News from Nutrition/Pain Management

COMMERCIAL MESSAGE: Marty and I would like to thank those of you who refer patients to our practice. We prefer to grow by referrals since this is an indication of the faith patients place in our ability to help their friends and family. We always try to accommodate referrals the same day. CM 2: This year, I am expanding my services to patients to cover nutritional guidance. If you would like to discuss or address concerns about current nutrition, interactions with medications, or other concerns that might be responsive to nutrition please call and set up an appointment. The modern diet is not particularly healthful. I am looking into an online version eventually.

PREVENTATIVE HEALTH:

MAINTENANCE CARE: The majority of joint, muscle and nerve problems tend to be recurring. Why? Is it because you came to the chiropractor? You know the old statement-once you go to a chiropractor you have to keep going. Not true. No, nada, nein, nyet, Ii, ikke (English, Spanish, German, Russian, Japanese, Norwegian). The simple truth is that problems with joints and the surrounding tissue tend to be progressive. This is due to poor conditioning, trauma, developing arthritis, scar tissue, postural distortions, health habits and good old aging among other things.

MAINTENANCE CARE is getting treated/adjusted regularly to slow down or prevent problems. It is the same as going to the dentist and getting your teeth cleaned or having a mammogram or annual physical. Maintenance care also allows regular monitoring of problem areas to head off more serious problems or deterioration. Letting problems go for more than a few days or longer is not healthy either. Many patients do well with treatment monthly or every six weeks. Some patients do well every 2-3 months. Let us know if you'd like to be on regular maintenance and we can put you on a call or e-mail schedule on our books to drop you a line when it gets about time for a follow up.

News From Nutrition:

Fish Oil Tops Defibrillators in Preventing Cardiac Death: a recent report suggests that Omega-3 fatty acids found in fish oils is associated with reduced risk of fatal heart rhythms (arrythmias). Supplementation is estimated to reduce deaths by about 6.4%.

More About Fish Oils: doses above 3000 mg have been shown to lower fibrinogen levels (cardiac and cancer risk factor). Unbelievable-a drug company has now come up with a prescription fish oil costing a mere $237 per bottle which they are trying to get the cardiologists to prescribed. It takes 5 capsules of over the counter fish oil to do what 4 of their capsules does. So taken another over the counter capsule at about $40 a bottle for a month's supply.

Conflicts of Interest/Media Reporting of Studies: Read nutritional reports carefully and preferably the original study. The media reporting of results is often inaccurate and misleading. In a recent study where glucosamine was compared with Celebrex, it was reported that glucosamine was not effective. Actually, it was more effective for moderate-severe pain and not significantly for slight pain. Celebrex was reported effective but actually was little more effective than a placebo. Interestingly, the glucosamine benefits were downplayed and the Celebrex results exaggerated. They were not using the commonly used form of glucosamine sulfate but were using glucosamine hydrochloride. One thing to check is to see if critics and researchers are taking fees from the drug manufacturer. Many of this study were-Objective. Not!

Promoting Stomach Health Naturally: statistics show tens of millions of Americans are infected with Helicobacter pylori (H. pylori) , the culprit in the majority of stomach ulcers. Nutritional and herbal agents can help support stomach health by relieving inflammation, promotion healing and defending against H. pylori. A combination of zinc and L-carnosine inhibits H. pylori. This complex is available as a supplement and is biochemically identical to the Japanese drug polaprenzinc used for ulcers. This combination enhances healing of the stomach lining due to its anti-inflammatory properties and promotes tissue repair and healing. Licorice extract also heals the stomach lining and blocks H. pylori growth. Cranberry may also retard H. pylori growth by preventing bacterial adhesion to the gastric cells, disrupting the H. pyloric membrane, inhibiting a bacterial enzyme and disrupting energy production as well as via its anti-oxidant properties.

REFLUX: Orange Peel Extract- a substance in orange peel called d-limonene may help reduce reflux symptoms (GERD). Studies are underway on possible cancer fighting benefits as well as antibacterial and antiviral effects. It may also help with other GI disorders. GERD sufferers should avoid: smoking, chocolate, tomatoes, raw onions, garlic, black pepper, vinegar, peppermint, spicy/fatty foods, caffeinated and carbonated beverages and lying down within 3 hours of eating.

