Does Pain Medication do More Harm than Good?

pain med 2There is something frustrating about talking to patients who take pain medications and believe in their heart that the drugs are doing them good. We see the advertisement for Alleve that show a woman with arthritis taking Alleve so she can have a better work out. Doctors, when prescribing NSAIDs, impart the idea that the drugs actually help the condition. Too often people in pain are given drugs to mask their symptoms, but are given the idea that healing is somehow being facilitated. The purpose of this paper is to give the practitioner a tool to teach patients.

When you give these people dietary advice and try to tell them that it will affect their pain, they look at you like your dog might if you made a strange noise. The head tilts; the mouth drops open and there is a blank expression on the face. Their pain is physical, so why would diet have anything to do with it?

Chronic pain is the most costly health problem in America, with an estimated annual cost of about $90 billion per year. This cost includes lost productivity, legal costs, doctors’ visits and medication; 80% of all visits to the doctor are pain related.

An estimated 40 million Americans have arthritis or other rheumatic condition. That number is expected to climb to 59.4 million, or 18.2% of the population, by the year 2020, according to a new report published as a collaborative effort between the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Arthritis Foundation, and the American College of Rheumatology.1

Approximately 12% of all Americans suffer from migraine headaches.2,3 Nine out of 10 migraine sufferers report they can’t “function normally” during days in which a Migraine strikes. Three out of 10 migraine sufferers require bed rest when suffering from a migraine2,3.

In 2001, over 13 million people saw a physician for the treatment of back pain. According to the NIH, 65 to 80% of all people have back pain at some time in their life. Half of all working Americans admit to having back pain symptoms each year4. Back pain costs an estimated $50 billion each year5.

There is a tendency for patients to think of pain medicine as the only way to treat pain and inflammation. Many people automatically take medication when they have pain and think that they are somehow helping their condition. More than $4 billion is spent each year on over-the-counter pain medications for headaches. Americans consume 20,000 tons of aspirin each year. But we all know medication is not a cure for pain; and it often makes matters worse, and this fact needs to be communicated to our patients.

According to research appearing in the American Journal of Medicine, “Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nosteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures for all NSAID users would be overwhelming, yet the scope of this problem is generally under appreciated”6

Other research links pain medications to high blood pressure7, kidney failure8, heart failure9, ulceration of the GI tract10, and some drugs even interfere with bone repair11. One study found that in 2,000 arthritic patients, NSAID use increased ulcer risk 10-fold. Almost 25% of NSAID users have ulcers, most of which are without symptoms10.

NSAIDs perpetuate the very problem that they are designed to treat. They actually increase the body’s oxidative stress—leading to further inflammation and pain. Research has demonstrated that NSAIDs interfere with the formation of cartilage12, 13. So someone with arthritis who takes these drugs is trading short-term relief for long-term degeneration. The drugs actually make the condition worse.

Many arthritis sufferers take glucosamine sulfate or chondroitan sulfate products. Many studies have shown that these products can help arthritis sufferers. Patients suffering from arthritis in the knee experienced relief in a study published in the journal, Drugs and Aging. The researchers concluded, “In short-term clinical trials, glucosamine provided effective symptomatic relief for patients with osteoarthritis of the knee. In addition, glucosamine has shown promising results in modifying the progression of arthritis over a 3-year period. Glucosamine may therefore prove to be a useful treatment option for osteoarthritis.” The Journal of the American Medical Association acknowledged that these supplements may be of benefit to arthritis sufferers13. The Lancet has also published research supporting the use of these supplements14.

Patients hear about research like this, and their tendency is to go out and buy glucosamine supplements and to take them in place of the NSAIDs, They are still looking to a pill to solve their problem. Scientific studies contribute to this thinking. Researchers will give one group in the study a drug and the other group will take glucosamine or chondroitan supplements—they are merely comparing one pill to another. Generally, in the beginning of the study, the people taking the drug will feel better than the group taking the supplements, but as time progresses, the group taking the supplements do better. This should be obvious, because the supplements help to repair cartilage and the drugs destroy it. The drugs also undermine the body’s general health and make it more prone to inflammation—short term relief turns into long term degeneration.

Various herbs, like boswellia, ginger, willow bark or curcumin15,16,18 are anti-inflammatory. Taking herbs can indeed help reduce pain and inflammation. And there is research supporting their value. The problem is that people want to use these things like they are drugs—addressing symptoms. They need to understand that natural health care works best when you combine diet, lifestyle and therapy. In natural health care, you are not treating symptoms, but improving the body’s infrastructure to overcome the pain. Healthy bodies don’t hurt.

There is also a lot of research to support the importance of diet and exercise in eliminating pain. How you live and what you eat really does have an effect on how much pain you feel. Eating a diet that is high in fresh fruit and vegetables will decrease your pain and inflammation. In a study published in the American Journal of Clinical Nutrition, Researchers at the University of Athens Medical School found that people who ate the highest amount of cooked vegetables had a 75% lesser risk of developing rheumatoid arthritis than those who ate few vegetables17. Also, the Journal of the American Medical Association has published research that a diet high in vegetables and olive oil—the so called “Mediterranean Diet” helps to reduce inflammation19.

A combination of fish oil and vitamin E reduced the levels of cytokines (which are pro-inflammatory proteins that cause the joint swelling, pain and tenderness). Fish oil, in general is anti-inflammatory. Dr Richard Sperling, found in his research that fish oil may reduce inflammatory substances produced by white blood cells. Professor Caterson and other Scientists at Cardiff University in Wales have found that the Omega-3 fatty acids in cod liver oil work to inhibit enzymes that break down joint cartilage. There is so much research showing the anti-inflammatory effect of fish oil24,25,26,27.

The bottom line is; that for patients to minimize pain, they should be consuming a lot of fresh fruit and vegetables, and omega-3 fatty acids, like those found in fish oil. They also need to avoid foods that promote pain and inflammation. High fat and high sugar diets promote inflammation, according to research appearing in the American Journal of Clinical Nutrition20. Even the Journal of the American Medical Association has published research that says a low-sugar diet reduces pain and inflammation19. To most of us, this is obvious, but it is hard to make patients understand.

