CHRONIC HIP FLEXOR PAIN
HOW AGES FORM
WHAT AGES DO TO YOU
One of the biggest factors that increases the AGE content in meat and poultry is the cooking method used. Meat that has been blackened, fried, seared, broiled, or grilled, has a tendency to be very high in AGES. This has to do with the Maillard Reaction mentioned earlier --- a "carmelization" sort of thing that occurs with the darkening of meats or other food products via heat (Video #1). As far as AGES are concerned, meat is better off slow-cooked in fluids at a lower temp, like you would do in a crock pot. Interestingly enough, The AGE Foundation tells us that, "acidic marinades [think lemon or vinegar here] can suppress AGE formation by up to 50 percent when cooking meat." Cooking, however, is not the biggest factor in our exposure to AGES ---- not by a long shot. Meet Chris Masterjohn.
Dr. Masterjohn earned his Ph.D in Nutritional Sciences from UConn, and currently works as an Assistant Professor of Health and Nutrition Sciences and researcher at City University of New York, Brooklyn campus. He runs the website CHOLESTEROL AND HEALTH (his blog is called 'The Daily Lipid'). Allow me to summarize his post, 'Where Do Most AGEs Come From? O Glycation, How Thy Name Hast Deceived Me!'
Remember that there are two different ways that AGES get into our bodies. Firstly, and most importantly, is the Maillard Reaction --- an internal reaction that is directly related to the amount of HIGH GLYCEMIC INDEX CARBOHYDRATE / SUGAR that we consume (endogenous --- it's made by our bodies in response to sugar). Secondly, are the AGES that come directly from our diet (exogenous --- not made by our body, but consumed). Listen to what Dr. Masterjohn says about exogenous AGES.
"The available evidence suggests that we do absorb certain AGEs from the intestinal tract, but almost immediately begin peeing them out. As a result, dietary AGEs are unlikely to contribute meaningfully to the pool of AGEs circulating in our bodies at any given moment."
What does this sound like? Although the mechanism for clearing the body is certainly different, this reminds me of what we know about CHOLESTEROL. For years we were told not to eat any fat (HERE), all the while being lectured that carbs and sugar can't make us fat since they don't contain any fat. Hence, we endured forty years of stupid BS like, DON'T EAT EGGS or DON'T EAT RED MEAT OR FAT (but eat all the carbs you want) --- positions that have been turned on their heads by several decades of research (not to mention the fact that we are the sickest and fattest society in the history of the world).
In other words, the Cholesterol you consume does not cause your blood cholesterol levels to increase (see first link in this paragraph) --- and neither does dietary consumption of AGES cause blood levels to rise like you would assume they would. It's kind of akin to people going on the Atkins Diet and not only losing a ton of weight, but getting their blood work in order as well --- even though they are probably consuming more fat than they ever have before. Masterjohn then says something that I myself have said in the past, "Diabetes is not so much a sugar problem, as it is an Inflammation problem" (my quote, not his). Dr. Masterjohn reveals that.....
"Diabetes involves a lot more than high blood sugar. Most likely, increased concentrations of glucose and ketones, defective energy metabolism, defective insulin signaling, and oxidative stress lead to the increased production of and decreased detoxification of dicarbonyls. These dicarbonyls then form AGEs, defective degradation of AGE-modified proteins elevates their concentration further, and if the diabetes damages the kidneys, even the free AGEs released from degraded proteins will not be efficiently excreted. High blood sugar is a part of this, but only a part."
Interesting, but this brings up a whole other issue for those using a Low Carb or Paleo approach --- ketones. WebMD says this about having lots of ketones in your bloodstream. "Ketosis is a normal metabolic process, something your body does to keep working. When it doesn't have enough carbohydrates from food for your cells to burn for energy, it burns fat instead. As part of this process, it makes ketones. If you're healthy and eating a balanced diet, your body controls how much fat it burns, and you don't normally make or use ketones. But when you cut way back on your calories or carbs, your body will switch to ketosis for energy. For people with uncontrolled diabetes, ketosis is a sign of not using enough insulin." Did you catch that? Ketosis is "normal" when you burn fat for energy. Unfortunately, many people confuse Ketosis with Keto-acidosis.
