminal pro–B-type natriuretic peptide (NT-proBNP) also help. (See more on ProBNP below).
Inflammation and body fat. Another important target in reducing inflammation in the body is to address excess body fat, which increases the risk for HF. (Harada) Adipose tissue, especially belly fat, secretes a variety of cytokines, also referred to as adipokines, which have a higher likelihood of pro-inflammatory actions. Conversely, the production of adiponectin, an anti-inflammatory adipokine that inhibits cardiac hypertrophy, inflammation, and fibrosis, is suppressed in obesity.
The cardiac fat pad adds additional risk for HF. There can also be significant fat accumulation around the heart. In addition to the increased cardiovascular risk from visceral obesity, it has recently been found that increased fat around the heart, called epicardial adipose tissue or fat (EAT) creates an additional risk for the heart. (Mookadam) It is also often called the pericardial fat pad. This is usually detected on chest x-rays, chest CT scans or echocardiography. There is a correlation between the amount of visceral obesity and the EAT. The risk factors contributing to visceral obesity also apply to EAT.
EAT increases the mechanical load on the heart, releases adipokines and cytokines, metabolically modulates adjacent cardiac tissue, diffuses free fatty acids directly into adjacent heart cells, and contributes to the overall metabolic burden of obesity in the body. EAT > 5 mm is associated with left atrial enlargement, lower ejection fraction, increased size of the left ventricle and abnormal diastolic function. All of these can contribute to heart failure.
Innate immune system. Activation of the innate immune system contributes to the inflammatory milieu in HF. (Murphy) The toll-like receptor four (TLR4), which has the highest amount in the heart, contributes to the myocardial inflammation that occurs in HF, myocarditis, ischemia-reperfusion injury, aortic valve disease, hypertension and atherosclerosis. TLR4 expression is increased in patients with advanced HF. Inhibiting TLR-4 has been found to reduce IL-1b and IL-6 concentrations and lessen cardiomyocyte hypertrophy in response to pressure overload in animal models of HF.
70% of patients with end-stage HF have anti-cardiac antibodies, which may be directed against a variety of cardiac proteins or enzymes. (Murphy) Although only <1% of the healthy population have autoantibodies against b1-adrenergic receptors, up to 60% of patients with nonischemic cardiomyopathy and >90% of LV assist device recipients have them. Removing these antibodies has been shown to improve cardiac function and left ventricular EF.
Skeletal muscle effects of inflammation. Beyond the negative effects these antibodies have on the heart itself, inflammatory cytokines also affect skeletal muscle oxygen extraction during exercise, worsen anemia and loss of muscle mass, promote sodium retention in the kidneys leading to plasma volume expansion, and increase pulmonary pressures during exercise due to pulmonary vasoconstriction. All of these contribute to shortness of breath and reduced exercise tolerance. Yet another reason that dealing with whole body inflammation reduction is needed for a more comprehensive approach to controlling heart failure.
Sterile inflammation. The hemodynamic stress of HF induces a state of sterile inflammation, whereby increased heart muscle wall tension and mechanical stretch trigger the release of an array of proinflammatory cytokines by cardiomyocytes and cardiac fibroblasts, including TNF-a, IL-6, IL-1b, angiotensin II, and myostatin. (Murphy) HF itself also triggers mitochondrial dysfunction, generates reactive oxygen species, and leads to activation of the NLRP3 inflammasome, with subsequent maturation of proinflammatory cytokines, such as IL-1b and IL-18. Simultaneous with the production of inflammatory cytokines from within the heart, inflammation occurs as a result of activation of the innate immune system, neurohormonal activation, and oxidative stress, and through cross-talk with other organ systems.
Ischemia of the gut mucosa.
Later stages of HF may lead to ischemia of the intestinal mucosa by either a decrease in cardiac output or venous congestion in the setting of right-sided HF and elevated venous pressures. Gut mucosal ischemia alters its permeability and the consequent impaired barrier function allows crossing over of endotoxins, microbial components, and metabolites into the systemic circulation. Released endotoxins decrease after successful treatment of decompensation or following diuretics. HF is also associated with dysbiosis of the gut microbiome, with low bacterial diversity and depletion of butyrate-producing bacteria. Butyrate exerts anti-inflammatory effects and stimulates regulatory T cells, which have a key role in limiting the inflammatory response.
Endothelial senescence
Senescence is a protective response from organisms against stress that limits the proliferation of aged non-functional cells. However, senescent cells accumulate in fibrotic regions and there is cumulative evidence that senescence is closely related to cardiovascular disease. (Gevaert) Indeed, endothelial cell senescence is associated with an augmented dysfunction and vascular inflammation. Recent studies further demonstrated that endothelial senescence contributes to HFpEF.
Fibrosis and HF
Fibrosis, also known as fibrotic scarring, is a form of wound healing in which connective tissue replaces normal tissue. To the extent that it goes unchecked, it can lead to significant tissue remodeling and the formation of permanent scar tissue.
