Jul
08
2017

Stem Cells For Osteoarthritis

Many clinicians have used stem cells for osteoarthritis of the knee or other joints for some time. However, objective publications about the effectiveness of stem cells are only coming out now. Both stem cell types, derived from fat or stem cells from the bone marrow, are effective. Most doctors are using stem cells from fat (mesenchymal stem cells), because they are so much easier to harvest.

CNN reported about a man, Bill Marlette who had lost one of his arms in the past. He ended up overusing the other arm and as a result developed end-stage osteoarthritis in his wrist. He could not find relief with conventional methods of anti-inflammatories and pain pills. Next he went to a stem cell expert in Munich, Germany where he was treated with mesenchymal stem cells from his fatty tissue. Only one treatment took away his chronic pain and helped him regain his wrist mobility.

Prof. Dr. Eckhard Alt, an expert in regenerative medicine has previously treated patients with end stage osteoarthritis and had good clinical outcomes with it. As a result the German regulatory agency has approved his treatment protocol.

Dr. David Pearce, executive vice president for research at Sanford Health in South Dakota said that Prof. Dr. Eckhard Alt was the first one to use fat cells as a source of mesenchymal stem cells to treat osteoarthritis. He went on to say: ”Those stem cells don’t have to be programmed in any way, but if you put them in the right environment, they will naturally turn into what the cell type around them is.” The stem cells are harvested with a liposuction procedure. An enzyme mixture is used to separate the stem cells from fat cells, oil and connective tissue. A cell separator can also help separating the stem cells from the rest of the cells and tissue.

As indicated before only one injection was needed to relieve the chronic pain of Bill Marlette’s wrist. Since his return the doctors in the US have followed Bill closely. They took MRI scans and noted that the bony cysts associated with the severe arthritis have disappeared. His wrist and hand strength have returned to normal. The pain is almost gone. There were no side effects whatsoever. Because the stem cells are of the same tissue type as all his other cells of his body, one would not expect any tissue rejection by the immune system. Bill Marlette has not taken any pain pills since his procedure was done in August 2016. And he says: “I have more range of motion with my wrist, shaking hands didn’t hurt anymore,” he said. “My wrist seems to continue to improve, and there’s less and less pain all the time.”

Past experiences treating osteoarthritis with mesenchymal stem cells

  1. A 2014 clinical trial from Korea involved 18 patients with osteoarthritis of the knee where adipose mesenchymal stem cells were injected. The high dose group did best. After 6 months there was significant improvement, also confirmed by arthroscopy. The previous cartilage defect in the femoral and tibial condyles had decreased in size. Range of motion in the knee joints and pain had also improved. There were no adverse effects from the treatment.
  1. Mesenchymal progenitor cells are known to have the potential to develop into cartilage. At the Shanghai Medical College, Fudan University Shanghai, China the following experiment took place in 2015. Human adipose mesenchymal cells were grown in vitro. Later these mesenchymal progenitor cells were injected into the knees of rabbits where osteoarthritis had been experimentally produced. Despite doing xenotransplants (human cartilage to rabbits) with known HLA differences the cartilage grew and cured the osteoarthritis of the rabbits. The new cartilage had human HLA markers and was layered on top of the rabbit cartilage with rabbit HLA markers. At the end of the experiment at 16 weeks all the animals were sacrificed and the tissues were examined under the microscope and HLA marker testing was done also.
  1. A study from Tehran, Iran was carried out on 18 patients with ankle, knee and hip osteoarthritis in 2015. Stem cells derived from the bone marrow were injected into the osteoarthritic joint. Patients were followed clinically and by MRI scans for 30 months. All of the patients had improved significantly with regard to their joint function and pain. The MRI scans also showed thickening of the joint surfaces from new cartilage production.
  1. In a 2016 joint French/German study 18 patients with end stage knee osteoarthritis were treated with stem cells. The stem cells came from adipose tissue that went through a cell separator. The mesenchymal stem cell fraction was injected into the osteoarthritic knees. The study was a phase I study designed to rule out any adverse reactions, but none were found. It also established that there were significant positive improvements in pain and mobility with regard to the affected knees.

General remarks about how stem cells heal osteoarthritis

The example above with end stage osteoarthritis of the wrist was just one example of where osteoarthritis can strike. Perhaps the more common other locations are hips, knees and the facet joints of the lower lumbar spine (causing chronic lower back pain).

The same treatment procedure that was used with Bill Marlette’s wrist can be used for all these other locations. The common factor in osteoarthritis is that the cartilage is getting thinner and thinner until bone rubs on bone causing excruciating pain. It is here where mesenchymal cells can come to the rescue. After they have been injected into the affected joint, the stem cells will assess what needs to be done. They recognize that there is a lack of cartilage. Then they transform themselves into chondrocytes, which are cartilage-forming cells. How can they do that? They are programmed to replace missing cells, particularly cartilage and bone cells. But when they are bound within fatty tissue, they cannot act within a joint that has osteoarthritis. The doctor has to transport the mesenchymal cells into the joint where they can then begin their healing function.

Other methods to treat osteoarthritis

When osteoarthritis is diagnosed, stem cells are only one of several regenerative treatment modalities. Another method is called platelet-rich plasma (PRP) injections. Platelets have a lot of anti-inflammatory substances in them and also growth factors that can stimulate stem cells contained in the synovial membrane, the lining of any joint. In order to get PRP plasma, blood needs to be spun down and the PRP fraction is harvested with a syringe. After three PRP injections were given into the knees of 90 patients with end stage osteoarthritis these patients were followed for two years.

In the beginning before treatment 100% of the patients had symptoms. After one year following the treatment with PRP their knee functions were normal in 67% of them. After two years only 59% had normal knee function. The investigators pointed out that this treatment modality initially helped to a certain point, but then the effects were slowly fading away.

Stem cell treatment of osteoarthritis of the knee

The literature on either bone stem cells or fat stem cell use for osteoarthritis of the knee in man is still sparse. Nobody has done larger clinical trials. Part of the reasons could be that total knee and total hip replacement in orthopedics is very lucrative. We are still in a symptomatic treatment mode. Physicians treat osteoarthritis conservatively with anti-inflammatories and pain pills. When bone rubs on bone, the pain is getting excruciating and the patient is referred to the orthopedic surgeon who happily will do invasive surgical procedures. My own impression in general practice has been that these procedures do not always turn out the way they are supposed to work. Following total hip or knee replacement joint swelling often remains; pain issues are still there. There can be unequal height issues, balancing problems and so on.

Here is a review of mesenchymal stem cell therapy for osteoarthritis.  I am getting the impression that this publication is seen through very conventional medicine eyes. I suspect an attitude change is required by conventional medicine to catch up with what is happening in real life. Some patients will travel abroad to Munich as Bill Marlette did. But others may travel to other places like India, Mexico or wherever medical tourism takes you. Regenerative medicine is there to stay.

Stem Cells For Osteoarthritis

Stem Cells For Osteoarthritis

Conclusion

We have learnt about a case of severe osteoarthritis of the wrist that has been cured in Germany with one injection of mesenchymal stem cells. More common than wrist osteoarthritis is osteoarthritis of the hips, knees and the facet joints of the lower lumbar spine. The same stem cell therapy can be given for osteoarthritis in these locations. I find it very strange that progress in stem cell treatments is so slow in the US. The FDA has decided to be open to clinical trials with stem cell treatments, but progress seems to be much slower than in other countries. Why? We may never know. In the meantime, patients may seek treatments in other countries where such treatments are offered. In real estate sales there is a saying: “Buyer beware”. The same goes for stem cell treatments in another country. Should you contemplate doing this, do your homework; ask about the qualification of the treating physician, about safety records and whether the local authorities have approved this procedure. In the case of Bill Marlette’s osteoarthritis of the wrist the procedure in Munich, Germany had been accepted by the European equivalent of the FDA, the European Medicines Agency. Safety is top priority, effectiveness is next.

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May
05
2017

New Treatments For Premenstrual Syndrome

Dr. Pamela W. Smith gave a talk about new treatments for premenstrual syndrome (PMS). She presented this talk on Dec. 11 at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. The original title was “New Treatment Modalities for PMS”.

Signs and symptoms of PMS

Dr. Smith discussed signs and symptoms of PMS first. She showed 9 slides where she listed all of the symptoms of PMS that commonly occur.

Symptoms are varied; they can mimic various psychological problems like anxiety, depression, panic attacks and more. But physical symptoms like abdominal bloating, acne, back aches, and asthmatic attacks are also common. There are a myriad of more symptoms of PMS: constipation, cramps, clumsiness, dizziness, drowsiness, decreased sex drive, facial swelling, forgetfulness, fatigue, headaches, a herpes-like outbreak, hot flashes, sensitivity to light and noise, insomnia, joint pains, mood swings, palpitations, restlessness, poor memory, sore throat, tearfulness, vomiting and weight gain.

What do we know about PMS?

  1. There is no definitive test that would help in the diagnosis of PMS. But we do know that there is a hormone dysfunction that leads to a monthly recurrence of symptoms during the two weeks prior to the woman’s menstruation. When her period begins or shortly after all of these symptoms disappear.
  2. PMS is very common; 70to 90% of women have a certain degree of PMS. In 20 to 40% of women symptoms are severe. Many researchers have shown that there is a problem in the feedback loop between the pituitary gland and the ovaries. This leads to a decrease of progesterone production in the ovaries. The result is an overabundance of estrogen, which is called estrogen dominance.
  3. But things can get complicated when other hormone changes occur. A woman may also turn hypothyroid. When she gets closer to menopause estrogen deficiency may also develop. Electrolyte disturbances can occur from high estrogen levels causing excessive aldosterone levels. This would lead to high sodium and low potassium blood levels. The end result may be an activation of the renin-angiotensin system, which could cause high blood pressure.
  4. Neurotransmitters are often disbalanced. When serotonin is low in the brain, depression can develop. Noradrenalin deficiency leads to a lack of focus, energy and memory.
  5. Hypoglycemia is also common among women with PMS. This may be due to cravings for sweets and consumption of starchy foods. Women who crave sweets may also consume caffeine excessively. But caffeine increases prostaglandin production in the body. This leads to breast tenderness, abdominal cramping, arthritis and back pains.
  6. A partial hysterectomy can cause PMS in a woman who never before had symptoms of PMS. The current school of thought is that blood supply to the ovaries after a hysterectomy has decreased, and this could be the reason for the onset of PMS.
  7. The birth control pill can bring on PMS due to the progestin component in it.
  8. Tubal ligations can also be a cause: 37% of women who had tubal ligations develop PMS. The reason is a change in hormone production. In these women estrogen is produced to a higher degree than progesterone is.
  9. Pregnancies, miscarriages and abortions can also bring on PMS.

Lab tests for women with PMS

Although there is no single test that would be able to diagnoses PMS, a variety of abnormal tests are often abnormal in association with PMS. Frequently there is deficiency for vitamin A, B6, E, magnesium, potassium, zinc and trace minerals. Calcium can be too high or too low, but blood tests will reveal that.

Four PMS types

Dr. Smith said that PMS has been divided into 4 subcategories depending on the main symptoms.

  • PMS A: Anxiety
  • PMS C: Carbohydrate craving
  • PMS D: Depression
  • PMS H: Hyperhydration

PMS A is associated with estrogen excess and progesterone deficiency. There is a diminished stress response in the hypothalamus/pituitary/adrenals axis. Symptoms are mainly anxiety, irritability, insomnia and emotional lability.