According to the American Diabetes Association, Ketoacidosis (aka Diabetic Ketoactidosis or DKA) occurs, "When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are chemicals that the body creates when it breaks down fat to use for energy. The body does this when it doesn’t have enough insulin to use glucose, the body’s normal source of energy. When ketones build up in the blood, they make it more acidic. They are a warning sign that your diabetes is out of control or that you are getting sick. High levels of ketones can poison the body. When levels get too high, you can develop DKA. DKA may happen to anyone with diabetes, though it is rare in people with type 2." While true, is this definition completely accurate? After all, the purpose of the 'Induction Phase' of Dr. Atkins' diet was to put people into Ketosis. According to the website Ketogenic Diet Resource, never confuse the two.
"Ketosis is NOT Ketoacidosis. The difference between the two conditions is a matter of volume and flow rate. Benign dietary ketosis is a controlled, insulin regulated process which results in a mild release of fatty acids and ketone body production in response to low carbohydrate intake, and higher fat consumption. Nutrional ketosis associated with a properly formulated ketogenic diet is not dangerous because it is regulated by insulin within the body. It's simply the metabolic process of burning your own body fat for fuel, and unless you are diabetic and lacking insulin, or you are a raging alcoholic, it is perfectly safe. Ketoacidosis is a condition in which abnormal quantities of ketones are produced in an unregulated biochemical situation. In order to reach a state of ketoacidosis, the body has to be in a state of not producing enough insulin to regulate the flow of fatty acids and the creation of ketone bodies. If left untreated, acidosis can result in a coma and death."
All of this brings me to another interesting point concerning the KETOGENIC DIET. Despite the negative reviews by people in the (Ornish camp), not only is a state of Ketosis an excellent way for the VERY OBESE to lose weight in a hurry, but for those with severe neurological conditions to help get them under control as well. Almost a century ago, Dr Russell Wilder of the Mayo Clinic designed a diet specifically used to treat Epilepsy, which was based on consuming large quantities of cream (unlike milk, cream has no sugar or carbs) and other protein-based foods. Although, not surprisingly, it has fallen out of favor due to the advent of anti-seizure drugs, this begs the question of whether or not it was / is effective? A 2012 Cochrane Review (Ketogenic Diet and Other Dietary Treatments for Epilepsy) helps answer this question.
"Several large observational studies investigated the effect of ketogenic diets in epilepsy and reported a beneficial effect. Recently, this view has been strengthened by the publication of four randomized controlled trials including one study which looked specifically at the Atkins diet, a related diet.These studies suggest that in children, the ketogenic diet results in short to medium term benefits in seizure control, the effects of which are comparable to modern antiepileptic drugs. We found one randomized study of reasonable quality of the Atkins diet. This study showed similar benefits in seizure control with a less restrictive diet. For those with medically intractable epilepsy or those in whom surgery is unsuitable, a ketogenic diet could improve seizure control, but tolerability is poor (dislike for the diet). All studies showed 30-40% reduction in seizures compared to comparative controls."
Did you catch that? The effects of the KETOGENIC DIET are comparable to drugs. But enough of this; let's get back to AGES. Although there is a huge debate about whether or not dietary AGES are bad for you (or at least as bad for you as some say they are), there is no debate as to whether the AGES created by your body in response to sugar / carb consumption are bad. I went over to PubMed and cruised through studies on AGES published just in the past few months. AGES have been tied to Diabetes, OSTEOARTHRITIS, problems with the eye, hearing problems, liver problems, any number of cardiovascular problems, AUTOIMMUNITY, CANCER, SYSTEMIC INFLAMMATION, PCOS, MS, HASHIMOTO'S THYROIDITIS, periodontal disease, mutations of DNA, cellular apoptosis (death), ULCERATIVE COLITIS, wrinkles (premature aging), kidney problems, OSTEOPOROSIS, OXIDATIVE STRESS, pregnancy complications / preterm labor, inability to heal bone fractures, and all-cause mortality (death by any and all causes) ---- and this was only going back to July.
