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Small Steps Are Excellent
Pain Killers Have Headaches
Pain Medication Alternatives
Supplements for Arthritis
Ask Dr. J: Cholesterol Risks
References
In The Health News
Diet and Disease
Recipe of the Month: Curried Polenta and Vegetables
Dear Friends,
In a book on time management, Edwin Bliss noted a difference
between striving for excellence and striving for perfection.
“The first is attainable, gratifying, and healthy. The
second is often unattainable, frustrating, and neurotic. It’s
also a terrible waste of time.” In striving for excellent
health, you can go a long way by making small steps in the
right direction.
I always suggest learning, as much as possible, the ideal
approach to healthy diet, dietary supplements, exercise, stress
management, personal growth, and aesthetic living. However,
it is neither possible nor necessary to be perfect in the
implementation of these ideals, and any step that you take
toward your health goals, no matter how small, is an important
contribution.
For example, if you can start walking 30 minutes four times
a week, it will do more for you than setting a goal of running
40 minutes every day and then giving up when you miss a day.
It will help you much more to do a visualization exercise
for two or three minutes several times a day than planning
to meditate for 20 minutes twice a day, only to find that
intrusions and scheduling problems interrupt your schedule
so that you don’t do any.
Eventually, if you set reasonable goals, you may find that
you can expand your commitment and add more to your health
program without undue stress. For example, a complete dietary
change might not be feasible for you at one time, but this
does not mean that smaller changes are not significant. I
recommend the elimination of foods with added sugars (as opposed
to fruits that naturally contain sugars). This is a great
step in making a transition to a healthy diet. Even if you
find that eliminating sugary foods on weekdays is the best
you can do, it will be a help. If you can also eliminate margarine
and hydrogenated oils, that will be another positive step.
Later you can make further dietary changes for better results.
Of course, some people find that they can make greater changes,
and for them I like to provide a complete program during my
consultations, while cautioning others that if they do not
do it all they are not failures. Achieving good health and
promoting longevity is a gradual process, and there is no
need to feel guilty if you find you do not get there all at
once. I made changes during the early 1970s, but did not become
strict until 1975, but by then I had a lot of experience with
better practices.
Of course, the motivation to make positive changes is greater
if you have health problems and are suffering, but even then,
small changes will help, and may alleviate a great deal of
pain and anguish. By all means, do your best to follow an
ideal health program, but remember that you are striving for
excellence, not perfection, and you can give yourself a great
gift of health without strict resolutions that you are unable
to fulfill, all the while, aiming at a greater goal.
The recent spate of reports on the heart health risks from
commonly prescribed pain killers have created real headaches
for drug companies, physicians, and patients. These “COX-2”
inhibitors work by interfering with the production of substances
called prostaglandins or prostanoids. They reduce inflammation,
pain, and fever.
Non-steroidal anti-inflammatory drugs (NSAIDS) have been
around for a long time, and include older ones such as aspirin,
ibuprofen (Advil and Motrin), and naproxen (Naprosyn, Aleve).
They work by blocking the enzyme cyclo-oxygenase. Earlier
COX inhibitors block COX-1, which protects the stomach lining,
as well as COX-2, and this causes a high incidence of stomach
inflammation and bleeding.
The newer COX-2 inhibitors (Vioxx, Celebrex) are less likely
to cause gatric bleeding, but they have their own side effects.
In fact, before the recent revelations about increased risk
of death due to heart disease, significant side effects were
comparable in patients on the newer drugs and the older ones,
but they had different toxicities.
While it is true that the side effects of Celebrex and Vioxx
were noted at higher doses and in patients taking them for
a longer time, it is not clear whether typical doses might
also cause problems, but too few to be revealed in these studies.
Often, patients take these medications for the long term,
and after they no longer need them for pain control.
The recent information that has led to Vioxx being pulled
from the market in September and to Celebrex coming under
fire is a 2- to 3.5-fold increase in the risk of heart attacks
and an increased risk of stroke. The information was found
in a National Cancer Institute study on colon polyp prevention.
It appears that even the older drugs, such as naproxen, can
increase these risks, so patients are in a quandary regarding
what to do for their arthritis. Some are taking older drugs
that might cause gastrointestinal bleeding, but taking antacid
drugs along with them. Unfortunately, these drugs designed
to protect the stomach also have side effects.
In a recent interview on NPR, a rheumatologist from Boston
was asked what his office is advising patients about these
newly revealed risks, and he mentioned several options, such
as reducing their doses, returning to the older drugs along
with drugs to protect the stomach, and seeing if they can
do without medications, learning to live with the pain. Not
once did he mention the many alternatives to drugs, including
acupuncture, stress reduction, weight loss, and many supplements,
even those that are commonly known by rheumatologists (their
patients have informed them).
