Saturday, June 30, 2007

One Week Update...

So far so good! I have been getting some positive feedback about the blog and some constructive criticism. I will be out of town for a few days, and will have limited access to the internet. Please post any questions and continue sharing the blog address with your co-workers.

Stay healthy,


Sachin

Tuesday, June 26, 2007

Glucosamine, where's the proof?

Millions of Americans are plagued with arthritis. Arthritis is synonymous with old age. However, I am diagnosing younger and younger patients with arthritic changes in the joints of their spine, hips, shoulders and knees.

So what can you do? Well, the answer is not that simple. There is little you can do to reverse the bony spurs that occur with osteoarthritis (OA). You can however address the muscles, joints and cartilage of the affected areas.

Clinically, chiropractic manipulation of the spine has mixed results. Some patients respond very well to manipulation where as others respond less favorably. My approach consists of addressing tight muscles and joint capsules. I find that stretching is very effective in reducing "tightness" associated with OA. Of course the location of the arthritis may limit these treatments. Once the joints are moving more freely, there is much less pressure in the joints and thereby providing a lot of relief. The next step is dietary modifications. Remove all inflammatory foods from your diet, such as dairy and wheat. The next step is supplementation. There is strong scientific support for the use of Glucosamine to promote healthy joints and reduce the pain associated with OA. Although results vary from study to study, the literature does support its use.

All human studies of glucosamine have been done using glucosamine sulphate. However, there is new evidence suggesting that glucosamine HCL is more readily absorbed, cheaper to manufacture and provides more glucosamine by weight. Therefore, you are getting more for your money. For the purposes of literature review and for this blog, consider these products as equals.

Glucosamine is a natural compound that is found in healthy cartilage. Glucosamine sulfate is a normal constituent of glycoaminoglycans in cartilage matrix and synovial fluid.

Dosage:

*** the most common mistake patients make when taking glucosamine is that they do not take enough of the active ingredient and they do not take it long enough. Remember cartilaginous tissue builds slowly, subjective changes can take 2-3 months, be patient.

Adults (18 years and older)
In most available studies, 500 milligrams of glucosamine sulfate has been used, taken by mouth as tablets or capsules three times daily, for 30 to 90 days. Once daily dosing as 1.5 grams (1,500 milligrams) has also been used.

Glucosamine hydrochloride provides more glucosamine than glucosamine sulfate , although this difference may not matter when products are prepared to provide a total of 500 milligrams of glucosamine per tablet. Glucosamine HCL will provide about 20% more than glucosamine sulphates by weight.

Children (younger than 18 years)

There is not enough scientific evidence to recommend the use of glucosamine in children.
Research in children has shown that there could be a relationship between the ingestion of MSM (methylsulfonylmethane) and autism; whether it is beneficial or harmful is unclear. MSM is often marketed with glucosamine as a dietary supplement and at this time should be avoided in children.


Allergies

Since glucosamine can be made from the shells of shrimp, crab, and other shellfish, people with shellfish allergy or iodine hypersensitivity may have an allergic reaction to glucosamine products. A serious hypersensitivity reaction including throat swelling has been reported with glucosamine sulfate.


Side Effects and Warnings

In most human studies, glucosamine sulfate has been well tolerated for 30 to 90 days.
Side effects may include upset stomach, drowsiness, insomnia, headache, skin reactions, sun sensitivity, and nail toughening. There are rare reports of abdominal pain, loss of appetite, vomiting, nausea, flatulence (gas), constipation, heartburn, and diarrhea. Look for a product that contains other GI soothing elements such as Ginger, this should help reduce these symptoms.

It remains unclear if glucosamine alters blood sugar levels. Several human studies suggest no effects on blood sugar, while other research reports effects on insulin. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a health care provider, and medication adjustments may be necessary.
In theory glucosamine may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

In several human cases, abnormal increased amounts of protein were found in the urine of patients receiving glucosamine/chondroitin products. The clinical meaning of this is unclear. Glucosamine is removed from the body mainly in the urine, and elimination of glucosamine from the body is delayed in people with reduced kidney function. Increased blood levels of creatine phosphokinase may occur with glucosamine/chondroitin, which may be due to impurities in some products. This may alter certain laboratory tests measured by healthcare providers.
Preliminary data suggest that glucosamine may modulate the immune system, although the clinical relevance of this is not clear.