In a study published in the August issue of Molecular Aspects of Medicine (Dietary Glycemia as a Determinant of Health and Longevity), the authors looked at what it takes to live for a very long time, by specifically studying the link between visual health and dietary carbohydrate consumption. "Extending healthful life is a millennia-old dream and objective. During the intervening centuries a multitude of concoctions and remedies have been offered, usually with few substantiated results. Loss of vision due to age-related cataracts or age-related macular degeneration is widely prevalent, affecting about 85% and 15% of the elderly respectively. With centenarians among the fastest growing segments of societies, and with loss of vision a very costly personal and societal burden, there is keen interest in extending vision - that is, delaying age-related macular degeneration and cataract - or diminishing risk for these debilities. Using extensive epidemiologic and nutritional information from the Nurses' Health Study and Age-Related Eye Disease Study we determined that measures of total carbohydrate, and even more so, glycemic index, are associated with visual health."
I'm not surprised. I have shown you repeatedly that LIVING A HIGH CARB LIFESTYLE will not only kill you, it can make your life a living hell (just look at the list of diseases above). And as for the whole don't-eat-meat-because-it-causes-AGES thing, lets take one last look at what DR ART AYERS of Cooling Inflammation has to say about this in his post called Diabetic Hypertension, Browning of the Arteries. "Should we fear browned foods as inflammatory. I don't think that AGE in foods is any more of a hazard than all of the toxic phytochemicals that are touted as plant antioxidants. I think that the gut and liver provide protection. I brown the sugar on my flans and sear my steaks, even as I relish eating my veggies. The body can detox these natural products in the gut better than it can handle the AGE made by high blood sugars." To see precisely what Ayers is talking about, you can read THIS POST.
The truth is that we have to be worried about dietary AGE consumption causing the high blood levels of AGES that lead to all sorts of sickness, pain, and disease, about as much as we have to worry about eggs or dietary fat making us fat. In a blog comment on Diabetes Forecast (Foods High in AGES), commenter Rehun says it nicely when he states......
"Wow! talk about misinformation! The proof that exogenous AGE's make it into the bloodstream is very dicey. Just like the idea that eggs have cholesterol, therefore we shouldn't eat eggs. Show me the proof that meat, which is protein contributes to AGE's in our bodies. Sugar contributes to AGE's. The AGE's we need to be concerned with are endogenous AGE's, that are created in our bodies when a glucose molecule binds with a protein/lipid molecule without a controlling enzyme. Those AGE's (glycation) become "ugly" molecules sticking to cells throughout our bodies and, with time, create a great deal of damage and disease. Want to lower blood sugar and AGE's? Reduce the carbs and increase protein. Then exercise and look for anti glycation products....they're out there. The idea that AGE's attached to the food we eat causes damage is just like the ridiculous idea that eating fat creates fat in our bodies."
WANT TO GET HEALTHY?
SHOW SOME LOVE TO YOUR MICROBIOME
A TRIBUTE TO "COOLING INFLAMMATION "
Many researchers complain in the biomedical literature that there is insufficient focus on the cause of disease and too much emphasis on the study of the impact of specific drugs on disease symptoms. The result is that in most cases the symptoms are treated and the disease becomes chronic. Of course this also means that the patient is a permanent consumer of health care.
The foundation of all healthcare should be to improve the lifestyle of the patient. Diseases don’t just happen. People are sick because there is something wrong with how they live. Drugs can reduce chronic inflammation, but will also produce additional side effects that will also require interventions. It makes more sense to attack the original causes of inflammation." Dr. Art Ayers --- Cherry-picked from his website, Cooling Inflammation, as are all the quotes in this post.
If you are sick, OVERWEIGHT, DEPRESSED, or struggling with any number of CHRONIC PAIN SYNDROMES, Ayers' blog (COOLING INFLAMMATION) should be at the very top of your short-list of must-read material. The focus of much of Dr. Ayers' work-related and personal research has been the intimate relationship between INFLAMMATION, Gut Flora, and the foods you eat / lifestyle choices you make. If your eyes have not already been opened to this relationship, you'll soon see just how important it really is when it comes to your health.
The chief principle I've gleaned from following Dr. Ayers' site is that our MICROBIOMES are everything; and that everything we eat or are exposed to is either building or destroying them (HERE is a recent example of this). I will warn you, however, that some of his wisdom is rather unconventional. "Hygiene should be minimal, because most people repair damaged gut flora due to antibiotics, for example, by intimate contact with friends and pets. Antimicrobial soaps and sterile home surfaces prevent gut flora repair, because the vast majority of bacteria killed by hygiene are beneficial. Prescription to Repair Gut Flora: Anti-Inflammatory Diet, Soluble Fiber, Fermented Vegetables, Less Hygiene..... keep your tooth brush near the open toilet."