A key mechanism of HF is cardiac remodeling, which includes two aspects: cardiomyocyte injury and myocardial fibrosis. (Liu) Cardiomyocyte injury presents as cardiomyocyte hypertrophy, necrosis, and apoptosis. Repeated cellular injuries, chronic inflammation and repair are susceptible to fibrosis where excessive accumulation of extracellular matrix components, such as the collagen is produced by fibroblasts, leading to the formation of a permanent fibrotic scarring and thickening of the affected tissue. Fibrosis acts to deposit connective tissue, which can interfere with or totally inhibit the normal structure and function of the organ or tissue. Mast cell deposition in heart muscle leads to fibrotic and inflammatory reactions. Mast cell density is increased in ischemic cardiomyopathy and hypertension.
There are two types of heart fibrosis: replacement and interstitial fibrosis. Replacement fibrosis usually occurs after heart cell necrosis from myocardial infarction. It can also occur from hypertrophic cardiomyopathy, sarcoidosis, myocarditis, chronic renal insufficiency, and toxic cardiomyopathies. Interstitial fibrosis is diffuse, and includes reactive and infiltrative interstitial fibrosis. Reactive fibrosis is seen in many diseases, including hypertension, and in aging. Infiltrative fibrosis is less common and caused by the progressive deposition of proteins (amyloidosis) or glycosphingolipids in the space between cells. Eventually, both interstitial and infiltrative fibrosis can lead to heart cell apoptosis and replacement fibrosis.
Assessment of the degree of fibrosis can be evaluated using blood markers or cardiac magnetic resonance imaging (CMR). There are two myocardial fibrosis blood markers, galectin-3 and soluble ST2, which can be used for risk stratification and detection of risk even without heart failure. CMR imaging can effectively detect and evaluate the degree of myocardial fibrosis, edema and infiltrates in the heart, with various heart problems and especially in HF. (Liang)
N-terminal pro–B-type natriuretic peptide (NT-pro N-terminal BNP)
NT-proBNP is commonly used to monitor HF. Plasma BNP concentration increases with the severity of HF. If BNP < 100 pg/mL, HF is unlikely; BNP between 100 – 500 pg/mL, HF is more likely; with BNP >500 pg/mL, HF or cardiac dysfunction is probable and rapid therapy for HF is suggested. (Cao) HF is more likely in those less than 50 years old with NT-proBNP levels > 450 pg/mL; between 50 and 75 years old with NT-proBNP levels > 900 pg/mL; and if more than 75 years old with NT-proBNP levels > 1800 pg/mL
The reduction of elevated BNP and NT-proBNP levels in HF predicts an improvement in clinical symptoms. A study of acute myocardial function patients found that BNP and NT-proBNP predicted sudden cardiac death and were the strongest predictors, even after adjusting for clinical variables, including EF. Plasma BNP and NT-proBNP can be used clinically to guide the management of individuals with HF and cardiac dysfunction, and they are also used as prognostic indicators which can help clinicians adjust their therapy strategy. BNP and NT-proBNP are still underused by clinicians in the management of HF.
Common medical treatments for HF
The conventional medical treatments for HF are based on the stage of HF.
| Type of Heart Failure (HF) | Conventional Therapies |
| Acute decompensated HF | oxygen, water pills (diuretics), vasodilator pills, ACE inhibitors and/or muscle contraction enhancers |
| Chronic HF | hypertension control, water pills, ACE inhibitors, ARBs, beta blockers, aldosterone antagonists, etc. Beta-blockers, ACE inhibitors, and aldosterone antagonists are called the “Golden Triangle” of HF treatment |
| Advanced HF | persistent or progressive severe symptomatic state with decreased cardiac function despite guideline-based optimized medical and device therapy – consideration given to advanced cardiac surgery options, such as heart transplant or left ventricular assist device (LVAD) implantation, or to initiate the management of end-of-life care |
Expanded therapeutic strategies
While the above common, conventional medical treatments for HF focus on the medical aspects of HF, strategies that target the many other aspects of the pathophysiology of the condition are rarely considered. Adding several interventions to target these known pathophysiological aspects should be able to improve function and extend the life of those suffering with HF.
It has been shown that in HF there are: poor heart muscle contractions, reduced general heart muscle health, increased sympathetic activity in the body and related neuroendocrine reactions, reduced nitric oxide levels and sensitivity, ATP depletion, increased reactive oxygen species, elevated heart cell death rate (apoptosis) and an increased rate of autoimmune diseases.
The known pathophysiological aspects that should be addressed with multiple coordinated strategies include the following:
When there is atherosclerotic plaque significantly obstructing coronary blood vessel flow, the heart will attempt increasing angiogenesis and collateral formation. These can be important and valuable self-preservation strategies initiated by the heart. However, these reactions are a double-edged sword by virtue of enhancing the development of hypertrophy. By reducing several of the other pathophysiologic aspects of HF, one may decrease the need of the heart tissue to make these vascular changes.
As yet there are no proven effective and safe anti-fibrosis medications available. Herbal therapies may have some effectiveness in decreasing cardiac fibrosis. (Li X; Wang J) At the moment the best strategies are preventive, other than the probable effectiveness of PEMFs, discussed below.
Inflammation
A very important aspect of controlling inflammation is by stimulating a ubiquitous molecule in the body called adenosine, acting through its generalized receptor, the adenosine receptor (AR). Adenosine regulates the function of every tissue and organ in the body and is considered a “guardian angel” in human disease (Borea). Release of adenoisine is enhanced with PEMF stimulation, inflammation, pH change, hypoxia, tissue damage, or nerve injury in all the tissues of the body. (Varani) The concentrations of adenosine are naturally at physiologically low levels in body fluids between the cells of unstressed tissues. These concentrations increase rapidly in response to cell injury-causing stress conditions such as low oxygen (hypoxia), lack of blood supply (ischemia), inflammation, or trauma.