PMS C is associated with sugar craving, hypoglycemia, headaches, heart palpitations and spontaneous sweating.

PMS D is leading to increased neurotransmitter degradation. Symptoms consist of depression, crying, despair, feeling hopeless, fatigue, low libido, apathy and insomnia.

PMS H is caused by increased aldosterone activity triggered by estrogen surplus in the late luteal phase. Symptoms are weight gain, swelling of hands and feet, a feeling of bloating, breast tenderness or engorged breasts. Women will find that their clothes simply fit tighter.

Migraine headaches in PMS

Some women with PMS are plagued by migraine headaches. It may have started in puberty or after taking birth control pills for contraception. Sometimes the onset is after a pregnancy, miscarriage or abortion. When PMS develops and a woman has migraines, they usually occur around the same time in her menstrual cycle. With pregnancy the migraines disappear in the last trimester when progesterone hormone production from the placenta is the highest.

Hormonally related headaches can occur for 4 main reasons.

  1. When estrogen and progesterone are on the rise around the time of ovulation
  2. When a woman has hypoglycemia (due to hyperinsulinemia)
  3. When estrogen levels are changing
  4. When there is estrogen dominance

Treatment for PMS

Dr. Smith explained in detail the various treatment modalities for PMS. Treatment has to be personalized according to what type of PMS the doctor thinks that the patient is suffering of.

Dietary factors

In the beginning it is important to pay attention to the diet. Studies have shown that PMS patients tend to eat too many carbs and too much refined sugar compared to patients without PMS. PMS patients also eat too many dairy products and too much sodium. In addition PMS patients are deficient in iron, manganese and zinc. A good start is a Mediterranean diet, which is at the same time anti-inflammatory.

The recommendations is to eat 6 small meals a day. Avoid caffeine and alcohol. They are antagonists to the B complex vitamins. By avoiding sugar, you also avoid fluid accumulation and magnesium deficiency. A low fat, high-complex carb diet helps reduce breast tenderness. Reducing fat and increasing fiber in the diet decreases estrogen levels in the blood. These steps help PMS symptoms.

Nutritional supplements

Magnesium, vitamin B6, A, D3, E, L-tryptophan, calcium, zinc, fish oil (EPA/DHA) and evening primrose oil are the main supplements recommended for PMS patients. Your healthcare provider can advise you what you should take and what dosage.

Exercise

Regular exercise has very beneficial effects on reducing many symptoms of PMS. Even as little as 8 weeks of exercise -as was done in this study- had a significant effect. Exercise elevates endorphin levels, improves blood sugar stability, decreases norepinephrine and epinephrine in the brain and helps to decrease estrogen levels. This will control blood sugar levels, reduce anxiety, reduce estrogen-related symptoms and increase satisfaction.

Thyroid medication

Many women with PMS have borderline hypothyroidism or are overtly hypothyroid. In these cases the patient should receive small amounts of thyroid hormones.

Progesterone

Progesterone is the one hormone that is found persistently lacking in most PMS patients. The best test for this is a saliva hormone test, because this reflects the tissue levels. Blood levels test too low and are useless. Bioidentical progesterone cream is applied transdermally (through the skin) from day 14 to 25 of each menstrual cycle. Micronized progesterone pills are also bioidentical and could be used instead of the cream.

Botanicals

There are a number of home remedies, which are heavily promoted on the Internet. They may, however, not be as effective as advertised.

  1. Black Cohosh is said to balance estrogen and is anti-spasmodic.
  2. Chasteberry decreases LH and prolactin. It raises progesterone, acts as a diuretic and binds opiate receptors. This reduces PMS related aches and pains.
  3. St. John’s Wort helps these symptoms: anxiety, depression, mood swings, feeling out of control and pain.
  4. Ginkgo biloba is a mild blood thinner. Women who are on blood thinners should not use it! It improves depressive symptoms and mood, has anti-inflammatory effects and helps with anxiety control.
  5. Saffron: In a clinical trial the Saffron group did significantly better in PMS symptom control than the placebo group.  Saffron is rich in magnesium, vitamin B6, iron and other nutrients that are missing in PMS patients, which explains the effectiveness of this botanical.
  6. Other botanicals: Other botanicals are Lavender, Motherwort, and Dandelion.

Candidiasis

Due to prolonged exposure to high sugar and refined carb intake many women with PMS suffer from candidiasis (chronic yeast infection). Anti-Candida programs help to eradicate Candida overgrowth, which often improves several PMS symptoms.

Mind/body therapy

Cognitive-behavioral therapy helps for depression and anxiety. Hypnotherapy, yoga and biofeedback therapy are also useful methods.

New Treatments For Premenstrual Syndrome

New Treatments For Premenstrual Syndrome

Conclusion

At the present time there is a better understanding of PMS than in the past. Progesterone deficiency and other hormone weaknesses seem to be at the center of this condition. But vitamin and mineral deficiencies also play a role. The healthcare provider should order some baseline blood tests and hormone tests for the patient, including a saliva progesterone level.

Treatment consists of a combination of steps taken simultaneously. The dietary approach comes first: a Mediterranean diet will be beneficial. Next add nutritional supplements. Regular exercise is essential. Finally bio-identical hormone replacement of the missing hormones is necessary.

If there is an underlying chronic candidiasis infection, it needs treatment. The choice of drug would be nystatin. Some botanicals may be helpful, as discussed. When anxiety and depression are important parts of the PMS symptoms, mind/body therapy (such as cognitive therapy etc.) may also be helpful.

The key with PMS treatment is to not give up, but to re-evaluate the condition, if the initial attempt does not bring full relief. By not giving up and using all modalities of treatment the patient will be able to get rid of the condition, eliminate the symptoms of PMS and achieve well being.

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Apr
01
2017

When Food Causes Inflammation

Dr. Hal Blatman gave a talk about when food causes inflammation. His talk was presented on Dec. 9 at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. The original title was “Food, Pain and Dietary Effects of Inflammation”.

Dr. Blatman is the medical director of Blatman Health and Wellness Center, Cincinnati and Batman Medical Services, Manhattan.

General remarks about nutrition

Dr. Blatman pointed out that mistakes of nutrition are often behind chronic diseases and illnesses. The physician’s task is to explain to patients how their food intake can be changed to improve inflammation in the body and how the body can heal itself.

Hippocrates said 400 BC “Let food be thy medicine and medicine be thy food”.

In this context Dr. Blatman stated that nutrition could exacerbate symptoms or relieve symptoms and there must be rules for good nutrition. If we do not take care of our nutrition, the gut flora composition changes and causes leaky gut syndrome. But if we consume healthy foods all of this improves.

Mathematical formula for when food causes inflammation

To make it easier to understand the impact of food on our health the speaker offered this formula: G-B+R=P

G stands for good, beneficial things you can put into your body.

B = bad, toxic things that affect your body negatively.

R = reserves that your body has since birth (minus the amounts you have used up)

P = pain and problems you are going to experience

It is P (pain and other medical problems) what brings the patient to see the doctor. G and B is what the patient can change. When done right, the P value in the formula reduces and the pain or medical problems go away.

Nutritional rules

Dr. Blatman said there are three rules about nutrition.

Rule #1 is to not eat fake or toxic foods

He listed NutraSweet, Splenda, Saccharin, margarine and olestra.

  1. Aspartame experiments on rats showed that it can cause cancer: Dr. Blatman said that in man it has been shown to cause multiple myeloma and Hodgkin’s lymphoma. Aspartame worsens depression, 10% is metabolized in the liver into methanol, a nerve poison.
  2. Splenda (sucralose) is made from chlorinated sugar. It reduces beneficial microflora in the gut. It also interacts with liver enzymes that are known to interfere with the bioavailability of oral drugs.
  1. Saccharin alters gut bacteria and increases glucose tolerance.
  2. Hydrogenated fat and margarine. Insects don’t eat margarine, mold will not grow on it, and it will not support life. Merchants like it because food does not turn stale on shelves. Hydrogenated fats like margarine are considered to be poisons. They raise the bad LDL cholesterol levels and reduce beneficial HDL cholesterol levels. The prostaglandin balance changes so that inflammation occurs. There is increased evidence of diabetes and the cell membrane composition changes. Proinflammatory cytokines can cause pain in the dorsal root ganglions. It follows from all of this that it is best to cut out all hydrogenated fat and margarines.
  1. Partially hydrogenated vegetable oil. The cell membrane consists of two lipid layers at a specific ratio of omega-6 essential fatty acids and omega-3 essential fatty acids. It also contains triglycerides, phospholipids and protein. It is expected that the cell membrane absorb nutrients to move into the cell and eliminate waste out of it. The cell membrane needs to remain flexible and within neurons needs to transmit electrical information. The membrane composition is critical for the cell membranes to perform optimally. It is here that the physician has to explain this to the patient. All the fats we eat are the raw material, which will make up our cell membranes. So what fat we eat that day is built into the cell wall that is made that day or is repaired. If we eat hydrogenated fat that day, this is built into the cell wall.  A membrane with hydrogenated fat will:
  • Not transmit nutrients inside the cell
  • Will not transmit waste out
  • Causes the membrane to lose flexibility
  • In a nerve cell there will be abnormal neuron transmission

If we eat hydrogenated fat, we become like a “genuine GM truck fixed with inferior parts”, so Dr. Blatman. The interesting observation is that it takes 4 months after eliminating hydrogenated oil from the diet to get it out from red blood cells. Be aware that French fries increase pain for 4 months, so why eat them?

  1. Olestra, an artificial fat: Olestra has been developed as an artificial fat and is used in chips. It can cause diarrhea, abdominal cramps and weight gain with long-term use. Olestra belongs into the group of fake/toxic foods. Don’t eat Pringles or chips that are made with this.
  1. Healthy oils

There are two types of essential fatty acids, omega-6 fatty acids and omega-3 fatty acids. Many processed foods contain only omega-6 fatty acids, because this is the cheapest way to produce them (they are based on vegetable oils). Instead you want to eat healthy fats like omega-3 fatty acids contained in nuts and fish. You can also add molecularly distilled, high potency omega-3 fatty acids (purified fish oil) as a supplement to help restore the balance between omega-6 and omega-3 in your food intake. Avoid omega-6 fatty acids from corn oil, safflower oil, grape seed oil, soybean oil, cottonseed oil, canola oil and peanut oil.

Compare the metabolism of omega-6 fatty acids with that of omega-3 fatty acids.

The linoleic acid of omega-6 fatty acids gets metabolized into arachidonic acid, which causes pro-inflammatory mediators, PGE2 and LTB4. On the other hand with omega-3 fatty acids alpha-linolenic acid (ALA) is metabolized into EPA, DHA and the anti-inflammatory mediators PGE3 and LTB5.

It is easily understandable why a surplus of omega-6 fatty acids from processed foods will disbalance the omega-6 to omega-3 ratio. This ratio should be 1:1 to 3:1, but many Americans’ omega-6 to omega-3 ratio is 6:1 to 18:1. Omega-6-fatty acids cause arthritis, heart disease and strokes. Be particularly careful in avoiding soybean oil, which is the most popular oil in the last few decades to foul up the omega-6 to omega-3 ratio through processed foods.

