Sunday, November 1, 2009

Fibromyalgia, Chronic Fatigue, Pain, Inflammation and Diet

Inflammation is implicated increasingly in major pain and disease processes such as heart disease, fibromyalgia, dementia, diabetes, and chronic pain. There is some evidence showing chronic inflammation could be linked to diet and that when diet changes the body becomes less susceptible to inflammation and long-term pain.

Research tells us some individuals are genetically predisposed to develop type II diabetes.[1-4] .This does not mean that they will but that prevention is an important factor in preventing the cascade that leads this metabolic disorder. As individuals age the body is less effective at metabolizing sugars, in addition we become less physically active. The unfortunate thing is that sugar and fat release brain chemicals that make us feel better short term so the worse we feel or the more stressed we are the more we want food that we would be better off without.

One type of sugar, Glucose, is critical to brain functioning and we need it to live and think .When we eat sugar or starches in our diet, these are broken down to glucose. This glucose has to get into cells to be used effectively it acts like a started in a car to initiate energy production. A hormone called insulin is the key that unlocks the door for the glucose to enter all of your cells and be used as energy. Some people produce too much insulin in response to sugars in the diet. This has been tagged Metabolic Syndrome.[5-9] Over time, these massive amounts of secreted insulin cause the cells to become less sensitive to insulin and we can develop insulin resistance.

Cortisol is also released during stressful times and binds with another neuro-chemical to increase cravings for sweet and fatty foods. Stress and pain can disrupt glucose levels even though individuals often have normal or near normal fasting glucose levels, so they are rarely diagnosed with anything at this point. These people mostly become overweight in middle age, triglycerides and blood lipids levels rise and often high blood pressure ensues. They are tired most of the time, as their blood sugar levels drop substantially after a high glycemic meal (lots of carbs and/or sugar).

What does all of this have to do with pain? Its all about the inflammation. In last 5 years, hundreds s of studies have been completed finding strong links between heart disease and inflammation. One measure of total body levels of inflammation is C-reactive protein or CRP. Patients with the Metabolic Syndrome or diabetics in training have elevated CRP levels.[8, 10-13] While not much study has been focused on how diet can impact osteoarthritis, elevated inflammatory markers have been found in several studies of patients with hip, knee, and erosive hand osteoarthritis.[14-17] It would seem logical then that patients who have early insulin resistance may be able to control both onset of diabetes and inflammation by dietary changes. In other words you have the power to stop the negative cascade no matter what your phenotype.

Many individuals on the South Beach, the Zone or even the Pritikin diet report feeling less pain and increased energy. Most of us do not pay attention to what we eat. I remember listening in amazement as a doctor berated the AMA about heart healthy guidelines and low fat diets. The anguish was evident as the individual felt they had obeyed the rules and the AMA was fraudulent but in actuality this person like most others had no idea what they actually consumed on a daily basis! None of us is immune…a researcher colleague found out the little pastry he had with coffee was 600 calories and loaded with sugar and fat. It was so few bites he had dismissed it as inconsequential until his ‘diet’ plan proved useless.

Some guidelines below were posted on the former Spinal Injury Foundation website and amended to include more recent research:

1. Avoid white flour. This also means that you significantly limit bread intake to small amounts of true whole grain bread or some of the low carb breads on the market. This is as little as 2-4 slices of bread (or the equivalent) per day. This means no cakes, pastries, or other concoctions made with white flour. Your intake of any of these types of sweets (even if made with whole wheat flour) should be significantly limited.

2.Avoid all candy.

3.The best sweetener to use is natural honey (not processed big company brands that add sugar, but old fashioned small farm honey from real bees). Several studies have shown that small amount of natural honey have a stabilizing effect on blood sugar and also contains anti-inflammatory properties.[18, 19] Depending on how you feel about artificial sweeteners, you can also use small amounts of Equal, Stevia or Splenda (but these can also elevate blood sugar and in susceptible individuals can increase cravings).

4. Caffeine will drop your blood sugar by triggering insulin release, avoid this as much as possible.. This also means that teas and diet colas are also off limits. Green teas seem to be a little easier on blood sugar levels, in moderation. In order to accomplish this part of the diet in our busy world, you have to take care of yourself and rest when you are tired. We've gotten into the habit of tanking up on caffeine when we are tired and not resting, this is bad for your pain, blood sugar, and your health.

5. Avoid potatoes and other very high carbohydrate fruits and vegetables (such as carrots, peas, yams bananas), enjoy lots of all other kinds of fruits and vegetables.

6. Pasta made with semolina, rice noodles and white rice are best to avoid.

7. Limited amounts of fat and olive oil are helpful to stabilize blood sugar, however the Dana Foundation has found that fat sets off cravings (like we needed scientists to tell us this!) Our hormones can betray us.  This link is an excellent article and shows clearly why most diets don't work long-term. The largest funded dietary study (WHI or Women's Health Initiative) failed to show any benefits to avoiding saturated fats but these women were not carefully watched and there is no way to tell if they were able to stick to the guidelines. It is best not to avoid natural fats but to use them in moderation.