PEMFs stimulate the activation of adenosine receptors (ARs), increase their functionality, and augment chemical agents that also stimulate these receptors. PEMFs primarily influence A2A and A3 ARs. A2A AR is the predominant receptor subtype responsible for coronary blood flow regulation. Stimulation of the A2A AR dilates coronary arteries in both an endothelial-dependent and -independent manner. (Mustafa) Stimulation of A2A and A3 ARs by PEMFs in cells throughout the body results in reduction of inflammation by lowering many proinflammatory tissue cytokines, including reduction of: tumor necrosis factor-α (TNF-α), Interleukins IL-1β, IL-6, and IL-8 and NF-kappa B.
Immunomodulatory
PEMF therapy has immunomodulatory effects to decrease the production of proinflammatory cytokine production, while stabilizing or increasing anti-inflammatory cytokine production and NF-kB expression during inflammation activation. PEMFs help to restore inflammatory cascades to homeostatic (healthy) production levels. (Ross)
Obesity and body fat
PEMFs have also been shown to reduce inflammation associated with obesity. (Baranowska; Du) Since the visceral/abdominal fat compartment is the greatest source of inflammation with obesity, applying PEMFs to a large part of the abdomen with a sufficient intensity daily is expected to help significantly. This would be true for any level of obesity, for existing inflammation and for preventing the damaging consequences of the secondary inflammation caused by abdominal cytokines released to circulate throughout the body. A better option would be to apply sufficient intensity whole-body PEMFs to help not only visceral, abdominal, fat and the fat under the skin but also the systemic effects of the inflammation caused by any excess fat. Generally, a fairly high intensity (equal to or greater than about 2000 gauss (200 mT)), whole body PEMF system would work best to deal with the broadest area of inflammation throughout the body.
Multiple physiologic actions
PEMFs have been shown to have numerous physiologic actions that address many of these known pathophysiologic aspects of HF (see Pawluk, Section 2: How PEMFs affect the body). As a result, PEMFs may be ideally suited for sole therapy and/or to complement other approaches in the treatment of HF. This would be especially true when working to control cardiac hypertrophic remodeling. PEMF therapy should be started early in the course of development of HF, and especially when cardiac hypertrophy is already seen, even before HF is diagnosed. The ideal time to begin daily PEMF treatment would be when the EF is already seen to be decreasing, before symptoms or signs of HF remodeling become evident. Once HF has already been diagnosed and medications have been begun, PEMF therapy should make HF medications even more effective and may allow the reduction of dosages, thus limiting side effects. (Pawluk)
ATP and mitochondrial function
There is a significant need to increase ATP production and improve mitochondrial function, and PEMFs are the ideal tool to do so. It has been shown that using PEMFs for only 20 minutes can stimulate ATP production (Zhang S) up to 600%, averaging 111-241%. However, since ATP is constantly recycled, frequent PEMF treatment to the heart may be needed to maintain ATP production and utilization. At this point it is unknown how long and how much of the ATP produced by PEMF stimulation will last. If a significant benefit is seen in cardiovascular function with PEMF therapy, attention should be paid to how long that benefit lasts and how often PEMF therapy should be repeated. It’s possible that with higher intensity PEMFs, treatment times could possibly be reduced to 10 – 15 minutes, multiple times a day depending on response.
Stem cells
The heart is continually making stem cells both for health maintenance and to replace natural cell turnover and for repair, especially in the presence of ischemia. PEMFs have been found to increase neural stem cells (Goodwin) as well as many other types of stem cells in the body (Maziarz; Poh). Research has also found that extremely low-frequency PEMFs tuned by ion cyclotron resonance for the calcium ion (Ca2+-ICR) could be used to drive cardiac-specific differentiation in adult cardiac progenitor cells without any pharmacological or genetic manipulation of the cells, increasing the lifespan of cardiomyocytes. (Gaetani)
Angiogenesis
Disruption of the natural coordinated tissue growth and angiogenesis in the heart contributes to the progression from adaptive cardiac hypertrophy to heart failure. Supplementation of angiogenic factors during progression from adaptive to maladaptive cardiac hypertrophy preserves cardiac function. Cardiac microvascular endothelial cells (CMECs) increase myocardial angiogenesis. Cardiac myocytes (CMs) also play a crucial role in myocardial angiogenesis. Pulse-burst magnetic field stimulation could augment angiogenesis, with associated improvement in ventricular function and reduced infarct size as found when studied in vitro in rats.
(Li F) The peak magnetic field of the coils used was 18mT. The PEMF promoted the proliferation and migration of CMECs and cardiac myocytes (CMs) directly. The PEMF also had an effect on the intercellular communication between CMECs and CMs. These results show novel cardiac cell mechanisms for PEMF action, indicating potential application in the treatment of ischemic myocardial disease and pathological cardiac hypertrophy. Thus, the use of PEMFs to promote angiogenesis in hypertrophic myocardium becomes a new therapeutic target of heart failure. Therefore, PEMF may potentially improve pathological myocardial hypertrophy and ischemic myocardial disease.