Dr. Riggs’ Comment: Please check on the side effects of any nutritional supplement and its possible drug interactions, especially for licorice. Also, bismuth which is found in pepto bismol has been found to help kill off the H. pylori bacteria and aid in healing.

Weight Loss/Appetite Control: Most have heard of hoodia the San tribe from Africa's appetite suppressant. Another nutritional appetite suppressant is the Korean pine nut (pinolenic acid). Apparently, this lowers appetite while improving insulin usage by cells.

HEART HEALTH: pomegranate may reduce or reverse atherosclerosis (hardening of the arteries) as well as reducing cardiovascular risk by lower LDL, improving heart blood flow and lower blood pressure. It may also lower PSA in men which is a marker in prostate cancer. It may also have anti-tumor effects against breast cancer. The juice is a highly absorbable anti-oxidant.

News from pain management:

Carpal Tunnel Pain: A recent study by the Mayo Clinic suggests the carpal tunnel syndrome disease process begins with a shearing injury. The resulting scar tissue from healing impedes the sliding motion of the tendon, compresses the median nerve, cuts off the nerve’s blood supply and eventually leads to the pressure buildup characteristic of carpal tunnel syndrome. It results in the carpal tunnel syndrome symptoms of hand pain, numbness and tingling. The study may lead to new treatments for the syndrome.
Dr. Riggs’ comments: deep tissue myofascial release will often help mild to moderate cases that have been present for a short time. I personally feel the instrument assisted version of deep tissue work to release scar tissue adhesions gives my patients the best results. If the scar tissue can be reached with the deep tissue work, it generally will improve. Graston technique is useful with cases that are mild to moderate without permanent nerve injury. Dr. Riggs is the only Graston trained health care provider west of Dallas/Fort Worth. The next closest is Albuquerque. This technique if effect on scar tissue and chronic soft tissue injuries.

Pain Management: A recent evaluation by the University of Wisconsin shows Michigan and Virginia to be the better states for pain management. Texas was in the bottom category and got an average rating. The past 3 studies show Texas did not improve over several years.

Rehab: most painful problems have a soft tissue problem accompanying a joint problem. If the problem is due to an injury or due to out of shape muscles, it is important to restrengthen or recondition the muscle. Some of these exercises can be done at home: balance balls, balance exercises, core strengthening, etc. They should not be done without guidance and follow up under the direction of a qualified health care provider. Dr. Riggs will happily discuss any exercise or strengthening concerns you may have.

Natural Anti-Inflammatories

NSAIDs (non-steroidal anti-inflammatories) are frequently used to control inflammation and may be over the counter or prescription. Significant complications may be associated with such medications including: ulcers or other gastrointestinal hemorrhage (bleeding), heart attacks and stroke. Medical studies have evolved new drugs such as Vioxx, Bextra and Celebrex, often with increased risks or complications. Lesser known side-effects of NSAIDs include reduced healing (muscle, ligaments, tendons), negative effects on muscle tissue (increased necrosis/death), muscle weakness, delay of bruise healing, delayed muscle regeneration, and kidney side effects in athletes.

There are 3 main pathways involved in controlling inflammation: LOX (5-lipoxygenase), COX-2 and COX-1. Basically, these pathways involve inflammatory chemicals through the arachidonic acid pathway. Inflammation is controlled by decreasing the chemicals in this pathway. Some medications influence more than one pathway.

WHAT ARE THE NATURAL ALTERNATIVES? Article Medscape by Maroon, Bost, Borden, Lorenz and Ross is the source of this discussion with back up information from Natural Standard: Herb & supplement handbook by Basch and Ulbricht. CAUTION: do not substitute or start any supplementation program without consulting with your MD, DO, or pharmacist if on medications. Check with your DC to rule out any contraindications if not on medications. This article is for information purposes only and does not substitute for health care advice.

Natural medicines/herbs have been used in folk medicine to control inflammation and pain. Although concerns exist over quality and contaminants, many natural substances exist which reduce inflammation and pain effectively. Seeking pharmaceutical grade or standardized products will help alleviate such concerns.

