1830 S. Alma School Rd
Bldg 7, Ste 135
Mesa, AZ 85210
(480) 839-2273
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GET RID OF OSTEOARTHRITIS WITH SOFT TISSUE APPROACHES – (12-03-07)
Chondroitin for Osteoarthritis of the Knee or Hip
This review found minimal or no benefit to the use of chondroitin for arthritis of the knee. Before we jump to conclusions… How many people in these studies with knee/hip pain was actually coming from the joint itself? The answer, of course, is that we don’t know. Degenerative joint disease = pain in clinical studies but that just isn’t always true.
For a physician that addresses soft-tissue components of injuries, how often does a knee loaded with arthritis get complete relief with some solid soft tissue approaches? I can personally say that aggressive soft tissue techniques like Graston can sometimes bring complete relief for many OA sufferers. Did we fix the OA? Of course not–but in these cases the soft tissues were the primary pain generators. So we could assume that any type of joint support would not be effective in these cases.
So, in these studies, did they rule out non-joint related pain generators? More of a rhetorical question because of course they did not.
RECIPE TO CREATE A DRUG USER
The Federal Bureau of Narcotics was formed over 80 years ago in 1930. In 1954, President Eisenhower formed a council to battle narcotics use here in the United States. In 1971 President Nixon coined the term “war on drugs.” This was further strengthened by President Reagan in 1982. Overall, untold billions of federal dollars have been spent on this effort. Man did we get it all wrong.
We were spending our money and efforts at illicit drug use, while slowly building a society that not only condoned prescription narcotic drug use, but PAID FOR IT! Beginning at least in 2008, the number of deaths associated with prescription narcotic use exceeded those deaths caused by illicit drug use.
Codeine, OxyContin, Percocet, Vicodin, morphine, Xanax and Valium (these 2 are benzodiazapines–but frequently abused), Valium, Tramadol, Tylenol 3.
It never ceases to amaze me how quickly prescriptions for narcotic pain relievers are given out. In the ER it is almost a given. High likelihood in urgent care. Still far too common in a primary care settings.
And then there are the non-steroidal anti-inflammatory drugs (NSAIDs). Why should we throw something as safe and harmless as NSAIDs in with the narcotic drugs?
I firmly believe that, as time progresses (decades, probably) we will begin to understand just how dangerous this class of drugs is. Arthritis / joint damage, heart attacks, strokes, impotence, GI bleeds, disruption of intestinal barriers, dementia…this list of known effects seems to lengthen every month.
The problem here is that of sheer scale of use. Between over the counter use and the 70 Million prescriptions per year, it is estimated that there are 30 BILLION doses used per year. That’s with a “b.” Even uncommon side effects become magnified by this volume of use. Of course, bleeding ulcers, heart attacks and strokes are not uncommon, so the math just gets more complicated from there.
So what does all of this have to do with this particular article? This article looked at analgesic use after low risk surgery (gall bladder, cataract, TURP for prostate enlargement and varicose vein stripping) and what happens after 7 days and one year. The results were surprising:
- Opioids were newly prescribed to 7.1% within 7 days of being discharged from the hospital
- Opioids were prescribed to 7.7% at 1 year from surgery
- Instead of going down, the number of patients receiving a prescription for opioids at 1 year increased to 15.9%
- Overall, an opioid prescriptions within 7 days of surgery made it 44% more likely to be a long term user
- NSAIDs were prescribed to 0.3% within 7 days of discharge
- NSAIDs prescriptions jumped to 7.8% at 1 year from surgery
- Those taking NSAIDs within 7 days of surgery were almost 400% more likely to become long-term NSAID users
Wow. Talked about generating a society that is addicted to drugs. And while this study looks at low risk surgery, how similar would the numbers be for neck pain? Low back pain? Knee pain or headache? Makes me happy to be a chiropractor.
Again, I would ask…is the “War on Drugs” looking at the wrong side of the prescription pad?
TREATMENT OF IRRITABLE BOWEL SYNDROME WITH OSTEOPATHY – (02-11-08)
Treatment of irritable bowel syndrome with osteopathy: Results of a randomized controlled pilot study
There has almost been much controversy about whether spinal adjusting has the ability to affect visceral function. Over the years, there has been a surprising number of studies (mostly in osteopathic journals) that do show an effect of manipulation on visceral function.
In this small study we see that osteopathic manipulation was effective in symptom scores for irritable bowel syndrome. Couple manual therapy with some aggressive lifestyle changes and targeted suplementation and you’ve got quite a nice set of tools to drastically help IBS.