Exercise can also help to reduce pain. Children with juvenile arthritis took part in an eight-week individualized program of resistance exercise at the University at Buffalo. Their ability to function was greatly improved by the exercise. Some improved by as much as 200%21. According to a study, found in the Journal of Nursing Scholarship22, Tai Chi can reduce arthritic pain.

To sum up, patients need to do the following:

  • First, eat plenty of fresh fruits and vegetables. Eat live food, brightly colored produce—natural foods that are dark green, purple, yellow, orange, or red. Those rich colors are actually antioxidants that protect the plant. They contain antioxidants and phytochemicals that protect your cells as well.
  • Avoid foods that contain refined sugar, or high fructose corn syrup; like soda pop, candy cookies, donuts and other sweet snacks. Also avoid refined grains like white bread, white noodles. These foods promote pain and inflammation.
  • Change the oil—the chemicals that produce inflammation are made from fatty acids. Certain fats are anti-inflammatory, and some contribute to pain and inflammation. Absolutely avoid hydrogenated and partially hydrogenated oils, avoid trans fats—these are linked to cancer and heart disease, but they are also linked to pain and inflammation28. This is huge, we have all seen that step alone get many people out of chronic pain. Animal fats are also linked to inflammation—eat lean meats, chicken and fish and avoid high fat items like bacon and sausage. Omega 3 fatty acids, like those found in fish oil and in flax seed oil are very useful for reducing pain and inflammation.
  • Avoid chemical additives. These promote inflammation
  • Get moving.

Patients who make these changes are often amazed at their improvement. I try to get them to follow the dietary advice here for 30 days. It’s long enough for the patient to feel the difference without making them think they have to change forever. We need to get them to understand that drugs manipulate the body’s chemistry to block pain; this is simply a way to control the body’s chemistry naturally and reduce pain.

Patients get very good results from following this very simple advice. It sometimes gets frustrating in a busy practice saying the same obvious things all of the time, but the results make it worthwhile.

 

  1. Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, Heyse SP, Hirsch R, Hochberg MC, Hunder GG, Liang MH, Pillemer SR, Steen VD, Wolfe F. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998;41:778-99.
  2. Press Release: “Study Finds Millions of Migraine Sufferers Continue to Live with Pain Despite Available Preventive Treatments.” Philadelphia: June 24, 2005.
  3. Loder, Elizabeth & Biondi, David (2005) “General Principles of Migraine Management: The Changing Role of Prevention.” Headache: The Journal of Head and Face Pain 45 (s1), S33-S47. doi: 10.1111/j.1526-4610.2005.4501002.
  4. Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.
  5. Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD, Summer 1994.
  6. American Journal of Medicine, July 27, 1998
  7. Archives of Internal Medicine (October 28, 2002;162:2204-2208)
  8. New England Journal of Medicine (December 20, 2001;345:1801-1808)
  9. Archives of Internal Medicine (February 11, 2002;162:265-270).
  10. Archives of Internal Medicine (July 23, 1996)
  11. Journal of Bone and Mineral Research (June, 2002 17:963)
  12. Journal of the American Medical Association (2000; 283(11):1469-75)
  13. The Journal of the American Medical Association (March 15, 2000;283:1469-1475, 1483-1484)
  14. Long-Term Effects of Glucosamine Sulphate on Osteoarthritis Progression: A Randomized, Placebo-Controlled Clinical Trial,” The Lancet, 2001;357:251-256.
  15. Phytomedicine (Jan, 2003; 10(1):3-7)
  16. Gagnier J, Vantulder M, Berman B, et al. Herbal medicine for low back pain. Cochrane Database Syst Rev 2006; 19:CD004504.
  17. American Journal of Clinical Nutrition (1999 Dec;70(6):1077-1082)
  18. American Journal of Medicine (2000;109 9-14)
  19. JAMA Vol. 292 No. 12, September 22/29, 2004
  20. JAMA (2004Nov 24; 292(20):2482-90)
  21. American Journal of Clinical Nutrition (2004 Jul;80(1):51-7); American Journal of Clinical Nutrition (2004;79(4):682-90))
  22. Study performed at the University of Buffalo 1999; source: Science Blog
  23. Journal of Nursing Scholarship(May, 2001)
  24. Journal of the American College of Nutrition
  25. British Journal of Rheumatology (1993 Nov;32(11):982-9)
  26. Journal of Gastroenterology and Hepatology (Volume 13 Issue 12 Page 1183; December 1998),
  27. Annals of Internal Medicine(1987 Apr 106(4):497-503)
  28. Journal of Clinical Nutrition November, 2004

 

 

One Inexpensive Way to Reduce the Chance of Developing Arthritis

arthritisA prospective cohort study, appearing in Public Health Nutrition (doi: 10.1017/S1368980010001783) looked at osteoarthritis in the knee and the effect of vitamin C supplementation. At the start of the study the 1,023 participants were taking part in the Clearwater Osteoarthritis Study from 1988 to the present. The subjects, all aged 40 or more at the start of the study, were x-rayed and their knees evaluated using the Kellgren-Lawrence ordinal scale to determine osteoarthritis. The subjects who took vitamin C supplements had an 11% reduced risk of developing osteoarthritis in the knee when compared with subject who did not take vitamin C supplements. The authors concluded, “…after controlling for confounding variables, these data suggest that vitamin C supplementation may indeed be beneficial in preventing incident knee OA. Given the massive public health burden of OA, the use of a simple, widely available and inexpensive supplement to potentially reduce the impact of this disease merits further consideration.”