What could possibly make such an educated individual say something that sounds so utterly crazy to the biggest portion of our largely 'germophobic' society? Easy; few people understand the importance of the Microbiome in the ways that ART AYERS does. While it might be true that "Cleanliness is next to Godliness," the extremes that our society has gone to rarely promote optimal health (HERE, HERE, and HERE). Today I want to take you on a short and simplified journey through Gut Health as seen through the eyes of a true expert.
If you are interested in giving your kids a fighting chance in this life; start them out right. What does this entail? For starters, the hope is that it involves a VAGINAL DELIVERY. "If the baby is delivered by Caesarian, then her first gut flora will resemble the nursery staff. If she forces her way out the old fashioned way, her first flora will resemble her mother's vaginal flora." From there, it is critical to either breast feed, or use a milk bank, as formula causes any numbers of problems.
"Milk is a baby's first prebiotic [food source for 'good' bacteria] and a major function of mother's milk is to prevent adult gut bacteria from inflaming a newborn's gut, before the gut is sealed up and a new immune system is developed. Formula..... artificial milk substitutes undermine baby gut flora with tragic results. Formula made from cow's milk or soy is toxic to baby gut flora and even a single bottle of formula can permanently damage it. The only reason that babies can survive formula and the growth of adult gut flora in the first weeks of life, is that the disrupted gut flora is highly inflammatory and the inflamed gut provides some protection from infection. The disastrous impact of formula on gut flora is readily observed in the change to smelly diapers."
Dr. Ayers is leading from the front as he reveals how he and his wife birthed and raised their own children. "My three daughters were all born at home and never used formula -- they started to eat some mashed up food at about six months and continued to nurse for more than two years." Despite this amount of nursing seeming excessive here in America, it is par-for-the-course for a large segment of the world's population. Which brings me to the next big topic --- what should you be eating and feeding your families on a daily basis?
Any time a discussion turns to diet, controversy abounds. It shouldn't. As Dr. Ayers shares through his quote from the top of the page, there is a CHASM / CANYON between what is being published in peer-review, and the recommendations / GUIDELINES put out by physician groups and our government. This is the nature of a large portion of what we erroneously refer to as EVIDENCE-BASED MEDICINE. Fortunately, if you click on the previous link you can see how this hypocrisy is being brought to the public eye via the worldwide web.
Dr. Ayers' anti-inflammatory diet is not much different than the ANTI-INFLAMMATORY DIET that I promote on my site and in my clinic. Control blood sugar via "LOW CARB". Avoid HFCS, TRANS FATS, and VEGETABLE OILS at all costs. Get plenty of high quality SATURATED FATS. Make sure to eat fish or take a QUALITY FISH OIL SUPPLEMENT ("omega-3 supplements are needed to overcome existing inflammation -- take with saturated fats."). Dr. Ayers is not big on taking vitamins because most vitamins can be produced by properly functioning Gut Flora (he correctly considers Vitamin D a hormone).
"Several research studies show that typical multivitamin supplements or the levels of vitamins in 'enriched' foods do not provide improvements in health. Since gut flora produce all of the needed vitamins, this should be no surprise. But why do gut bacteria release vitamins needed for the normal functions of the human body? Vitamins are enzyme cofactors. Bacteria can synthesize all of the vitamins needed for metabolism, but humans can't. Health requires gut biofilms to supply vitamins and control the immune system. Eating vitamins may disrupt normal biofilm formation. All needed vitamins are supplied by healthy gut flora (as biofilm chemical signals) and healthy people do not benefit from multivitamin supplements, but people with damaged gut flora, e.g. because of antibiotic use or autoimmune disease, may require specific vitamins."
In other words, consuming vitamins for the sake of consuming vitamins can, and sometimes does, disrupt normal Gut and BIOFILM function (HERE). The result --- in similar fashion to taking Antibiotics --- is something called DYSBIOSIS; an imbalance in the ratio and types of bacteria living in your Gut. A gross over-simplification would be that Dysbiosis means you have too many bad bacteria and not enough good bacteria. The problem is that "good" bacteria can go 'rogue' and become "bad" when exposed to the environmental or dietary conditions discussed in this post, or if their numbers are outside the proper ratio. The quote also reveals how poor Gut Health can lead to vitamin deficiencies. This is also the reason that when I do recommend vitamins to patients, it is almost always WHOLE-FOOD VITAMINS.