PULLED A MUSCLE? WHY POPPING THAT ALEIVE IS A VERY BAD IDEA
Obviously, this article is going to sound a little self serving since I am, after all, a chiropractor with a vested interest in my patients not taking drugs of any kind unless absolutely necessary. My more inquisitive patients all seem to ask a similar question…if the body is so brilliantly designed, where do chronic musculoskeletal complaints come from?
Certainly there are injuries that are severe and result in tissue damage that is much greater in degree and have a high likelihood of producing chronic pain. Think skiing, skateboarding or snowboarding injury. High speed car crashes. Motorcycle accidents. Equestrian wipeouts. Surgery.
But what about the weekend warrior who pulls a hamstring? The 8 hour per day computer user? Or me, as a lifelong martial artist, who has had untold injuries over the decades to pretty much every potential area of my body? Why do these situations lead to chronic pain?
My personal thought (backed by lots of research and years of clinical practice) is that the development of chronicity has much to do with how we handle the immediate period after the injury or onset of symptoms. What do the vast majority of us do (which is, of course, the direction indicated by billions of dollars of advertising) in this immediate period? Rest the area and pop an over the counter pain medication or anti-inflammatory. This is arguably the worst possible combination possible.
Why?
First, let’s address the immobilization aspect. Literally within minutes of immobilization, the soft tissues surrounding the immobilized joint begin to break down. The longer that joint is kept from a full range of motion, the worse the tissue damage. Anyone who’s ever broken a bone and had it casted can attest to how much joint motion is lost once the cast comes off. Recovery time can be even longer than the immobilization time.
With tissue injury, ultimately, the size of the region affected is larger than the original injury size. Consider the swelling associated with an ankle sprain—the area of the ligament injury may actually be very small, but the entire ankle, foot and lower leg swells up to the size of a balloon and becomes discolored. Now the amount of injured tissue is much larger than the original injury and this tissue has to heal. But healing occurs in a haphazard fashion if the area is not used. I give the analogy of a leak in your bathroom faucet. You call in the plumber. He shows up with a crew that’s been drinking at the bar for half the day. They proceed to rip out half the bathroom to fix the leak and rebuild with a level of skill only a three-sheets-to-the-wind Irishman can achieve.
Our body is no different. As we heal after an injury, the new tissue, whether it is bone, muscle, ligaments, fascia or tendons, is laid down in a disorganized manner. Only as that region goes through movement do these healing tissues become stressed and become organized along the lines of force. Immobilization becomes the enemy of proper healing.
Next, let’s address the routine use of over the counter anti-inflammatories, or prescription, for that matter. All anti-inflammatory medications are, by their very nature, designed to interfere with the inflammatory process. Unfortunately, inflammation is the normal process of healing. Disrupt this and you disrupt the ability of our tissues to heal the way they were designed. Contrast this with the use of ice right after an injury. Ice works simply by reducing blood flow to the newly injured area, thus keeping the damage of the drunken plumbing crew from getting too out of hand. Arguably a good idea. But then blocking the crew from repairing the area in specific ways, like maybe taking all their crescent wrenches away from them, is going to result in improper repair.
Hopefully you can begin to understand why the combination of immobilization and anti-inflammatory medications immediately after an injury may be the first step in developing chronic pain. Repeat this cycle the next time you injure the area and the dysfunction begins to mount.
This particular study demonstrates just how bad the outcome can be when non-steroidal anti-inflammatories (NSAIDs) are used after a rotator cuff surgery tendon repair. Researchers looked at the tendon to bone healing that occurred in the presence of NSAIDs and found that every case was affected, from complete failure of healing to weakened tissue. No normal healing tissue was present when compared to the group in which no NSAIDs were used.
While this relates to surgical cases in animals, the same process is interfered with in every case of tissue injury that happens in our body when NSAIDs are used. While my opinion that you should run to your chiropractor at the first hint of any type of pain may sound self-serving, the reality is that you may be diverting the development of chronic pain.
DOES ARTHRITIS MEAN I HAVE TO HAVE PAIN FOREVER?
DOES ARTHRITIS MEAN I HAVE TO HAVE PAIN FOREVER? In our office, the answer is almost always a strong “NO,” but it is a perception that many patients have, possibly because their PCPs don’t have many answers. Keep in mind that the joint is surrounded by the soft tissues (fascia, ligaments, tendons, muscles) and, in most cases, these tissues actually create much more pain than the joint does. Address the problems in the tissues surrounding the joint and the pain can go away.