Cardiac fibrosis and myocardial stiffness
As far as the development of cardiac fibrosis is concerned, PEMFs have been shown to decrease the development of fibrosis in orthopedics. (Huegel) PEMFs have not been studied directly on cardiac fibrosis. However, PEMFs can indirectly affect the development of cardiac fibrosis by decreasing the cardiac inflammation that leads to fibrosis.
Arrhythmias and atrial fibrillation
Firstly, Arrhythmias and atrial fibrillation are common in those with heart failure, as a cause or consequence. PEMF therapy may be helpful in controlling or reducing the frequency and severity of these arrhythmias. Low-frequency, high intensity PEMF (LF-hiPEMF) could suppress atrial fibrillation by mediating the heart’s own natural autonomic nervous system. Left stellate ganglion (LSG) – located just above the first rib in the lower neck – autonomic neural activity can affect ventricular arrhythmia.
Studies have shown that LSG hyperactivity appears to predispose to the development of ventricular arrhythmia. The effect of LF-hiPEMF stimulation of has been studied in acute heart attack research. (Wang S) LF-hiPEMF stimulation reduced both the neural activity of the LSG and the incidence of ventricular arrhythmia. Therefore, this form of PEMF stimulation could be a novel noninvasive substitute for the existing implant device-based electrical stimulation or sympathectomy approaches, conventionally used in the treatment of arrhythmias.
Moreover, other research has also shown that lower intensity PEMFs applied directly to the heart in a dog model decreases the risk of episodes of atrial-fibrillation (Scherlag). In addition, see: Atrial Fibrillation (A-Fib).
Functional capacity limitation in HF
Additionally, generalized functional capacity in HF can be severely limited and debilitating. The functional capacity limitation in heart failure can be due to many factors not directly related to heart muscle function. Consequentially, rather, the cause may be the result of peripheral muscle changes. (Sbruzzi) These peripheral changes include decreased blood supply in the periphery, reduced capillary function, transformation of slow-twitch type I to fast-twitch type II fibers and changes in general metabolic and nutritional status that include reduced skeletal muscle size (atrophy/sarcopenia) and muscle strength. These changes are predictors of both exercise intolerance and the poor prognosis of the value of muscle training. If able to be accomplished, functionally useful muscle training has the potential benefit of increased maximum oxygen consumption, muscle mass (type I fibers), oxidative enzyme levels, endothelial function improvement and better performance in functional tests.
Moreover, Neuromuscular electrical stimulation improves peak O2, walking distance, quality of life, muscle strength, endothelial function, and depressive symptoms in patients with HF and could be important in cardiac rehabilitation for HF patients. (Neto) However, neuromuscular electrical stimulation (NMES), which is most commonly used, can be painful very uncomfortable. To provide adequate results, higher intensity levels of NMES are needed and therefore are of limited value. When NMES is used to treat weakened or atrophied muscles, high intensity stimulation is needed to generate sufficient deep muscle contractions. One study (Sbruzzi) found that NMES in individuals with HF produced only about one quarter of the peak intensity muscle contraction compared to maximum voluntary muscle contraction. While this may be useful in individuals with very weak local muscles and the inability to contract these muscles voluntarily, it would not be sufficient for general, whole-body rehabilitation.
On the other hand, neuromuscular magnetic stimulation (NMMS) is much more tolerable, especially for larger, deeper muscular enhancement. NMMS was studied in 40 healthy volunteers, 20 receiving active NMMS and 20 controls. (Yang) The active group received 15 minutes of quadriceps NMMS at maximum tolerable intensity three times per week for five weeks. The maximum magnetic field output intensity was 3.1 T/s. Visible muscle contractions were seen in all participants.
Furthermore, the tolerated NMMS intensity was about 45% of maximum possible. Even so, the isometric maximum and average peak torque of the NMMS group increased significantly by 22% and 23% respectively. The speed of being able to straighten the knee after stimulation also improved between 20 – 27%. The control group had no changes in their peak torques. This research indicates that the high intensity PEMF indicated for the stimulation of the heart in those with heart failure, would also be useful in peripheral muscular rehabilitation.
Conclusion
Finally, continued research into the pathophysiologic mechanisms of heart failure have discovered a number of changes that may be amenable to innovative therapies, such as PEMFs. Some of these cardiac changes include poor heart muscle contractions, reduced general heart muscle health, increased sympathetic activity in the body and related neuroendocrine reactions, reduced nitric oxide levels and sensitivity, ATP depletion, increased reactive oxygen species, elevated heart cell death rate (apoptosis) and an increased rate of autoimmune diseases. Root causes for some of these changes, whether acting individually or synergistically, include: Inflammation, fibrosis, cardiac hypertrophy, endothelial dysfunction, reduced energy supply (ATP), tissue calcium imbalance, poor tissue metabolism, cardiac vascular changes, metabolic tissue stress, dysregulated intestinal function, muscle weakness, hypoxia, and so on.
Lastly, as it happens, an innovative therapeutic strategy that addresses many of these dysfunctions, both as a cause and a consequence of HF is the use of pulsed elect magnetic field (PEMF) therapy. Evidence is accumulating for the value of PEMF therapy to address many of the pathophysiologic changes. Fortunately, there is increasing availability of PEMF devices. Research is desperately needed to determine the value of PEMF therapy as a complementary modality specific to the treatment of heart failure.
