Saturday, September 7, 2013

Natural Supplements to Reduce Pain and Inflammation, the Underlying Cause of Most Chronic Disease

Inflammation is the underlying cause of most of the chronic diseases of modern society:   conditions like chronic pain, arthritis, heart disease, obesity, diabetes, peripheral neuropathy, dementia, Alzheimer’s, depression, cancer, and even ADHD and autism.  A study of a generally "healthy" elderly population found that those with the highest levels of C-reactive protein and interleukin 6 (two markers of systemic inflammation) were 260 percent more likely to die during the next 4 years. The increase in deaths was due to cardiovascular and other causes.

There are many traditional herbs and treatments used throughout the world that scientific studies have shown to have anti-inflammatory affects.  There are many that are not listed here, but these are some of my favorites.

The most common natural anti-inflammatory used in Germany is Proteolytic enzymes, including protease, bromelain from pineapple, and papain from papaya, and have long been used to reduce inflammation and promote tissue healing. They appear to down regulate the activities of several chemical mediators of inflammation and pain transmission, including PGE2, bradykinin, , and substance P.  Studies show their use helps reduce swelling and edema associated with arthritis, injuries, and other inflammatory conditions. To achieve the best effect they must be taken between meals.

Serrapeptase is a proteolytic enzyme produced by bacteria in the gut of silkworms and is used to digest their cocoons.  It has been used in Europe and Asia for over 25 years. Because the enzyme digests or dissolves all nonliving tissue, including blood clots, cysts and arterial plaque, it is used to treat a variety of conditions, including sprains and torn ligaments, postoperative swelling, venous thrombosis (clots in the legs), ear, nose and throat infections and atherosclerosis. Studies show that it may reduce pain and inflammation by:   1. thinning the fluids formed from injury, and facilitating the fluid’s drainage. This in turn, also speeds tissue repair, 2. inhibiting the release of pain-inducing amines called bradykinin, and 3. It may enhance cardiovascular health by breaking down the protein by-products of blood coagulation called fibrin. Conveniently, Serrapeptase is able to dissolve the fibrin and other dead or damaged tissue without harming living tissue. This could enable the dissolution of atherosclerotic plaques without causing any harm to the inside of the arteries.

Tumeric has a long history of use in Asia as a spice and for medicinal uses. It contains a polyphenolic compound called curcumin that exerts widespread modulatory activity on NF-κB, TNF, COX-2, IL-1, IL-6, and a number of other inflammatory mediators. It has been shown to reduce Cardio-CRP, a blood marker of inflammation in the vessel walls which correlate with heart disease risk.

Galangin is a dietary bioflavinoid which is found in the medicinal plant Alpinia officinarum and in propolis, a natural beehive product.  It down regulates the expression of interleukin-6 and TNF-alpha, potent pro-inflammatory cells.  Galangin has shown anti-cancer activity in vitro in several studies, causing the hypothesis that it may also prevent cancer.  Galangin also prevented rise in plasma glucose, insulin and triglycerides and improved insulin sensitivity, one of the causes of inflammation.

MSM (Methylsulfonylmethane) is one of nature’s richest sources of sulfur. Sulfur is the fourth most abundant mineral in the human body, stored in every cell with the highest concentrations in the skin, hair, nails and joints. Sulfur is necessary, along with Vitamin C, for collagen synthesis. Studies have reported reduced pain and improved physical function in osteoarthritis.

Phenylalanine, an amino acid, has been shown in studies to assist in relieving both acute and chronic pain.

Goji berry extract increases the body’s own Super Oxide Dismutase (SOD), which is a potent antioxidant and anti-inflammatory.

Mangosteen extract contains xanthones, which have been shown to be direct COX-2 inhibitors.

Nopal cactus pear contains betalains, which may be potential COX-1 and COX-2 inhibitors, and has been shown to reduce c-reactive protein (CRP).

