First Do No Harm…

One of the most difficult elements of being a physician is caring for someone in pain while having nothing to offer.  We are compelled at least to attempt to provide something palliative, when there is no cure.  But, we must all recognize our goals, and as with any intervention, heed the risks.  We all welcomed Vioxx when it hit the market as the next and best pain reliever.  And for those suffering with the daily draining discomfort and disability of osteoarthritis, Vioxx seemed to be a godsend.  Well, now we know different.  Here it seems the unfortunate risks outweigh the benefits.  Vioxx is clearly out, but where does that leave us?

If you are one of the many who suffer from osteoarthritis this question is surely on your mind.  Osteoarthritis is the most common type of the many forms of arthritis, affecting millions of Americans.  It represents a complex response of our joint tissues to aging and environmental and genetic factors.  It used to be that doctors and patients accepted stiff, painful joints as an inevitable consequence of aging.  And, because osteoarthritis was considered unavoidable, medical intervention focused primarily on relieving pain with nonsteroidal anti-inflammatory medications and steroid injections. That thinking has changed.  It is now understood that the risk and burden of osteoarthritis can be reduced by dietary and other lifestyle changes including all those good things that seem to be generally enhancing for one’s health: exercise, weight control, mind-body techniques that reduce mental and muscular tension, and even a few dietary and nutritional supplements.

Obesity, recently elevated to a major risk factor for coronary heart disease, also causes osteoarthritis.  In fact, though it may appear obvious that weight bearing joints would be damaged by the burden of excess pounds, remarkably not just these joints are more prone to developing arthritis in overweight people.  All joints are affected, implying a systemic effect of obesity as well.  Fortunately this effect is reversible.  And better yet even small amounts of weight loss convey large benefits.  In the Framingham Knee Osteoarthritis Cohort Study, people who lost just 10 pounds or more over ten years cut their risk of osteoarthritis of the knee in half.

Regular exercise, a great weight loss tool, also independently helps stop development or progression of osteoarthritis.  This occurs as a consequence of various physiological changes that follow exercising any joint:  joint fluid production is increased, joint strength is enhanced, pain is lessened and overall joint function has even been shown to be maximized.  Though you might intuitively believe that exercising an already arthritic joint would be bad, the opposite is true.  Exercise improves the damaged joint by stabilizing and strengthening it.  So, if you have not yet been exercising regularly, don’t be intimidated. Just start with whatever you can do easily. Get help if you need it. Just do it!

When it comes to symptom relief there is more good news.  Unbeknownst to many, there is and has been for some time, an alternative to those nonsteroidal anti-inflammatory drugs (NSAIDs).  NSAIDs which can cause stomach pain, kidney damage, and paradoxically, may also inhibit cartilage repair and accelerate cartilage destruction, need not be the mainstay of your treatment. Studies dating back twenty years have been touting the benefits of glucosamine sulfate – a natural product found in the human body.  Glucosamine sulfate exists in the body to build and maintain cartilage, tendons, and other connective tissues while inhibiting the growth of cartilage-destroying enzymes.  Osteoarthritis is the result, in part, of a short supply of glucosamine in our joints, resulting in severe pain and swelling in the joints, and loss of flexibility in the limbs.  The best news is that the benefits of this natural remedy go well beyond symptom relief.  On January 21, 2001 MSNBC reported the conclusions of what the prestigious and quite conservative Lancet medical journal found with respect to use of glucosamine sulfate in treating osteoarthritis.  In no uncertain terms the Lancet article reported, “Previous studies had indicated glucosamine could dull the pain of arthritis, but experts say the latest study shows for the first time that it can improve structure in the joints.”  Studies have shown that oral supplements of glucosamine sulfate are readily absorbed and can lead to stimulation of healthy new cartilage and other protective molecules.  Studies have also shown that this benefit came without any toxicity, contraindications, or other harmful side effects.

Glucosamine should be taken every day.  It is a slow acting supplement that may take up to three months to show its full benefits. Dosage is 1,500 mg per day.  It is best taken with several other components that have been shown to be important in cartilage synthesis and repair.  Chondroitin sulfate also exists naturally in our cartilage and has a synergistic effect when used in combination with glucosamine to treat osteoarthritis and promote overall joint health and resilience.  Enteric coated chondroitin sulfate has been suggested to be most beneficial as it is better absorbed by our bodies.  Several essential vitamins and minerals are important for their role in synthesis and repair of cartilage: Vitamins E and C, Pantethine (Vit B5), Vitamin A and B6, Zinc, and Copper.  Omega-3 fatty acids from fish oils are yet another helpful component:  an excess consumption of omega-6 as compared to omega-3 fats predisposes to inflammation, while supplementing omega-3 fats has been shown to actually diminish inflammation.

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Why Take VitalRemedyMD’s JointFormula?