References
Heart disease is the number one cause of mortality in the United States and Canada. The heart is a very electrically dynamic organ. Heart disease includes many causes. These range from vascular disease, electrical conduction defects, muscle problems, valvular effects, congenital defects, infectious problems, trauma and pericardial problems, all as the direct or primary cause of the cardiac disease. Other non-direct problems can also affect the heart secondary to other systemic issues, including, but not limited to, hypertension, kidney disease, lung disease, autoimmune diseases, toxicities of various kinds, etc. Finding nonpharmacologic and noninvasive ways of managing heart disease in a safe, effective, nontoxic way is always a goal.
Magnetic fields have been found to significantly affect cardiac function, in addition to effects on a myriad of other body systems and problems. Not all magnetic fields are the same. Different types of magnetic fields may have different effects on the heart. Treatment of secondary causes can be just as important as the primary management of the heart itself.
The purpose of this paper is to explore the interaction of electromagnetic fields (EMFs) and the heart. We will review the basic science of EMFs and tissue, the heart as an electromagnetic organ and the geomagnetic and occupational influences that may affect it. This will serve to emphasize how readily cardiac tissue may be affected by EMFs. Animal studies often serve as a basis for understanding how human functioning may be affected by any therapy, before human treatment is tried. Finally, we will end with evidence of human benefits.
EMFs either pass through the heart without interaction or they interact directly. The latter is called “coupling.” There are established, basic mechanisms through which static and time-varying electric and magnetic fields interact directly with living matter. Induced time-varying fields can stimulate excitable cells such as cardiac muscle. Static and time-varying fields interact with the body differently.
Every mammalian system reacts to the influence of EMFs. On the cellular level, cell membranes, mitochondria and nuclei are the most sensitive. Effects of EMFs depend on many factors, such as age (children and old people are more reactive), sex (men are more sensitive), and functional state (a functioning organ reacts more strongly).
The heart muscle itself, because of its electrical activity, creates its own endogenous EMFs. Using a special magnetometer, one can see that the heart produces its own measurable, dynamic magnetic fields – electrical and magnetic activity follow each other, as night and day. These measurable fields allow for the mapping of the heart’s magnetic field under normal and pathological conditions and making possible a new tool for functional cardiology. EMFs generated by the cardiovascular system itself have biological effects not only on the heart itself but also on non-cardiac cells in the body distal to the heart by interacting with the immune system.
Extremely low frequency (ELF) EMFs easily penetrate tissues and cause virtually no sensory reactions. The reaction of the cardiovascular system to ELF EMFs is complex and includes direct responses of cardiac muscle, the autonomic nervous system, blood vessels, etc., and reflex responses mediated by the central nervous system. ELF EMFs increase the diameter of capillaries and greatly improve microcirculation, systemically and locally in the heart itself.
High frequency and high strength EMFs undoubtedly affect the cardiovascular system. Laboratory studies show that effects result even from EMFs below 150 Hz and 1G. The cell membrane is the primary site of EMF interaction, leading to intracellular changes in gene function and protein synthesis. These effects are highly nonlinear, with dose-response patterns that show “windows” of action and resonance-like phenomena. Power transmission lines can have health effects, but electrical transportation systems and electrical appliances are more common sources and have much more powerful EMFs.
Movement in the environment interacts with other external EMFs and work synergistically together to cause bioeffects. New lower limits to field strength actions are often discovered. There are no known lower limits for the intensity of EMFs to affect biological systems. Only the microscopic design of a receptor in the body and the time-variation dependency of its interaction with the many varied EMFs define the level of sensitivity to EMFs.
Extremely weak alternating, sinusoidal (power line) fields of certain frequencies interact with the local geomagnetic field and/or with EMF therapeutic systems. EMFs can act through another organ or tissue’s EM field, local and/or atmospheric geomagnetic fields and possibly even the moon. Even the body’s electrical currents interact with external fields and participate in control of life processes. External EMFs interact with most, if not all, organs and functions in the body. All these interactions clearly paint a very complex picture of EMF actions on the body – leading to the natural conclusion that human functioning is fundamentally inseparable from the EMFs around it.
ELF (below 300 Hz) EMFs interact strongly with biological systems, both electrically and magnetically. The magnetic field aspect of an ELF EMF penetrates the body without obstruction since the magnetic permeability of tissue equals that of air. Effects are directly related to the strength of the electrical currents induced in the tissue by the magnetic field aspect. Effects are seen at current strengths close to natural currents in the body and even fields well below those of natural tissues cause cellular responses. These involve membrane signal systems, cell surface receptors and all body biochemical systems, including enzyme activity and gene expression.
In dogs’ hearts, considered comparable to human hearts, the natural heart EMFs, due to the beating of the heart, are much larger by adding external EMFs. The heart contributes between 5% and 10% of the total field induced in the human body by external electric and magnetic fields.
Cells or tissues can be protected against a lethal stress by first exposing them to a sublethal dose of the same or a different stressor to produce stress proteins in tissues. This concept is known as “preconditioning” and gives protection against oxidative stress, caused by ischemia/reperfusion, UV light exposure, heat, chemicals and electromagnetic field (EMF) exposure. Rodent heart muscle cells preconditioned by low energy EMFs for 30 minutes have more effective induction of stress proteins than heat. As little as 10 seconds of exposure produce a detectable response at 30 minutes, last for more than 3 hours and can be restimulated by a second exposure to fields of different intensity.