Pregnancy & Breastfeeding

Glucosamine is not recommended during pregnancy or breastfeeding due to lack of scientific evidence.

Interactions with Drugs

In theory, glucosamine may decrease the effectiveness of insulin or other drugs used to control blood sugar levels. However, there is limited human research to suggest that glucosamine may not have significant effects on blood sugar. Nonetheless, caution is advised when using insulin or drugs for diabetes by mouth. Patients with diabetes should be monitored closely by a qualified health care provider, and medication adjustments may be necessary. Based on limited evidence, the combination of glucosamine with diuretics (water pills) such as furosemide (Lasix®) may cause an increased risk of glucosamine side effects.

In theory, glucosamine may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®). Please consult your physician if you are taking any medications.

Interactions with Herbs and Dietary Supplements

In theory, glucosamine may decrease the effectiveness of herbs or supplements that lower blood sugar levels, also glucosamine may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding.

There are preliminary reports that use of glucosamine with vitamin C, bromelain, chondroitin sulfate, bioflavonoids or manganese may lead to increased beneficial glucosamine effects on osteoarthritis. Simultaneous use with fish oil may have additive beneficial effects in the treatment of psoriasis, based on preliminary research.

Bromelain is a natural protein-digesting enzyme from the pineapple plant. It has been used therapeutically for reducing acute and chronic inflammation in joints and muscle tissue. The literature supports the use of proteolytic enzymes such as Bromelain along with glucosamine to reduce swelling in the affected joints.

When choosing a good glucosamine supplement you should consider several factors. Glucosamine HCl contains more glucosamine by weight and is the most absorbable form. Look for a supplement that also contains a proteolytic enzyme (bromelain, papain) and a strong anti-oxidant such as green tea extract.

Be patient, appreciable changes and improvements may take several months to achieve. Be sure to make dietary modifications, exercise regularly and take a good multi-vitamin.

Stay healthy!

Sachin

References:

1. Reginster JY, Deroisy R, Rovati LC, et al: Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001c; 357(9252):251-256.

2. Pavelka K, Gatterova J, Olejarova M, et al: Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med 2002; 162(18):2113-2123.

3. Houpt JB, McMillan R, Wein C, et al: Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee. J Rheumatol 1999; 26(11):2423-2430.

4. D'Ambrosio E, Casa B, Bompani R, et al: Glucosamine sulphate: a controlled clinical investigation in arthrosis. Pharmatherapeutica 1981; 2:504-508.

Monday, June 25, 2007

Functional Diagnostic Medicine

Chances are most of you have not heard about Functional Diagnostic Medicine (FDM). This is a relatively new field of medicine that is going to revolutionalize health care. FDM is a system of using objective diagnostic testing (blood work, urinalysis, etc) to determine the root cause of illness. The traditional medical approach does not address the root cause of most conditions, it merely addresses the symptoms. The flaw in this approach is that you are not addressing the real cause of the dysfunction, you are merely providing a band-aid solution.

My interest in this new field is a result of clinical frustration. I quickly realized that there is no cookie cutter approach to one's health even through natural means. Although two people might present with the same set of symptoms, the root cause may be completely different.

An example that might help you understand is Acid Reflux. A very common complaint amongst patients.

Traditional medical approach:

1. Dietary modifications; avoid foods that you know cause heart burn
2. Over the counter acid medication such Tums to neutralize stomach acid
3. If those don't work let's try Nexium (the purple pill).
Nexium reduces the production of acid by the glands of the stomach. Keep in mind the stomach is supposed to be acidic. This acidity helps to digest food and also aids in the absorption of nutrients such as Calcium.

**** this approach in most cases will eliminate the symptoms of acid reflux, but will not address the cause. Keep in mind there are also side effects to this approach.

Now, let's discuss the problem with this methodology.

The most common causes for acid reflux are as follows:

1. H. Pylori - a bacteria commonly found in the stomach

2. Food sensitivity - these are foods that your body has become sensitive to (different than an allergy)

3. Lack of acid production - yes, you read that right, most stomachs don't produce enough acid. Poor acid production can lead to poor break down of food, this allows the food to ferment in the stomach, producing pressure and discomfort.