Joint Care and Repair by Joe Buishas (transcribed from recording)

knee xrayAlmost all people over the age of forty have some pathological changes in the weight-bearing joints. The Merck Manualof Diagnosis and Therapy goes on to state that osteoarthritis becomes universal by age 70. Over 22 million people spend over 20 billion dollars each year to relieve their pain and suffering. Knees, hands, wrists, elbows, shoulders, hips, ankles, bones in the feet, and over 200 bone surfaces in the back are all prey to degenerative changes in the joints. Clearly this is a huge problem and yet there are many things we can do to prevent and even reverse osteoarthritis.

Hi, my name is Joe Buishas. As a licensed clinical nutritionist and a nutritional practitioner for over 20 years, I have seen both sides, the pain and the recovery of this degenerating condition. When we talk about osteoarthritis what we are really talking about are the degenerative changes to the cartilage in the joints.

To maintain healthy mobility, our goal is to have healthy cartilage. Dr. Jason Theodosakis described this process in his book, The Arthritis Cure. To get an idea of how cartilage works, imaging rubbing together two perfectly flat, slightly wet ice cubes. They glide across each other, quickly and easily, never catching or slowing. Now imagine a surface that is five to eight times more slippery than ice. That’s your cartilage, the material to make it possible for the ends of your bones to slide smoothly and easily across each other. No man made substance compares to the low-friction and shock absorbing properties of healthy cartilage

The Makeup of Cartilage

What is cartilage? Cartilage is composed of four components: Water, collagen, proteoglycans, and chondrocytes. The primary ingredient in cartilage is water. In fact, 65% to 85% of cartilage is water. Water is attracted into cartilage by an ingredient called chondroitan sulfate. Chondroitan sulfate has the ability to bind up to 100 times its weight in water. Imagine a sponge full of water versus a sponge that is dry and parched. The sponge with water has greater resiliency and spring, almost like a mini shock absorber. The dry sponge, on the other hand, when it is bumped or jarred will pass the impact on to whatever is beside it. Our goal is to maintain healthy joints, and it can never be accomplished if we are not properly hydrated.

Dr. Bhatman Geldi in his book, Your Body’s Many Cries for Water, describes many conditions which can be cured by drinking water alone. He shares the mechanisms by which many cases of stomach problems, excess cholesterol, depression, angina and other heart conditions, asthma, allergies, neck pain, back pain, headaches, hypertension as well as other conditions have been successfully treated by water alone. He shares in his book that we are constantly consuming liquid diuretics such as pop, coffee, tea, alcoholic beverages, and even fruit juices which force the body to use up its stored resources. Our bodies must dilute some of these toxins or sugars and as a result some of the storage areas for water are depleted.

As we’ll see later in this tape, chondroitan sulfates and associated co-factors play a major role in regenerating healthy cartilage. But unless a person is properly hydrated, they can never achieve the goal of attaining and maintaining healthy cartilage. A good rule of thumb is to take your weight, divide it by two and consume that number in ounces of water each day. For example, a 200 pound man should try to drink 100 ounces of water each day. Obviously, the liquid diuretics mentioned previously should be minimized.

The second ingredient in cartilage is collagen. Collagen is a protein used to make tendons, skin, bones and even the clear membranes of the cornea. It is the most abundant protein in our body, making up approximately 6% of our body weight. Collagen has been called the glue that holds the cartilage matrix together. It may appear as a single, hair-like strand, or maybe braided together like rope, giving it incredible strength and flexibility. A word-picture that may help understand the value of collagen would be to compare it to the steel in buildings to which the bricks, wood mortar, windows and doors are attached. These building materials must attach themselves to something to stay in place. The same is true of collagen and its structural role in our bodies. Collagen is very difficult for humans to digest and therefore cannot be provided in supplemental form. However we can supply the cofactors or precursors necessary to make collagen. As long a good supply of amino acids, which come from protein, vitamin C, copper, iron, and manganese are present our bodies will continue to make the necessary collagen.

The next category in cartilage is called proteoglycans. That’s a big word. Proteoglycans: proteo stands for protein; glyco is a term used to describe long structural sugars. Imagine a bottle brush, with the stem of the brush being protein to give it strength and the bristles being the structural sugars. Proteoglycans, or little round bottle brush structures are woven around and through collagen fibers, forming a dense netting inside the cartilage. Proteoglycans act like a thirsty sponge attracting water and providing a cushion or shock-absorber for the cartilage. Remember the bristles on the bottle brush? They are really long structural sugars and are called “GAGS”, glyco-amino glycans. The most important and the most abundant ones are called chondroitan sulfates. The chondroitan sulfates are the part of the proteoglycan that attracts water and acts like a sponge.

The body makes chondroitan sulfates very slowly. This is partly due to the poor circulation to the joints, and precisely why proper exercise is so important. The turnover time for the body to make 50% of the glycol-amino glycans in the cartilage is about 1.5 years. Things move very slowly in the life of cartilage.

If we were to look at cartilage through a microscope, you would see sprinkled inside the cartilage matrix tiny cells, called chondrocytes. Chondrocytes represent the fourth major category in cartilage. Looking at a picture of cartilage, they almost appear like pepper. Chondrocytes make up 5% of the cartilage. They are the factories that manufacture the new collagen and proteoglycan molecules. These cells also have the responsibility of tearing down the old cartilage as they rebuild the new. To perform this task, they secrete enzymes to break down cartilage. What happens if, during the rebuilding process they do not receive key ingredients? What happens if you are baking a cake, and you realize that you do not have enough eggs? The baking process slows or stops. If you have to wait long enough for the ingredients, you may decide to use alternative ingredients and make an inferior cake, without the eggs. Our analogy may be crude, but you can see how years of borderline deficiencies of key nutrients can result in poor cartilage construction and can produce problems in flexibility and mobility.

Add to slow cartilage production, the continuation of the cartilage “chewing” enzymes and it’s easy to see how degeneration takes place. Our goal is to make sure that the chondrocytes have the nutrients they need to produce healthy cartilage.

