Tag Archives: medical

Fix your pain with your diet

Businesswoman Having Backache At Work

Inflammation is all the rage lately. And rightfully so. Research has shown that chronic inflammation is at the core of most, if not all, of the chronic diseases that affect Americans. But what about chronic pain? Could chronic joint pain, back pain, or muscle pain be caused by chronic inflammation? And can it be alleviated by changing your diet? The answer is yes.

What is Inflammation?

First, we must understand what inflammation is. Inflammation is the term given to describe the biological response that occurs as a result of tissue damage. Bacterial infections, trauma, chemical exposures and dying tissue may all start the inflammatory cascade. In human physiology there are two kinds of inflammation. First, there is the acute form. In this form of inflammation the body responds to an injury by creating an environment that is conducive to healing and tissue repair. The body does this by sending fluids and blood to the area. That’s why the injury swells, turns red and becomes warm to the touch. This is a necessary step after an injury. Acute inflammation is a good thing for the body.

The second type of inflammation, called chronic inflammation, is not a good thing for the body. Chronic inflammation is a lower grade inflammatory response, but it is persistent. Unlike acute inflammation, which resolves, chronic inflammation is a continuous phenomenon that persists silently for years on end. The chronicity of the response is precisely what makes it so problematic. It increases the risk of heart disease, cancer, Alzheimer’s disease, diabetes and many other conditions.

Chronic Inflammation and Pain

How does chronic inflammation affect your pain level? First, it’s important to remember the most widely used pain relievers in the world like ibuprofen, acetaminophen, and aspirin work by reducing inflammation, not by working directly on nerves. This should illustrate the importance of inflammation in producing pain in the human body. However, there are ways to reduce inflammation without resorting to medications, which have serious side-effect profiles, even when taken as directed. The diet is the key.

Dietary-induced chronic inflammation produces an assortment of inflammatory chemicals capable of sensitizing the pain pathways. Moreover, if this sensitization of the pain pathways persists, adaptive responses by the brain cause the sensation of the pain to become exaggerated or inappropriate. The key to fixing this is to reduce the chronic inflammation.

The Pro-Inflammatory Diet

In this country, most people eat a “pro-inflammatory” diet.  That is, they consume food that consistently feeds the inflammatory cascade in the body, leading to chronic inflammation.  As previously pointed out, chronic inflammation leads to tissue destruction and many disease states.  In order to fully understand why our diets lead to this state, we must understand the basics of fatty acids.

Fatty acids are individual molecules that make up triglycerides in our body.  Triglycerides are the storage form of fat that humans use for energy.  In human physiology there are three important fatty acids.  There are omega-3 (n-3), omega-6 (n-6) and omega-9 (n-9) fatty acids.  Omega-3 and omega-6 fatty acids are essential in the human diet.  This means that we must consume them in our diet in order to survive.  Omega-9 fatty acids are classified as non-essential because we are able to synthesize them from other unsaturated fats in our body.  It is the balance of these fatty acids that is critical for controlling and reducing inflammation in human physiology.

First, we must examine the role of fatty acids in our body when speaking about inflammation.  Fatty acids work to produce a variety of chemicals in the body called eicosanoids.  These chemicals are at the heart of the inflammatory cascade.  Some eicosanoids are beneficial while others can contribute to inflammation.  The harmful eicosanoids that contribute to the inflammatory cascade are related to an omega-6 fatty acid called arachidonic acid.  If arachidonic acid is incorporated into a specific eicosanoid then it becomes pro-inflammatory.  If it is not incorporated it becomes anti-inflammatory.  It is arachidonic acid that will fuel the inflammatory cascade, eventually resulting in the production of chemicals capable of sensitizing the pain pathways.

So, we must take a closer look at this specific fatty acid called arachidonic acid.  Arachidonic acid is found preformed in animal products, especially meat.  In addition, it is easily converted in the body from the fatty acids found in grains and vegetable oils like corn, safflower and sunflower oil.  Also, animals fed a steady diet of grain are exceptionally high in arachidonic acid.