Boswellia, also known as Indian frankincense, has long been recognized as an herb with anti-inflammatory properties. The gum resin of boswellia contains boswellic acids, the most potent being AKBA, which inhibids 5-LOX activity, downregulates TNF-induced gene expression and blocks the activation and nuclear translocation of NF-κB. In 2 separate double-blind, placebo-controlled studies, Boswellia extract significantly reduced pain and stiffness and improved joint function in persons with osteoarthritis of the knee. Clinical trials also showed symptom improvement in inflammatory bowel disease and in asthma.

Rutin is a flavonoid found in foods such as buckwheat, asparagus, tomato, carrot, sweet potato, berries, citrus fruits and black and green tea. Rutin might be therapeutic for varicose veins, rheumatoid arthritis, and other conditions associated with inflammation, such as heart disease, diabetes, cancer, inflammatory bowel disease and autoimmune diseases by inhibiting oxidative stress and inflammatory cytokine production.

Holy Basil Leaf is a tropical herb used in ayurveda. Research shows that holy basil contains powerful anti-inflammatory agents which significantly reduce inflammation and enhance detoxification. It is considered a sacred plant to the Hindus.

Green tea (decaffeinated) contains the polyphenol EGCG, which has been shown to significantly downregulated inflammatory mediators IL-8, macrophage inflammatory protein-3α, and PGE2. It has also been shown to inhibit NF-κB activity.

Devil’s claw, native to southern Africa, has been used for thousands of years by the Khoisan peoples of Madagascar and the Kalahari Desert to treat pain and inflammation. Scientific evidence supports the use of devil’s claw root to help relieve pain and inflammation in osteoarthritis and other pain. In a study on mild-to-moderate back and neck pain it was shown to be equivalent to Celebrex in symptom relief.

Capsicum, red pepper, has been shown through studies to have anti-inflammatory and anti-oxidant effects.  It has been used as a digestive aid to ease intestinal inflammation, stimulate protective mucus membranes of the stomach, and also relieve pain caused by ulcers.  It is commonly used to buffer pain from other ailments, including arthritis, varicose veins, headaches, menstrual cramps and respiratory conditions such as asthma.  Capsicum is also used, through its circulatory effects, as a catalyst to increase the effectiveness of other herbs.

Trace minerals—it has been shown in studies that abnormal distributions of trace minerals may aggravate oxidative damage and inflammation. The dynamic equilibrium that takes place with liquid ionic minerals and trace minerals has created the same basic balance in sea water that is found in healthy blood plasma and lymphatic fluid and is necessary for proper cellular function.

Piper Nigrum extract is from Black Pepper. It has been shown to increase the bioavailability of other nutrients, in this case the curcumin from the turmeric.  It also has shown anti-inflammatory effects.

Homeopathic cell salts are a group of 12 homeopathic remedies made from minerals which are important constituants of human cells and enzyme activity.

Astaxanthin is thought to be one of the  most powerful antioxidants and anti-inflammatories in nature, and only a low dose is needed for its effect.  It crosses the blood brain barrier to reduce inflammation in the brain, and the blood retinal barrier to affect the eyes.  It absorbs UVB and reduces DNA damage.  Astaxanthin suppresses a variety of inflammatory mediators—including tumor necrosis factor alpha, a major prostaglandin and a major interleukin, nitric oxide, COX-1 and COX-2 enzymes. It takes longer to produce effects than NSAIDS, but this means it doesn't result in the dangerous side effects.  

We are proud to announce SpringTree Health’s new and improved Pain and Inflammation.  Pain and Inflammation may be one of the most potent natural products for pain or inflammation on the market, with good levels of all of the ingredients above.  The supplements in this product have been shown to deal with inflammation not only in acute injuries and problems such as tendonitis and arthritis, but also in chronic inflammation which may be causing chronic disease.

Taking the recommended dose of Pain and Inflammation along with the recommended dose of SuperMulti Plus gives a potent 6 mg of astaxanthin.  SuperMulti Plus also has high levels of anti-oxidants to reduce the effects of inflammation.  Together, they provide a potent anti-inflammatory and anti-aging combination.  