Before we look at the nutrients to make healthy cartilage, let’s look at the manner in which osteoarthitis is usually treated. The current treatment approach of traditional medicine is a reduction of pain and stiffness. Analgesics, or non-steroidal anti-inflammatory drugs (NSAIDS) are most commonly prescribed. Although NSAIDS have a definite effect in pain reduction, a percentage of patients have severe gastrointestinal problems after prolonged intake. Some NSAIDS, particularly aspirin can actually destroy cartilage and block its repair.

Pain Medication, a Flawed Solution

In the July 23, 1996 Archives of Internal Medicine, it states that in nearly 2,000 arthritic patients studied, ulcer risk increased 10-fold. It also stated that almost 25% of NSAID users have ulcers, most of which are without symptoms.

Even more shocking is the fact the NSAIDS slow or inhibit the chondrocytes. Chondorcytes make collagen and proteoglycans (especially chondroitan sulfates). NSAIDS work in terms of pain reduction, but they can make the condition worse over a prolonged period of time. They should be used cautiously. Our goal is to get to the cause of the problem and, according to European researchers, reverse the degeneration.

Protecting and Repairing Cartilage

I’d like to introduce a term that you’ll be hearing more about in the upcoming years as mainstream medicine begins to look at nutrition in joint repair. The term is chondro protection. The word “chondro” means joint or cartilage. So a chondro protective agent is an agent that protects existing cartilage and encourages repair.

One of the most important (chondro protective agents) is chondroitan sulfate. Multiple studies in Europe and the United States have shown that chondro protective agents make a difference. Let’s look at why they may work. Chondrocytes are the cells that make proteoglycans and the cells that make the cartilage “chewing” enzymes. If, because of injury or stress, the chondrocytes make more of the cartilage “chewing” enzymes, the cartilage is being destroyed faster than it is being rebuilt or replenished. By adding additional chondroitan sulfate in the joint space where these enzymes are present, free or added chondroitan sulfate can “take the hit” or become denatured. The chodroitan sulfate protects existing cartilage for premature breakdown by inhibiting the action of certain cartilage “chewing” enzymes.

Some people feel the result of chondro protective agents quickly, and this can be one of the reasons. One of my friends is a farmer and he couldn’t get off of his tractor without excruciating pain. After two days of taking 1200 mg. of purified chondroitan sulfate, he could get up and down without pain. Cartilage builds very slowly; there’s no way he could have received relief so fast by the creation of new cartilage. But the pain and swelling of the existing cartilage could be reduced. Our goal is to feed the body, to create new cartilage, but we would also like to protect what is already present.

We’ve already mentioned that chondroitan sulfates act as shock absorbers. Due to the sulfate part of the molecule, chondroitan sulfate can absorb water up to 100 times its weight. We used the analogy earlier, that with proper hydration, the chondroitan sulfates act like a sponge, a cushion or a shock absorber. Here’s another picture that may bring the point across. If you own a waterbed and it’s filled to its capacity, and you fall face-first into the sheets, you will experience relief. You may have fallen four feet, if you’re six feet tall, and yet you experience no pain. What would happen if someone were to drain your waterbed while you were at work, and you came home at night and fell face-first into your soft sheets? That would notbe a pleasant experience. Without the water, you would experience intense pain.

As we age, chondroitan sulfates are replaced by another type of glyco-amino glycan, called keratin sulfate. It does not have the ability to absorb water the way chondroitan sulfate does. Therefore the degree or quality of cushion we have become accustomed to is no longer present. Small bumps and bruises become a big event; whereas 20 years ago they were no big deal.

Can Supplementation Help? Studies Say Yes

The good news is that through supplementation, we can increase the quality of the glyco-amino glycans, and increase the body’s ability to make and use chondroitan sulfate. The bad news is that it takes time. In an era where so many side-effects are present with pharmaceutical agents, the question of long-term safety should be a concern with any supplement we ingest. Good news on the chondroitan sulfate. Dr. Lester Morrison, in a six-year study, using purified chondroitan sulfate, at 1000-1500 mg. per day, showed profound changes in a six-year study involving 120 patients with documented arteriosclerosis. Positive changes, let’s look at the study briefly. The most important area of concern was the survival rates. The people in the study had documented hardening of the arteries. All of the patients underwent standard cardiac therapies, the one exception being the addition of purified chondroitan sulfates daily. Here are some statistics: In the purified chondroitan sulfate group, four out of 60, or 7% had died, which means the 93% lived. In the control group, which had received standard cardiac therapies, 13 out of 60, or 23% had died; which means that 77% had lived. But let’s look closer at the survivors and see how they fared. In terms of non-fatal hospitalizations, six out of 60 (of the chondroitan sulfate group) had problems that required hospitalization—that’s 10%. In the control group, however, 42 out of 60 had to be hospitalized with further heart attacks, strokes, or other cardiovascular complications. We also saw a reduction in serum cholesterol levels from 10% to 20% (in the chondroitan sulfate group), especially the LDL cholesterol. Serum triglycerides were reduced.

Dr. Morrison, in other research with lab animals, has actually shown arterial healing taking place with purified chondroitan sulfates; with some cases of reversing arteriosclerosis in monkeys. Imagine taking a product for your joints and your arteries become more flexible. Studies of this show the safety of long term use of purified chondroitan sulfates, and how oral levels of purified chondroitan sulfates can be absorbed and utilized by the body.

Another example of a chondro protective agent is glucosamine. Glucosamine is manufactured by the chondrocytes. Glucosamine is necessary to manufacture chondroitan sulfates. Glucosamine is necessary to make collagen. Glucosamine is also necessary to make the backbone of the proteoglycans—remember the bottle brushes?

The backbone of the proteoglycan molecule is called hyaluronin. Let’s take the handle of our bottle brush and stick 20 or 30 on a long protein molecule. The protein molecule, or stem-like structure is called hyaluronin. Your doctor can suggest further reading if you wish to know intricacies. But for our discussion, glucosamine feeds or primes the chondrocytes to make materials for healthy cartilage.

Remember the chondrocytes create cartilage, building materials (namely glucosamie) and cartilage “chewing” enzymes. By supplementing additional glucosamine, new research suggests that chondrocytes will switch back toward cartilage repair mode.