Obviously, what we eat will determine our fatty acid profile and potentially contribute to chronic inflammation and pain.  One might think, based on the information given above, that becoming a vegetarian would significantly reduce one’s overall inflammatory load.  And it does make sense especially if we take into account that arachidonic acid is preformed in meat.  It has been shown, however, that the opposite is true.

The average American diet has unfortunately shifted to promote excessive production, storage and utilization of arachidonic acid.  This leads to the over-production of pro-inflammatory eicosanoids.  Research has shown that man evolved with a ratio of omega-6 fatty acids to omega-3 fatty acids of about 1:1.  Today, the average ratio in the diet is anywhere from 10:1 to 20-25:1.  This is disadvantageous because we know that omega-3 fatty acids are anti-inflammatory and have a wealth of other health benefits.  Plainly put, our diets have shifted to favor inflammation.

As mentioned earlier, it would seem that vegetarian diets would be most beneficial in creating an anti-inflammatory state because animal products are high in preformed arachidonic acid.  This hypothesis, however, has not held up in clinical studies.  It has been shown that vegetarians, in fact, have a higher plasma level of arachidonic acid and an essentially equal level of arachidonic acid found in red blood cells when compared to meat eaters.  The study also showed that vegetarians have lower levels of the protective and anti-inflammatory omega-3 fatty acids, specifically EPA and DHA. This suggests that  vegetarian diets shift people closer to an inflammatory state than they probably desire.

A diet high in fruits, vegetables and healthy proteins and fats it ideal for stopping and preventing chronic inflammation.  This type of diet will invariably be low glycemic.  The glycemic index refers to the effect on blood sugar that a particular food will have.  A food that has a low glycemic index (GI) will raise blood sugar much more slowly than a food with a high GI.  Foods with a low GI are much more beneficial for controlling inflammation because low glycemic foods cause a much smaller response from the hormone insulin.  Insulin is the hormone that’s required for most of the cells in our body to use and store sugar for energy.  Insulin, which is secreted from the pancreas, actually stimulates an enzyme that converts omega-6s into the dreaded arachidonic acid.  So a diet that is high glycemic will cause one’s body to over secrete insulin and further drive the inflammatory cascade.

So a diet high in fruits, vegetables, protein and healthy fat will lead to lower inflammation and greater pain control, but are there are other things you can add into your diet to help? As it turns out, there are. Certain spices have powerful anti-inflammatory effects. Turmeric, ginger, garlic and black pepper all have the potential to reduce inflammation when consumed in the diet. There are many other spices that have anti-inflammatory properties so go ahead, spice up your food! Your body may thank you for it.

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Your Cholesterol Matters Less Than You Think

Eraser deleting the word Cholesterol

The Cholesterol Hypothesis

The cholesterol hypothesis is the prevailing theory on why human beings develop heart disease. It goes something like this; elevated total cholesterol and, especially, elevated LDL cholesterol, is the primary cause of atherosclerosis and cardiovascular disease. Further, replacing saturated fat in the diet with vegetable oils lowers serum cholesterol and, therefore, lowers cardiovascular disease risk. This information is decades old and has become medical dogma. Unfortunately, it’s not true.

Much of this information comes from the Seven Countries Study originating in the 1950s, although data is still analyzed today to glean more knowledge from it. It tied fat consumption to heart disease. The lead author, Ancel Keys, found the more fat a society consumed the higher the rate of heart attacks. It seemed to be very convincing evidence. This observation helped shape health policies for governments and the medical field. In fact, to some degree, it still does today.

Missing or Unpublished Data

There was a problem with it, though. Data showed that there were populations of people who consumed lots of fat but had low heart attack rates. Conversely, there was data showing there were populations of people who consumed very little fat but had high rates of heart attacks. This information was omitted from the study. The study also failed to account for the fact that the people who consumed the most fat were also most likely to consume the most sugar. While nutrition science is notoriously difficult, these seem like variables that shouldn’t have been ignored.