In this particular study, the authors looked at what patients did after being given a diagnosis of knee arthritis. 75% percent of them took matters into their own hands by increasing activity levels, 33% turned to acupuncture, orthotics, braces and 36% started supplements. The results were very encouraging–after 6 months, the majority of patients in the study had found some relief from this approach. I know that in our office, we strongly urge patients to increase their activity levels with very good results.
CONSIDERING SURGERY FOR YOUR KNEE PAIN?
Knee pain is something we see commonly in our office. Unfortunately, I think these are many more cases because patients have been told that their knee pain is arthritis and there is nothing that can be done. This could not be further from the truth.
From a treatment viewpoint, the knee is really not a complex joint. Basically it is referred to as a ginglymus (“hinge”) joint with a slight degree of rotation. There are ligaments, meniscus, muscles, the joint itself and….most importantly…the fascia!
While it is difficult to describe, I generally refer to the fascia as the sheath that our joints and muscles are encased in. It is far more complicated than that, but it seems to get the point across. Many patients come in concerned that they may have torn a ligament in their knee and may even have an MRI to back up the idea. However, current theories are actually debunking the idea that ligaments truly exist.
Rather, they are thickenings of the fascia along areas of a joint that provide increased stability. We have called them ligaments and have seen them on cadavers because anatomists have dissected out what they were looking for. In other words, they were looking for a ligament so, as they dissected out a region they actually created the ligament from the fascia surrounding that area. So, this thickening of tissue exists, but it is actually the continuation of the fascia from the area above and below it.
So what does this mean?
It means that the fascia surrounding a joint may be the most critical tissue that needs to be addressed for joint pain. This can be addressed with fascial manipulation, Graston technique or Rolfing. Laser, chiropractic adjusting, ultrasound, strengthening exercises and any number of other techniques are not going to address the problems that occur in the fascia and may not be as effective for relieving knee pain.
The fascia is also a major source of pain in the knee. Because of this, patients develop knee pain, their primary care doctors orders X-rays (or worse-an MRI) done before any treatment, and they are told they have arthritis. They try some pain meds, maybe a short course of physical therapy, but don’t notice much of a difference. At this point they are resigned to wait until the pain gets debilitating enough for a knee replacement. Sounds like a great plan, huh?
It is common for this patient to come into my office, only to leave 2 or 3 visits later with much less pain in their knees. Did the arthritis suddenly get fixed? Of course not. Rather, the pain was not coming from the joint itself, but rather from the fascia surrounding the knee.
So what does all of this have to do with this particular study?
Because of the marked increase in the number of knee replacements being done in the US, researchers look to confirm that this increase was due to the increased obesity and the increasing age of the population. This was not what they found. Rather, knee pain increased independently of age and BMI.
Of extreme importance is what they did NOT find.
They did NOT find an increase in arthritis of the knee. So, our country is performing more and more knee replacements. This is not due to obesity (obesity did play a role, but it was a smaller one) or age. And there was not more arthritis found. So basically, we are replacing perfecting good knee joints because of problems likely due to fascia surrounding the joint that was never effectively treated.
The bottom line is that anyone with knee pain should first be evaluated by a chiropractor that specializes in the treatment of the soft tissues that surround a joint (in this case, the knee). If pain persists after several visits, then an evaluation by a surgeon may be warranted, but certainly not before.
December 3, 2007 Research Update
James Bogash,D.C.Mesa,AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com
Maternal Nutrition, Low Nephron Number, and Hypertension in Later Life: Pathways of Nutritional Programming.
This is yet another pathway by which forcing women into pregnancy artificially, whose bodies are not ready for pregnancy because of physiological imbalances, is upsetting the balance of our health. The evidence is piling up that the decisions made in pregnancy can haunt that unborn child’s health for decades into the future. In this article, the idea is put forth that, when mom is not eating properly, the fetus will develop a lower number of filtration units (nephrons) in the developing kidneys. Later in life, as that chilld becomes overweight (because they will be at increased in risk for obesity because of the unhealthy mom), this will place excess burden on the kidneys, resulting in kidney failure. Add to this mix a society that doesn’t realize the dangers of NSAIDs on the kidneys and you’ve got a nasty increase in dialysis centers. Read More.
Migraine and coronary heart disease mortality: a prospective cohort study.
The bottom line is that migraine is a systemic disorder, most likely a result of altered mitochondrial function and / or oxidative stress. These dysfunctions are not limited to the brain, but rather have an effect everywhere in the body, playing a role in most, if not all, chronic diseases. So, if this is the case, then finding increases in other diseases like heart disease should be no big surprise. So, the ONLY best way to approach migraine treatment is to look at the entire patient and make global lifestyle changes to improve the way their neurons are functioning. Read More.