However, in egg embryo studies, continuous exposure to ELF EMFs for 4 days, twice daily for 30 minutes or 60 minutes for 4 days reduced the protective effect. 30-minute exposures once daily and 20-minute exposures twice daily did not reduce protection. A protective role is seen against cardiac ischemia in chick embryos. EMFs for 20 minutes induce stress proteins in the laboratory. This raises the strong possibility that using them before, during and after the surgical trauma can use EMFs for minimizing heart damage from heart surgery or transplantation or heart attack in humans.
For other kinds of cardiac actions, short-term exposure to sinusoidal ELF EMFs (5-8 Hz) in adult and old male rabbits for 15-120 minutes causes mild decreases in the ECG heart rate if exposure lasts 60 minutes. Old rabbits developed extra beats. In animals with experimentally induced myocardial infarctions, EMFs are not necessarily beneficial. There is little data comparing different kinds of EMFs. It remains to be determined what the optimal configurations are for different situations.
One study examined the difference between pulsed (PEMF) and alternating/sinusoidal (AMF) field effects on the hearts of dogs, exposed for an hour per day for 10 days. The AMF caused marked changes in heart dynamics: decreased ventricle function and increased peripheral resistance and end diastolic pressure in the right ventricle, as well as, left ventricular work. Systolic blood pressure (BP) and contractility and heart rate still decrease with PEMFs, but are less marked. Thus, use of PEMFs may be less aggressive for cardiac problems than sinusoidal fields.
Basic actions at the cell level account for these actions. A 16 Hz frequency modulation increases mean flow of Ca++ out of frog heart cells at low intensities. This compares with calcium flow in brain tissue, suggesting that neural tissues may generally react at these modulations and intensities and act through changes in Ca++ in and around cells. Chronic exposure to 50 Hz EMFs of rats at 2 hr/day for lower intensities or 0.5 hr/day to higher intensities produced increased blood flow to the heart tissue and enlargement of the coronary vessels. Higher intensity EMFs affect the heart function of rats (25) with 14 days, 4 hours a day of stimulation. EKG changes are temporary, but, at the end of 14 days of stimulation only heart rate remains decreased.
Hypertension, if untreated for a long time, can cause heart damage and ultimately heart failure. Static magnetic fields (SMF) of 2000 G placed on each carotid sinus area (south and north poles, respectively), decrease systolic, diastolic, and mean blood pressures by 10%. Heart rates were not affected. This action is most likely due to Ca++ transport changes across the carotid pressure receptor membranes.
Stress has very strong actions on the heart. When ultrahigh-frequency (UHF) EMFs are given to dogs subjected to emotional stress, several cardiovascular changes resulting from stress are improved. Stress increases blood pressure by 40-50%, heart rate by 20% and makes the left ventricle function hyperdynamically. Even though the UHF EMF does not eliminate the stress reaction of the cardiovascular system, it is less pronounced overall. UHF EMFs seem to accelerate central adaptation mechanisms, rebalancing circulation and decreasing adaptation time for cardiac stress.
Studies from Eastern Europe have found that changes in the geomagnetic field can worsen heart disease and that the major effects occur on the first or second day after a magnetic storm. Geomagnetic activity can be quiet, unsettled, active, or stormy.
While myocardial infarction rates (MIs) from circulation blockages do not seem to change with geomagnetic activity, cardiac electrical activity is probably more sensitive and affected. The admission rates of patients with new episodes of electrical conduction problems causing paroxysmal atrial fibrillation (PAF) were highest during the two lowest levels of geomagnetic activity, more in males and persons over 65 years. Males under age 65 with PAF are at greater risk of stroke from the PAF. Thus, increases in heart electrical instability appear to happen during periods of lowest geomagnetic activity.
Geomagnetic fields (GMF) also interact with ELF EMF therapy. Even a very weak EMF, up to 70 uT applied to the whole body or locally, for 8-12 minutes, 1-2 times per day for 10-20 days has clinical benefit in most patients. Sensitive patients improve after only one or two days, most others take 5-10 days. On days when GMF increases two-three fold, some patients complain of discomfort during the exposure and have increased blood pressure (BP). In most, (47%) the BP shows no changes, 38% decrease BP and 15% are increased.
Environmental exposure of EMFs also affects cardiovascular function. Average 50-60 Hz working environments do not have much effect on human heart rates. In AM radio station workers exposed to high frequency (HF) fields, 83% have heart rhythm disturbances and decreased signals in their ECGs.
There are significant differences between clinical ELF PEMF systems and high frequency (microwave or cell phone levels) sources. Any publicly oriented article or book, unselectively citing references mixed with ELF exposures and those in the HF kHz and over range, clearly does not understand EMFs and is indiscriminately comparing apples and oranges, in terms of their clinical effects. Indeed, there are many clinical therapy systems that use high frequencies, but they are usually used for tissue destruction, for tumors and colon, bladder, skin and heart arrhythmia lesions, etc. General or public use of EMFs for personal use should be restricted to low strength ELFs or high frequency EMFs that do not create heating.