Superimpose the above inconsistencies with interventional studies conducted in the same time period and you’ll quickly see you’ve been misled. Ancel Keys’ study was an observational study. This means he observed a connection between two sets of data. Observational studies cannot prove cause and effect. For example, imagine this headline; “New science has observed a connection between high heel wearing and breast cancer.” Does wearing high heels cause breast cancer? Of course not. It just happens that people who wear high heels (mostly women) also develop the majority of breast cancer. This silly example shows just how easily an observational study can get it wrong.

The gold standard for proving cause and effect is an interventional study where populations are randomized and given either an experimental intervention or are controls, generally receiving a placebo. In dietary trials, placebos are difficult, if not impossible, to give so participants diets are often left unchanged for the control population.

The Sydney Diet Heart Study and the Minnesota Coronary Experiment

Around the same time that Ancel Keys was doing his work, two interventional studies were conducted. One was called the Sydney Diet Heart Study and the other the Minnesota Coronary Experiment. Both of these studies were incompletely published (data was missing) or went completely unpublished for reasons no one really knows. It is likely because they contradicted accepted dogma and scientific journals were hesitant to put their reputations on the line for something they viewed with skepticism. We know about them now because a group of researchers recently uncovered the unpublished data, reanalyzed it with modern methods and found some shocking results. The reanalysis of both studies was published in the British Medical Journal.

In both of these experiments, totaling about 10,000 participants, saturated fat was removed from the diets of the experimental group and replaced with vegetable oils. This is precisely what the American Heart Association says you should do. What did they find? They found that by removing saturated fat, the participants’ cholesterol went down. This is not unexpected. What they didn’t expect to find was that in both studies the low saturated fat group experienced more cardiovascular disease, more coronary heart disease, and an increase in all-cause mortality.

So let’s summarize; Removing saturated fat and replacing it with vegetable oils lowers cholesterol. But lowering cholesterol raised the risk of heart disease? Yes. This puts an enormous, truck-sized hole in the cholesterol hypothesis. In fact, in the Minnesota Coronary Experiment for every 30 points a person’s cholesterol dropped their risk of death increased by 22%.

This information is counter to everything nutrition science says. Three other randomized controlled trials have confirmed the results. Couple this with another very recent study evaluating over 68,000 elderly people which found an inverse relationship in those over 60 between LDL level and mortality, and I think we seriously need to evaluate the cholesterol hypothesis.

The Real Cause of Heart Disease

If cholesterol doesn’t cause heart disease, what does? It’s quite simple actually – endothelial damage. The endothelia are the cells that line your blood vessels. There are things that are known to damage this lining – high blood pressure, inflammation, high blood sugar, smoking, oxidative stress, and aging. These triggers, and pursuant damage, set into motion a cascading set of events that allows your immune system (in the form of white blood cells) to infiltrate the lining of the vessels. Only after they do this do they begin the process of engulfing cholesterol, which eventually leads to arterial plaque formation. Control those triggers and you will never develop heart disease. If you do not control those processes, it doesn’t matter how low your cholesterol is. You will still develop heart disease. I hear you saying, “But how do I control aging?” That is more difficult as we will all age, but living a healthy lifestyle helps with all of those factors, including aging. Plus, aging alone is unlikely to be a significant cause of heart disease.

It’s important to recognize that cholesterol is not your enemy. Sedentary lifestyle, smoking, a diet high in refined food, the excess consumptions of sugar, and poor stress management are much more serious concerns. Lowering cholesterol for the sake of lowering it has no beneficial effect on your heart. As a matter of fact, the research shows it could be downright dangerous for it. So if you’ve been told you have high cholesterol and that lowering it will lower your risk, you might want to consider the information above and seek an alternative.

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8 Pictures That Perfectly Describe Leaky Gut (and how to fix it)!

Our gut has many functions. Changes in the balance of bacteria, leaky gut, bacterial overgrowth and other factors may affect how your GI system works. This may have systemic consequences.