A Few Words about the Quality of Joint-Repair Supplements

Let’s look at how some of these chondro protective agents are made, and what makes them unique. Chondroitan sulfates currently come from bovine trachea and from shark cartilage. Bovine trachea is intertwined with collagen, so that only 20% to 30% of bovine trachea is actually chondroitan sulfates. Because of the collagen, only 5% to 20% of that 20% to 30% is going to be digested and absorbed. Shark cartilage is approximately the same with 15% to 20% of shark cartilage being chondroitan sulfates. It’s a more expensive product, and it is not as readily available. Shark cartilage also has problems with contamination, some studies showing high mercury exposure.

Purified chondroitan sulfate, on the other hand, is a process where the beef trachea is pre-digested in a series of steps to remove the collagen and to purify or isolate the chondroitan sulfates. Purified chondroitan sulfate is 90% chondroitan sulfate, and according to Dr. Lester Morrison and Dr. Muirata, 90% is absorbed.

Let’s take a look at glucosamine hydrochloride and some of its sources. Chitin, or the shells of crabs and shrimp can be hydrolyzed with various acids. The result is glucosamine hydrochloride. Take glucosamine and add sulfuric acid and we have glucosamine sulfate. As salts, glucosamine hydrochloride and its cousin, glucosamine sulfate, dissociate or break down in the stomach. Most of the American studies have been done with glucosamine hydrochloride. Many researchers believe that the sulfate portion of the glucosamine sulfate molecule is important to human metabolism, which indirectly affects cartilage synthesis and repair. We know that it is extremely valuable in liver detoxification, and helps to detoxify and bind unwanted minerals or metals. Your physician will be able to help you with the decision about which form would be best for you.

Unfortunately there is a dark side to this story. A rather shocking analysis was published in the June, 2000 in the Journal of the American Neutraceutical Association. It compared actual bottle contents of glucosamine and/or chondroitan sulfate products against label claims. The report found that of 14 glucosamine label claims analyzed, only six fully met label claims, with deviations ranging as low as 25% of label claims. Even more disturbing was that the report also analyzed chondroitan sulfate label claims, using the titration method and found that a shocking 26 or 32 products failed to meed even 90% of label claims. More than half of all the products tested contained less than 40% of label claims, and that 14 or 32 products tested had only 10% or less of label claims of chondroitan sulfate. 84% of brands tested are inferior products. That’s an embarrassing statistic to the natural foods industry.

The article goes on to state that because chondroitan sulfates are large molecules, bioavailability has also been in question. Interestingly enough, the same study that analyzed intestinal transport or permeability of several marked sources of chondroitan sulfate. It appears from this study that some chondroitan sulfate material was absorbable and that others demonstrated little or no permeability, even though they were all labeled as chondroitan sulfate. It appears that lower molecular weight chondroitan sulfate is absorbable while those containing a higher molecular weight are in question.

Earlier I mentioned the cardiovascular work of Dr. Morrison and his six-year study. This study as well as other studies performed by Dr. Morrison and his colleagues show that purified chondroitan sulfates are well absorbed and have produced admirable cardiovascular protection. This same study noted a relationship between cost and available chondroitan sulfate. The literature suggests that the daily dose of unpurified chondroitan sulfate is 1200 mg. per day. Of the six products tested, those under a dollar per day, or $31 for a month’s supply did not even have 10% of label claims (or 120 mg.). Another 10 products tested in the $1.25 to $4 range contained less than 30% of the label claims.

It is clear that glucosamine and chondroitan sulfates have their place in respect to joint health and repair. It’s also clear that label claims for these neutraceuticals are highly questionable. One would think that if a product says on a label that it contains a particular ingredient that it does, in fact, have that ingredient. Unfortunately that is not always the case.

Other studies in the past have shown that enzymes and vitamins have varied from label claims. Coenzyme Q10, vitamin E, and superoxide dismutase, have all shown label claim discrepancy. It’s also suggested that patients stay with products from companies with the absolute highest quality standards.

Your health care provider is aware of these practices and investigates for you which products meet their label claims and which ones can be utilized for your body. A carpentry nail is a good source of iron; however a ground up piece of nail is not going to be a very good source of iron for your body. Ideally nutrients should be in a form that your body can utilize without having to expend too much energy converting it to a form that your body can use.

As one searches for the best product, for the best price, it is important to compare apples with apples and not watermelons. Labeling practices vary from company to company. Products sold through physicians’ offices are usually labeled using elemental levels of the nutrient desired. Many companies list what they believe to be truthful amounts of glucosamine hydrochloride and glucosamine sulfate on their labels. To the average consumer, they are not aware that the elemental weight of glucosamine is different from the weight of the entire compound. For example, 1,200 mg. of glucosamine hydrochloride yields approximately 1,000 mg. of glucosamine. 1,200 mg. of glucosamine sulfate yields approximately 600 mg. of glucosamine. The discerning physician will take these levels into account as he or she makes recommendations. The average consumer is not aware of these distracting label inconsistencies.

Beyond Glucosamine and Chondroitan Sulfate: Nutrients that Benefit the Arthritis Patient

We’ve discussed the role of purified chondroitan sulfates and glucosamine as chondro protective agents, and how to provide the best sources. However, these are not the only nutrients that can have a therapeutic value. Let’s look at some of the cofactors needed to make healthy cartilage and joints. A cofactor is an ingredient that is relatively insignificant in terms of the volume of a reaction, yet without its presence the reaction or synthesis cannot take place. Cofactors can be compared to spices in meal preparation. In terms of the volume of the meal, the spices are insignificant, but without them the food can be very boring and unappetizing.

One such cofactor is vitamin C. Vitamin C was isolated in the synovial fluid of people with rheumatoid arthritis, and much to the researchers’ surprise, they found that 80% of the vitamin C has already oxidized. For vitamin C to be utilized as an antioxidant, it has to be in a reduced form (in other words, not oxidized). In fact, with healthy patients or healthy people, 80% of vitamin C is reduced, with only 20% being already oxidized. The exact opposite is true with rheumatoid arthritic patients, showing that free radical damage is taking place within the joint. Vitamin C should always be accompanied by bioflavonoids and used in the ascorbate form.