4. Poor production of digestive enzymes - these enzymes help you break down your food. Digestion starts in the mouth. As you chew your food your salivary glands release enzymes that help you break down proteins, fats and carbohydrates. The process continues in your stomach. Without enzymes food would pass through our bodies the same way it went in. A simple example is a kernal of corn. Our body lacks the enzyme cellulase, this enzyme is required to digest plant matter. Since all plant cell walls are made of cellulose and humans lack this enzyme chewing your food become more important (more on this later). Poor digestion of proteins will lead to bloating, gas and foul smelling stool as an example. Enzymes allow you get the most benefit out of the healthy foods you eat.

5. Lack of healthy intestinal flora - Lactobicillus acidophilus and bifidobacterium lactis are beneficial bacteria that aid in digestion and nutrient absorption in the small and large intestine.

6. Poor chewing habits - slow down, enjoy your meal. Digestion begins in the mouth. Be sure to properly chew your food so your digestive track is not overworked, it will also increase nutrient absoorption. When a particle of food passes through the gastrointestinal tract (GI) it is attacked by digestive enzymes to allow the breakdown and absorption of the food.

So, it becomes quite clear that acid reflux can be multifactoral in its etiology. Using the same approach with each patient is a disservice. You must address the root cause.


FDM approach:

1. Complete a comprehensive intake form that includes over 300 questions about your general health, diet, GI function etc.
2. Order diagnostic testing that determines the exact pH of the stomach, presence of bacteria (good and bad) and digestive enzymes
3. Order a food sensitivity test
4. Restore the flora of the gut, supplement with enzymes, eliminate the sensitivities and restore the stomach pH is necessary

The treatment will be individualized for each patient.

Restoring the homeostasis of the digestive tract is very important in your overall health. Your stomach is designed to be acidic, this acidity will aid in the digestive processes and help with nutrient absorption. Neutralizing stomach acid will lead to further complications down the road.

These are some the side effects of Nexium:

http://www.rxlist.com/cgi/generic/esomeprazole_ad.htm

Nexium and other heartburn medications increase the chance of hip fractures:

http://www.msnbc.msn.com/id/16358462/

You can clearly see how the FDM approach is to restore the normal function of the body, not to further disrupt it.

Stay healthy,

Sachin

How Regular are you?

This health tip may appear to be a bit unusual but don't under-estimate the value of having a regular bowel movement.

Regular bowel movements are vital for optimal health.

Optimal bowel elimination should be at least once a day.

Two times a day is even better.

Toxins are eliminated by having a bowel movement in addition to urinating, breathing and sweating. If you are only moving your bowls every couple of days, then toxins are accumulating in your body

Toxins will build-up and be re-circulated back through the liver causing a host of health challenges. Many conditions that plague Americans are related directly or indirectly to poor bowel movements. These conditions may include; leaky gut syndrome, migraines, Fibromyalgia, chronic fatigue syndrome etc.

In addition to regular bowel movements, your stool should be well formed and void of offensive odor.

A little odor is OK, but in the event your bowel movement causes your family to have to leave the house is not good

A little known fact is that the army used stool analysis to determine the nutritional and health status of their enemies. Analyzing your stool can be a very effective way to determine your overall health.

Stay healthy,

Sachin

Grains, the real story...

Today's topic is a radical departure for most people.

The thought that grains could contribute to so many health problems is difficult to accept.

However, please read this important article and I would encourage you to give it a try for 30 days.

You will be absolutely amazed with the positive impact it has on your health.

Very few people know that there are strong arguments against eating a lot of whole-grain products, and that researchers don't agree on their value.

In half the world, bread provides more than 50 percent of the total caloric intake, and in a few countries of Southern Asia, Central America and the Far East and Africa cereal products comprise up to 80 percent or more of the total caloric intake.

Think about your own intake of grain products.

In a month's time, most of us will have eaten several slices of bread, several bowls of cereal with milk, pasta, rice, bagels, rolls, muffins, crackers, cookies, pastries, corn or other forms of chips, and tortillas.

One individual who has researched this problem extensively is Dr. Loren Cordain, Professor of Exercise Physiology at Colorado State University in Ft. Collins, Colorado.

Dr. Cordain is a well-known expert in the area of Paleolithic nutrition.

So What's The Problem With Cereal Grains?