Zero prevalence of diabetes in camel milk consuming Raica community of north-west Rajasthan, India.
Can’t say I’ve seen it in the local aisles of Safeway, but there is definitely something to be said for people eating the foods that their ancestors ate. And in this particular instance, ZERO percent is kind of hard to argue with, especially when compared to comparable non-milk drinkers at 5.5%. Almost wants to make you run out and buy your own camel. Not sure how my HOA would react to that one… Read More.
Insulin Resistance Increases the Risk of Spontaneous Abortion after Assisted Reproduction Technology Treatment.
“Patients with IR should be advised to improve their insulin sensitivity through lifestyle change or medical intervention before infertility treatment to reduce their risk of spontaneous abortion.” HAH!! Like that would ever happen!! Why change anything when IVF is available on every corner? The bottom line is that we cannot and should not ever try to cheat Mother Nature. There will always be a price to be paid. The rapid increase in IVF pregnancies will come with a price to society–as unhealthy mothers give birth to predisposed babies who are raised in the same unhealthy manner we will start seeing chronic diseases begin earlier and earlier in age. Read More
Long-term weight losses associated with prescription of higher physical activity goals. Are higher levels of physical activity protective against weight regain?
Not to burst anyone’s bubble, but we’re finding a much harder job of shutting the barn door after all the animals have gotten out. This article finds that very few people beginning an aggressive workout routine remained complaint w/ that routine, but these were the only ones that had successful long term weight loss. Two things to consider here. First, obesity, just like any other chronic disease, is easier prevented then treated. Consider the overweight 10 year old. They actually have more fat cells, and as they lose weight, these cells merely shrink but do not go away. They will forever be fighting their weight. Second, maybe aggressive activity may not have been the answer to their exercise dilemma. Stay tuned to these Updates for further information on why many may not achieve balanced body composition with aerobic type exercises. Read More.
Is higher dairy consumption associated with lower body weight and fewer metabolic disturbances?
In public health circles, the devotion to dairy is almost godlike. Try to find ANY kind of public health recommendation that doesn’t include daily dairy servings. The problem is, there is very little strong research to actually support these recommendations, and plenty of reasons not to. There has been much blame on childhood obesity on the switch away from milk to soft drinks. However, we see in this study that dairy has very little ability to help manage weight, and this was at 4.1 servings / day. Combine this with the hormones, antibiotics and allergy potential, and it really has no right being on the ranks of every public health recommendation. Read More.
Effect of Cocoa and Tea Intake on Blood Pressure.
Let’s face it. Adding dark chocolate to your daily life really isn’t all that painful. Dark chocolate is a regular staple around our house and my 2 year old always gets a small corner of whatever I’m eating. This article is actually a meta-analysis, looking at 5 different studies on cocoa consumption and blood pressure. The authors concluded that, in a mere 2 wks, that cocoa could drop systolic blood pressure an average of 4.7 mm. Not that may not sound like much, but remember that the best approach to any chronic condition is multifactorial, and in this case increasing intake of dark chocolate is only one intervention that would be used to help manage blood pressure along w/ managing insulin resistance, exercise and stress management. Read More.
Dietary Flavonoids and the Risk of Colorectal Cancer.
I’ve said many times before that one of the reasons I do not support our national organizations is that they spent very minimal time on prevention and consistently preach about finding a cure. The bottom line is that we have so many opportunities to prevent many types of cancer that they should essentially not be present in our society, let alone a major killer. But the appropriate details never seem to get out to the general public. The most specific we ever get is “eat you fruits and vegetables.” Hardly specific. Knowing which fruits and veggies pack the strongest punch can help. This article reviews the effect of a variety of flavonoids on colon cancer and found that the risk reduction could be as high as 32% for quercitin (high in onions) and catechins (high in teas). This is with one single intervention. Add in vitamin D, exercise, high fiber coupled w/ healthy bacterial flora, etc, and you’ve pretty much eliminated all but the most tough cases. Read More.
Free radical scavengers vitamins A, C, and E plus magnesium reduce noise trauma.
Sometimes the breadth of health related conditions that can be affected by nutrition really astounds me. In this study, it reviews that noise related hearing loss actually occurs as a result of free radical production in the cochlea. The combination of these antioxidants, but not each individually, resulted in strong protection to hearing loss. So, next time you go to your Iron Maiden concert or Nascar.. Read More.
Chondroitin for Osteoarthritis of the Knee or Hip.