8. Years ago cake or cookies went bad after a week. In my house they are lucky to last a full day! In the 1950s the food industry fixed that by superheating the oils (Trans fats). It extended the shelf life of foods so that you could keep crackers on the shelves for years without them going bad. However, it also introduced a completely foreign substance into the food supply. For general health, avoid trans fats like the plague! These are hydrogenated or partially hydrogenated oils. They are found in most foods that have a substantial shelf life, so read the labels! Artificial whipped toppings and coffee creamers are loaded with these and other harmful chemicals. While this may not have much to do with pain, these types of fats are a substantial heart health risk among just about all studies. To get an idea of how to avoid these fats, go into your cabinets and spend 10 minutes reading labels, you will be surprised at how these fats are in almost everything.

9. If you feel tired after a meal or are ravenously hungry before a meal or when you wake up, you have exceeded your glycemic load. This means that you ate more starchy or sugary carbs than your body can handle. Avoid these foods and/or cut back severely on them and increase your protein and fresh fruit and vegetable intake. It is best to limit fruit juices though as these are high in sugar and can raise insulin levels.True hunger is a deep gnawing realization that you should probably eat. An insulin overload from eating the wrong foods is the realization that you will eat anything as long as you get it right now! You should study yourself after meals and in the mornings to learn the difference between these two sensations.

10. Like everything you've heard, exercise will help you control weight and will also help you control blood sugar. How do you exercise when you hurt all the time? Warm water pool therapy, walking, stretching, gentle yoga and even pilates is a great start for many people.

For more information google under glycemic index. Many great articles will come up. Eating this way will help you lose weight, feel better with less fatigue, and may just help your joint pain!

Joint pain can sometimes be helped by taking glycosamine, vitamin C, fish oil, and vitamin D and eat foods rich in magnesium. 20 minutes of sunshine daily can help lower pain levels for some people.

1. Fernandez-Real, J.M., Genetic predispositions to low-grade inflammation and type 2 diabetes. Diabetes Technol Ther, 2006. 8(1): p. 55-66.

2. Herbert, A., et al., A common genetic variant is associated with adult and childhood obesity. Science, 2006. 312(5771): p. 279-83.

3. Horikoshi, M., et al., A polymorphism in the AMPKalpha2 subunit gene is associated with insulin resistance and type 2 diabetes in the Japanese population. Diabetes, 2006. 55

4. p. 919-23. 4. Li, Y., et al., Association between functional FABP2 promoter haplotype and type 2 diabetes. Horm Metab Res, 2006. 38(5): p. 300-7.

5. Baxter, A.J., T. Coyne, and C. McClintock, Dietary patterns and metabolic syndrome--a review of epidemiologic evidence. Asia Pac J Clin Nutr, 2006. 15(2): p. 134-42. 6. Caballero, A.E., Metabolic and vascular abnormalities in subjects at risk for type 2 diabetes: the early start of a dangerous situation. Arch Med Res, 2005. 36(3): p. 241-9.

7. Haffner, S.M., Risk constellations in patients with the metabolic syndrome: epidemiology, diagnosis, and treatment patterns. Am J Med, 2006. 119(5 Suppl 1): p. S3-9.

8. Hanley, A.J., et al., Metabolic and inflammation variable clusters and prediction of type 2 diabetes: factor analysis using directly measured insulin sensitivity. Diabetes, 2004. 53(7): p. 1773-81.

9. Reynolds, K. and J. He, Epidemiology of the metabolic syndrome. Am J Med Sci, 2005. 330(6): p. 273-9.

10. Bo, S., et al., Does C-reactive protein identify a subclinical metabolic disease in healthy subjects? Eur J Clin Invest, 2005. 35(4): p. 265-70.

11. Florez, H., et al., C-reactive protein is elevated in obese patients with the metabolic syndrome. Diabetes Res Clin Pract, 2006. 71(1): p. 92-100.

12. Gonzalez, A.S., et al., Metabolic syndrome, insulin resistance and the inflammation markers C-reactive protein and ferritin. Eur J Clin Nutr, 2006. 60(6): p. 802-9.

13. Temelkova-Kurktschiev, T., et al., Subclinical inflammation is strongly related to insulin resistance but not to impaired insulin secretion in a high risk population for diabetes. Metabolism, 2002. 51(6): p. 743-9.

14. Garnero, P., et al., Cross-sectional association of 10 molecular markers of bone, cartilage, and synovium with disease activity and radiological joint damage in patients with hip osteoarthritis: the ECHODIAH cohort. J Rheumatol, 2005. 32(4): p. 697-703.