Given all that we now know about conventional pharmacological treatments of osteoarthritis in contrast with a natural approach using exercise, stress modification and the nutritional supplements glucosamine sulfate and chondroitin sulfate it seems prudent to take the latter approach as a first measure. The natural supplements glucosamine sulfate and chondroitin sulfate have been utilized and studied for over twenty years.  As reported in the finest medical journals they were found to reduce symptoms, improve cartilage and joint health, and reduce joint space narrowing. They are well tolerated and there appear to be no side effects other than mild gastrointestinal upset for some people, which is generally alleviated by taking the supplements with a meal. Vitamins and minerals – B6, E, C, B5, Zinc, and Copper – are included in VitalRemedyMD’s JointFormula as they are known to be essential for maintenance of healthy cartilage and joints.  The addition of the omega-3 fish oils, EPA and DHA, further enhances the potential benefits derived from JointFormula.

Perhaps the best reason to consider JointFormula is that so many of our patients have been pleased with the results, a fact expressed repeatedly in their letters to us:

Dear Doctor, “After my heart surgery you told me to walk, which I did. I was walking three miles in 45 minutes every other day and was feeling good.  However, in the past two years or so, due to my arthritis this became impossible.  The pain in my knees was very severe.  You sent me to my Rheumatologist and he put me on prednisone and methotrexate.  This helped me, but no where near enough.  You advised me to try VitalRemedyMD’s Joint Formula for three months. I did, and in one month it kicked in.  It really works.  I call it “The Miracle Vitamin.”

I have to thank you for prescribing the vitamin JointFormula.  For the first time in three years I have not had fluid drained from my osteoarthritic knees.

Dear Doctor, “I have to thank you for prescribing the vitamin JointFormula.  For the first time in three years I have not had fluid drained from my osteoarthritic knees.  Previously I had my knees drained every two to three months, plus cortisone shots, to relieve severe pain.  Since I have taken JointFormula, I have not had any fluid in my knees and I no longer take Darvocet for pain.  You know that I am a pessimist from the word go, and I reluctantly took the pills, but I am so glad you convinced me to do so.  Again, thank you.”

Dear Doctor, “For years I suffered with lower back pain in the area of my tailbone.  I saw several physicians, had CT-scans and X-rays, but no one could find the cause.  The last physician I saw said it might be some kind of arthritis.  When I told my husband about this, he said that he heard that your JointFormula worked great on arthritic joints.  Being a skeptic, I said that I would try it, but would only take two a day instead of the recommended four.  After about a month with little change I decided to stop taking them.  My husband convinced me to continue them at the recommended four a day regimen.  After two weeks I began to notice a difference and after a month, the pain was almost completely gone.  It has now been six months since I started them and the pain is gone.  As a bonus, the moderate pain that I was experiencing in my elbow is also gone!  Thanks so much for such a great product.”

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Failure To Exercise Is Not An Option

How do I convince thee?

Let me count the ways…  Exercise improves heart and lung function, decreases resting blood pressure, decreases body fat, decreases total and LDL “bad” cholesterol, raises HDL “good” cholesterol, increases energy levels, increases tolerance to stress and depression, and controls or prevents the development of diabetes.  Even from the first day, you will feel better if you exercise.  Because you feel better, you will look better, and the world will look better to you.  With time, your body will respond by increasing muscle mass and tone and decreasing body fat.  You will be thinner, stronger, more limber and flexible, and your body will function better and be less vulnerable to orthopedic injury. You will be healthier and decrease your risk of cancer, heart disease and chronic illness.  Did I mention you will feel better?  The day will seem more sunny, your tasks will seem more manageable, you might even notice suddenly your “glass is half full.”  Tell me, where is the down side?  Before you even start with excuses, I will point out that they are just that, excuses – transparent attempts at procrastination – and I have used them all myself:  “it’s too hot, it’s too cold, it’s raining,” or my personal favorite:  “I don’t have time.” Well a wise man once said, “Those who think they have not the time for bodily exercise will sooner or later have to find time for illness.”

Those who think they have not the time for bodily exercise will sooner or later have to find time for illness.

Myriad studies have shown the health benefits of exercise and they all sound something like this:  Scientists at universities around the country as well as at the Centers for Disease Control and Prevention followed more than 74,000 women ages 50 through 79 for almost five years.  What they found was that women who walked briskly (or biked, swam easy laps, or danced) for just an hour and a half to 2 1/2 hours a week were 18 percent less likely to develop breast cancer during that 5-year period than women who were sedentary.  That comes to just a half hour three to five times a week.  Not too much to ask in order to reduce your risk of dying from cancer.  A quick glance at some more recent medical studies included the following titles:  Exercise reduces risk of recurrence and death in early stage colon cancer patients; exercise and stress management show physiological benefits for heart patients; a new New Year’s reason to work out:  exercise improves three measures of heart protection; exercise helps reduce symptoms of depression…and on and on it goes.