This review found minimal or no benefit to the use of chondroitin for arthritis of the knee. Before we jump to conclusions… How many people in these studies with knee/hip pain was actually coming from the joint itself? The answer, of course, is that we don’t know. Degenerative joint disease = pain in clinical studies but that just isn’t alway true. For a physician that addresses soft-tissue components of injuries, how often does a knee loaded with arthritis get complete relief with some solid soft tissue approaches? I can personally say that aggressive soft tissue techniques like Graston can sometimes bring complete relief for many OA sufferers. Did we fix the OA? Of course not–but in these cases the soft tissues were the primary pain generators. So we could assume that any type of joint support would not be effective in these cases. So, in these studies, did they rule out non-joint related pain generators? More of a rhetorical question because of course they did not. Read More.
April 10, 2006 Research Update
James Bogash,D.C.Mesa,AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com
Effect of a high-protein breakfast on the postprandial ghrelin response.
Ghrelin is a hormone that stimulates appetite. This study found that a high protein breakfast resulted in lower ghrelin levels, thus leading to higher satiety. I usually try to steer patients towards a higher protein breakfast (such as real peanut butter, high omega 3 eggs…) because these seem to keep them full longer. Unfortunately, look at what most breakfasts consist of–high glycemic index carbs that lead to earlier hunger and increased overall caloric intake through the day. Read More.
Green tea consumption and cognitive function.
While everyone seems to know that green tea is good for you, sometimes we’re just not sure how much is needed for an effect. In this study, those drinking greater than 2 glasses per day (very easy to accomplish) had over half the incidence of cognitive decline. And, while results were also seen for black tea and oolong tea, green tea was the stronger. I would be interested to see where white tea would fall on this spectrum. Read More.
Molecular markers of cartilage breakdown and synovitis at baseline as predictors of structural progression of hip osteoarthritis.
This study evaluated the use of markers of cartilage breakdown as marker for osteoarthritis progression. The markers used were effective, but I would like to see this same type of study done on natural approaches such as glucosamine and chondroitin instead of instead of an anti-inflammatory compound like diacerein. Granted, diacerein does not inhibit the metabolism of chondrocytes like other NSAIDs, but we all know my bent towards natural compounds..Read More.
Clinical, microbiological, and immunological effects of fructo-oligosaccharide in patients with Crohn’s disease.
For as much research as there is supporting the role of healthy microbial flora in the development and treatment of IBD, it continues to amaze me that I have yet to have a patient come through my office w/ IBD that was given the slightest bit of information from their GI specialist on the effect of a healthy GI flora. I even had a patient come in a few weeks ago that had a colonoscopy done and they found some ulcerative lesions, but not enough for a full diagnosis of UC. The approach? Watch and wait. The concept that prevention may be a good idea didn’t enter into the picture. Read More.
Prediction of Lifetime Risk for Cardiovascular Disease by Risk Factor Burden at 50 Years of Age.
Wow. The difference in risk between those without CVD by age 50 compared with those diagnosed w/ CVD by age 50 is quite dramatic. The problem is that is remains difficult to get young people (i.e. under 50) to understand the dangers that their lifestyle is producing. It also makes you wonder what’s going to happen in the next few decades as our unhealthy moms have unhealthy children and these kids get raised in unhealthy households. It seems that each generation is noting the onset of chronic disease earlier and earlier.
Read More.
Decreased Melatonin Production Linked to Light Exposure.
It really seems like we’re just starting to find out exactly how extensive melatonin’s influence on our health is. We starting realizing that it helps regulate our circadian rhythm. Than we found it was a powerful antioxidant in the nervous system. Now we see that it may play a role in breast cancer development. Interesting too, that female night shift workers have a much higher risk of breast cancer. Recall that sunlight exposure (and, in this case, artificial light exposure) surpresses melatonin production from the pineal gland. This study would suggest that all night shift workers strongly consider melatonin supplementation before going to bed in the morning. Read More.
OP Pesticides in Children’s Bodies: The Effects of a Conventional versus Organic Diet.
One of the nasty little secrets about today’s advanced society is that we are exposed to a very large number and variety of chemicals. Of particular concern is pesticides. Here in the good ‘ole USA, as would be expected from our oversight of the drug companies, the determination of pesticide safety is left up to the pesticide manufacturers. In determining the levels of “safe” pesticide exposure (is there such a thing?) most would be sure that there are studies after studies done to determine safe. Not quite. The pesticide manufacturers determine what would be expected to be a “normal” exposure to a typical human, and that becomes the safe level. Not too rigorous when it comes to scienitific method, huh? Read More.
Horizontal transmission of the Leningrad-3 live attenuated mumps vaccine virus.