Let's spend a few moments discussing the relationship between things like fiber, grains, and meat. One of the statements that Ayers makes on his site is that, "Most people would be healthier on a celiac diet. The anti-inflammatory diet proposed here for celiacs should be uniformly healthy......" According to Dr. Ayers, however, either a vegan diet or all meat diet can be healthy for you, depending on whether your Microbiome is adapted to handle it properly. "Vegan and paleo extremes can lead to healthy gut flora diversity, if the gut bacterial community is permitted to adjust to the diet composition by avoiding rapid changes and providing diverse bacterial sources. Meat contains complex polysaccharides, e.g. glycosaminoglycans, such as chondroitin sulfate and heparan sulfate proteoglycans, which are bacterial fodder equivalent to soluble fiber." And as far as FIBER is concerned, "Soluble fiber, e.g. pectin in fruit or inulin in leeks or chondroitin in meat, is healthy food for gut flora; but insoluble fiber, such as in whole grains is a scam and just sucks out micronutrients."
In another of his posts, Ayers goes on to say that, "Grains are frequently a problem -- gluten intolerance." In answering a comment on one of his posts, he says that, "I wouldn't agree that grain is fundamental. I think that it has always compromised health, but has become a problem in the presence of so many other inflammatory factors, such as escalating Cesarean births and use of artificial formula. Women are getting pregnant and giving birth at much higher levels of chronic inflammation. Babies are born with higher initial inflammation." At one point in a post against some of Dr. Oz's "questionable" advice (HERE is some I wrote about), Ayers says that, "He also seems to ignore the relationship between grain, antibiotics and autoimmune disease." I wrote about this relationship HERE, and almost blanketly recommend that individuals with AUTOIMMUNE DISEASES (click for a list) at least try a GLUTEN-FREE DIET --- even if they have been told they are NOT CELIAC and don't need it.
Dr. Ayers speaks extensively on his site about one other dietary topic as well --- fermented foods (there is an inexpensive book he recommends --- less than twenty bucks on Amazon). Although he certainly believes that PROBIOTICS have their place, he is not high on milk-based Probiotics --- the majority of the Probiotics on the market today (for years I have recommend HSO's or 'soil-based' Probiotics, or just EATING DIRT). He also happens to be a vocal advocate of FMT --- Fecal Microbiota Transplant (yes, it is exactly what you think it is). If you want to see why Probiotics don't hold a candle to FMT ("Probiotics are unique bacterial species that do not persist in the gut of adults, but dominate the gut of milk eating babies and stimulate development of the gut and immune system."), make sure to take a look at THIS POST.
As you might guess, Dr. Ayers warns us time and time again on his site about the insane numbers of problems that ANTIBIOTICS create in the Guts of babies, children, and adults alike. But he does not stop there. Ayers has at least half a dozen posts dealing with the fact that all drugs have antibiotic-like properties as far as your Gut is concerned (HERE and HERE). There are also the drugs that suppress your ability to kill pathogenic bacteria (for instance, PPI'S or "Heartburn / Reflux Drugs).
Let me end by saying that Dr Ayers is a hero for taking the time to put up mountains of valuable information on his site, and not charging you a nickel for it. You won't find one in a hundred MD's that knows (or is willing to share) what Ayers has revealed about what it takes to raise healthy kids from birth, or how to solve CHRONIC INFLAMMATORY DEGENERATIVE DISEASES / AUTOIMMUNITY at the grass-roots level, by dealing with the ultimate causes of Inflammation. Whether you are a layperson or a Ph.D researcher; are sick and trying to get well, or are simply wanting to keep your family as healthy as possible, "Cooling Inflammation" has something for everyone. Make sure to bookmark his site, and don't forget to browse the comments as well.