Another essential cofactor for the synthesis of collagen and chondroitan sulfates is manganese. Studies have shown that as we age the amount of manganese in our cartilage decreases. Manganese is not only critical for healthy cartilage production, but is also essential for bone health, and may play a serious role in the prevention of osteoporosis. Retarded bone growth, tendon problems, Osgood Schlatter’s and Lupus may all benefit from manganese supplementation. The essential daily requirement for manganese is 2.5 to 5 mg. per day. This means that the average American is marginally deficient.

Turning to silicon, silicon supplemented animals have been shown to have a greater proportion of articular cartilage. The silicon content of many tissues has been shown to decline with age. I found it interesting to discover that the silicon content of normal human arteries is as much as 10 times higher in silicon than arteriosclerotic arteries. A lack of bioavailable silicon in the diet has been postulated to be a causative factor in the development of cardiovascular disease. Klaus Schwartz, published in the Lancet, “The Silicon Connection”, that silicon acts as a cross-linking agent, of the ground matrix found in cartilage and connective tissue. Silicon is found bound to chondroitan sulfate in connective tissue forming oxygen-silicon-oxygen bridges. These bridges contribute to the architectural strength of connective tissue in membranes.

Still another cofactor is MSM. MSM is a sulfur compound shown to bind or chelate heavy metals. Clinical feedback from physicians from across the country has shown that when chondroitan sulfates or glucosamine have not been effective, the addition of MSM has made a difference in mobility and pain reduction. Another study shows that the sulfur content in the fingernails is lower than that of healthy controls.

Another cofactor is pantothenic acid, or vitamin B5. In a group of 77 people with osteoarthritis, the daily intake of pantothenic acid was 80% of the RDA. Please note that many physicians and nutritionists think that the RDA is seriously low for many nutrients. The RDA is what is needed to prevent disease; it does not reflect what is needed to produce optimal health. Also, rats made acutely deficient in pantothenic acid develop joint changes similar to those of osteorarthosis.

Still another pair of cofactors are folic acid and B12, two nutrients that are commonly deficient world wide, especially in the elderly. This is partly due to the high amount of fast and convenience foods coupled with the consumption of a multitude of drugs like oral contraceptives, aspirin, antacids etc. This pair of nutrients is essential for cell growth and division. A double-blind crossover study showed B12 and folic acid to be more effective than non-steroidal anti-inflammatories in pain reduction and grip strength.

Still another cofactor is superoxide dismutase. Superoxide dismutase is one of the most prevalent enzymes in our bodies, and a potent antioxidant. It has been shown to be deficient in some arthritics.

A Few Words about Biotics Research

Biotics Research Corporation, one of the leaders in the field of nutritional supplementation, and a pioneer in cartilage repair products, has developed several products for your doctor to choose from as he or she assists your repair process. Chondrosamine Plus or Chondrosamine PlusS both contain the purified chondroitan sulfate, glucosamine, and the cofactors described above to feed your body the nutrients it needs for maximum joint health and repair. Chondrosamine Plus has glucosamnie hydrochloride as its base; Chondrosamine Plus S has glucosamine sulfate as its base. Your doctor may also suggest that you try a form of purified chondroitan sulfate once pain and repair criteria have been satisfied. Because Biotics only uses purified chondroitan sulfates and not powdered bovine trachea, the use of the purified chondroitan sulfate is more cost-effective and well-tolerated by the digestive tract. The purified chondroitan sulfate will not only improve regular joint repair, but can have significant effects on the cardiovascular system as well. The research discussed earlier by Dr. Morrison was performed using purified chondroitan sulfates.

Dietary and Lifestyle Changes

I would be neglectful to discuss nutritional supplementation without discussing dietary changes. Nutritional supplements are just that—supplements to a good diet.

There are some things that you can do to increase your joint health from a food perspective. First of all, you need to increase sulfur-containing foods; eat foods like onions, garlic, slow-cooked beans, broccoli, Brussels sprouts, etc. We want to decrease sugar content. The average American eats over 170 pounds of sugar according to USDA statistics. These empty calories place a tremendous stress on the body, causing vitamin and mineral depletions; they place added stress on the blood sugar mechanisms of the body, especially the adrenal glands. We also want to eat whole foods, versus processed foods. Eat whole grained bread versus white bread. Eat brown rice versus white rice. Eat the orange or the apple, don’t drink the juice. You want to eat foods that will rot and spoil, but eat them before they do. Bacteria and mold are not deceived by Madison Avenue type marketing. Eat food that will sustain life. We eat food because it looks good, tastes good, or is convenient. Food that will rot and spoil will sustain life. Just make sure that you eat it before it spoils. On the same lines, move towards a cave man type diet. A cave man diet is a diet without bottles, cans, packages, boxes, or wrappers. The idea is to eat as if we didn’t eat all of the convenience foods of today. Eat simply and eat fresh.

The Role of Free Radicals and Antioxidants in Joint Care

There’s another area of concern when we talk about cartilage care and repair. Certain white blood cells will secrete free radicals and enzymes that will degrade the synovial fluid. Free radicals will destabilize molecules, which will destabilize cells and ultimately destabilize tissues. If the tissue is heart tissue, we have heart disease. If the tissue is cartilage, we have inflammation and joint pain. One free radical molecule, if left unchecked can destabilize a million other molecules before it stops. Free radicals are like raging fires causing destruction wherever they are found.

The body manufactures and stores many substances called antioxidants, to combat free radical damage. Antioxidants slow or eliminate the damage done by free radicals. Many of the progressive theories of anti aging, especially in the prevention and treatment of cancer and cardiovascular disease, center around the elimination of external free radicals, and increasing antioxidants, both in our diet and supplementaly. Antioxidants protect us from the environmental toxins, as well as the toxins and free radicals that are generated by daily, healthy metabolism.