When it comes to balancing omega-3 and omega-6 fatty acids in your diet, be aware that nutritional balancing can help you restore the ideal omega-6 to omega-3 ratio of 1:1 to 3:1. An easy way is to cut out processed foods as much as possible. Supplement with molecularly distilled fish oil capsules to add more omega-3 fatty acids into your food intake. Dr. Blatman gave the example of rheumatoid arthritis patients that were put on omega-3 supplements. After 24 weeks their joint swelling and tenderness went down.

Rebalancing the omega-6 to omega-3 ratio was able to treat depression as this research showed. This makes you wonder how much depression may be caused by overconsumption of processed food.

Dr. Blatman suggested the following doses of omega-3 supplementation for various purposes:

  • 1 gram/day as supplementation for healthy adults with a good diet
  • 1-3 grams/day for people with cardiovascular disease
  • 5-10 grams/day for patients with an autoimmune disease, with chronic pain or with neuropsychiatric conditions

He mentioned that these doses are empirical, but in his opinion definitely help. Due to quality differences he suggested that you buy fish oil capsules in a health food store where the quality is best. Stay away from discount stores (the quality is the worst) and drug stores.

Other healthy oils are olive oil and coconut oil. They are also useful for cooking.

Rule #2 is not to eat inflammatory foods

Our body functions like a luxury car; it needs pure food to function. Anything less leads to inflammation, particularly when you eat sugar and processed foods.

Inflammatory foods are sugar, white flour, fruit juice and white/red potatoes. A medium potato=1/2 cup of sugar! Other problematic foods are wheat grain contained in breads, pasta, cereal and thickeners in soups and sauces.

What is the problem with these foods? They break down the zonulin proteins that are a bridge between the lining cells of the gut.

This leads to an increase of intestinal permeability, and leaky gut syndrome can develop. Inflammatory cytokines from visceral fat add to the gut inflammation, and cardiovascular disease and high blood pressure can develop.

Fried potatoes, in particular the consumption of French fries, have been identified as the cause of inflammatory bowel disorder (IBD). Countries with the highest consumption of French fries have the highest incidence of IBD.

A Mediterranean diet and the DASH diet are anti-inflammatory diets.

Rule #3 is to not disturb the bowel flora

A healthy bowel flora is symbiotic with the body. You achieve this by eating green leafy vegetables. A toxic flora from dysbiotic microbes comes from eating white flour, white sugar and red meat. Red meat leaves residues on which dysbiotic bacteria thrive.

Symbiotic gut bacteria produce vitamin K, cobalamin, pyridoxine, biotin, riboflavin, pantothenic acid and short fatty acids. They also degrade metabolic toxins, prevent pathogens from colonization and they stimulate the immune system to mature.

Dysbiosis occurs when the wrong diet consisting of sodas, white flour, sugar and red meat is over consumed. There are toxins that are produced by the dysbiotic microbes. These injure the bowel wall and make the immune system work harder. Immune system dysfunction, fatigue and fibromyalgia can follow.

Dr. Blatman stated that gut dysbiosis that causes leaky gut syndrome could also cause ulcer disease, diabetes, heart disease, fibromyalgia, chronic fatigue syndrome, chronic pain and even cancer.

When Food Causes Inflammation

When Food Causes Inflammation

Conclusion

This was a whirlwind tour through a talk given by Dr. Blatman during the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas. What food we eat determines what gut bacteria we harbor, symbiotic ones or toxic ones. This in turn determines which way our health develops. But the content of what we eat is also important. If we consume processed foods we end up consuming way too many omega-6 fatty acids, which cause inflammation, arthritis and heart disease. This is happening in front of our eyes, if we start seeing things the way they are. I was aware of this since the mid 1990’s. In a lecture I attended at a continuing education conference a cardiologist pointed out that inflammation was the determining factor of whether or not our patients would get a heart attack. The lecturer mentioned then that the older cholesterol concept would be replaced by the newer inflammation concept. He was right, but it goes even further! There is the important omega-6 to omega-3 ratio, and fish oil supplementation helps. At the same time it is necessary cutting out processed foods. But there is the newer insight that our bowel flora and red meat consumption can culture toxic bacteria in our own gut. It is in our power to start eating more vegetables and cut out sugar and starchy food. It is time to see chips and French fries not as a “convenience” but a hazard to your health. Food does not have to cause inflammation; right food choices will help us to stay well and live longer.

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Nov
26
2016

Chronic Shoulder Pain Treatment

This overview is about chronic shoulder pain treatment. A 71- year old health conscious patient was exercising in a gym. When he used the shoulder machine, he suddenly experienced a stinging pain in his left shoulder. The pain seemed to be localized in the upper (superior) portion of the trapezius muscle. With this he also felt pain in his left neck.

This was fitness gone wrong! It can happen, that exercise is overdone or lack of judgment leads to injury. Trainers caution us, when we embark on exercise programs, and yet, it happens! Often the road to recovery is a bumpy stretch, and if the problem is not corrected, it can lead to chronic pain. With this knowledge the patient sought help. The first approach was visiting a

Chiropractor

He sought the help of a chiropractor and had 6 manipulations in the neck and thoracic spine. The spine had good range of motion, but the left shoulder pain in the trapezius muscle stayed.

He found that heat application to the trapezius muscle helped, so he bought an electric heating pad that he applied once or twice a day for pain relief. He also sought the input of his G.P. He was offered

Pain pills

This was the predictable regimen, but the patient was concerned about the side effects of pain pills, and he declined. He had heard of a supplement, called Trilipotropic (from Trophic), which contains 300 mg of choline bitartrate, 300mg of inositol and 300 mg of methionine in one tablet. He learnt at a medical conference that two of these tablets were as effective in relieving the pain as one tablet of Motrin, an anti-inflammatory drug. He took two of these pain relievers from the health food store a couple of times per day alternating with the heating pad to control his pain.

Since the condition improved only marginally, he looked at the option of

Prolotherapy

When the chiropractor mentioned after 5 treatments that he could not treat the pain successfully, the patient decided to try prolotherapy, because he had heard that this would be good for chronic musculoskeletal pain. The naturopath whom he saw examined thoroughly and determined that the patient would be a good candidate for 2 to 4 prolotherapy treatments. After one treatment on the left side along the cervical spine and the left trapezius area the pain was reduced by 30% of what it was before. The second prolotherapy treatment was given again to the left side and also to the right side to keep it symmetrical. The naturopathic physician told the patient that he would see him for follow-up in 4 weeks. The treatment of the right asymptomatic side did not cause any pain, but the left side started flaring up after the second treatment, causing pain that was almost as bad as the original pain. When the patient returned to the naturopath and told him about the flare-up of pain in his left shoulder, he was told that this is what sometimes happens when treatments are not spaced far enough apart. He felt that this should be observed now and reassessed in 6 months in case there was

No progress. It was time to look at other options:

IMS treatments

When the chiropractor had admitted that he could not help removing the pain, he suggested that maybe a physiotherapist trained in intramuscular stimulation treatment (IMS), also known as dry needling could be of help. The patient was waiting for the appointment with the naturopath for prolotherapy when he saw the physiotherapist for IMS treatments. He examined the patient and noticed a persistent trigger point in the upper trapezius muscle, which he thought was causing the chronic pain.

Two IMS treatments relieved the pain by about 50%. But about two or three days later the pain came back to about 75% of the original pain after the gym injury. The appointment for the prolotherapy by the naturopath had taken two months to wait for, so he had already had 3 IMS treatments just before the prolotherapy to get some pain relief. The IMS trained physiotherapist thought that perhaps a few more treatments, up to five or six might be able to take the pain away. So the patient continued treatments on a weekly basis.

Unfortunately the hope for pain relief did not materialize. The pain improved to about 30 to 40% of the original pain, but it always came back just 2 or 3 days later. Fortunately for him he could apply the heating pad and the pain would stay away for 3 to 5 hours. It also responded to taking two tablets of the choline bitartrate/inositol/methionine combination that took the residual pain away for several hours. Self-massaging the trigger point also gave some relief. But occasionally the pain came back with a vengeance and felt like a charley horse that suddenly could occur in his left shoulder making it difficult to move his left arm, particularly when he needed an outstretched arm for ballroom dancing, lifting of heavy objects or for working out in the gym. Even just holding on to the rails of the treadmill when doing a fast walk on the treadmill for half an hour could lead to a flare up of the left shoulder pain. It is frustrating, when there is only temporary relief, but no real cure, but giving up is no option. Often we find more information on the Internet. What came up was

Low-dose laser therapy

The patient remembered having heard of low-dose laser therapy that might be useful in treating chronic pain. This method, called interstitial low-laser therapy was used to treat his trigger point in his left shoulder. A physician who is the president of ISLA –the international society for laser applications- specializing in laser treatment treated him by inserting a cannula into his left trapezius muscle close to the trigger point. He injected a small amount of procaine (local anesthetic), then 5 ml of normal saline. This was followed by three low-laser beam treatments for 10 minutes each, first blue, then green and finally yellow color, all given interstitially after which the cannula was removed.

He was surprised to feel relief almost instantly. There was still a bit of pain from the interstitial needle for about two days, but he noticed that the trigger point in the trapezius muscle had completely vanished. Finally after 6 months of intermittent pain there was relief of about 50% of the original pain. This time the pain in that particular trigger point stayed away, which was encouraging.

But there were two other trigger points that were bothering him. After one month he got a second interstitial low dose laser treatment by the naturopath who had previously given him the prolotherapy into another trigger point, and finally 2 weeks after this, the third laser treatment was given for yet another trigger point. This continued on for another few months. The pain disappeared, then it crept in slowly again, but at a lower level. It became a quest to eradicate the trigger points! Each time the latest trigger point that was still palpable was treated with the same low-dose laser treatment method. It took a total of 9 interstitial treatments to finally reach the point where all of the pain was gone.

It felt strange: the chronic left shoulder pain had disappeared!

Chronic Shoulder Pain Treatment

Chronic Shoulder Pain Treatment

Conclusion

When pain lasts for more than 3 months, it is referred to as “chronic pain” and is often termed neuropathic pain that is difficult to treat. You may have guessed by now that I was the patient in this blog, and so I had a vested interest in getting rid of this pain. I had previously described a similar pain in my lower back that was relieved with just one interstitial low-dose laser treatment at that time and my back has remained pain free since. Shortly after that successful treatment I developed the left shoulder pain from a soft tissue injury in the gym as mentioned. I was fortunate that Dr. Weber could treat me again, this time at his clinic in Lauenförde, Germany on occasion of a Germany trip that I had booked for holiday purposes.

I was lucky that this treatment responded similar to the one in my lower back. The difference was that my left shoulder required a total of nine low-dose laser treatments to be resolved and my pain had lasted a total of 14 months!

It occurred to me that a successful outcome of treating pain requires collaboration between patient and therapist. Call it trial and error. In my case it was only the fourth treatment modality, the low-dose laser therapy that worked permanently.

I feel that the chiropractor did his best to ensure there was no nerve root irritation and told me when he had reached his limits.

The IMS trained physiotherapist treated me before and after the prolotherapy and also told me after a total of 12 visits that he likely could not help me any more than he did.

The naturopath who did the prolotherapy said that he had strengthened the ligaments along the spine on the left side, but that the trigger point from the gym injury likely was not responding to prolotherapy.