Yes, this is a shameless sales pitch, but the reason I developed this product is because I believe reducing inflammation to be an extremely important part of disease prevention and treatment.  The majority of my patients who have used this product notice a definite difference in their pain levels when they use it.  If you are using chronic anti-inflammatory medications, it may be worth it to see if you can reduce the amount you take by using these healthy, natural and reasonably priced products.

Until we meet again,
Dr. Judi

Healing Chronic Inflammation Naturally: Protect Yourself from the Most Common Causes of Death

We have learned that acute inflammation assists the body's healing mechanism and should not be overly suppressed or it increases healing time.  However, long-term, chronic inflammation damages the body and causes, among other diseases, chronic diseases that are the most common causes of death:  heart disease, cancer, Alzheimer's, stroke and diabetes.

Medications do reduce the amount of inflammation but don't deal with the cause and have a high rate of serious side effects.  See my two previous blogs.

The following are steps that can be taken to deal with the causes of chronic inflammation.

1.  Look for the cause.  An elevated C-reactive protein or cardiac (hs) C-reactive protein is the most common sign in blood tests that there is inflammation in the body. Lp-Pla2 levels show inflammation in the arteries. Causes are varied and can include:

  • SAD diet (standard American diet, high sugar, trans-fats, gluten, dairy, low nutrient diet)
  • inflammed intestinal tract from poor diet, candida, food allergies, not enough good bacteria, parasites, etc.
  • Psychological stress
  • low grade infection, including gum disease and teeth infections, low grade infections causing chronic fatigue such as Epstein-Barr and Cytomegalovirus, or Mycoplasma Pneumonia and Chlamydia pneumonia which are associated with chronic joint pain, arthritis, rheumatoid arthritis and autoimmune diseases, etc.
  • hormone imbalance including insulin, thyroid, and sex hormones
  • weight gain--fat cells produce inflammatory cytokines
  • allergies--both environmental/inhalant and food allergies
  • environmental pollutants and toxins, heavy metals
  • arthritis--often caused by one of the above

2.  Improve Your Diet.  Foods implicated to cause an increase in inflammation are:

  • Processed foods including soda and fruit juice cocktails.  Processed foods tend to be high in sugar, high fructose corn syrup, and many chemicals.  Also be careful as well with the processed "gluten-free" breads and other products, as they also tend to be high in sugar and chemicals.
  • White sugar, high fructose corn syrup, other sweeteners and flour products.  These turn into glucose quickly in the body, causing a rapid rise in blood glucose.  This causes insulin to rise which causes inflammation. 
  • Polyunsaturated vegetable oils and Trans-fatty acids (Crisco, vegetable oil, corn oil, margarine, etc.). These have too much omega 6 fatty acids, which are pro-inflammatory.  The trans-fats replace the healthy fats on the cell membranes and don't have the capacity to do the job of the omega 3 and 9 fats, and the cells cannot function to full capacity, causing inflammation.  They also increase free radicals which trigger inflammation.
  • Excessive meat (in some situations too little meat can also cause inflammation).
  • GMO (genetically modified) grains and gluten (cause inflammation in the intestinal tract); etc.

Above is Dr. Andrew Weil's anti-inflammatory pyramid, eating mostly fruits and vegetables.  The only problem I have with this pyramid is that he puts grains on the second level.  Many people are allergic to various grains, especially since most grains (especially wheat and corn) are genetically modified.  This will increase inflammation in the gut.  Many people with insulin sensitivity will have their insulin rise when they eat grains, which also will increase inflammation.  It is important to determine if you have allergies or insulin sensitivity if you are eating grains.

The other concern I have is soy.  Many people are allergic to soy, and unfermented soy has some inflammatory effects.  If you eat soy, eat the fermented versions, such as fermented bean paste, miso, natto, real soy sauce, tempeh, pickled tofu, etc.

Some foods have anti-inflammatory effects.  Papaya and pineapple have proteolytic enzymes (papain and bromelain), which "digest" the inflammatory cells.  Salmon has omega-3 fatty acids which are used by the body to stop inflammation.  It also has astaxanthin which has high anti-inflammatory properties.  Tomatoes are high in lutein which has anti-inflammatory properties (though some people with arthritis are aggravated by plants from the nightshade family such as tomatoes and peppers).  Red peppers, avocados, and cruciferous vegetables also have anti-inflammatory properties. Walnuts have healthy anti-inflammatory fats. The spices tumeric, ginger, rosemary and oregano are also on the anti-inflammatory list.