Let’s look at a specific example pertaining to rheumatoid arthritis. Human synovial fluid from patients with rheumatoid arthritis have been shown to be deficient, or in some cases void in one of the key antioxidants, the antioxidant enzyme super oxide dismutase. Super oxide dismutase was completely missing in some patients. Antioxidants put out the free radical fires in the joints’ synovial fluid. What would we expect of someone void of antioxidant enzymes in their joint space; hot swollen joints? How do patients with rheumatoid arthritis describe their joints? Hot and swollen. Antioxidants alone will not cure rheumatoid arthritis. It is a complicated condition that can be caused by many conditions. But the point of discussion is that antioxidants can be a powerful adjunct as we develop and maintain healthy cartilage.

Where can we find antioxidants in nature? Look for foods with color, like tomatoes, carrots, all the dark or purple berries. Our dinner plates should have oranges, purples, yellows from squash, and dark green leafy vegetables of all types. Examples of specific antioxidants would be vitamin antioxidants. Vitamin A and its cousin, beta carotene, vitamins C and E, mineral antioxidants such as selenium and zinc, amino acid antioxidants such as taurine, methionine and n-acetyl cystine, and enzymes with antioxidant properties like glutathione and superoxide dismutase, catalase and coenzyme Q. Biotics Research makes an excellent product fulfilling the above suggestions in a product called BioProtect.

Fats, Oils and Pain Modulation

Let’s change subjects for a minute and talk about another concept called pain modulation. The word “modulate” means to turn up or down. Whether we know it or not, we can turn up or down our body’s ability to perceive and experience pain by the food we eat. If we bombard our bodies with the wrong fats or oils, we’ll put ourselves in what I call a hyper pain state, which simply means a slight injury or stress will cause pain—lots of pain. Many of the patients I see are eating diets that promote inflammation and pain.

Our goal should be to eat healthy oils, necessary to make enzymes, antibodies, and hormones and to decrease partially hydrogenated oils in our diet. Your doctor can help you to assess which oils are best for you. One of my favorites is called Mixed Essential Fatty Acids, by Biotics Research Corporation. It contains the omega threes, sixes and nines in a balanced ratio. Your doctor may also choose to support your body’s natural enzymes by adding additional proteolytic enzymes. We can cut recovery time by as much as 50%. Intenzyme Forte has been valuable for injury repair and to reduce short-term inflammation. Bioflavonoids are potent antioxidants and have been recently shown to have an effect with long term inflammation. Your doctor may recommend another product by Biotics, called Bio FCTS, to help decrease inflammation.

Exercise and Joint Health

We can’t close a discussion about joint health without some mention of exercise. There is no direct blood supply to the cartilage. So the basic nutrients of life, oxygen and water must enter through passive circulation. Passive circulation to the joints depends upon movement. Healthy joints need exercise and mobility. Non-weight bearing exercises can be used daily.

For example, sit in your chair and let your legs hang over the edge. Use a book or cushion to sit upon, so your feet do not hit the floor. Thrust your foot back and forth to exercise the knee joint. Do not force your foot forward to the point of pain, unless your doctor directs you to. This back and forth motion of your leg will create the passive circulation necessary for the nutrients to enter the cartilage.

This type of exercise can be created for almost any joint. Your doctor will help to design a mobility program for you. It is imperative that you move your joints if you are to maintain or replenish their needed nutrients. Joints do not work well if they are overused or underused.

Conclusion

Other factors may come into play as you begin the process of feeding the nutrients necessary for your joints to heal and repair. Each person is an individual, and as such, has an individual biochemistry, with its own strength and weaknesses. Your doctor may decide to do further testing to assist your recovery. He or she may recommend books for you to read, discussing the value of becoming a self-detective.

We would like to blame someone else for the way that we feel, but the truth of the matter is that we all make choices everyday that will strengthen our bodies or weaken them. It is important to discover what we are doing to our bodies, consciously or unconsciously that may be weakening them. If good health is our desire, we need to take the necessary steps to repair and rebuild our bodies. One of the best books on the market in detecting such habits and educating us in how to go to the next level was written by Deborah Wilcox, entitled Arthritis Relief,

I hope this discussion has been helpful. We’ve touched upon many areas designed to stimulate your interest in your own health. I want to leave you with a wise old proverb. If you do not take good care of yourself, no one else will. Good health is not an accident, it is purposed in what we choose, the food we eat, the thoughts we think. Good health begins with a choice, your choice.

Can Your Hayfever Medication Cause Cancer?

hayfeverResearch published in Science News (1994;145:324) raises the question of whether the antihistamines we take for allergies be linked to cancer. Studies in mice have shown that antihistamines promote the growth of malignant tumors. Scientists at the University of Manitoba believe that the consumption of various medications, including antihistamines and antidepressants, may increase the risk for cancer. In February, 1994, the Department of Health and Human Services noted an increase in the incidence of cancer in the United States. Scientists at the University of Manitoba believe that the consumption of various medications, including antihistamines and antidepressants, may increase the risk for cancer and may be part of the reason for the increase. They have demonstrated that drugs like Elavil, Claritin, Hismanal, Atarax, Unisom, Prozac, NyQuil and Reactine have all created tumors in animal studies. Some antihistamines behave like the drug DPPE, which has been linked to enhancing tumor growth. By binding to histamine receptors, which interferes with enzymes designed to detoxify and remove poisons from the body. This will also interfere with the system that regulates cell growth. The drugs do not necessarily cause cancer, but can enhance the growth of cancer.