The final answer came from the treatment by Dr. Weber in Germany and the naturopath in Kelowna using the same Weber system machine with low-dose lasers. I think that this is an under-recognized treatment modality of musculoskeletal injuries, including sports injuries. You can find treatment providers for low-dose laser therapy throughout the US, Canada and Europe where many physicians and naturopathic physicians use it as part of their pain management methods. The equipment has been FDA approved; Health Canada approved and is approved by the Medical Devices Directive in Europe. Please note that this type of laser (low-dose laser) has nothing to do with laser treatment for cosmetic purposes.

It has to be stressed that chronic pain treatment requires attention to detail, feedback from the patient to the healthcare provider and persistence on behalf of the patient to follow through until the chronic pain is resolved. It also shows that giving up is not an option!

Aug
06
2016

Pain Treatment

General practitioners see a lot of patients with various pain symptoms for which they seek pain treatment. The underlying conditions might be from an arthritic problem that suddenly becomes symptomatic, or an acute back injury may send pain from the lower back into one of the legs. Others may experience excruciating headaches like migraines or tension type headaches. Often these painful conditions require some immediate pain relievers to treat the pain, but this can turn into a nightmare of drug dependency and may even lead to the development of chronic pain. Here I like to review an article that I found in the June edition of ConsumersReports.org.  In my review I included most of the content, but added a few newer pain treatment modalities.

Acute pain

Here I’m discussing back pain as an example. When a disc bursts in the lower back because the person was lifting an object too heavy to lift, acute pain develops in the lower back. This is often located at the lower lumbar spine level (L5/S1) causing radiating pain into one of the legs.

In a case like this it will often take several weeks before the body can heal this condition.

Chronic pain

It can happen in many cases that the pain will still be there 3 to 6 months down the road. If a disc fragment pushes on the nerve root in the nearby canal through which the nerve root travels, this will cause the muscles supplied by the nerve root to melt away in the leg of the affected side. If nothing is done about this, the acute pain turns into chronic pain, which is much more difficult to resolve. The initial physician may refer the patient to a neurosurgeon who will review the case together with the help of an MRI scan that shows the underlying pathology. The neurosurgeon may determine that a mini discectomy will reduce the pressure onto the nerve root. This surgery may be able to prevent chronic pain from setting in. Once the pressure is relieved, the nerve can start the healing process. It is critical to not miss the point where acute pain crosses over into chronic pain. This happens at around 2 to 3 months into the pain condition. Chronic pain is much more difficult to treat as some of the neurological pain pathways that form after such injuries can persist within the spinal cord or even within the central nervous system, even after successful disc surgery that is done too late. With respect to the example given above, if the patient is operated on too late (1 to 2 years after the injury), the procedure may not be effective in relieving the pain. A chronic pain syndrome has started.

How pain treatment is done

  1. Avoid bed rest

In the past (up to the late 1970’s to mid 1980’s bed rest was the accepted initial mode of treatment. Even though patients often felt some relief of pain initially, this led to muscle atrophy (literally a melting away of muscles) in the muscles that are supporting the spine. These structural changes destabilized the spine and often made the pain more chronic until physiotherapy treatments and active exercises rebuilt the supporting muscles again.

  1. See a physiotherapist

Physiotherapists can use different treatment modalities like traction, a TENS machine, active exercises that all can help to alleviate back pain due to muscle spasm. If there is only a strain, this will often help to resolve your back pain within 4 weeks. But if there is an underlying disc herniation as previously explained, you need to be assessed by a physician in an urgent care center, primary care setting or by an emergency physician in the emergency department of a hospital. When the examination confirms an abnormal reflex from a nerve root compression, a referral to a neurosurgeon or orthopedic surgeon is usually made as previously explained.

  1. Chiropractic treatment

Some people have their backs treated periodically to prevent back troubles. When they get an acute back pain they likely will see the chiropractor again. In cases of a back strain, where one or more muscles are pulled, this approach will be helpful together with some home exercises and swimming to build up muscle strength along the spine. However, in the case of a herniated disc chiropractic adjustments should not be done (physicians say they are “contra-indicated”). Instead the patient should be referred to either a neurosurgeon or an orthopedic surgeon.

  1. Medication for pain

Often physicians prescribe Tylenol with codeine, hydrocodone (Vicodin), oxycodone (OxyContin, Percocet) or morphine for pain relief. All narcotic medication have side-effects; they can cause constipation, can cause vomiting, make you feel dizzy and can lead to falls, particularly in elderly patients. These falls can cause hip fractures and other fractures that complicate the recovery from the original pain. Never exceed the dosage of pain medicine prescribed on the label, and if it does not relieve the pain, see your physician again for a reassessment to rule out any complications. Often people with back pain also have depression. To address this issue your physician may prescribe an antidepressant like duloxetine (Cymbalta), which has been approved by the FDA for treatment of lower back pain. But there are two rare, but important side effects to know about. Cymbalta can cause lowering of blood pressure, which leads to dizziness. This can cause serious falls with the danger of fractures. The other complication is the risk of liver failure.

Side effects of pain treatment

  1. While there seems to be an urgency to treat a patient who is in pain with pain medication, the treating physician must not forget that pain medication is potentially addicting and patients often use higher doses than advisable. However, pain medication has a narrow therapeutic window meaning that the toxic levels are not much higher than the drug levels necessary to relieve pain.
  2. There are medications that are only marginally effective, if at all. Glucosamine and chondroitin are used for relief of arthritic pain in osteoarthritis sufferers. They are eliminated by a liver enzyme system that also eliminates blood thinners. If a patient is on blood thinners, the addition of glucosamine and chondroitin can lead to dangerous bleeding. Instead of using glucosamine and chondroitin when you experience pain and inflammation in joints, reduce your activities, but stay as active as you can to avoid your symptoms from getting worse.
  3. When a patient has a severe migraine headache it is tempting to want to rule out a brain tumor. But a CT scan exposes the patient to dangerously high radiation doses that over time could cause brain cancer or leukemia. There are physical examination methods to rule out a brain tumor. If the findings are positive, an MRI scan can be used to get much more detail of the brain than a CT study would reveal. MRI scans do not have undesirable side effects.
  4. Before you rush into using anti-inflammatory drugs, use gentle movement to remobilize the painful joint, back or limb. Activities like swimming, walking or yoga can reduce pain and allow you to recover from a painful condition according to a Cochrane Library analysis of 61 studies.
  5. For more pain relief NSAID (non steroidal anti inflammatory drugs) pain relievers like ibuprofen (Advil) or naproxen (Aleve) for a brief period will also help. The problem with long-term use of NSAIDs is that it can cause kidney damage. With longer use of NSAIDs there is also a danger of stomach bleeding, heart attacks and strokes.
  6. The pain drug acetaminophen (Tylenol) has a narrow therapeutic window and is less effective in pain relief than the NSAIDs. The FDA has recommended as the highest daily dose 4000 mg of acetaminophen. But if you are a heavy drinker or you have liver disease, your daily dose of acetaminophen should not exceed 3250 mg to avoid liver toxicity. Long-term use of acetaminophen can also damage your kidneys, therefore the recommendation to use acetaminophen only for a short period of time (a few days).
  7. Migraine headache drugs: The newer migraine drugs, called triptans temporarily narrow widened blood vessels. This relieves severe migraines within about 2 hours. However, these medications are not recommended for those with high blood pressure, chest pain, heart disease or circulation problems in the legs, as blood vessel constriction could bring on heart attacks or worsen circulation problems.

Common sense approach to pain treatment

The key for any pain condition is to treat the pain right away to minimize the impact that pain has on you and to prevent developing chronic pain, which is more difficult to treat.

Here are some examples.

  1. Migraine headaches

    If you have a migraine headache, use an over-the-counter pain reliever like naproxen or ibuprofen to treat the migraine pain very early. A combination of acetaminophen, aspirin and caffeine (like Excedrin Migraine or a generic copy) will also do. This will stop the release of prostaglandins, which would send pain signals to the brain. Heat packs or cold packs on your head can also help in the treatment of a headache. A 2013 study from Germany has shown that migraine sufferers can get rid of their migraine headaches in 60% by having sex. It sounds like a nice idea, but what they have not considered may be the fact that somebody who has a splitting headache is not feeling like sex at all! If your home remedies did not help, see your physician for one of the triptan pills. Sumatriptan or a similar drug constricts blood vessels to the brain. The doctor will also look for common triggering factors that can bring on a migraine. Weak neck and shoulder muscles may respond to physiotherapy strengthening. In women a condition called estrogen dominance is associated with migraines and can be treated with bioidentical progesterone to balance estrogen and progesterone in the body by elevating progesterone concentration.

  2. Acute lower back pain 

    Acute lower back pain usually follows an event where the person lifted something too heavy or injured the back from a fall. The important part is to rule out a fracture. Most of the time there is no underlying fracture, just a muscle strain. A muscle strain usually sorts itself out in time. Stay active as much as possible. But if the back pain does not resolve within a few days, see your physician for more tests. An X-ray may be required to rule out structural changes like a fracture. As explained earlier, an MRI scan may be required to rule out a disc herniation. Instead of neurosurgery, further options nowadays are prolotherapy, stem cell therapy or a combination prolotherapy/stem cell therapy. This type of therapy will also work for knee injuries (meniscal or ligamentous tears).

  3. Hip or knee pain

    Conventional medicine usually treats osteoarthritis with NSAIDs, but may not warn you about the possibility of gastric erosions that can lead to massive stomach bleeding, heart attacks or strokes when using NSAIDs. It also can lead to kidney damage that can cause sudden kidney failure. The key is to use anti-inflammatory medication only for a few weeks. If arthritis persists, it is wiser to seek the advice of a naturopathic physician for prolotherapy treatment. Pain relief is usually achieved with one or two treatments of prolotherapy. If prolotherapy does not succeed, it is best to move on to mixed stem cell therapy with bone marrow and mesenchymal stem cells (from fat cells) as well as PRP (platelet rich plasma). This usually leads to complete healing of osteoarthritis and eliminates the need of total knee or total hip replacement.

  4. Neck and shoulder pain

    This often develops because of poor posture, shoulder tendinitis or neck muscle spasm. Physiotherapy is often successful treating this. If not, intramuscular stimulation (IMS) with acupuncture needles can be used. This may be more successful in interrupting the abnormal neuropathic pain pathways. Alternatively electro acupuncture with a TENS-like device can also be successful. The newest treatment modality is the Weber medical system using a low-dose laser applicator. Prolotherapy can also be used for shoulder and neck problems, if the ligaments are lax. It requires a lot of experience on behalf of the health professional to choose the right treatment protocol for the condition.

  5. Tension headaches

    Anxiety, stress and fatigue can all lead to tension headaches. Initially you may want to drink liquids, as dehydration is related to tension headaches. If your headache is still present after one hour, use naproxen or acetaminophen. Take a warm or cold shower and lie down with a cool cloth on your forehead. If you still have a headache, check with your doctor whether it is indeed a tension headache or a migraine. You may have jaw clenching or teeth grinding during your sleep. If your bite seems off, see a dentist. For stress control use relaxation techniques. Some suggestions sound mundane enough, but they can be effective: Get enough sleep, get enough exercise, and work on improving your posture. A physician trained in trigger point injections with local anesthetics (often anesthetists or general practitioners) can freeze your suboccipital and supraorbital nerves with lidocaine, which I have seen to work in 60% to 70% of cases in my former practice.