It still surprises me how many people have full faith in vaccination’s ability to completely protect them from the disease they were vaccinated for. Here’s a perfect example of just how false that assumption is. In this report, vaccinated patients actually transmitted the mumps virus from the vaccine to other patients who had been previously vaccinated. Try to explain this one with 100% vaccine effectiveness…Read More.
Dietary cholesterol, eggs and coronary heart disease risk in perspective.
The concept that dietary cholesterol leads to a direct elevation in blood cholesterol and subsequent risk of CVD has been promoted for some time now, despite evidence to the contrary. This article reviews egg’s “bad rap” and the lack of validity to the idea that eggs raise contribute to CVD. I recommend eggs as a good protein source for breakfast, and steer patients towards the “veg-a-fed” type. These animals are fed a diet high in omega-3 fatty acids, leading to a higher content of omega-3 fatty acids in the egg. Read More.
Dairy Products and Ovarian Cancer.
While the association between ovarian cancer and 3 servings of dairy per day was not that strong, the fact that any risk was there is of concern given the blind faith we give in dairy products. I have patients that guiltily admit that they don’t drink milk and so are worried about their bone health. I have patients in community health presentations that are astounded that I would even suggest that dairy is not good for us. I will continue to give the dairy industry credit for one of the most phenomenol marketing campaigns in history: getting the American public to religiously believe that dairy is absolutely essential to good health despite very minimal evidence to support this. Read More.
December 27, 2006 Research Update
James Bogash,D.C.Mesa,AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com
Glucose ingestion induces an increase in intranuclear nuclear factor κB, a fall in cellular inhibitor κB, and an increase in tumor necrosis factor αmessenger RNA by mononuclear cells.
Hate to start off an Update with a title like that, but… One thing people may not realize is that the mere act of eating is an inflammatory process. Our best bet is to eat a diet loaded with phytonutrients to mitigate this inflammation. This article just further confirms this process and looks at glucose’s ability to turn on the entire inflammatory cascade. Compare this with the ingestion of refined carbs–all the sugar with no phytonutrients.
To update.
Association Between Serum 25(OH)D Concentrations and Bone Stress Fractures in Finnish Young Men.
I think the most interesting thing in this study was the OR–lower serum Vit D levels led to an increase in risk for stress fractures by 3.6 times. And in a relatively young population that we would not normally think of bone health/Vit D as being of concern. So add Vit D supplementation to any patients that have stress fractures and shin splints that just won’t heal from anything else.
http://onlinelibrary.wiley.com/doi/10.1359/jbmr.060607/full
Low-Level, High-Frequency Mechanical Signals Enhance Musculoskeletal Development of Young Women With Low BMD.
Our office, since this article triggered an interest in Whole Body Vibration, has since purchased one of the higher-end WBV units. The research behind this therapy is intriguing, but probably the strongest is in the region of increasing bone density, to the point where some researchers have suggested using this therapy in teens to build their bone mass as high as possible to lower the risk of osteoporosis decades later.
http://onlinelibrary.wiley.com/doi/10.1359/jbmr.060612/full
Effects of Extended-Release Niacin on Lipoprotein Particle Size, Distribution, and Inflammatory Markers in Patients With Coronary Artery Disease.
While niacin has been known for a long time to be one of the few compounds used in a pharmacologic manner (soy, flax and exercise does as well–but these aren’t use in a pharmcologic approach), the beneficial subclass changes in the specific lipids in this study were quite surprising. Recall that we have further delved into the HDL and LDL molecules and found that these particles can be furthered subdivided, and that these subclasses can have even more dramatic abilities to predict heart disease risk. Niacin in this study was found to raise the “best of the best” as large particle HDL by 32% and reduced the small particle LDL by 12% while also raising the large particle LDL by 82%. Taken together, these changes would suggest that niacin has a much greater ability to lower CVD risk than many other molecules available.
http://www.sciencedirect.com/science/article/pii/S0002914906010678
Obese Children and Adolescents–A Risk Group for Low Vitamin B12Concentration.
As if obese kids didn’t have the deck stacked against them already. I guess the important question may be how are these kids deficient? Vit B12 is readily available in an animal-based diet, so why would this population, which is much more likely to eat animal based rather than plant based, be deficient? I am unsure why B12 would be deficient in this age group. In seniors and stressful persons, we can look to digestive deficiencies that impair our absorption of B12 and this is relatively common.
http://archpedi.ama-assn.org/cgi/content/abstract/160/9/933
Low serum concentrations of 25-hydroxyvitamin D in older persons and the risk of nursing home admission.