"Use olive oil, reduce starch, eat vegetables, eat more fish and less meat, get daily sun, use fish oil supplements, get frequent muscle-building exercise, and stay lean." Dr. Art Ayers from Cooling Inflammation
THE KEY TO STAYING THIN, HEALTHY, AND OUT OF PAIN
In a study published in last month's issue of the Journal of Oral Microbiology (The Commensal Microbiota and the Development of Human Disease - An Introduction), we learn that, "Humans and microorganisms, both exist in a symbiotic or mutualistic relationship. We are colonized by a diverse, resident microbiota, which develop into structurally and functionally organized biofilms. The resident microorganisms gain a secure, warm, nutritious habitat from the host and, in return, contribute to the development of many important host functions. The resident microbiota of each habitat is natural and provides important benefits for the host including immunological priming, down-regulation of excessive pro-inflammatory responses, regulation of gastrointestinal and cardiovascular systems, and prevention of colonization by exogenous microbes." We go on to learn that, "on occasions, this symbiotic relationship breaks down". According to the study, what are the main reasons things fall apart? "Changes in lifestyle, changes in immune status, or following broad spectrum antibiotic therapy."
Think about the implications of the last sentence above for a moment. Most of us are not only far more sedentary than our forefathers, we are FAR CLEANER as well. If you click the link, you will begin to understand how this is not necessarily a good thing. On top of that most of us are eating terrible diets. And as for ANTIBIOTICS, even those people who claim that they "DON'T TAKE MANY" are, if they aren't careful, either fooling themselves, or being exposed VIA THEIR FOOD SUPPLY (and HERE). What are the results of these changes in microbiota? Something called "DYSBIOSIS" --- too many 'bad' bacteria and not enough 'good' (sometimes Dysbiosis is simply an imbalance in the ratio of the various strains of good bacteria). The study goes on to tell us that Dysbiosis is, "associated with a number of clinical disorders such as obesity, allergy, and a variety of inflammatory diseases, including periodontal diseases."
This process of Dysbiosis starts early --- even before you are born, due to mom taking antibiotics while pregnant. Last month's issue of BJOG: An International Journal of Obstetrics and Gynecology carried a study on this very topic called Impact of Maternal Intrapartum Antibiotics, Method of Birth and Breastfeeding on Gut Microbiota During the First Year of Life: A Prospective Cohort Study. In this study, we learned that, "Dysbiosis of the infant gut microbiota may have long-term health consequences. Intrapartum antibiotics in caesarean and vaginal delivery are associated with infant gut microbiota dysbiosis." We already knew that C-SECTIONS are bad for infant microbiota, but as we might guess, the good news is that, "breastfeeding modifies some of these effects." Note that breastfeeding is not an excuse to let doctors give mother or child Antibiotics indiscriminately, as is often the case (HERE).
On top of this, we know that giving infants antibiotics really screws them up --- often times for the rest of their lives (HERE and HERE are a couple of examples of this). A study from last month's issue of Nature Communications on psoriasis --- an AUTOIMMUNE DISEASE ---- confirms this via its title; Antibiotics in Neonatal Life Increase Murine Susceptibility to Experimental Psoriasis. Not only will you find this true with just about any of the thousands of Autoimmune Diseases you might choose to do a similar experiment on, but the latest issue of the Journal of the American Medical Association (Another Frontier in Microbiome Research: Preterm Birth) is saying that, "a woman’s vaginal microbiome during pregnancy interacts with other factors, such as obesity, inflammation, and host genetics, in relation to preterm birth." In other words, mothers who take antibiotics are putting their yet unborn infants at risk in any number of ways.
SUGAR AND LEAKY GUT SYNDROME PROPAGATE THE PROCESS
"AGEs have been implicated in the pathogenesis of diabetes-related complications and several chronic diseases via.... inflammation." Although several pathways for this are discussed in the paper, one of them is, "changes in gut microbiota profile". The authors go on to say that, "In animal models, restriction of dietary AGEs attenuates [decreases / suppresses] chronic low-grade inflammation." Great, but how do the authors of this study suggest solving the problem? Easy; LOW CARB DIETS ("dietary AGE restriction as a therapeutic strategy for the attenuation of chronic diseases..."). HERE are the reasons that I go one step further and suggest you at least think about doing a Paleo Diet if you have any sort of health or CHRONIC PAIN issues.
Interestingly enough, just last week, the journal Diabetes published the transcript of the American Diabetes Association and JDRF Research Symposium: Diabetes and the Microbiome (HERE is the complete article). Both forms of DIABETES (Type I is Autoimmune, and Type II is 100% a lifestyle issue) are associated with Gut Flora / Microbiome. Not only have I already shown you this (HERE), but this group of about 100 specialists in their field revealed what you may have already guessed. "Changes in environmental conditions, such as diet, hygiene, antibiotic use, and other medical practices, can be correlated with the growth of these diseases. Such factors may be influencing the composition and function of the microbiome in ways that significantly impact the immune and metabolic systems, contributing to the increased risk for these diseases." The truth is, much of this can be found in studies I have covered over the past several years (HERE are a bunch of them). But the hits keep coming --- and Leaky Gut Syndrome is one of the biggest and most vicious.