Our gut has many functions. Changes in the balance of bacteria, leaky gut, bacterial overgrowth and other factors may affect how your GI system works. This may have systemic consequences.

Increasingly, chronic disease is being seen as stemming from altered gut function. Follow the arrows to see what the risks for chronic disease are. All of the factors that increase chronic disease risk adversely affect gut function too.

Increasingly, chronic disease is being seen as stemming from altered gut function. Follow the arrows to see what the risks for chronic disease are. All of the factors that increase chronic disease risk adversely affect gut function too.

The bacteria in our gut is EXTREMELY important and there is lots of it. If it becomes unbalanced, all symbiotic functions are lost.

The bacteria in our gut is EXTREMELY important and there is lots of it. If it becomes unbalanced, all symbiotic functions are lost.

These disease have all been linked to changes in the balance of bacteria in the gut

These disease have all been linked to changes in the balance of bacteria in the gut

The gut forms an important barrier between what's inside the intestines and what gets absorbed. Those blue structures highlighted by the orange arrows are tight junctions. They hold the cells together do nothing can squeeze between them and pass into the local blood supply unchecked. This is a very important function.

The gut forms an important barrier between what’s inside the intestines and what gets absorbed. Those blue structures highlighted by the orange arrows are tight junctions. They hold the cells together do nothing can squeeze between them and pass into the local blood supply unchecked. This is a very important function.

All of these factors can lead to breakdown of the tight junctions and leaky gut. NSAIDs are pain relievers like Aspirin, Aleve, Advil, etc. SIBO is an acronym for small intestinal bacterial overgrowth.

All of these factors can lead to breakdown of the tight junctions and leaky gut. NSAIDs are pain relievers like Aspirin, Aleve, Advil, etc. SIBO is an acronym for small intestinal bacterial overgrowth. Additionally, low exercise levels is a stressor under the category of physical stress. 

LPS are toxic structures located on the surface of the bacteria in the gut. When bacteria die, they are free to potentially enter our bloodstream. This would happen through a leaky gut. If this occurs your body's response is inflammatory. This inflammation alters your energy levels, your mood, and eventually increases the risk of heart disease, cancer, diabetes, and many other chronic diseases.

LPS are toxic structures located on the surface of the bacteria in the gut. When bacteria die, they are free to potentially enter our bloodstream. This would happen through a leaky gut. If this occurs your body’s response is inflammatory. This inflammation alters your energy levels, your mood, and eventually increases the risk of heart disease, cancer, diabetes, and many other chronic diseases.

Start in the upper left corner of the diagram and follow the arrows to see how a leaky gut leads to disease.

Start in the upper left corner of the diagram and follow the arrows to see how a leaky gut leads to disease.

Fixing the problem – follow these steps to fix your leaky gut

  1. Get advanced stool testing done to properly evaluate your GI health.
  2. Eat a paleo-inspired diet full of vegetables, healthy proteins, and healthy fats.
  3. Avoid food sensitivities.
  4. Consume fermented foods regularly.
  5. Supplement according to your needs. This might include nutrient repletion, probiotics, whey protein, anti-inflammatory herbs like curcumin, or fish oil.
  6. Exercise vigorously 3-4 times per week.
  7. Eliminate artificial sweeteners, do not overuse NSAIDs, antibiotics, or alcohol, manage your stress, and manage your stress.

If you do all of that, your can heal your leaky gut and feel better than you ever thought you could!

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Health Doesn’t Come In A Pill

PillsWe live in an instant gratification society. It permeates every aspect of our lives. From the way we consume our news with 24 hours news networks or online surfing, to the way we gossip with Facebook, our desire for things to be done now(!) is staggering.

The same applies to our health. We want results, and we want it yesterday. The problem? There is no quick fix for anything in terms of your health. We’ve become accustomed to seeing the ads on TV that promise results with just one simple pill per day. We’re so accustomed to it, we’re starting to believe it. Heck, some people believe it so much, they demand it! Unfortunately, health doesn’t come in a pill.