Wow!! 3.5 times the risk for nursing home admission in Vit D deficient patients. Skip the long term care insurance and buy some supplemental Vit D… But seriously, if something as simple, cheap and safe as Vit D supplementation can drastically reduce the number of nursing home admissions, than articles like this one need to be plasted all over the news. With all the research on Vit D and the large range of strong benefits, Vit D supplementation in the range of 2,000 IU/day needs to be moving in the direction of a national recommendation.
http://www.ajcn.org/cgi/content/abstract/84/3/616
Thiazolidinedione Use and Bone Loss in Older Diabetic Adults.
Avandia and Actose are a class of diabetic drugs known as TZDs that act on the PPAR gamma receptor. Unfortunately, like every other drug out there, they have some long lists of side effects. This particular study looks at the bone damaging effect of these drugs. Interestingly, while sticking with the near-Vitamin-D-worship status of this Updates, Vit D not only protects bones but also helps manage insulin resitance, a precursor to diabetes. You can also add exercise to that list as well. So basically, the approaches we should be taking that involve diet and lifestyle will lower the risk of diabetes while protecting the bones. This class of drugs, however, actually contributes to more bone loss the longer you’re on them. Would SEEM like a no-brainer, huh?
http://jcem.endojournals.org/cgi/content/abstract/91/9/3349
Combined high-resolution magnetic resonance imaging and histological examination to explore the role of ligaments and tendons in the phenotypic expression of early hand osteoarthritis.
As a chiropractor that has a strong focus on the soft tissue component of musculoskeletal health, I found this article rather intriguing. Basically, whenever they looked at arthritis in the small joints of the hand, those areas that had ligaments with pathological changes (basically scar tissue and thickening) had more arthritis. While no one study confirms anything, this articles does lend support to those physicians focusing much more strongly on how much the soft tissues contribute to long term joint health.
http://ard.bmj.com/cgi/content/abstract/65/10/1267
Maternal Supplement, Micronutrient, and Cured Meat Intake during Pregnancy and Risk of Medulloblastoma during Childhood: A Children’s Oncology Group Study.
While this is a very unfair situation and I am not casting blame in any one parents’ direction, I do strongly blame society for believing that childhood cancers are a “luck of the draw” scenario that we have little control over. I have always strongly believed that the enivronment in the womb does a huge amount of programming of that infant for the decades to come, and this article further supports that. It also should be some type of impetus to get doctors away from those poor quality pharmaceutical prenatal vitamins that just barely provide enough folic acid and iron to address the anemia and neural tube defect issues but nothing else of substance.
http://cebp.aacrjournals.org/cgi/content/abstract/15/9/1660
Vitamin D Intake and the Risk for Pancreatic Cancer in Two Cohort Studies.
Aw heck…I thought I’d begin and end this Update with more info on the importance of Vit D. And to add hear–pancreatic cancer is a great killer. We just don’t get 5 year survival rates with pancreatic cancer. With all the research showing strong protection of Vit D on several types of cancer, I am waiting for the American Cancer Society to come out with recommendations to increase Vit D intake. They wouldn’t even notice this drop in the bucket for prevntion within that massive budget devoted to “finding a cure….”
http://cebp.aacrjournals.org/cgi/content/abstract/15/9/1688.
March 29, 2004
James Bogash,D.C.Mesa,AZ
info@lifecarechiropractic.com
www.lifecarechiropractic.com
Selenoprotein synthesis and side-effects of statins.
I must admit that this biochemical pathway much have been covered while I was sleeping in biochemisty… I have always felt that the side effects from statin drugs was related to their inhibition of CoQ10 synthesis via the inhibition of the the enzyme HMG-CoA reductase. This enzyme produces mevalonate, which is a precursor to both cholesterol and CoQ10. Maybe the answer to patients who suffered fatal rhabdomyalisis (basically their muscles melted) lies somewhere with both mechanisms. I could envision a SNP (single nucleotide polymorphism) along both pathways that severely reduced these patient’s antioxidant reserves. Either way, there are so many other ways to lower cholesterol that most patients would not have to use them if they were willing to make the right lifestyle choices. The Journal : Back Issues - Click here for more information.
Musculoskeletal pain in Europe.
As a chiropractic physician, I am not surprised that the authors were basically beating up on the medical profession in their handling of musculoskeletal complaints. I see many patients in my office who’s cases were not handled properly. I do not fault allopathic medicine for their lack of training and knowledge in musculoskeletal medicine–there is so much to learn it really is its own cirriculum. There just is not enough time in medical school to learn all of it. What I do have a problem with is physicians handling musculoskeletal complaints when they are not familiar or trained in them. Ann Rheum Dis — Abstracts: Woolf et al. 63 (4): 342 - Click here for more information.
Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease.
If I have a dime for every time I heard someone say (in my office or otherwise) that they have arthritis I would be writing this from a small island in the Bahamas. I know that in my office it is rare that someone with arthritis does not get complete relief under my care. Did I get rid of the arthritis? Of course not. It’s just that the arthritis was not causing their pain. Remember that arthritis is just something we find on xray–just because it’s there does not mean it’s the pain generator. This article confirms this–using ultrasound these authors found “subclinical” arthritits in high numbers. Of course–if these patients had no arthritis they should be in a lab somewhere trying to find out why. Ann Rheum Dis — Abstracts: Wakefield et al. 63 (4): 382 - Click here for more information.
Clinical comorbidity in patients with osteoarthritis.
While we’re on the subject, might I mention that much research points to osteoarthritis as a systemic disorder. Poor nutrition to the joint surface does not give the synovium the nutrients it needs to keep up with normal wear-and-tear. This article would support prior research along these lines–it’s not just the joint surface getting poor nutrition, it’s all other organs systems as well. Ann Rheum Dis — Abstracts: Kadam et al. 63 (4): 408 - Click here for more information.
Link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing.
This is an interesting one. Although the diagnosis of fibormyalgia no longer seems to be the “flavor of the month,” patients with symptoms that would match those in FM are still walking around. Here is my concern: I firmly believe that a relatively small amount of true FM patients really exist. I feel that FM is more of a systemic manifestation of IBS. Dysfunction of the GI tract can explain all the symtoms of FM if you follow the physiology. In this study, the authors found evidence of small bowel bacterial overgrowth in both IBS and FM patients, and the patients with more overgrowth the more likely they had somatic (muscle) pain. Research has shown that small bowel bacterial overgrowth can occur with anti-secretory therapy for GI complaints and from destruction of normal, protective bacterial flora. Some research has also shown the small bowel bacterial overgrowth will increase small bowel permeability–basically stuff is getting into the body that shouldn’t be and the body has no choice but to react and attach the invaders. Then, following that further, small bowel bacterial overgrowth has been linked to non-alcoholic steatohepatitis. So, not only could we have an upregulated immune system from the leaky gut, but the liver is now likewise burdened. Put these together and you’ve got a recipe for FM. Ann Rheum Dis — Abstracts: Pimentel et al. 63 (4): 450 - Click here for more information.
Increased antigen and bacterial uptake in follicle associated epithelium induced by chronic psychological stress in rats.
Okay, so we’re not all rats. But this does suggest, and common sense will tell you, that chronic stress can have some serious, negative, long term side effects. In this study, the altered GI permeability will result in stuff getting past the GI tract into the body that should never get in. Now the immune system and liver have to deal with these invaders, and many times the liver is already overloaded from our chemical-laden lifestyles. Gut — Abstracts: Velin et al. 53 (4): 494 - Click here for more information.
Fatigue and primary biliary cirrhosis.
And, just in case you were thinking, “so what if my liver is overburdened?” This study looked at patients with primary biliary cirrhosis–their livers were losing the ability to move things out of the body into the GI tract for elimination–and found that these patient’s fatigue may be related to brain damage from increased manganese levels. Manganese elimination is via the bile, so these patients have a reduced ability to get rid of manganese and it accumulates in the brain. Really makes you appreciate just how interactive the human body systems truly are. As a side note, manganese has been implicated in violent behavior in institutionalized criminals. Gut — Abstracts: Forton et al. 53 (4): 587 - Click here for more information.
Requiring doctors to take part in continuing medical education doesn’t improve heart attack care.
The bottom line that is probably at the heart of why research takes decades to reach clinical practice is that many physicians’ continuing education is sponsored by the drug companies. Every year there is a functional medicine symposium with some 20-odd experts in functional medicine. The cost is usually around $1000. I recently got an invite to a family practice symposium in CA with some 30+ speakers. The cost of this pharmaceutical sponsored symposium? $35 if you register early. bmj.com Tanne 328 (7441): 664 - Click here for more information.
Severe Hypovitaminosis D in Patients with Persistant, Non-Specific Musculoskeletal Pain.
I must admit that an article like this really does open up my eyes. I know that osteomalacia (softening of the bones) can present as generalized pain, but this is not something that I routinely check for in my office. The results of this article are definately eye-opening. Receptors for Vit D are found on every cell of the body, which means that Vit D has functions in all cells, most of which have not yet been identified. Serum levels of 25-hydroxyvitamin D are easily checked and are a good marker of Vitamin D status. Click here for more information.
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