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.
