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
Saturday, June 30, 2007
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.
*** 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
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.
*** 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)
Children (younger than 18 years)
Allergies
Side Effects and Warnings
Pregnancy & Breastfeeding
Interactions with Drugs
Interactions with Herbs and Dietary Supplements
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
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
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