The most common reason that NSAIDS are recommended is for
chronic pain due to arthritis, and it is with their chronic
use that the problems arise. Arthritis pain and inflammation
are often helped with non-drug therapies, and very likely
to respond to dietary supplements.
Aerobic exercise and resistance training both help to reduce
the pain and disability in patients with osteoarthritis. In
a study of 439 adults over 60 with knee osteoarthritis showed
that the treatment groups improved in functional ability and
in reports of pain. Weight loss in overweight patients with
arthritis has been effective in reducing symptoms.
Most of the dietary changes that have helped with arthritis
are related to rheumatoid arthritis, including vegetarian
diets and avoidance of food allergens. So far, research has
not supported the relationship of the nightshade family vegetables
(tomatoes, potatoes, eggplant, and peppers) to arthritis pain.
Mild to moderate pain of osteoarthritis is responsive to
glucosamine sulfate(GS), chondroitin sulfate (CS), methylsulfonyl
methane (MSM), niacinamide, S-adenosyl methionine (SAMe) and
fish oil. Inflammation is reduced by curcumin and ginger.
While both GS and CS work for arthritis, it is not clear that
combining them is better than either alone. I usually recommend
the GS because it is less expensive, although some patients
have reported that the combination helps them.
On the other hand, recent research does show that combining
GS with MSM works better than either alone. The typical dose
of GS is 1500 to 2000 mg daily, and adding 1500 mg of MSM
has a synergistic effect. The usual effective dose of CS is
1200 mg daily. Niacinamide has been known to help arthritis
since the 1950s, usually in doses of 1500 to 2500 mg (other
forms of B3 appear to be equally effective).
Research shows that SAMe is as effective as some NSAIDS
in reducing the pain and inflammation of osteoarthritis. In
comparative studies, 1200 mg of SAMe was more effective than
ibuprofen in 150 patients with knee osteoarthritis treated
for 30 days. In addition, the drug group had more side effects
than those on SAMe. SAMe is also beneficial for the liver
and helps with mood. Vitamins E and C and other antioxidants
can help both with symptoms and to slow the progession of
arthritic joint deterioration.
Fish oils contain the omega-3 essential fatty acids EPA
and DHA (eicosapentaenoic acid and docosahexaenoic acid),
which are known to promote the production of prostaglandins
that inhibit the inflammatory response. Typical daily doses
are 6 to 12 gms of oil in capsule form. this is the equivalent
of 6 to 12 ounces of wild salmon. Fish oil as well as SAMe
are also beneficial in relieving symptoms of rheumatoid arthritis.
In summary, it may not be necessary to take pharmaceutical
pain killers, and it may be possible to either reduce the
dose or the length of time they are taken while still achieving
symptom relief. While medications do have their role, lower
doses are likely to be far safer.
Q. A friend has a high cholesterol, but
because his blood pressure is normal, he is not concerned.
Shouldn’t plaque in his arteries from the cholesterol
cause high blood pressure?
—MV, via email
A. While high cholesterol is a risk factor for atherosclerotic
heart disease, it does not necessarily cause plaque, especially
if someone exercises regularly, maintains normal weight, and
has other low risk factors. However, not having hypertension
is no guarantee that he does not have atherosclerotic plaque.
Many factors contribute to blood pressure regulation, including
stress, hormones, mineral levels, and more.
Atherosclerosis is something that develops over time, and
how soon it happens is quite variable from person to person.
A normal blood pressure may be independent of the development
of arterial disease, and he would be well advised to make
an effort to lower cholesterol and any other risk factors.
A healthy diet is valuable not only to maintain a good cholesterol
level, but also to provide protection, through high fiber,
nutrient, and antioxidant content, from a variety of degenerative
diseases, including cancer, arthritis, macular degeneration,
cataract, Alzheimer’s disease, and Parkinson’s
disease, among others.
He can lower his cholesterol with regular exercise, dietary
fiber, a low fat diet, and supplements of B3 (niacin or inositol
hexaniacinate), policosanol, vitamins C and E, chromium, red
yeast rice, pantethine, and soy isoflavones and others. Good
health practices are like wearing seat belts—they are
not perfect protection, but they add to the likelihood of
a long healthy life. In addition, diet, exercise, and supplements
can often treat problems once they occur.
FDA Issues Public Health Advisory
Recommending Limited Use of Cox-2 Inhibitors. FDA Talk Paper,
December 23, 2004.
NCI-Sponsored Trials of Cyclooxygenase
(COX) Inhibitors for Cancer Prevention and Treatment. www.nci.nih.gov/newscenter/COXInhibitorsFactSheet,
December 17, 2004
Celebrex linked to heart attacks:
Celebrex Ups Heart Attacks 2.5-Fold in Cancer Study. WebMD
Medical News, December 17, 2004.