Pain Treatment

Pain Treatment

Conclusion

Pain treatment can be confusing as pain itself can be very multifaceted. The key is to search for the cause of the pain and then treat pain very quickly before it has time within 2 to 3 months to turn into a chronic pain condition. Chronic pain is much more difficult to treat. Every effort should be made to treat acute pain successfully. Conventional medicine has to yet learn from naturopathic medicine and alternative medicine practitioners that prolotherapy, stem cell therapy, IMS, trigger point injections with local anesthetics and low-dose laser therapy (Weber medical system) are valuable alternative methods that can successfully treat pain conditions and get incorporated into general medical practice.

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Feb
27
2016

Orthopedics Without A Knife

At the 23rd Annual World Congress on Anti-Aging Medicine on Dec. 12, 2015 in Las Vegas Dr. Fields gave a talk entitled “Regenerative orthopedics – non-surgical repair with stem cells/PRP/prolotherapy. In essence the talk was about alternative treatments to surgeries in orthopedic medicine.

Dr. Peter Fields, MD, DC is a board certified medical physician and chiropractor. He is the director of the Pacific Prolotherapy & Medical Wellness Center in Santa Monica, CA.

Introduction

Joints, muscles, tendons, ligaments and joint capsules control the movements in joints. Due to injuries and wear and tears these body parts can have a lack of function, and this will lead to pain and disorders. The result can be weak, torn or damaged ligaments and tendons, arthritic changes, excessive joint motion, increased pressure, and a decrease in range of motion.

This is the common treatment cycle in medicine: joint pain prompts you to see the doctor. You are told it is arthritis, and you get non-steroidal anti-inflammatories (NSAID’s). You come back with more pain, and you’ll get a stronger NSAID prescription. Eventually a cortisone injection is given, which helps for a few months, but then the pain reoccurs. The doctor arranges for an MRI scan. A referral to an orthopedic surgeon is likely to be the next step, and an arthroscopy (pinhole surgery) is arranged. If this does not resolve the pain, surgery like a knee replacement or hip replacement is suggested.

Common sayings when traditional medicine has nothing to offer: You may have heard some of these common sayings before. “Nothing more we can do about it!” -“I suggest you learn to live with it”- “You should never play that sport again!”- “Take these pain medications” and “The only alternative is surgery!”

The problem is, that none of these pieces of advice are really helpful. This type of approach does not treat the cause; it is directed against symptoms.

How to treat the cause?

  1. Prolotherapy is a natural, non-surgical method to assist the body to heal torn soft tissues. It works in cases like torn ligaments, damaged tendons, cartilage, menisci or a torn labrum in the shoulder. Hyperosmolar dextrose solution is injected into the injured area. This stimulates the body’s healing forces and the body repairs what is damaged. More information is found here. Prolotherapy fixes the cause, not just the effect; it heals, and it is permanent. Prolotherapy strengthens tissues, relieves pain and increases the range of motion in joints. There is 80 to 85% full pain relief and more than 80% improvement in range of motion. Prolotherapy promotes the healing of torn or damaged ligaments and tendons. Suitable conditions to be treated with prolotherapy are sports injuries, muscle tears, arthritis, tendinitis, bursitis, sciatica, TMJ problems, and fibromyalgia. Common areas treated with prolotherapy are the hip, knee, shoulder, ankle, neck, lower back and elbow. Dr. Fields showed MRI scans before and after prolotherapy treatments of ligament injuries within the knee and of shoulder ligament tears before and after treatment. Normally these injuries would have been expected to have needed surgery. But all that was done was one or two injections (prolotherapy treatments) with reactivation of the affected joint. There were astounding results shown with MRI’s before and after herniated disc injuries and how they healed in a relatively short time following prolotherapy.
  2. PRP prolotherapy: platelet rich plasma (PRP) is a tool from regenerative medicine that is used in connection with stem cell therapies to amplify the healing response.  Blood is taken from the patient’s own blood. The blood is subsequently spun down in a centrifuge. The platelet rich fraction (PRP) contains all of the growth factors, which have the healing power of the blood, and this can be combined with prolotherapy to make healing even more successful. This is particularly useful for labral tears in shoulders, meniscus tears in knees and other localized injuries.
  3. Stem cell prolotherapy: Stem cell therapy has been the gold standard for repairing more serious problems. Dr. Fields is using stem cell therapy combined with prolotherapy to treat more serious injuries like end stage arthritis when bone rubs on bone, where conventional orthopedic medicine would offer a joint replacement in the hip or knee. Any joint that has cartilage damage can also be repaired much simpler with stem cell prolotherapy. A severe meniscus tear in a knee or a severe labrum tear in a shoulder would also be situations where stem cell prolotherapy is superior to surgery or to just using prolotherapy alone.

Here is how the procedure is done: Before the patient’s procedure the physician first harvests bone marrow stem cells by way of a pelvic bone aspirate; secondly, mesenchymal stem cells from fatty tissue are obtained by aspiration of abdominal fat. A cell separator provides the stem cell fractions. Both types of stem cells, the bone marrow stem cells and the mesenchymal stem cells from fat, are mixed as each one has its own strengths and combined they are more effective in repairing whatever tissue needs to be repaired. Thirdly, the patient’s blood is harvested as described above to obtain PRP, which contains the growth factors needed to activate the stem cells to do their job of healing. The last step is that the physician now combines hyperosmolar dextrose (the prolotherapy part) with the stem cell preparation and mixed in PRP and injects this mixture into the injured area. This procedure has superior healing power. Judging from the before and after MRI scans regarding all of the major body regions mentioned above, and seeing several video recorded testimonials it is surprising how quickly and completely fairly severe injuries can heal using stem cell prolotherapy. One particularly nasty condition is osteonecrosis of the hip, which can occur as a side effect of chronic cortisone treatment for arthritis, asthma or chronic obstructive lung disease. One or two stem cell prolotherapy treatments will heal this condition because the stem cells build up brand new bone and get rid of the old necrotic bone from the osteonecrosis. Conventional medicine has no answer for this condition. Regenerative orthopedics is successful by using stem cell prolotherapy.

What are the advantages of regenerative orthopedics?

Regenerative orthopedics reduces pain very quickly and it improves function rapidly. Healing occurs naturally, and it strengthens the tissues involved. Particularly complicated lower back pains or lower neck pains (due to degenerative disc disease, facet joint osteoarthritis, spondylolisthesis and significant foraminal stenosis) respond really well to stem cell prolotherapy, getting rid of chronic pain. Again before and after MRI scans were shown and testimonials given. This is quite in contrast to what conventional orthopedics has to offer: discectomy with fusion surgery, where the patient often has scar pain later. With a laminectomy to treat a foraminal stenosis the patient may have limited improvement of the chronic back pain for a couple of months, only to experience new back pain from a subsequent spinal stenosis as a late complication from the prior surgery. The end result with conventional orthopedics is disability, pain and suffering; the end result with regenerative orthopedics is a patient that is well, active, pain free and thankful.

Orthopedics Without A Knife

Orthopedics Without A Knife

Conclusion

There is a form of orthopedics without a knife: it is called regenerative orthopedics. The tools are prolotherapy for minor musculoskeletal problems. This is still scoffed at by some very conservatively minded physicians, but wrongly so. More severe injuries require more healing power and PRP prolotherapy is used for them. In the severe cases all of the healing power (minus the knife) is needed: this is where stem cell prolotherapy is utilized. With this the healing is initiated where it is needed using two types of stem cells that turn into the cell types that are required to do the repair. Research has shown in the past that the mesenchymal stem cells alone will not heal cartilage of joints very well, but if combined with bone marrow derived stem cells this is healed quite well and efficiently. Healing osteonecrosis and complicated lower neck and lower back problems borders to miraculous healing. Regenerative orthopedics is definitely something to remember should you get into trouble down the road. There are alternatives to the knife!

Jan
23
2016

Life Extended By Several Decades

Have you ever thought about the possibility to prolong your “Freshness Date”? At the 23rd Annual World Congress on Anti-Aging Medicine on Dec. 13, 2015 in Las Vegas the endocrinologist, Dr. Thierry Hertoghe from Belgium gave a talk about “How to extend the human lifespan by 40 years”. Dr. Hertoghe explained that it is possible to extend life by paying attention to the factors that prolong life and combining them as an anti-aging type lifestyle. He made a distinction between

  1. normal aging: up to age 82
  2. healthy aging: up to age 100
  3. anti-aging medicine: up to age 122
  4. reversing aging medicine: much more than 122, perhaps to age 150 or more.

Normal aging (up to age 82)

When you live without any interventions your life expectancy on average is about 82 years. From the age of 50 to 60 onwards you may encounter problems with increased cholesterol, high blood pressure leading to heart attacks and strokes. Coronary artery by-pass surgery may extend an individual’s life by 10 to 15 years. But hardening of the arteries in the general circulation will eventually cut down the blood supply to vital organs leading to premature death that could have been avoided.

Around the mid 60’s to mid 70’s 12.4% of African Americans or 2.9% Caucasians get Alzheimer’s disease. These figures worsen rapidly with further aging: in their mid 70’s to mid 80’s 32.5 % of African Americans and 9.8% of Caucasians suffer from Alzheimer’s disease. At the age of 85+ years 54% of African Americans and 27% of Caucasians have Alzheimer’s disease. Particularly with normal aging Alzheimer’s has already increased, and this trend is likely going to continue.

Memory loss also leads to a shortened survival curve; people with memory loss live two years less on average than compared to a group with no memory loss.

Add to this loss of life because of depression, which is common in older age. Compared to a non-depressed group of older people the depressed group lived 30% shorter over a period of two years.

Musculoskeletal pain is reported in younger age (18-44) to be 38%; the next demographic group aged 45-64 reported 61% of musculoskeletal pains; seniors between 65 and 74 had 68% of musculoskeletal pain, and in the demographic group of 75 and up 71% of persons suffered of musculoskeletal pain. As we will learn later there may be hormone deficiencies behind these neck and back pains that, if left alone. lead to falls, fractured hips and premature loss of life. Those who survive accidents will often become wheel chair bound and get admitted to nursing homes.

One specific subgroup of patients with musculoskeletal pain are rheumatoid arthritis sufferers. After 10 years of having rheumatoid arthritis patients will have a survival of only about 50%; if more than 30 joints are involved (more severe form of the disease) only about 40% will survive. In other words, rheumatoid arthritis is an important factor for lowering people’s life expectancy.

At an age of 65 to 74 men have 23% of disabilities, while woman have 27.5% disabilities. This increases between the ages of 75 or older to 40% for men and 44.5% for women. At the age of 65 disabled men have a 3.5% higher death rate than the average population; disabled women’s death rate is 2.5% higher than the normal population. In other words, disability kills.

Urinary urgency and incontinence leads to a 3.13-fold higher mortality rate than a control group of men who do not have these symptoms.

65% of men and 85% of women above the age of 50 have abdominal obesity. This is not just a harmless condition. It is associated with increased triglyceride levels and increased mortality due to cardiovascular disease and diabetes.

By the age of 65-74 heart disease has a frequency of 32% in men and 23% in women. At the age of 75 years and older this jumps to 44% in men and 32% in women. Once heart disease is established, it causes a lot of premature deaths: on average persons with heart disease live 10 years shorter than those who do not have heart disease!