Is Green Tea Good for the Heart?

green tea 5A study that appeared in Clinical Research in Cardiology (March 10, 2010, epublished), looked at the effect epigallocatechin-3-gallate (also called EGCG, which is an antioxidant extract [polyphenol] from green tea) had on patients with amyloidosis involving the heart. Amyloidosis is a disease that occurs when proteins accumulate abnormally in the organs. Amyloid protein is an abnormal protein that is produced by cells in the bone marrow. Amyloidosis affects different organs in different people and can affect the heart, liver, spleen, kidneys or nervous system. The disease begins in the bone marrow. One of the roles of bone marrow is to make antibodies, which are proteins that help protect against infection. In amyloidosis, the body has trouble breaking down those proteins. The proteins accumulate and are deposited in various organs.

The subjects of the study were 59 patients who had amyloidosis, with cardiac involvement. The subjects were placed in one of two groups. One group consumed green tea, the other, acting as a control, did not. The group that consumed the green tea had a decrease in the thickening of the heart wall and a decrease in the size of the left ventrical. They also had improvement in cardiac efficiency (increase in the left ventricular ejection fraction). The control group enjoyed none of these improvements.

Irritable Bowel Syndrome? Maybe it is Your Pain Medication

pain medsResearch appearing in the American Journal of Gastroenterology (2000;95:157-165) looked at the connection between pain medication and symptoms of irritable bowel syndrome (IBS). A survey was given to 892 adults between the ages of 30 and 64. IBS symptoms were present in 12% of the respondents. The researchers found a significant connection between the use of pain medication and IBS.

Irritable Bowel Syndrome and Bacteria

ibs 6Irritable bowel syndrome (IBS) may be due to bacterial overgrowth. Between 11% and 14% of Americans suffer from IBS. An article appearing in the Journal of the American Medical Association (August 18, 2004;292(7):852-858) looked into the possibility of bacteria overgrowth in the small intestine. The lactulose breath test (a way of testing for bacterial overgrowth) is abnormal in 84% of patients with IBS. Furthermore, there is a 75% improvement in symptoms when small intestine bacterial overgrowth is treated. In research that appeared in the American Journal of Gastroenterology (December 2000;95(12):3503-3506), the effect of killing small intestine bacteria was tested on IBS patients. The subjects were 202 people suffering from IBS. According to the results of a lactulose hydrogen breath test, 157 had small intestine bacterial overgrowth and 45 patients did not have bacterial overgrowth. Those with the bacterial overgrowth were treated with antibiotics. During a follow-up visit, 47 of those patients no longer had bacterial overgrowth and 48% of those patients no longer had IBS symptoms (according to Rome criteria). The subjects who tested for bacterial overgrowth during the follow-up visit did not experience improvement in symptoms. The researchers concluded that there is a link between small intestine bacterial overgrowth and IBS.

Irritable Bowel and Celiac Disease

irritable bowelAn article appearing in the journal Gastroenterology (June 2004;126(7):1721-1732) spoke of the connection between celiac disease and irritable bowel syndrome. The article noted that 75% of patients with celiac disease (gluten sensitive enteropathy) had the symptoms of irritable bowel syndrome (especially when diarrhea is present). Patients with celiac disease often do well on a gluten-free diet. The authors suggest that it may be a good idea to test patients with irritable bowel for celiac disease. Celiac disease is more widespread than we previously believed.

Iodine and Thyroid Function

thyroid 3Iodine is necessary to produce thyroid hormone. A review article appearing in the Lancet (March 28,1998;351:923-924) pointed out the that 1.5 billion people were at risk for brain damage due to lack of iodine. An article in the Journal of Clinical Endocrinology and Metabolism (1993;77(3):587-591) summarized the health problems brought on by iodine deficiency. These include cretinism, goiter, intellectual disability, growth retardation, neonatal hypothyroidism, increased miscarriage, increased perinatal mortality and increased infant mortality. Too much iodine can create hyperthyroidism. There may be a connection between low birth weight and iodine deficiency, according to research appearing in Pediatrics (October, 1996;98(4):730-734). Research appearing in the American Journal of Clinical Nutrition (2009; 90(5): 1264-71) looked at iodine status and its relationship to brain development. The subjects were 184 children (between the ages of 10 and 13) with mild iodine deficiency. In the randomized, placebo-controlled study, the subjects were given either 150 mcg of iodine or a placebo each day for a period of 28 weeks. Those given the iodine had improved iodine status and improvement on two of four cognitive tests. Research appearing in the American Journal of Clinical Nutrition (May, 1996;63(5):782-786) found a connection between low iodine levels in children and slow learning.

Iodine supplementation may be useful in the treatment of fibrocystic breast disease. The Canadian Journal of Surgery (October 1993;36:453-460) found that women supplemented with iodine had greater improvement in their symptoms when compared to controls. Earlier animal research appearing in the Archives of Pathology and Laboratory Medicine (November, 1979;103:631-634) looked at rats who were given sodium perchlorate. Sodium perchlorate blocks iodine and the researchers were able to mimic iodine deficiency in the rats–creating fiborcystic breast disease in the rats.

Iodine is an important nutrient. It is especially important to pregnant women and children. Iodine is classified chemically with the halogens–it is similar to fluorine, bromine and chlorine. These other halogens can displace iodine; so drinking water with fluorine and chlorine may increase the need for iodine. Bromine is used in preservatives, like borminated vegetable oil (BVO), and should be avoided. Iodine requirements are 150 mcg per day for adults and 200 mcg per day for pregnant and lactating women. Some physicians believe that these numbers are too low.

One Nutrient that is Important for Child Development

child developmentResearch appearing in the Journal of Pediatrics (epublished ahead of print April 12, 2011) looked at the relationship between maternal thyroid function, iodine levels and child development. The level of free thyroxine in the mothers of the children in the study was measured during the first trimester of pregnancy. The 86 children involved in the study were evaluated using the Bayley Scale of Infant Development at 12, 18 and 24 months of age.

Researchers found that there was a relationship between the mothers’ free thyroxine levels and the children’s psychomotor development at ages 18 months and 24 months. The children of mothers in the bottom 25th percentile of free thyroxine levels tended to be more developmentally delayed than the children of mothers with higher thyroxine levels. The authors of the study saw these findings as showing a need for iodine supplementation before conception and during pregnancy and lactation.