But my doctor promises me that if I take my high blood pressure medication, my statin, and my baby aspirin just once per day, I’ll live a long, healthy life!

Yes, yes. That is a comforting thought isn’t it? The problem is it isn’t true. Check out this information:

Statins: For those who took statins for at least 5 years with no history of heart disease:*

  • 98% saw no benefit
  • 0% were helped by being saved from death
  • 1.6% were helped by preventing a heart attack
  • 0.4% were helped by preventing a stroke
  • 2% were harmed by developing diabetes
  • 10% were harmed by muscle damage

Aspirin: For those who took it daily for a year with no history of heart disease:*

  • 99.94% saw no benefit
  • 0% were helped by avoiding death
  • 0.05% were helped by preventing a non-fatal heart attack
  • 0.01% were helped by preventing a non-fatal stroke
  • 0.03% were harmed by developing a major bleeding event

Blood Pressure Medications: For those who took them for mild hypertension:*

  • 100% saw no benefit
  • 9% were harmed by medication side effects and stopped the drug

(*Statistics gathered from www.thennt.com)

Isn’t it amazing that you’re more likely to be harmed by these medications than you are to be helped? So, given that these drugs are so popular and prescribed so widely, why don’t they work? Health doesn’t come in a pill. Our medical model is flawed and flawed greatly. There are too many factors to assume one can take a pill and live longer or healthier. And most medical doctors receive very little, if any, training in nutrition.

You must fuel your body properly. This means a healthy diet and exercise. Those things work. Those things take time and effort. Obviously, time and effort don’t fit with our current lifestyle of “I want it now.” We need to change our lifestyle.

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Muscle Mass Beats BMI as Longevity Predictor – Who Knew!?

Fit at 70!I’ve written a couple of times (here and here) about my dislike of the imperfect science of body mass index. In particular, I’ve stated that it does not accurately assess the elderly because of low muscle mass. The elderly are likely to have a “healthy” BMI despite being anything but. As people age they lose weight through muscle loss. This brings their BMI down and may even bring it into what is considered an optimal range. The problem is muscle mass loss reduces strength, which increases the likelihood of falls and a reduced ability to exercise. The last point is particularly problematic.

Now new research shows that when it comes to longevity, a focus on weight loss may be misplaced. Because BMI isn’t actually a very reliable indicator of life span. A more useful measure, some physicians say, might be muscle mass. Researchers analyzed BMI and muscle mass data from more than 3,600 seniors in a long-term study. And they tracked which seniors had died, a decade later. Turns out BMI wasn’t much good at predicting chance of death.

But muscle mass was: more muscle meant better odds of survival. The study appears in The American Journal of Medicine. [Preethi Srikanthan and Arun S. Karlamangla,Muscle Mass Index as a Predictor of Longevity in Older-Adults]. For more information see here.

Critics argue that it’s nearly impossible for the elderly to build muscle. I think they are missing the point. It’s not necessarily that the elderly need to bulk up. It’s that they need to minimize muscle loss. This is done through resistance training. Anyone, yes even the elderly, can resistance train. By doing so muscle loss is minimized. This may mean you don’t fit into the BMI scale perfectly, however, it does mean you are healthier. So, here’s to weight lifting!

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Why Your Pants Shouldn’t Fit!

Have you heard about a metric used by health professionals called the waist to hip ratio? It’s a measure of abdominal obesity. Abdominal obesity is strongly associated with an increased risk of type 2 diabetes, cardiovascular disease and death, even after controlling for other factors like overall weight. In the waist to hip ratio, waist circumference and waist size are compared to hip size. Several organizations have defined cut points for abdominal obesity with different cut points for men and women. 

According to the World Health Organization (WHO) the waist circumference should be measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest, using a stretch‐resistant tape that provides a constant 100 g tension. Hip circumference should be measured around the widest portion of the buttocks, with the tape parallel to the floor. Practically, however, the waist is more conveniently measured simply at the smallest circumference of the natural waist, usually just above the belly button, and the hip circumference may likewise be measured at its widest part of the buttocks or hip. The WHO states that abdominal obesity is defined as a waist–hip ratio above 0.90 for males and above 0.86 for females. In layman’s terms, if your belly is bigger than your butt, you’ve got a problem.