Healthy aging (up to age 100)

If we look at normal aging, we realize that all these diseases and disabilities we discussed are eventually killing us. In order to live longer we have to take steps that are known to interfere with some of these factors. For instance, quitting smoking will prevent heart disease, several cancers and chronic obstructive lung disease (emphysema). Positive thinking, social support and transcendental meditation will increase survival by preventing mental illness and depression, which in turn will prevent suicides. A healthy diet such as the Mediterranean diet or the Pegan diet will avoid cardiovascular disease and cut down cancer rates. One dietary change called the “polymeal” would contain fish, fruit, vegetables, garlic, almonds, a moderate amount of wine and dark chocolate. Compared to the Standard American diet this type of diet would add 9 years for men and 8.1 years for women regarding their life expectancy. For instance, prostate cancer showed a 7-fold increase in a group of men who ate a lot of pickled vegetables, fermented soy products, salted fish and preserved meats, when compared to a control group who did not include these foods. In a group of women who had their meat well done and ate three servings of beef per week, breast cancer risk was 4.62-fold higher that the risk of women who had their meat done rare or medium rare.

Overall cancer and cardiovascular mortality dropped by 35% in a study where 5 or more servings of fruit and vegetables were eaten per day.

A regular exercise program will strengthen the heart and lungs, keep your weight stable, reduce heart attacks and strokes and reduce the probability to develop cancer. A group of men between 61 and 81 were observed over 12 years and divided into those who did not exercise versus those who walked more than 2 miles per day. The exercising men had 19% less mortality compared to the sessile men. Vitamin C from fruit and vegetables or from taking supplements reduces global mortality from all causes by 46% compared to controls that did not. Similarly taking omega-3 fatty acid supplements (fish oil) daily reduced all cause mortality by 20%.

Dr. Hertoghe calls this “healthy aging” and this would allow you to be able to reach an age of about 100 years.

Anti-aging medicine (up to age 122)

Dr. Hertoghe told the audience that further attention to anti-aging factors could reduce mortality even further. In particular, he found over the years that paying attention to correcting hormonal weaknesses would have profound effects on how old a person becomes. Thyroid hormone replacement has been one of the steps that have helped people to experience more energy and less musculoskeletal problems (less muscle pain, less falls, less fractures and complications). This translates into more energy and longer lives.

One slide showed that a low free T3 level (low thyroid) was associated with a 3.6-fold higher death rate. A low free T3 level predicts of cumulative death rate in cardiac patients most accurately.

T3 is also important for the maintenance of the immune system, which shows in patients with tuberculosis: the one-year mortality rate in thyroid deficient patients with low T3 levels was 75%, while patients with a normal thyroid had a mortality from tuberculosis of only 7%.

Secondly, replacing missing sex hormones can add more life because cardiovascular disease is postponed (less heart attacks, less strokes), there is less cancer and better cancer survival, if a person comes down with cancer. Many statistics were quoted.

One interesting slide showed the longitudinal survival follow-up of congenital dwarfs in comparison with their normal brothers or sisters. Untreated male dwarfs turned only 56 years on average, while their unaffected normal brothers turned 75 years on average (19 years longer). With female dwarfs the difference is even more striking: untreated females dwarfs turned 46 years on average, while their normal sisters turned 80 years on average (a difference of 34 years).

Another publication showed that the heart attack risk was 3.8-fold higher in a group of patients with hypopituitarism (under function of the pituitary gland), but the treatment group (treated with GH) had a normal rate of heart attacks.

11606 men aged 40 to 79 years were followed for between 6 and 10 years. The group who had the top 25% range of testosterone had a 19% lower mortality rated from heart attacks or cancer.

Older women, particularly aged 100 in Okinawa had 2.3-fold higher testosterone levels than women in the US at age 70. On the other hand 70-year old Okinawan women had 2.7-fold higher estrogen levels than US women.

Bioidentical hormone replacement therapy (BHRT) prior to developing breast cancer showed a 27% longer survival among 984 breast cancer patients in Sweden compared to those without prior hormone treatment.

In another group of breast cancer patients (2755 patients) aged 35 to 74 who were treated with bioidentical hormone replacement after their breast cancer diagnosis, 50% had a lower recurrence rate (compared to no-BHRT treatment) and there was a reduction of 66% of mortality from breast cancer compared to controls without BHRT treatment. Another study showed that breast cancer patients would have a mortality rate of 33.3% without hormone treatment, 12.5% mortality rate after non-estrogen hormone use and 6% after estrogen/progesterone use.

This shows the healing results of the various natural hormones.

A group of 280 men and women around the age of 50 were treated with anti-aging hormone replacement for 2 or more years. In the beginning there were 34% of women and 15% of men with coronary artery disease. There were also 36.4% of women and 34.1% of men with high blood pressure. After replacing all of the missing hormones with bioidentical hormones for more than 2 years, coronary artery disease had dropped to 1.6% of the women and 1.08% of the men; high blood pressure had dropped to 2% of the women and 3% of the men. No drugs, just hormones! Of course, initially there were drugs used to stabilize their condition, but they could gradually be dropped safely, because the underlying hormone deficiency, which was the cause of cardiovascular disease, had been treated (treating the cause rather than the symptoms).

Dr. Hertoghe presented data of 6.38-year follow-up of 286 consecutive patients using anti-aging medicine (replacement of missing hormones with bioidentical hormones). These patients had an overall cancer rate of 2.1%, which compared very favorably to the 3.2% cancer rate among US women, 3.1% French women and 3.1% Belgium women on no hormones. This is the type of information that is needed following the Women’s Health Initiative (WHI) that scared women into the false belief that hormones would be “poisonous”. In the WHI synthetic hormones were used causing cancer and heart attacks; the reason for this was that synthetic hormones are not the identical shape as the natural hormones. But hormones and hormone receptors have to fit like a key into a lock; otherwise they are not effective or even block the natural life prolonging action of the natural hormone. This is why in the WHI study the outcomes were poor. Using bioidentical hormones heart attacks and strokes are prevented and they are also cancer-protective.

Reversing aging medicine (much more than 122, perhaps to age 150 or more)

General medicine has the goal to make patients as healthy as possible. With reversing aging medicine the goal is to make patients as young as possible so that they are at their healthiest and feel younger again.

With anti-aging medicine using a healthy diet, exercise and bioidentical hormone replacement therapy the patients can add 15 years of good life. Add to these organ transplants, if necessary, telomerase activators and stem cell therapy and you can add another 25 years of life expectancy to a total of 40 years.

Growth hormone deficiency is the one factor that has been underestimated. We have seen in the discussion of dwarfs in comparison to their healthy brothers and sisters that normal growth hormone production can add between 19 and 34 years (average 26.5 years) of life. Dr. Hertoghe has done blood tests (IGF-1) and lately also 24-hour urine metabolite tests of growth hormone on aging patients and found that many are deficient with regard to GH production. These were patients who already had their thyroid hormones replaced, if abnormal and had their sex hormones replaced when they were found to be low. But they lost hair, developed old looking faces with wrinkles, loss of subcutaneous fatty tissue giving the face a hollow appearance. They also had muscle and joint pains and thin skin, particularly over the back of their hands. He replaced their missing GH using daily GH self-injection with a tiny needle (similar to diabetes injections) and within 1.5 to 3 years the wrinkles disappeared, the faces started to look younger and patients did feel younger. Their muscle and joint pains had disappeared and their hair grew back. The dosage range is between 0.1mg and 0.3mg, a tiny amount of GH daily. This is not inexpensive, but some health care plans pay for this, as a lack of GH is a true hormone deficiency.

Often it is a single limiting organ that determines when we die, typically the heart, lungs, brain, liver, kidneys, small bowel, pancreas or bone marrow. Organ transplants can add years of life, but it can be cumbersome to find a suitable donor. Another limitation is, as one study showed, that only 40% to 60% of organ transplants are surviving 8 years after doing the transplant surgery.

Stem cell therapies are other ways to prolong life. More research is needed to perfect this, but essentially 220 different cell types could be derived from stem cells in the future to replace malfunctioning organs.

Life Extended By Several Decades

Life Extended By Several Decades

Conclusion

The dream of staying younger for longer can be a reality today, if you are willing to discipline yourself to watch what you are eating (Mediterranean type diet), exercise regularly and have a positive psychological attitude. If the outdoor air is poor where you live, you may want to consider moving to a place with good air quality. Sleep well for 7 ½ hours every night and retire not later than 10 to 11PM. You need to be asleep between midnight and 3AM as the growth hormone peak occurs at that time. Take supplements that contain longevity micronutrients (magnesium, vitamins A, C, D, E, B6, B12, Co-Q-10, selenium, zinc, iron in premenopausal women etc.). Replace all missing hormones with bioidentical ones, like thyroid hormones (T3 and T4), sex hormones, DHEA and GH. Stem cell therapy and telomerase activators for cell rejuvenation will also have more of a place in the future.

Even, if you do only part of this reversing aging program you will slow down aging.

Jan
16
2016

Low Thyroid (Hypothyroidism)

Dr. Pamela Smith gave a detailed talk regarding hypothyroidism at the 23rd Annual World Congress on Anti-Aging Medicine on Dec. 13, 2015 in Las Vegas. As a lack of thyroid hormones is one of the causes of premature aging, it is important to pay attention to your thyroid hormones. Here I am summarizing the highlights of this talk.

Thyroid disease, particularly low thyroid hormone levels, called hypothyroidism is very common in the population. Part of the problem is that in 72% of the world population dietary iodine is insufficient to provide adequate amounts of iodine to the body that is required for thyroid hormone production in the thyroid gland. The US Institute of Medicine has recommended 150 micrograms of iodine intake every day. Japan with its emphasis on seaweed intake is one of the few countries where thyroid deficiency is extremely low (Ref.1).

But apart from dietary factors there are many other factors that can lead to insufficient amounts of circulating thyroid hormones (see below).

The production of thyroid hormones

The thyroid gland produces the thyroid hormones by adding iodine atoms into the amino acid L-tyrosine to make thyroxin (T4) and triiodothyronine (T3). T3 is the main active hormone, which is about 5-times more powerful than T4. There is a feedback cycle between thyroid hormones, the hypothalamus and the pituitary gland. Both the hypothalamus and the pituitary gland have thyroid hormone receptors that sense the level of T3 and T4 and can modify the production of these hormones. The majority of T3, which is the main active thyroid hormone, is produced by conversion of T4 into T3 by a selenium-dependent enzyme.

Most of the thyroid hormones are bound in the blood by thyroid binding globulin. Only the free T3 and free T4 are metabolically active and will affect the metabolism of our body cells. The delicate balance can be easily disrupted. Oral contraceptives and sex hormone replacement therapy can increase the amount of circulating thyroid binding globulin, thus creating a thyroid hormone deficiency state, as the free T3 and free T4 are diminished.