  • All grains have nutritional deficiencies.
  • As we eat more and more grain products we tend to eliminate other nutritional meats, fruits, and vegetables.
  • Cereal grains contain undetectable amounts of vitamin C, B12, carotenoids, and other vitamins and minerals, and they tend to displace foods rich in these substances that are associated with a decreased risk of heart disease and many forms of common cancers.
  • Cereal grains may actually inhibit the metabolism of these nutrients and cause autoimmune reactions.
  • Cereal grains deficient in vitamins but many contain substances that decrease the intestinal absorption of many other important nutrients.
  • Both wheat and sorghum are not only low in biotin but seem to have elements within them that elicit a depression of biotin metabolism.
  • Vitamin D utilization by the body can be inhibited by an excessive consumption of cereal grains.
  • Cereal grains are good sources of phosphorous, potassium, and magnesium, but are poor sources of sodium and calcium.
  • The high phytate content of whole grain cereals forms insoluble complexes with calcium, so that the net effect is a low Ca/P ratio.
  • Phytate is a salt or ester of phytic acid that is capable of forming insoluble complexes with calcium, zinc, iron, and other nutrients and interfering with their absorption by the body.
  • High phytate content frequently induces bone mineral pathologies in populations dependent upon cereal grains as a primary food source.
  • Iron metabolism is affected negatively by a diet high in phytate and fiber.
  • The bioavailability of zinc, copper, and magnesium in cereal grains is generally low.
  • Cereal grains are low in fats, including the omega-3 fatty acids, including EPA and docasahexaenoic acid (DHA).
  • Cereal grain lectins can interfere with digestive/absorptive activities and can shift the balance in bacterial flora shown to cause problems with normal gut metabolism.

    The potential to disrupt human health is high.

    Autoimmune diseases occur when the body loses the ability to distinguish invading proteins from self-proteins that make up the body.

    The loss results in destruction of self-tissues by the immune system.

    These diseases are thought to result from a combined influence of environmental and genetic influences.

    Dietary cereal grains are noted to be causative agents for autoimmune diseases.

    There are a number of diseases that may occur with grain consumption including Addison's disease, asthma, autoimmune thyroid disease, dental enamel defects, epilepsy, liver disease, and rheumatoid arthritis.

    The form of protein believed to be associated with auto-immune disease is gliadin.

    If you have digestive problems or suffer some of the classic autoimmune reactions (e.g. allergies) consider the possibilities that grains may be problematic.

    Look at your family members and your family history for clues about dietary problems. Adjust the ratio of cereal grains to meat, vegetables, and fruits and see if the adjustment has physiological and psychological effects.

    In my opinion one should supplement with vitamins, minerals, protein, and free fatty acids. Above all, eat a varied diet and not too much of one thing.

  • I encourage everyone to perform a food sensitivity test to determine the specific foods they should avoid. Chances are you are sensitive to wheat, gluten and yeast. From my clinical experience, 100% of my patients are sensitive to these foods!
  • APPLIED Knowledge is Power!

    It is what you do with this new information that will determine the impact it has on your health.

    Over the next 90 days, I would encourage you to take action. Take baby steps and gently move yourself in the direction of optimal health. I promise your life will take a turn for the good


Stay Healthy

Sachin

Hello!

I am very excited about this blog! It will prove to be a great resource for you and your family. Please feel free to share the information and the URL with everyone you know.

By coming to this website you have taken the very first step towards a healthier lifestyle. I encourage you to become more proactive about your health, it is a decision you have to make. I also encourage you to consider the health of your children and those you love...share this info with them :)

This blog was created on June 25th, 2007 so be patient as new information will become available daily.

Living longer and healthier lives is something most people take for granted. Are you prepared to be 100 years old? Sound crazy? Well, most people that are 100 now, never in their wildest dreams did they imagine to live to be a centenarian! The decisions you make now will affect the rest of your life. Live for the future, not for the moment. Some argue life is too short, but life with chronic pain and disease is a miserable way to spend your latter years. Trust me, I see it daily in my practice.

While treating patients it has become very clear that there are a lot of public misconceptions out there regarding diets, exercise, supplements etc. I hope to address some of the misinformation out there.

As a Chiropractor, my philosophy towards health is simple. Prevent, prevent, prevent! It is much cheaper and simpler to be healthy than it is to be sick. As the saying goes, "you pay for it now or you pay for it later". Living a healthy lifestyle may seem expensive, but your health is paramount. Think of all those nights at the bar or at fancy restaurants...chances are you waste more money on unhealthy habits than on being pro-active about your health. Remember, you pay for it now or later, you decide!


Please feel free to post any of your concerns so that I can answer your questions!

Stay healthy

Sachin