Generally a low simple carb, high complex carb, and palm size amount of protein at each meal with healthy fats is an anti-inflammatory diet.

3.  Heal the Gut.  The intestinal tract has more immune cells and receptors than anywhere else in the body.  It also has more neurotransmitter receptors than the brain, and is often considered the "second brain."  The immune system and the neurotransmitter system are intertwined, each one affecting the other.

The bacteria in the intestinal tract is like a living organism.  Then the bacterial colony is healthy, it performs many important functions for the body.  When it is sick (dysbiosis) with not enough good bacteria, too much yeast or fungus such as candida, or bad bacteria and parasites, inflammation results and important body processes are not completed efficiently.

Inflammation causes leaky gut (the glue between the cells holding them tightly together does not function well) which allows larger molecules of food to enter the blood stream. The immune system sees these particles as a foreign invader and cause more inflammation to fight them, causing food allergies and sensitivities.

It is important to clean out excessive candida.  This is most effectively done with medication for 1-2 weeks, followed by a good anti-candida supplement for a month or so.  My anti-candida diet for 2-4 weeks is no sugar, no grains, no dairy, no fruit juice, yeast or alcohol.  You can eat meat, fish and eggs, any vegetables (though limit the starchy vegetables), fruits, nuts and seeds and legumes.  This is different than many candida diets out there but it works well for my patients.  This is accompanied by a good probiotic, at least 100,000 billion units a day.  Continue the probiotics at a level of 20-30,000 billion units per day.

There are many products on the market to heal the lining of the gut.  We use one called GI Fortify from Pure.

Have food allergies tested through an IgG and/or IgA blood food allergy test.  If there are a high number of reactions follow a food rotation diet, which is usually described with the results of the testing.  Or do a food allergy elimination diet.  You find instructions at many websites.

4.  Deal with any underlying infections.

5.  Balance thyroid, insulin, and sex hormones.

6.  If inflammation continues, is chronic or severe, test for heavy metals and environmental toxins.

7.  Take anti-inflammatory supplements.

The next blog will be dedicated to describing anti-inflammatory supplements.

Until we meet again,
Dr. Judi

Wednesday, September 4, 2013

Anti-Inflammatory Medications for Chronic Pain and Inflammation: They Don't Always Work Well and They May Not Be Safe

Being in pain, especially chronic pain, is debilitating.  We naturally want to do anything we can to get out of it.  Most types of pain are related to inflammation, but chronic inflammation can also cause other diseases besides chronic pain.

The last blog was on how inflammation is a necessary part of dealing with micro-organism invaders and important in the process of healing from infection and injury.  However, when inflammation does not properly stop and becomes chronic, it can cause damage to the body, such as in tendinitis, arthritis--both osteo and rheumatoid, acne, interstitial cystitis, peripheral neuropathy, autoimmune diseases, and even depression and mood disorders from inflammation of the brain and intestinal tract.  Long term chronic inflammation is at the basis of most of the chronic diseases that bring death:  cardiovascular disease, diabetes type 2, dementia and Alzheimer's, cancer and more.

Most doctors use immune suppressors and anti-inflammatory medications to stop the effects of inflammation. They work very well to reduce pain, but they don't cure the inflammation (the inflammation returns when the drugs are stopped) and their side effect profile is high.

The strongest are some of the chemotherapy drugs for cancer.  Methotrexate is a chemotherapy drug often used in rheumatoid arthritis and other autoimmune diseases to suppress the immune system. The next are biologic response modifiers, such as Enbrel.  This drug works quite well in reducing painful joints in RA and other autoimmune diseases.  The largest problem with immune suppressors is that the immune system can't do its proper job, and those using these medications are at high risk of developing a serious infection.  (For a more effective treatment for rheumatoid arthritis and sometimes other autoimmune diseases see my blog

Steriods such as prednisone are given for conditions such as arthritis, asthma and autoimmune diseases. They are also injected into joints, the spine and the epidural space of the spinal cord to reduce pain.  Again, they usually work well to reduce inflammation and pain, but they can't be used long term because of the high level of side effects and the suppression of the adrenal glands and the immune system.