Duration of exposure to environmental fields is probably important as well. Changes in heart rhythm may be affected in the workers professionally exposed to 50-Hz electric and magnetic fields (EMF) over long periods. There can be a global decrease of cardiac rhythm in both high (over the industry norm) and low (at or below industry norms) professionally EMF-exposed groups compared to the non EMF-exposed control group. These changes may increase the risk of cardiovascular diseases. Other environmental or home-based “electromagnetic pollution” has the risk of inducing health problems. Fortunately, measures can be taken in the home and office to decrease background EMF risks.
Experimental studies show that EMFs can affect the function of the centers of the autonomic nervous system controlling cardiac rhythm. A temporary increase in BP is seen with clinical exposure to industrial 50-60 Hz EMFs, but extended exposure causes the systemic pressure to decrease. Microcirculation dilatation occurs, with increased blood flow in the capillary bed and precapillary arterioles and an increased permeability of the vascular wall. Even lymphatic vessel flow increases. Circulation changes produced by EMFs are depending on the functional state of the central regulatory apparatus, especially the hypothalamus. Experimental PEMFs are found to act directly on the tissue of a beating heart.
Medium powerline-type field exposure for 3 hours causes a significant slowing of the heart rate. EMF effects are related to changes occurring during the recovery phase of the cardiac cycle. Humans are more responsive to some combinations or levels of field strength than others.
EMF therapy acts beneficially on the functional state of the nervous and endocrine systems as well as on tissue metabolism. The heart rate and BP decrease and the cardiovascular system is less reactive to adrenaline and acetylcholine. The parasympathetic nervous system is activated. Stimulation of the autonomic ganglia along the spine reduces cortisol and aldosterone. MFs typically cause only a momentary change of the microvascular bed with slowing blood flow. This then changes over to a longer period of an increased heart rate, rate of blood flow and filling of the blood vessels.
Sinusoidal PEMFs improve microcirculation in people with ischemic heart disease and vascular diseases of extremities. PEMFs act more strongly than permanent magnets. ELF MFs improve both lipoproteins and cholesterol levels. But, a static magnetic field of more than 50 mT (500 Gauss) at the tissue increases risk of atherosclerosis, with irregularly arranged lipid deposits in middle to large size arteries and fibrosis and calcification. In people with low blood pressure, EMFs improve heart contractions and cause more normal bioelectrical function. In most people, EMFs lower BP by lowering vascular resistance, with vasodilatation.
Hypertensive patients are affected positively, depending on the function of the heart before magnetic treatment. People with normal functioning hearts just have their vascular resistance lowered. EMFs normalize heart function and circulation in patients with high BP, and at the same improve circulation. The improvements in systemic vascular tone, as well as lipid metabolism and coronary circulation make MFs very useful treatment for people with the combination of hypertension and ischemic heart disease.
Early in the course of use of MFs in patients, there are changes in ECGs to a lower wave size pattern, sinus rhythm and extra beats, and a decrease in heart rate. With continuing magnetotherapy, these changes disappear and cardiovascular function is improved. This is common with MF therapy. Meanwhile, there may be temporary worsening while repair and rebalancing is happening, with the outcome being more normal function and health.
To get better results with EMF treatments, understanding the underlying cause of the problem and function of the organ system is critical for designing the proper protocol to use for an individualized approach. The best outcomes occur this way. Without an understanding of the physiology and the type of field to use and how, less than optimal results can happen. Awareness of the potential for initial de-stabilization minimizes misunderstanding in managing the course of therapy and should be carried out with the assistance of a knowledgeable professional.
Good results are not always seen. In one small series, patients were treated with sinusoidal EMFs for arrhythmias caused by ischemic heart disease, post myocardial infarction and cardiomyopathy. A sinusoidal EMF used for 10 sessions daily, alternating between placement to the sternum for 15 minutes and “palm – wrist” area for 5-7 minutes. EMFs did not normalize heart rhythm. One woman had an attack of paroxysmal tachycardia occurred. Six patients reported unpleasant sensations (“sickness at heart” and headache) during or after EMF therapy, occurring most often with cardiomyopathy. A sinusoidal EMF may even increase BP in males, whether exposure was for 20-40 minutes or 1 hour.
Magnetolaser therapy (MLT) has been studied in single placebo control trial in the treatment of ischemic heart disease patients, with exertional angina and moderately to severely impaired function, post-myocardial infarction. Most had significantly decreased circulation. MLT was applied to 3 tender zones on the chest: in the front over the upper part of the heart and middle of the sternum, and in back between the scapulas to the left of the mid line, for 12 min, 4 min for each exposure zone, daily over 15 days. Work capacity increased in 84% of the MLT group but worsened in the placebo group.
The work increased most for patients with functional classes II and III angina. MLT was also useful for patients with conduction disorders, eliminating extra beats in 29% and decreasing them by more than 70% in 32% of cases and stopping paroxysmal atrial fibrillation in 53%. The treatment lasted through the follow-up period of 12 to 16 months. These impressive results show that MLT facilitates adaptation to a physical load, and promotes rearrangement of central hemodynamics and recovery and stabilization of electrical activity of heart cells, safely and simply.