15. Punzi, L., et al., Value of C reactive protein in the assessment of erosive osteoarthritis of the hand. Ann Rheum Dis, 2005. 64(6): p. 955-7.

16. Penninx, B.W., et al., Inflammatory markers and physical function among older adults with knee osteoarthritis. J Rheumatol, 2004. 31(10): p. 2027-31.

17. Takahashi, M., et al., Relationship between radiographic grading of osteoarthritis and the biochemical markers for arthritis in knee osteoarthritis. Arthritis Res Ther, 2004. 6(3): p. R208-12.

18. Al-Waili, N.S., Natural honey lowers plasma glucose, C-reactive protein, homocysteine, and blood lipids in healthy, diabetic, and hyperlipidemic subjects: comparison with dextrose and sucrose. J Med Food, 2004. 7(1): p. 100-7.

19. Shambaugh, P., V. Worthington, and J.H. Herbert, Differential effects of honey, sucrose, and fructose on blood sugar levels. J Manipulative Physiol Ther, 1990. 3

Tuesday, October 27, 2009

DIY Massage and Why it Makes a Difference

By Amy Price PhD

Dr. Tiffany Field, a clinical and developmental psychologist with the University of Miami, Fielding Graduate institute and Nova South Eastern university found in her research that touch in the form of massage reduced cortisol levels, increased dopamine and serotonin levels leading to improved outcomes in the hippocampus region and so increases the capacity for cognition as verified by psychometrics and pet scans. She explains the gate theory, apparently pressure and cold precede receptors for pain so therefore massage has the capacity to close the pain gate. Massage also reduces substance P a known pain receptor. Clinical improvements were noted in all individuals with pain, including, asthmatics autistic, ADHD, aggression and TBI. Often people with cognitive or biological abnormalities slip through the system however a therapy as simple as massage can improve outcomes to increase learning 

There are some effective, short easy to learn  free massage videos that show how a friend or family member can help out when you are unable to get to a massage therapist

Thursday, October 1, 2009

Cancer, Spinal Injury, and Inflammation

 By Amy Price PhD

There is considerable press given to the relationship between inflammation, trauma and cancer. This is a concern for trauma survivors who have topped the stress index due to litigation, job loss, relationship tension, drug use, traumatic injury and more. I find there is an almost fatalistic waiting for the blow to come because our stress points have been exceeded. It was with interest that I viewed multiple research articles that shows this link is not as solid statistically or from a science perspective as we were all lead to believe and that trauma only slightly increases cancer risk.

Cancer is actually a multifactorial disease and several areas have to go wrong before a malignancy occurs. People who are susceptible generally have a genetic mutation in the cellular ability to repair itself, or the off signal is defective and the cell grows consistently past its prime. Other areas of the DNA can still catch this by killing off the rogue section but in some people the gate keeper has ceased to work. Even then it takes multiple generations of mutated cells to form a cancer. The cancer cells examined under a high powered microscope look like they have exploded from the inside out. The tendency for mutations to grow out of control multiplies as we age simply because many of them are caused by things in our lifestyle or environment. I had heard erroneously that we all have cancer cells in our body and one day something just goes wrong. This always made me feel that there could be a betrayer with in me whom I could not know until I was already defeated.

The human body is actually much more ordered than this. Three types of genes are involved in cancers, oncogenes which are mutated proto-oncogenes (the signal to stop growing is broken) ,these cell promote cell division and and growth. Then there are tumor -suppressor genes which tell the cell when to stop dividing and finally there are the DNA repair genes which if they are defective let mutation continue unrepaired.  So individuals can inherit variants that increase their susceptibility to some cancers but even then it is is not a death sentence.

It is said that at least 30% of cancers are provoked by our lifestyle and that a stable life where we exercise, eat right and avoid smoking and other pollutants can indeed reduce mutations and increase quality of life. Humor and affection also help as they do reduce the stress response and gently lead us away from the bad habits that cause mutations.

So live life to the fullest and be kind to be your personal best. Seven years after severe injuries and multiple stress factors my husband and I found our way back to blood pressure and heart rates that a teen would envy. Indeed some of the degeneration we were consistently assured would put us in wheelchairs has slowly submitted to the power of a life well lived. Before the trauma we never really knew our neighbors, we were too busy globe trotting to form relationships. I recently aarrived home to find homemade cookies in my mailbox, fresh orchids and basil plants left with love and all my school books carefully protected by the mail man until my return. I still never see a day without physical pain but I am glad to be alive. Life is not over it is just different.  There is life after trauma!