There are many, many research findings that support the role of exercise in disease prevention. What has occurred to me is that most people know this at least intuitively without quoting studies. They also know that cigarettes cause cancer, and so on.  It may just come down to making a commitment to ourselves – breaking old habits and making new choices.  I used to play a game with myself when I had trouble getting motivated to go to the gym.  I would promise myself that I only had to exercise for 15 minutes, but I had to go.  Invariably once I had begun exercising I felt better and wanted to keep going. (I only acted surprised.)  I worked through my usual routine and then gave myself a pat on the back; the feeling lasted well through the day.  For the person who’s just getting started keep this in mind:  anything that’s more than you did yesterday is good.  No, in fact, it’s great!  Getting started is always the hard part.  Enlist a friend or even a personal trainer or make an appointment with yourself that can’t be broken.  Just do it, and then tell me how you feel.

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The Power of Protein

Protein plays a vital role in building, maintaining and repairing lean body tissues: muscles, tendons, ligaments, circulatory system, brain, immune system, skin and other organs. In fact, every cell in the human body contains protein. Proteins are complex organic compounds that are composed of smaller “building blocks” called amino acids. When you consume foods that contain protein, your body breaks down the protein into its amino acids, and rebuilds them in specific sequences to form the structures it needs. Amino acids are classified into two groups: essential amino acids, which cannot be made by the body and must be supplied by food, and nonessential amino acids, which are made by the body from the essential amino acids or through normal breakdown of proteins.

We require protein in our diet to allow for tissue repair and growth. Inadequate protein consumption can cause impaired development, loss of muscle mass, decreased immunity, weakening of the heart and respiratory system, and death. In many parts of the world, protein malnutrition causes kwashiorkor – you’ve seen the haunting images of a young child afflicted with this condition, naked and emaciated, but for the characteristic swollen belly. For most of us living in developed countries, getting sufficient protein is easy, but just like with the fats and carbohydrates, not all protein is created equal. A protein that contains all the amino acids needed to build new proteins is called a complete protein. Complete proteins are found in animal foods such as meat, fish, poultry, eggs, milk, and milk products such as yogurt and cheese. Soybeans are the only plant source of protein considered to be a complete protein. In contrast, incomplete proteins lack one or more of the essential amino acids. Sources of incomplete protein include beans, peas, nuts, seeds, and grain. A small amount of incomplete protein is also found in vegetables. Plant proteins can be combined, however, to provide all of the essential amino acids and form a complete protein. Examples of combined, complete plant proteins are rice and beans, barley and corn, and lentil soup with potatoes.

We know that protein is critically important for growth and development during childhood, adolescence, and pregnancy, but there are other conditions associated with increased protein requirement including low calorie weight reduction diets and endurance and strength training. With regard to weight loss, recent studies have suggested that for most adults a high-protein, low carb diet may keep you leaner than a traditional high-carb, low-fat diet. This is partly because high protein foods slow the movement of food from the stomach to the intestine, delaying hunger. Also, protein’s moderate, steady effect on blood sugar and insulin levels avoids the quick, steep rise and fall that drives carbohydrate cravings after eating rapidly digested high glycemic foods. Finally, the body uses more energy to digest protein than it does to digest fat or carbohydrate. When a low calorie diet is used to accomplish a daily negative caloric intake, the goal is weight loss, meaning fat not muscle. This is why increasing protein in the diet is critical. If we do not receive adequate calories from food, the body will compensate by drawing on its own reserves, both its fat stores and lean body tissue. Ideal weight loss will occur only when there is a daily deficit of calories, coupled with adequate amounts of high quality protein that will allow for fat loss while preserving lean body mass.

Exercise, particularly weight training, can also lead to a daily protein requirement that exceeds the current recommended daily allowance of 0.8 grams per kg (about 0.4 gm/lb) body weight for a sedentary adult. Daily intake for the adolescent or adult athlete should be in the range of 1.0 – 2.0 gm/kg (0.5 – 1.0 gm/lb) body weight. Protein requirements of athletes and physically active adults are increased above those of sedentary people due in part to changes in amino acid metabolism induced by exercise. A small amount of protein is used as fuel during endurance exercise, and muscle and whole-body protein synthesis is suppressed during exercise. Increases in exercise intensity and duration further depress protein synthesis. Catch-up occurs after exercise when protein synthesis increases. Extra protein is then needed to repair injuries to muscle fibers and to remodel muscle tissue in response to endurance and strength training. Unless a protein-containing meal is consumed during recovery, breakdown will exceed rebuilding of muscle mass. Several studies indicate that protein synthesis during recovery is enhanced when the recovery meal contains both carbohydrate and protein. Whether you’re an elite athlete or simply an individual who’s looking to build body mass, lose body fat, and increase strength, proper protein consumption is essential.

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