Heart rate variability (HRV) results from the action of neuronal and cardiovascular reflexes, including those involved in the control of temperature, blood pressure and respiration. Changes in HRV are predictive of a number of cardiovascular disease conditions and specific alterations in HRV have been widely reported to be associated with adverse cardiovascular health outcomes. Low strength, 60-Hz continuous or intermittent MFs in healthy males has little or no effect on HRV, indicating they do not induce stress effects. HRV alterations during magnetic field exposure may occur when accompanied by increases in physiologic arousal, stress, or a disturbance in sleep. There appear to be significant differences in heart rate and mean 24-hour personal exposure to MF between occupational and non-occupational group. It is not yet known whether clinical EMF exposure, in those who’s HRVs shows clear departures from normal, improves the HRV.
Patients with so-called Electrical Hypersensitivity (EHS) have a misbalance of autonomic regulation being more hypersympathetic, as measured by heart rate (HR) and electrodermal activity and sympathetic skin responses to visual and audio stimulation. There are frequency-intensity-duration components to these exposure sensitivities.
Much of the biological effect of high frequency fields is due to tissue heating, not just EMF effects. However, biological effects, not due to tissue heating (nonthermal) have been found with millimeter-range (MMR; about 300 GHz) MFs. These EMFs probably affect the command centers of organs through reflex systems. It is preferable to select biologically active points for MMR exposure; tender zones and areas of large joints, where tissue sensors are numerous and nerve fibers contact collagen directly. Local skin exposure to MMR EMF affects cerebral function.
Clinical benefits are seen with treating heart angina and hypertension, especially essential hypertension. It is noted that patients with symptomatic, renal hypertension don’t respond. Cardiac rehabilitation in rats with MMR EMF added after myocardial infarction promotes tissue repair and functional recovery. Human clinical studies confirm this. Only favorable effects occur: more rapid tissue healing, activation of ATPases, antioxidant properties, and so on.
Use of mobile phones is commonplace. Mobile phones produce biologically active HF EMFs. Digital mobile telephones have the theoretical possibility of affecting implanted cardiac pacemakers. The META series of pacemakers are mostly immune to clinically important EMF interference from digital mobile telephones. It appears that use of digital mobile telephones by patients with appropriately programmed pacemakers is safe.
There is also much evidence of accelerated tissue healing effects where there has already been tissue damage, either from ischemia or mechanical or surgical trauma. Tissue healing with PEMFs appears to be accelerated by about one third to one half the usual time and results in fewer tissue complications, such as infections and poor or aggressive scar formation. In addition to stress protein effects mentioned above, but also free radical scavenging and accelerating RNA/DNA production in laying down new repair tissue. This means that, if cardiac surgery is required, not only would EMFs help tissues to be less traumatized but also would help speed recovery afterwards.
Cardiac vascular and peripheral vascular blockages depend on the development of “soft” and “hard” atheromatous plaque formation. It is these plaques and their actions on platelet dynamics that can cause vascular obstructions, occlusions or thromboses, leading to cardiac ischemia (angina) or heart attacks. This is the basis for several drug therapies aimed at reducing platelet adhesiveness, including daily aspirin and warfarin, to name a few. PEMFs have similar, strong effects in reducing platelet function and other clotting factors and probably acts synergistically and additively with these drugs. The primary actions studied have been on ADP dependant platelet adhesion, reduction in thrombin and increased thrombolysis.
EMF therapy acts beneficially on the functional state of the cardiovascular, nervous and endocrine systems as well as on tissue metabolism. The heart has been found through numerous studies to be very electromagnetically sensitive. This sensitivity extends to all external fields, whether therapeutic or otherwise, including their interactions with each other and with the body.
Some of the benefits to the cardiovascular system are indirect, acting through stress reduction effects, emotional responses, endocrine system, the immune system and especially the autonomic nervous system. Autonomic neural regulation makes the tone of the vascular system normal. Even cardiac muscle blood vessels are dilated. Decreased vascular resistance decreases the workload of the heart, reducing strain, which if applied over long periods of time could lead to decreased cardiac wear and tear. EMFs have a moderating effect on cardiac function as well as the microcirculatory system. Pulsed magnetic fields, versus sinusoidal fields, appear to be less aggressive towards the heart. Much of their actions depend on cellular Ca++ ion changes.
There are multiple other actions of EMFs on the cardiovascular system. One is an anti-atherogenic effect and a reduction of platelet adhesion factors, which could reduce the possibility of cardiac vascular occlusions and cardiac damage. Because of actions on stress proteins, cardio-protection is now a feasible use, not only for treating or reducing cardiac ischemia but also for the trauma created by cardiac surgery. EMFs are even useful post-operatively in facilitating and accelerating recovery through wound healing effects, for superficial and even deep tissues.
There are significant differences between clinical ELF PEMF systems and high frequency (microwave or cell phone levels) sources. Any publicly oriented article or book, unselectively citing references mixed with ELF exposures and those in the HF kHz and over range, clearly does not understand EMFs and is indiscriminately comparing apples and oranges, in terms of their clinical effects. Indeed, there are many clinical therapy systems that use high frequencies, but they are usually used for tissue destruction, for tumors and colon, bladder, skin and heart arrhythmia lesions, etc. General or public use of EMFs for personal use should be limited to low strength ELFs or high frequency EMFs that do not create heating.
The evidence reviewed here gives reasonable support for wider medical application of magnetic field (MF) therapy as a method of non-drug therapy in cardiovascular disease, alone or in a complementary fashion with medical or other modalities.