I recently measured my waist to hip ratio. It was about 0.83 – well within the healthy range. Here’s how I found it. My waist measures about 34 inches. My hips measure about 41 inches. If you divide 34 by 41 you get 0.82926 repeating or about 0.83. For reference I’m about 5’11”, 187 pounds and about 18% body fat.

So what the heck does this have to do with my pants?

Everything! It’s a quick, down and dirty way to assess your waist to hip ratio. When I buy pants, the waist NEVER fits. It’s ALWAYS too big. This is a good thing. The reason it’s too big is I have to be able to fit them over my legs and butt. If you talk to anyone who works out or is athletic, they’ll tell you the same thing. If a pair of pants fits on the waist, it’s super tight in the legs and butt. If it fits the butt and legs, the waist is enormous. It’s a good, if not maddening, problem to have. Here’s what I mean:

Just about all of my pants are 1-3 inches too big in the waist, by they fit everywhere else!

Just about all of my pants are 1-3 inches too big in the waist, by they fit everywhere else!

This is what you don’t want:

This man's waist is clearly larger than his hips.

This man’s waist is clearly larger than his hips.

Everyone should have an idea of what their waist to hip ratio is. It’s a simple and easy metric for assessing your general health. Don’t want to take the time to measure it? Fine, how do your pants fit? Are the waists too big but legs and butt just fine? GREAT. Are you having trouble finding pants to fit your waist because when they fit your waist they fall off the rest of you? Uh-oh. Time to make some lifestyle changes and get healthy!

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I’m Overweight.

Dr. C

Or at least you would think so if you looked at my body mass index (BMI). I have written about the very imperfect science of the BMI scale before here on my blog, but I thought it deserved to be revisited. BMI is basically a height to weight ratio that comes up with a number designed to make it easy for clinicians to decide if a person is overweight or obese. Before the BMI scale was invented it was hard to assess someone’s weight and say that it was appropriate because height is also an important factor in weight. BMI combined those two.

Calculating BMI is relatively simple. You need your weight in pounds and your height in inches. Take your weight and multiply it by 703. Take your height and multiply it by itself (height squared). Now divide the first number by the second number and you have your BMI. To see my calculations or do your own click this link. My BMI falls in the “overweight category” with a score of 26.2. However, my body fat percentage is about 18%. This is well within the acceptable range for a 33-year-old man. (And I clearly do not look overweight!)

BMI misses many things when calculating whether someone is at the proper weight.

The problem for some people, like athletes, it does not take into account muscle mass. A person that is heavily muscled will always be overweight according to the BMI. As a matter of fact, I have been considered “overweight” since college despite always being is relatively good shape. If we look at professional level athletes, most of them would be considered obese!

I understand that not everyone is an elite athlete. What about the elderly? BMI is not ideal for them either. In the United States that equates to about 43 million people. Many times an elderly person will fit nicely into the BMI by being considered “ideal weight” for their height. This can be significantly misleading. Why? In the elderly muscle mass begins to drop. It happens to all of us. However, with this drop in muscle mass comes a drop in weight. As weight is lost a person is likely to fall into the “ideal weight” category even though they should be concerned about muscle mass loss. This loss in muscle mass causes a loss in strength and stability, increasing the risk of falls and increasing the risk of osteoporosis. Another problem with muscle loss is the change in your body composition. As muscle mass is lost one’s body fat percentage increases. Body fat percentage is a great indicator of health. The lower it is (within reason) the healthier you are, generally speaking.

BMI also fails to take into account many other health factors like diet, exercise, inflammatory markers, nutrient status, stress load, chemical exposure, social well-being, mood stability, and a whole host of other things we know have a large impact on our health. However, it is still widely used as a primary assessment of one’s health. As I said, it’s an imperfect science. In my opinion, it’s so imperfect it should be eliminated.

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