Opioid pain medications are often used to reduce the symptoms of pain, but do not deal with the inflammation or the cause of inflammation.  The pain receptors become tolerant to the medications easily and often more and more medication is needed to reduce the pain.  Often it reaches the point where the pain is as bad on the medication as it was when starting the opioids.  After chronic use the pain becomes much worse when the body doesn't get it because of withdrawal symptoms.  When the body goes through withdrawal the pain is higher, so often what a person may consider as high levels of pain needing medication is only withdrawal from the medication.

There is a high physical and emotional addiction potential, and these medications are very hard to come off of.  They affect the brain and worsen mood disorders.  They are often made with acetaminophen or aspirin and taking frequent daily doses can increase the toxic affects of those.

In my experience my patients who come to me already on chronic opioid pain medication do not get better with the treatments I do until they get off of their medication.

The most common anti-inflammatory medications are the non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac, naproxen, meloxicam, etc.  These do make a difference, but in chronic pain the difference isn't as much as might be expected, as the following study shows.

In a new US study from Northwestern Health Sciences University, more than 270 adults with chronic neck pain were divided into three groups. For three months, one group received brief chiropractic sessions at least once each week, one group got instructions for simple neck exercises from a physical therapist, and one group received over-the-counter drugs such as acetaminophen or prescription drugs such as NSAIDs and muscle relaxants.

Overall, these were the percentages of the results in each group:  
Chiropractic group — 57 per cent pain reduction
Exercise group — 48 per cent pain reduction
Drug group — 33 per cent pain reduction  

In a follow-up, one year later, pain relief was still significantly higher in the chiropractic and exercise groups. Many subjects in the drug group said they needed to increase dosages and frequency to maintain the lower level of pain relief.

This study didn't have a group doing nothing.  Often up to 30% improve over time anyway.  So it is hard to tell if it was the medications working or the patient improving with their innate healing capacity.

NSAIDS have been shown to cause gastrointestinal damage, ulcers and bleeding, kidney damage and cancer, increased risk of heart problems and heart attacks, drug dependency and other side effects.  They can exhibit a "rebound" phenomena similar to the withdrawal symptoms from opioid medications, in which if a dose is missed the pain is worse not from the chronic physical problem but from the drug withdrawal.

A recent study from the Royal College of Surgeons in Ireland shows that an alarming number of patients with ischemic heart disease or cardiovascular risk factors are being inappropriately prescribed NSAIDs for RA, musculoskeletal diseases, and other chronic pain-related conditions.  Dr. Carl Orr, the lead investigator, said that the cardiovascular risks of long-term NSAID use have been well documented, but it is less well known that even short-term use increases the risk for recurrent heart attacks and death.  Diclofenac shows the highest increased risk for heart disease and heart attacks.

Acetaminophen (Paracetamol in Europe and  South America) is not a true anti-inflammatory but is most often used for pain.  Most people believe because it is an over the counter medication that it is safe.  It is true that acetaminophen has a fairly good safety profile when used in proper doses and not with alcohol or other medications which affect the liver, but liver damage can occur with misuse and overdose.  In fact, in the US acetaminophen toxicity has replaced viral hepatitis as the most common cause of acute liver failure and is the second most common cause of liver disease needing transplantation. 

Just last month, in August of 2013, the FDA issued a safety warning concerning the use of acetaminophen.  They advised that anyone who has a skin reaction such as a rash or blister while taking the drug to stop and seek immediate medical care, because of the risk of three rare but fatal skin disorders:  Stevens-Johnson syndrome, toxic epidermal necrolysis, and acute generalized exanthematous pustulosis.

Aspirin has been the miracle drug of the last century, and when used judiciously for acute pain and inflammation can be very effective.  However chronic use can cause microscopic gastrointestinal bleeding leading to ulcers and major bleeding, abdominal pain, nausea, tinnitus (ringing in the ears), and more rarely kidney and liver damage.