Other factors influencing circulating thyroid hormones

  1. Low adrenal gland hormone activity can occur simultaneously with hypothyroidism. On the other hand, when thyroid hormones are low by themselves, the adrenal glands often compensate by producing more cortisol to offset some of the symptoms of hypothyroidism.
  2. An enzyme located in the liver, kidneys, pituitary gland, hypothalamus and brown fat is necessary for conversion of T4 to T3, the more active thyroid hormone. Anything that interferes with this conversion leads to hypothyroidism. Over the years medical research has identified many factors that interfere with this process. For instance, there are trace elements necessary for this enzymatic reaction, like selenium and zinc; if they are low in the diet, low T3 will be the result. But other nutrients, if missing, will also interfere with T4 to T3 conversion: iodine, iron as well as vitamins A, B2, B6 and B12.
  3. Several medications can also interfere with the conversion of T4 to T3: we already mentioned birth control pills; others are estrogen, lithium (patients with bipolar disorder are often on this), phenytoin, theophylline, beta blockers (such as propranolol), chemotherapy and clomipramine.
  4. But dietary factors can also lower T3 due to a lack of conversion from T4:too many cruciferous vegetables, a low carbohydrate diet, low fat diet, low protein diet, excessive alcohol use, walnuts and soy. In a study where the effects of soy were examined 37 adults on a high soy diet over three months 50% developed hypothyroidism. When the soy diet was stopped it took one month to normalize the thyroid function (Ref. 2).
  5. There is no end of factors that cause low T3 because of the inability to convert from T4: chronic inflammation due to cytokines, diabetes, aging, poisoning with heavy metals like mercury, lead and cadmium (cigarette smoking), fluoride, pesticides, exposure to radiation and stress. Other toxic substances that enter the body can interfere with the same T4 to T3 conversion process: dioxins, phthalates (chemicals added to plastics) and PCB. But excess calcium and copper (copper salts could come from spraying of organic fruit) can also lead to low T3.
  6. Other hormones can disbalance the equilibrium and cause low T3 because of a lack of conversion from T4: too much stress, which causes cortisol from the adrenal glands to rise. Surgeries associated with the same stress response (high cortisol levels) also have been shown to cause low T3.
  7. There is another conversion process that has been shown to lead to lowered T3: it is called “reverse T3 (rT3)”. rT3 is an inactive form of T3, which blocks thyroid receptors and renders T3 less active. rT3 is particularly important in stressful situations and in athletes who engage in extreme exercise. In these individuals T3 and T4 blood tests are normal, TSH is suppressed and rT3 is elevated. That’s how the doctor can diagnose this condition. Other conditions that lead to high reverse T3 are: aging, diabetes, exposure to free radicals (chemotherapy or radiation in cancer treatment), fasting, prolonged illness, toxic metal exposure, inflammatory cytokines, depression and anxiety, bipolar disorder, Alzheimer’s and Parkinson’s disease, chronic fatigue syndrome and fibromyalgia.
  8. After all this negative news it is almost a wonder that the thyroid is still doing its work! Since we know the risk factors, it is important to be aware that certain supplements and dietary habits can help to increase the conversion from T4 to T3. Here is a list of those that help: iodine, iron, zinc, selenium, potassium, Ashwaganda, and a high protein diet. Other positive factors are vitamins A, B2 and E; growth hormone, testosterone, insulin, glucagon, melatonin and estrogen (high dose).

Symptoms of hypothyroidism

There was an overwhelming amount of information about signs and symptoms of hypothyroidism that was reviewed. I can only highlight some of the more common symptoms here. It is important to know that some of these signs and symptoms occur several years before the lab values become abnormal; this is particularly true of the “eye brow sign” and the thinning of eyebrows is a pointer to hypothyroidism!

Depression, weight gain, constipation and migraine type headaches can be early non-specific signs of hypothyroidism. Women often present with irregular periods. Other symptoms are: decreased memory and inability to concentrate, anxiety/panic attacks, muscle and joint pains, a puffy face, swollen eyelids, decreased sexual interest, and sleep disturbance. Sparse, coarse, dry hair; missing hair confined to the outside 1/3 of both eye brows (eye brow sign) and carpal tunnel syndrome are also associated with a lack of thyroid function. Often there is also a loss of eyelashes or eyelashes that are not as thick. When blood tests show high cholesterol, iron deficiency anemia or vitamin B12 deficiency this should prompt the physician to order thyroid tests.

Blood tests for hypothyroidism

TSH, free T3, free T4, reverse T3 and thyroid antibodies need to all be ordered to have a complete documentation of what is going on. Among the thyroid antibodies these three types need to be ordered: antithyroglobulin antibody, antimicrosomal antibody and antithyroperoxidase (anti-TPO) antibody. There are a number of more studies that an endocrinologist would order in difficult to diagnose cases. Thyroid antibodies are an important cause of hypothyroidism in the US and can be due to Hashimoto’s thyroiditis, an inflammatory condition of the thyroid gland. Some people have autoimmune antibodies against adrenal gland tissue. There are also patients who have gluten sensitivity, and they may produce these autoantibodies to both the adrenal glands as well as the thyroid gland.

Treatment of hypothyroidism

Treatment for hypothyroidism consists of detoxification, proper nutrition and thyroid hormone replacement.

Detoxification can include intravenous chelation therapy, if heavy metals are involved. In some cases detoxification is all that is needed.

Proper nutrition with a Mediterranean diet and some iodine supplements or seaweed is important. But often the thyroid is damaged by the time hypothyroidism is diagnosed and thyroid hormones have to be replaced.

Replacement of thyroid hormones is best done by desiccated thyroid or compounded thyroid (both T3 and T4). The normalization of the TSH level is taken as the end point and should be below 2.0 (not the lab normal value of below 5); free T3 should be optimally between 3.5 and 4.3 and reverse T3 should be 50 to 150 pg/ml to be optimal.

If reverse T3 is high, the patient will have hypothyroid symptoms, even if T3 and T4 blood tests are normal. Because reverse T3 is derived from T4, the physician will have to lower T4 or take the patient off T4. Replacement with T3 will lead to lower TSH production by the pituitary gland and production of T4 and inappropriate conversion to reverse T3 will decrease.

Depending on what other conditions the patient presents with, it likely will help to eliminate stress, treat selenium and iodine deficiency, treat infections and treat growth hormone deficiency, if present.

There were many more pearls of wisdom in this very comprehensive talk on hypothyroidism, but there is not enough room in this blog to mention all of this. For more info read Dr. Pamela Smith’s book (Ref.3).

Low Thyroid (Hypothyroidism)

Low Thyroid (Hypothyroidism)

Conclusion

The thyroid is one of the main players involved in the maintenance of our health and well being. Hypothyroidism can develop for multiple reasons: inadequate iodine intake, toxins including heavy metals, autoantibodies from gluten or other sensitivity and certain medication usage. It is a fallacy to think that supplements, vitamins and lifestyle choices can “cure” thyroid deficiency. Once the levels are low, thyroid replacement is the only way to reestablish a hormonal balance! The treating physician must consider many factors when replacing thyroid hormones optimally. Desiccated thyroid hormone replacement (containing T3 and T4) is the best type of replacement of missing thyroid hormones. The needs can differ a great deal, as no patient is the same! For best results the treating physician needs to individualize treatment.

References

Ref. 1: Brownstein, D., “Iodine: Why You Need It, Why You Can’t Live Without It”. Medical Alternatives Press, 2004.

Ref. 2: Kelly, G., “Peripheral metabolism of thyroid hormones: A review,” Alt Med Rev 2000; 5(4):306-33.

Ref. 3: Smith, P. “What You Must Know About Thyroid Disorders”. Garden City Park, NY: Square One Publishers, 2016.

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Aug
14
2015

Intramuscular Stimulation For Muscle Pain

Dr. Gunn was working for the Workers’ Compensation Board of BC, Vancouver/BC in the 1970’s when he encountered a number of patients with chronic muscle spasm from work injuries. Being confronted with these difficult to solve pain issues he developed a hybrid of Chinese acupuncture and trigger point injections, called intramuscular stimulation or dry needling in 1973. Instead of hitting acupuncture points as is done with traditional Chinese acupuncture he concentrated on finding out where the trigger points were, and he needled them. This often elongated the chronically shortened muscles, alleviating or eliminating chronic pain. A trigger point is a focus point located within the muscle that has created the chronic pain. According to Dr. Gunn chronic muscle pain is a form of neuropathic pain. It means that there is an irritation in the junction of the nerve that controls the contraction of a muscle and the muscle itself. The physician or trained therapist feels the trigger point as a tender point and slightly lumpy sensation within the affected muscle and places an acupuncture needle right into it. Gentle manipulation of the fine acupuncture needle helps the irritation to gradually settle down. Typically it takes 4 to 6 visits, 1 week apart for one area with chronic pain to settle down.

Here is another site that explains intramuscular stimulation.

In the US IMS may be more known under the term “dry needling”, but the method is the same.

Trigger point injection

In Germany the Huneke bothers, two general physicians who took an interest in pain medicine developed what is now known as trigger point injections or neural therapy in 1928. Dr. Peter Dosch wrote a Manuel of Neural Therapy according to Huneke (Ref.1). It is interesting that the 11th edition of Dr. Dosch’s book is the first English edition. Essentially in this treatment modality for pain relief trigger points are identified and a local anesthetic (either Procaine or Xylocaine) is injected using a thin needle. I have used this method clinically in thousands of patients in my practice for over 16 years for back pain, neck pain, migraines and various localized pain issues involving muscle spasm. Sometimes scars from abdominal or other surgery can become a focus of irritation of nearby muscles, and freezing the trigger points in the irritated scars can suddenly relieve these painful muscle spasms. This happens so fast, literally within seconds, so the Huneke bothers called this “Sekunden-Phänomen”, which translates into “phenomenon of seconds”. Neural therapy or trigger point injections are quite commonplace now in pain centers. In the mid eighties it was not that well known among physicians. But since then anesthetists have incorporated trigger point injections into treatments at pain clinics. Unfortunately they often use Marcaine now, but Marcaine has been found to shorten telomeres, so Procaine or Xylocaine, which do not have a negative effect on telomeres, should replace Marcaine.

Here is a video how trigger point injections are done in the clinic.

Criticism of IMS and trigger point injections

There have been several critical reviews comparing dry needling (IMS) versus trigger point injection with local anesthetics. Some reviews find that IMS is giving more relief at a faster pace, but others say that trigger point injections with local anesthetics are less painful. All seem to agree that there is a place for both methods in myofascial pain. The initial criticism of a few conventional doctors that these methods would be “bogus” have been dispelled by the identification of trigger points on high-resolution ultrasound images (see next subheading) and also by clinical results, which stand for themselves.

A new look at trigger points

From the beginning conventional medicine has been fighting the existence of trigger points as an entity, so it was important to show that trigger points actually exist. To that end ultrasound investigations were done on patients, which confirmed trigger points as a small focus within the muscle.

Here is an article that states that with a high-resolution ultrasound it has been possible to locate trigger points within muscles and you can click on the image on the right side to see where the arrow points to.

Here is another view of a trigger point on a high-resolution ultrasound.

The theory is that these trigger points fire pain signals that are going up the dorsal spine and are perceived as pain in the thalamus and the cerebral pain centers. This is automatically switched to the motor neurons that will contract the muscles around where the trigger points are located in an attempt to “protect the muscle from getting injured”. This pathological reflex is what the pain specialist is attempting to interrupt by either dry needling (IMS) or using trigger point injections with local anesthetics.

Migraine headaches

One of the rewarding treatments for the therapist who does trigger point injections with local anesthetics is treating migraine patients. There are 6 nerve points that are injected with a local anesthetic: two supraorbital nerve exits; two infraorbital nerve exits and two greater occipital nerve exits.

I was amazed how quickly the patients with migraines responded to this; in several hundred patients about 60 to 70% had a complete response of relief from their migraines and another 10 to 15% had a partial response. Apart from directly helping patients with trigger point injections for migraines the doctor should do hormone tests. This is particularly important in women where estrogen levels need to be balanced with progesterone levels. In pre- and postmenopausal women missing progesterone hormone levels can cause estrogen dominance, which are frequently the cause for migraines.