Silverstein FE, et al. Gastrointestinal
toxicity with celecoxib... The CLASS study... JAMA. 2000;
284:1247-1255.
Bombardier C, et al, Comparison
of upper gastrointestinal toxicity of rofecoxib and naproxen...
N Engl J Med. 2000; 343:1520-8.
Vas J, et al., Acupuncture as a
complementary therapy to the pharmacological treatment of
osteoarthritis of the knee: randomised controlled trial. BMJ.
2004 Nov 20;329(7476):1216.
Berman BM, et al., A randomized
trial of acupuncture as an adjunctive therapy in osteoarthritis
of the knee. Rheumatology (Oxford). 1999 Apr;38(4):346-54.
Baird CL, Sands L, A pilot study
of the effectiveness of guided imagery with progressive muscle
relaxation to reduce chronic pain ... Pain Manag Nurs. 2004
Sep;5(3):97-104.
Messier SP, et al., Exercise and
dietary weight loss in overweight and obese older adults...
Arthritis Rheum. 2004 May;50(5):1501-10.
Ettinger WH, et al., ...aerobic
exercise and resistance exercise...knee osteoarthritis...
JAMA. 1997 Jan 1;277(1):25-31.
Glorioso S, et al., Double-blind
multicentre study of the activity of S-adenosylmethionine
in hip and knee osteoarthritis. Int J Clin Pharmacol Res.
1985;5(1):39-49.
Vetter G, Double-blind comparative
clinical trial with S-adenosylmethionine and indomethacin
in the treatment of osteoarthritis. Am J Med 1987 Nov 20;83(5A):78-80.
McAlindon TE, Do antioxidant micronutrients
protect against the development and progression of knee osteoarthritis?
Arthritis Rheum. 1996 Apr;39(4):648-56.
Hoffer A, Treatment of arthritis
by nicotinic acid and nicotinamide. Can Med Assoc J. 1959
Aug 15;81:235-8.
A study of lead levels and cataract in men shows that lifetime
exposure to lead from tap water, lead paint, and other sources
increases the risk of cataract formation. In the 795 men,
those with the highest lead levels had 2.5 times the risk
of cataract compared to those with the lowest levels. (Schaumberg
DA, et al., Accumulated lead exposure and risk of age-related
cataract... JAMA 2004 Dec 8;292(22):2750-4.) Lead is an insidious
toxin that is also associated with high blood pressure and
brain deterioration. Lead removal through chelation therapy
(intravenous with EDTA and oral treatment with DMSA) is a
safe and effective way to reduce body lead burdens.
•New research shows that the carotenoids in kale, spinach,
turnip greens, broccoli, collards, and other leafy greens
protect the lens cells from changes associated with cataract
formation. Ultraviolet light from the sun contributes to the
free-radical damage that leads to glycoprotein cloudy deposits
in the lens. The antioxidants lutein, zeaxanthin, and vitamin
E appear to be protective. (Chitchumroonchokchai C, et al.,
Xanthophylls and alpha-tocopherol decrease UVB-induced lipid
peroxidation and stress signaling in human lens epithelial
cells. J Nutr. 2004 Dec;134(12):3225-32.)
•In the past 50 years, the nutritional value of fruits
and vegetables has declined significantly. Protein, calcium,
phosphorus, iron, riboflavin (vitamin B2), and vitamin C were
all lower. For example, protein was 6 percent lower while
riboflavin was 38 percent lower. Farming practices or plant
breeding, designed to increase productivity, appear to be
detrimental to nutrient value (and flavor). All the more reason
that we need to increase fruit and vegetable consumption.
(Davis DR, J Am Coll Nutr 2004 December, reported by Reuters,
12-14-04)
Cooking polenta in a crock pot avoids the need for constant
stirring. I mix 2 cups of dry corn grits with 6 cups of boiling
water in the crock pot on high. An occasional stir is all
you need, and it is ready in about 90 minutes. Cook pinto
beans in a presure cooker or use cans of organic beans. Sauté
garlic, diced onions, celery, bell peppers, and carrots in
olive oil, curry powder, cumin, and ground pepper with some
soy sauce or sea salt. Add a can of crushed, roasted tomatoes
and the cooked beans and simmer, mixing well. In a baking
dish, put a layer of this vegetable mix, adding some baby
spinach or other green and chopped cilantro, filling about
half the dish. Cover this with the polenta to fill the remaining
half and garnish with some grated parmesan or romano cheese.
Put in the oven preheated to 350, and bake this for about
45 minutes.
drjanson@drjanson.com
November
through May: 386-409-7747
June
through October: 603-878-2256
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