Anti-inflammatory HERBS/SUPPLEMENTS:
1. Omega 3 EFAs (Fish Oil). The use of this product for musculoskeletal treatment can be traced back to the 18th century-good old Cod Liver Oil. The biggest problem with this product was rancidity (spoilage). Modern production techniques have fixed this problem. EPA and DHA are the active ingredients which have anti-inflammatory effects. The recommended dosage is 1.5 to 5 g of EPA and DHA/day with meals. Rare side effects include: belching and oily stools. May cause GI upset, slight alter blood sugar in diabetics, may deplete vitamin E, may increase vitamin A and D toxicity, may increase LDL (bad cholesterol) at certain levels, may elevate liver enzymes (rarely), may affect people who are bipolar or severely depressed, may rarely cause skin rashes. Contraindications: do not take if taking a blood thinner, herbs that thin the blood, or aspirin and other NSAIDs. Check with your heart doctor if taking a blood pressure medication or herbs that may lower BP as it may lower blood pressure. May add to triglyceride lowering effects of medications.
2. White Willow Bark. This is one of the oldest herbal remedies for pain and inflammation and has been using in ancient Egyptian, Roman, Green and Indian societies. The first record of its use was 3500 years ago. Aspirin was created from this herb with Bayer being the first to market it.. Salix alba (white willow) is most commonly used with properties similar to aspirin with effects comparable. The salacin is converted to salicylic acid by the liver and is considered to have less side effects than aspirin, although more costly. Contraindications: It should not be used with children and with patient having ulcers, liver disease, kidney disease or diabetes or any condition in which aspirin would be contraindicated. Dosage: usually 240 mg/day.
3. Curcumin (Tumeric): this yellowish colored spice is used in food flavoring and has been used by Ayurvedic and Chinese medicine as an anti-inflammatory, for digestive disorders and to enhance wound healing. It has been suggested as a treatment for colitis, arthritis, cancer and neurodegenerative disorders. Its centuries of use and recent studies show it works on the inflammatory pathways. Dosage: 400-600 mg, standardized powder 3 times a day. Side Effects: few but stomach upset and at high doses gastric ulcers. Comparable therapeutic effects to phenylbutazone.
4. Green Tea: long recognized as having cardiovascular and cancer preventative characteristics due to antioxidant properties.. Arthritic anti-inflammatory uses have been recognized more recently. It also inhibits chemicals that degrade cartilage (chondroprotective) Recommended dosage: 3-4 cups a day or 300 to 400 mg of extract. May irritate some peoples stomach lining and has a high caffeine content.
5. Pycnogenol (Maritime Pine Bark): been used since ancient times over 2000 years. Was mentioned by Hippocrates as an anti-inflammatory. It is considered helpful for wound healing, scurvy, ulcer healing and reducing vascular inflammation. It is one of the most potent anti-oxidants known. Research suggests it has the potential to counteract major cardiovascular risk factors for artery disease. It is 50 to 100 times more potent than vitamin E as an antioxidant. Studies show it helps reduce blood pressure and the risk of vein thrombosis. Dosage: 100-200 mg/day. Mild GI effects such as diarrhea and upset stomach have been noted. It should not be taken if on immunosuppressent or cortiocosteroid drugs since it enhances the immune system.
6. Boswellia Serrata (Frankincense): The resin has anti-inflammatory, anti-arthritic, and analgesic properties. Dosage: extract of 30-40% boswellic acids (300-500 mg two or three times a day) Well tolerated with some people experiencing: stomach discomfort, nausea, reflux, diarrhea. My Note: I have seen patients do as well on the combination of glucosamine sulfate, fish oils and bosewellic acids as they have on the prescription arthritic drugs like Celebrex, even with rheumatoid and osteoarthritis combined.
7. Cat's Claw (uncaria tomentosa): used as a treatment for arthritis, bursitis and intestinal disorders. Side effects are minimal but renal failure has been reported in lupus patients. Dosage: tea (1000mg root bark to 8 oz water) or extract, 20-60 mg.
8. Capsaicin (chili pepper): generally available as a topical roll on or cream. It may cause skin irritation in some people and burning. Do not use when sweating.