Wednesday, September 16, 2009

Ligament Trauma Worse Than A Broken Bone

By Amy Price PhD

Ligament injuries can be more painful and take longer to heal than a broken bone. They are common in traumatic injuries like a car crash, fall or sports injury. A ligament is a tough band of white, fibrous, slightly elastic tissue. They are an essential part of the skeletal joints; binding the bone ends together to prevent dislocation and excessive movement that might cause breakage. Some people like to compare ligaments to duct tape; they hold bones together. Another way of seeing this is to compare ligaments with elastic. Have you ever had favorite clothes where the elastic goes and loses its ability to follow and cling to your body? This is how lax ligaments work in your body. Torn ligaments could be compared to a fan belt in your care or a belt in your clothes dryer or vacuum cleaner, once it tears there is no real way to fix the problem because each time the appliance is used it puts pressure on the belt.
Ligaments contain signaling features which tell the bones how much to move. Ligaments also protect the joints and nerves. When these structures are injured, the body works to rebuild them but this is a slow process. A severe ligament tear can take 18 months to heal whereas a broken bone heals in weeks. When the tear is bad and the ligament can’t heal the surrounding muscles work overtime and the nerves do not have the same degree of protection which can lead to chronic pain and atrophy of the surrounding muscles. Severe ligament injuries that can’t heal produce instability in the surrounding structures. When this happens, deep supporting muscles get weak, nerves get irritated (causing more muscle weakness), and joints get inflamed and painful. Ligament injuries may be accompanied by popping and cracking.
Tight muscles and bad posture that come from the strain of chronic pain and injury can also cause cracking and popping however in this case the popping and cracking relieves pain and pressure. When popping and cracking makes you feel worse and produces more pain, numbness, or burning; it may be due to instability. Special x-ray techniques called flexion-extension views could be done to rule-out any type of instability.
Ligament injury can be treated with prolotherapy and adult stem cell treatment. Ligament repair can treat the injured areas as well but surgery is invasive, there is extensive rehabilitation and considerable down time. Targeted physiotherapy can be used to strengthen the area around the ligament to give it the opportunity to heal. Sometimes bracing is used to rest the area to give it time to recover however this is a temporary solution to reduce pain and used long term can make the situation worse because the surrounding support areas weaken with lack of use.
There are some antibiotics such as ciproflaxin which can make hinder ligament repair. Anti-inflammatories can also slow the healing process for ligament injury.
Supplements that promote cell health such as vitamin C, Glucosamine, Fish oil supplements and anti-oxidants can help. It is important to have high quality protein in your diet to promote a healthy balance of amino acids which help your cells increase the building blocks needed to heal. Getting enough sleep and regular exercise is important. Stress slows your body’s ability to heal. Learning stress busting techniques or avoiding stressors promotes health.

Sunday, August 23, 2009

Prolotherapy For Ligament Instability

Amy Price PhD

Prolotherapy prompts the body to naturally heal damaged and degenerated tissues. This is not a steroid which can block healing by inhibiting the natural inflammation cycle whereby new cells can regenerate and repair tissue, but a natural substance that promotes healing. In Roman times, soldiers with joint injuries would have those wounds cauterized to promote healing and reduce infection. While modern techniques are much more sophisticated, the concept is the same.

Prolotherapy works by prompting your body's natural repair mechanisms to heal damaged or degenerated tissues. It's done when ligaments have been stretched/damaged or torn. This technique can be used in most joints that are unstable. It's most commonly used for SI joint dysfunction with instability or chronic low back pain. This technique can help repair some of the ligaments and provide normal support to the joint. While most of our daily injuries heal completely, severe ligament tears, degenerated and worn out tissues, and those with a poor blood supply (such as in the knee) don't usually mend themselves. This is because low grade inflammation is taking place and causing pain but it is not strong enough to signal initiation of the repair process.

Prolotherapy practitioners start by injecting a growth factor stimulant which is not a growth hormone or steroid, but contains a mild irritant such as glucose mixed with local anesthetic to trigger healing response in the damaged area. This otherwise harmless, natural substance, causes a brief period of inflammation 3-5 days after the injection which triggers inflammation that causes the body to release it's own natural growth factors in the injured tissue.

Most practitioners do these injections in a series, with 3-6 times being considered the norm. This technique can be used in most joints that are unstable. It's most commonly used for SI joint dysfunction with instability or chronic low back pain.
These go to work immediately, directing your body's natural healing mechanisms to repair damaged and degenerated tissue. The first stage of healing usually takes about a week, but the tissue continues to restore itself for 4-6 weeks after the injection.

It is very important that this treatment is done with fluoroscopy guidance. Fluoroscopy is like an xray movie. Some doctors inject with out xray guidance. For this treatment to be effective it needs to be precisely targeted and done by a practitioner who is getting consistently good results for treatment. It may be good to ask the doctor for the name of a couple of satisfied recipients. They will be able to tell you about the procedure and what to expect as well.

For more information:
Mayo Clinic

This site has links to research, news and more information