Stretches to prevent trigger point development

It is well known that in order to prevent muscle injuries one should do frequent stretches. This is particularly important for any desk worker or for people doing a lot of work on computers. We tend to hold our head bent forward, which is hard on the muscles in the back of the head, the neck muscles and the shoulder muscles. The counter remedy is to engage these muscles by stretching them as shown in this link.

Why IMS (dry needling) and trigger point injections are helping patients with pain

According to the gate control theory of chronic pain it is possible to block a pain sensation that is generated through transmission in one nerve by creating a competing nerve impulse, in this case dry needling of injection with a local anesthetic (trigger point injection).

Once the pain sensation has been modified, the pain is diminished and stays diminished; in many cases, when switches are reset, the pain is gone. This is the principle behind the success of these procedures.

Prolotherapy and IMS

Prolotherapy is also a method that can be helpful for control of chronic pain. In cases that respond to prolotherapy often an area of the body that has lax ligaments or lax joint capsules is affected with chronic pain. By injecting sterile hyperosmolar dextrose solution with or without local anesthetic the ligaments or joint capsules are tightened up the way they used to be in the past. This allows the surrounding muscles that were in spasm and had trigger points in them to relax more and the pain is diminished or cured. Two to four such injections may be required for a successful treatment. The method can also be combined with stem cells and platelet rich plasma treatments to get higher healing results. The remaining milder pain can be treated with IMS (dry needling) to resolve any residual pain.

Conventional medicine approach

Conventional medicine does not have much to offer for pain control. When something is identified where surgery might be successful, this is often pursued, but the chronic pain may just get worse. In these cases of chronic pain often conventional treatment methods have nothing to offer. The patient is then told that the pain would be treated symptomatically with morphine tablets or injections or other similar prescription narcotic drugs such as codeine (e.g. Tylenol #3), hydrocodone (e.g. Vicodin) or oxycodone. However, this creates a new set of problems. Side effects such as drowsiness and impaired judgment can occur, and the patient is cautioned not operate a motor vehicle or other machinery. Even a seemingly harmless glass of wine in addition to the medication can cause severe impairment to the patient. Constipation is a well known side effect of pain medications, which can lead to impaction, where old, hardened stool forms a huge plug. Often these cases find themselves on the way to the emergency room to get relief. In addition there is nausea or vomiting, which can lead to dehydration and electrolyte imbalance. When you finally decide to get off narcotics you can have withdrawal symptoms.

Intramuscular Stimulation For Muscle Pain

Intramuscular Stimulation For Muscle Pain

Conclusion

Chronic pain associated with the musculoskeletal system can be caused by a variety of conditions. But the end result is often that trigger points develop, which set up pathological pain feedback arcs that perpetuate the effects of trigger points and the associated muscle spasm in the affected area. Fortunately in the last few decades alternative methods for pain control have been developed like IMS (dry needling), trigger point injections and prolotherapy. Many patients have experienced relief or even cures from their chronic pain. Chronic back pains, shoulder pains and migraines seem to all respond to these methods. Even scar-associated pains can be relieved. If you have chronic pain, search for alternatives: see a naturopath or an anesthetist who specializes in pain issues. Often physiotherapists have taken special training in IMS and can offer this service to the public. Any of these methods are better than depending on chronic narcotic drug administration.

 

References:

  1. Peter Dosch, MD: “Manual of Neural Therapy according to Huneke”,  Haug Publishers, Heidelberg, 1984 (eleventh revised edition, first English edition).
Apr
04
2015

Stop Suffering From Arthritis

Arthritis is an illness of the joints, mostly in older people (osteoarthritis or degenerative arthritis). However, a subgroup of younger patients can also develop a severe form of arthritis, called rheumatoid arthritis where autoimmune antibodies play more of a role.

In the 1950’s Dan Dale Alexander wrote a book called “Arthritis and common sense”. The medical establishment did not accept that simple remedy and Dan Dale Alexander was classified as a “quack”. However, Dr. Mirkin describes a study from Berlin that later confirmed that Dan Dale Alexander’s observation was correct: an emulsion made by shaking orange juice with cod liver oil and taken three times per day on an empty stomach would indeed improve osteoarthritis.

In 1964, still being a medical student I suggested to my future mother-in-law to give Dan Dale Alexander’s book about arthritis a try. Despite the well-established osteoarthritic condition in her left knee the arthritis vanished within 6 months and stayed controlled. I could not explain to her why this remedy worked, as higher doses of omega-3 fatty acids and higher doses of vitamin C were not yet known to be of value for arthritis.

This all changed with the advent of orthomolecular medicine (Ref.1). On page 76 of this book Dr. Frederick Klenner describes that ascorbic acid (vitamin C) at mega doses of at least 10,000 mg daily, but better even between 15,000 and 25,000 mg daily does have healing effects for arthritis. He stated further that repair of collagenous tissue (the joint surfaces) would require adequate ascorbic acid. On page 240 of Ref.1 Dr. Abram Hoffer, the founder of modern orthomolecular medicine reviewed the history of the use of vitamins in higher doses, particularly the use of vitamin B3 (niacin). He also mentioned that Dr. William Kaufman had used mega doses of vitamin B3 for arthritis as far back as 1950.

Overview of arthritis

Dr. Hoffer explains in Ref.2 that arthritis belongs into a group of diseases that are related to faulty nutrition, which in turn lead to vitamin and mineral deficiencies and a pandeficiency disease. Other diseases that belong to that group are cardiovascular disease, multiple sclerosis, cancer, diabetes, schizophrenia, mood disorders, alcoholism and autism. Contributing factors can be poor diets with overemphasis on refined and processed foods and consumption of sugar, allergies, diseases of the gastrointestinal tract and viral infections. Arthritis belongs into this group of illnesses as well. Niacin, vitamin B6 and zinc have been found useful to treat arthritis, but other vitamins and minerals are also needed. Here is a list of what Dr. Hoffer would suggest to use (Ref. 2):

1. Vitamin B3 from 100 mg to several thousand mg three times daily following meals. With niacin there can be skin flushing, which often goes away after the body gets used to the higher doses; but niacinamide could be used instead by those who are bothered by the flushing.

2. B complex: this contains each of the major B vitamins including vitamin B6 (pyridoxine). Take 100 mg once per day with a meal. Vitamin B6 may be needed up to 500 mg per day or more.

3. Vitamin C should be taken between 500 mg and several thousand mg three times per day after meals.

4. Vitamin D3: 4000 IU per day in the summer months. In the winter months particularly populations who live far north require 6000 IU per day.

5. Vitamin B1 (thiamine): alcoholics and very high sugar consumers need thiamine at 100 to 500 mg three times per day.

6. Folic acid at mega doses (prescription needed) works as an antidepressant, which requires 25 to 50 mg. To lower homocysteine levels lower doses of folic acid are sufficient.

7. Vitamin E: usually 400 IU to 800 daily. Muscle wasting diseases, Huntington’s disease and amyotrophic lateral sclerosis (ALS) require much higher doses up to 4000 IU per day.

8. Essential fatty acids (omega-3): It is strongly recommended to use a molecularly distilled product, which is free of mercury and PBC’s at 1000 mg three times daily following meals.

9. Selenium: The required dosage is 200 to 600 micrograms once daily (with any meal). In areas where selenium is deficient, this is particularly important.

10. Zinc: 50 mg of zinc citrate or 220 mg of zinc sulfate once per day with a meal.

11. Calcium and magnesium: Dr. Hoffer suggests 1000 mg of calcium with 500 mg of magnesium, although many experts now say that 1000 mg of calcium with 1000 mg of magnesium may be better.

Dr. Hoffer pointed out that this program is compatible with any medication and is non-toxic.

Thoughts on treating arthritis

 1. Conventional methods

The conventional approach to treatment of arthritis consists of anti-inflammatory medications like ANSAIDs. Unfortunately they have side effects like causing kidney damage after several years of use. Also, NSAIDs can lead to gastric bleeding from gastric erosions, which may require blood transfusions. Physiotherapy with reactivation and swimming have been found to be useful. Electro acupuncture can help for pain control.

2. Diet changes, multivitamins and minerals

As arthritis is found mostly in civilized nations, dietary factors have long been suspected to be of importance. Dr. Hoffer pointed out that arthritis is a pandeficiency disease meaning that overconsumption of sugar and processed foods has lead to multiple vitamin and mineral deficits that interfere with the cartilage metabolism leading to premature breakdown of cartilage and causing inflammation. It is not good enough to just take the supplements listed above; this needs to be combined with a fundamental change in diet. Cut out sugar and starchy foods. Return to homemade foods. Keep it simple with lots of vegetables, salads and organic meats. Now that you are starting to turn around your metabolism by a sensible diet the supplements listed above have a chance to work.

You will notice that Dan Dale Alexander’s idea of omega-3 fatty acids and vitamin C (from the freshly pressed orange juice) is contained in the list of supplements above. Dr. Klenner’s mega doses of vitamin C are also listed and Dr. Kaufman’s mega doses of vitamin B3 is contained in this list as well.

This list may not have been formally researched with controlled clinical trials, because the food industry and the makers of NSAIDs (Big Pharma) have no interest in this. But thousands of patients have been empirically treated with this regimen and a network of orthomolecular physicians has established that this regimen works to control the inflammation of arthritis and at the same time has no toxic side-effects.

 3.Laser, platelet rich plasma (PRP) and stem cells

Blue and green lasers have anti-inflammatory properties and are suitable for interstitial and intra articular laser treatments of arthritis. Dr. Weber has extensive experience with this treatment modality in Germany. I have discussed this in another blog.

However, prolotherapy, PRP and stem cell treatments are also an option for more severe cases of arthritis, particularly in arthritis of the knees, which can avoid total knee replacement surgery.

Stop Suffering From Arthritis

Stop Suffering From Arthritis

Conclusion

I met Dr. Hoffer in the early 1980’s during a meeting in Vancouver, BC when he wanted to establish a local orthomolecular division for British Columbia. Although I found the ideas fascinating, I felt that the College of Physicians and Surgeons (the regulatory body for physicians in BC) would scrutinize the practice of any orthomolecular member. At that time I would risk losing my license to practice medicine, which I just had received in 1978. So I decided not to join. Interestingly enough later in the 1980’s a member of the orthomolecular society of BC lost his license because of the use of mega doses of intravenous vitamin C. At this time the College considered these infusions useless or hazardous. Nowadays, any naturopathic and orthomolecular physician uses these intravenous vitamin C treatments as standard therapies. It shows how times have changed.

What has not changed is the food industry that undermines our health every day with hidden sugar contained in processed foods. In social functions it is customary to have a drink or two, if not more, which uses up our thiamine faster than we can replace it. Pandeficiency disease is alive and well as it was many years ago. It is in front of our eyes, but can we see it? Depending on what your eating habits are, do you need to make changes in your diet and perhaps take some or all of the ingredients of the multivitamin and mineral list above? Start by adopting a Mediterranean type diet, then add some of the supplements listed above. It is time to take a thorough look at natural treatment modalities against arthritis in the interest of preserving your health!

References:

Ref. 1: Andrew W. Saul, Ph.D.: “The Orthomolecular Treatment of Chronic Disease. 65 Experts on Therapeutic and Preventative Nutrition”, Basic Health Publications, Laguna Beach, CA, 2014.

Ref. 2: Chapter in Ref. 1 by Dr. Hoffer: “Pandeficiency Disease”, pages 24-30 (2014).

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