If you must take one of these medications to deal with your chronic pain or chronic inflammation, take them only according to directions, take the least amount that reduces the pain, and be sure you are aware of the safety profile of the medication and how it relates to your other medical problems.

But better yet, use diet and supplementation for chronic inflammation.  The next blog will be about natural treatments for chronic pain and inflammation.

Until we meet again,
Dr. Judi

Monday, September 2, 2013

Inflammation: the Good, the Bad and the Ugly; The Cause of Most Chronic Diseases

Inflammation is very important to our bodies.  It is a protective part of our immune system to fight infection and other foreign invaders and to initiate the healing process.  Inflammatory cells aid the body's healing mechanism.  Inflammation is not the same as infection.  An infection is caused by a micro-organism. Inflammation is the body's response to fight the micro-organism.

Acute inflammation is the initial response of the body to harmful stimuli, causing and increased movement of plasma and leukocytes (especially granulocytes) from the blood to the injured tissues.  It usually appears within a few minutes or hours and ceases on the removal of the injurious stimuli.  The classic signs of acute infection are pain, heat, redness, swelling and loss of function.  Without inflammation the body would not be able to heal well.  For example, when inflammation causing heat is generalized, we experience it as a fever.  The fever is part of the body's immune response to fighting the infection.  It has been shown in studies that reducing a fever with medicine increases the length of time of an infection.  It has also been shown that taking anti-inflammatory medications continuously after an injury increases the time it takes to heal the injury.

However, when inflammation becomes chronic, it can cause damage to the body, either locally (such as in tendinitis, tendinitis, knee arthritis caused by injury, etc.) or systemically.  These can be caused by overuse (not allowing the injury to heal), using enough anti-inflammatory medication so that it cannot completely heal, genetics, chronic low grade infection, the SAD diet (Standard American Diet), dysbiosis (an alteration in intestinal bacteria), toxins such as heavy metals and environmental pollutants, improper healing from surgery, etc.  Common chronic inflammatory illnesses are:  acne, allergies, asthma, autoimmune diseases, celiac disease, chronic urinary tract infections, interstitial cystitis and prostatitis, chronic kidney disease, Crohn's disease and ulcerative colitis, osteoarthritis and rheumatoid arthritis, etc.  Inflammation of the brain and gut has been implicated in ADHD and autism, depression and other mood disorders.

In the last couple of decades, more evidence is being found through research that most of the chronic diseases leading to death are also caused by chronic inflammation, including heart disease, diabetes, Alzheimer's disease, and cancer.  For example, atherosclerosis, which causes heart attacks and heart disease, was considered to be caused by high cholesterol.  More recent studies show that inflammation is implicated in every stage of this disease.  Most scientists studying the inflammatory cause of heart disease believe the moderate success of the statin drugs in lowering cardiovascular events is more from their anti-inflammatory effect than by lowering the LDL.

Studies are also showing that inflammation plays a large role in cancer.  It is felt that inflammation can cause cell mutation leading to cancer, and inflammation has been shown to promote tumor growth and metastasis.

Once chronic inflammation has set in a cascade of problems results, making it more difficult to heal.  For example, inflammation can cause an increase in insulin, which also causes inflammation.  Elevated insulin holds onto fat in the body and causes obesity.  Fat cells also secrete inflammatory chemicals and increase inflammation in the body.  This increases insulin further and leads to insulin resistance.  This can lead to Diabetes Type 2, which increases inflammation in the macro- and micro-circulation, causing damage to the arteries.  The arterial wall damage causes a release of inflammatory cells and chemicals to repair it, which can lead to platelet aggregation and plaque deposition.  This can lead to heart and vascular disease.

Most of us are dealing with one or more of these problems and have no idea of how to heal it.  Most doctors simply treat the symptoms rather than dealing with the root cause:  inflammation.  My next blog will look into medications generally used for the chronic inflammation that threatens our health and our lives, how well they work and if they are safe.

Until we meet again,
Dr. Judi