Despite decades of decrying the existence of LEAKY GUT SYNDROME (Increased Intestinal Permeability / Intestinal Barrier Dysfunction), the medical community at large is being forced to come to grips with this common, debilitating, and not-nearly-discussed-enough problem. Playing the "Ostrich Game" is no longer an option. Not only does the previous link reveal this, but so does brand new research from The Journal of Alternative Wackiness and Weird but Cool Natural Cures. Actually I made that up to see if you were sleeping. The August issue of Future Microbiolgy (Gut Permeability, its Interaction with Gut Microflora and Effects on Metabolic Health......) had some interesting conclusions in its abstract.
"There is evidence to link obesity (and metabolic syndrome) with alterations in gut permeability and microbiota. We propose that the gut barrier function is a primary driver in maintaining metabolic health with poor health being linked to 'gut leakiness'. This review will highlight changes in intestinal permeability and how it may change gut microflora and subsequently affect metabolic health by influencing the functioning of major bodily organs/organ systems: the lymphatic system, liver and pancreas. We also discuss the likelihood that metabolic syndrome undergoes a cyclic worsening facilitated by an increase in intestinal permeability leading to gut dysbiosis, culminating in ongoing poor health leading to further exacerbated gut leakiness."
Did you catch that? Seventy years ago, men like DR. ROYAL LEE were crucified for saying this. Just ten short years ago people like DR. GORSKI would have written a column calling you a quack, and had you investigated by the FDA. But there it is in black and white folks; a study written by seven doctors and published in one of the profession's most prestigious journals (it's Australian). It's why the natural healers of generations gone by had a simple principle for helping their patients get well with any number of chronic health issues --- Heal the Gut, Heal the Body. And in case you need any more confirmation, here it is.
The May issue of the Journal of Clinical and Experimental Pathology (Abnormal Intestinal Permeability and Microbiota in Patients with Autoimmune Hepatitis) had some intriguing conclusions in light of everything we've learned today about LGS, Microbiome, and Autoimmunity. "Autoimmune hepatitis is associated with leaky gut and intestinal microbiome dysbiosis." No muss. No fuss. Simple and straight to the point. Isn't it interesting how your doctor just keeps running the same old tests, and telling you the same old junk --- "Sorry; we don't know what's causing your problem Mrs. Jones." --- all the while continuing to ply you with Antibiotics and NON-ANTIBIOTIC MEDS WITH ANTIBIOTIC PROPERTIES (or HERE), and never mentioning some of the dietary changes that might actually solve your problem. But then again, if you SOLVED YOUR PROBLEMS THROUGH DIET AND LIFESTYLE, a lot of people would be out of a job!
NEUROLOGICAL AND IMMUNE SYSTEM IMPLICATIONS OF POOR GUT HEALTH
"Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS) are neurodegenerative diseases with pathophysiology that may be related to the gastrointestinal tract. It is well established that tissue barriers maintain homeostasis and health. Furthermore, gut microbiota may have an impact on brain activity through the gut-microbiota-brain axis under both physiological and pathological conditions. In this review, we highlight the current knowledge regarding the role of gut microbiota and tissue barriers in PD and ALS."
MULTIPLE SCLEROSIS did not fare any better in studies published in last month's issues of PLoS One and Neurologia (a Spanish journal) respectively. The first study (Role of Intestinal Microbiota in the Development of Multiple Sclerosis) stated something we already knew (see link), "Multiple sclerosis affects young adults; in that age group, it represents the second leading cause of disability in our setting. It is widely accepted to occur in genetically predisposed patients who are exposed to certain environmental factors. The discovery of the regulatory role played by intestinal microbiota in various autoimmune diseases has opened a new line of research in this field. Multiple evidence points to the role of microbiota......" This, folks, is epigenetics in action. The second (Dysbiosis in the Gut Microbiota of Patients with Multiple Sclerosis, with a Striking Depletion of Species) took this idea one step farther, revealing that the guts of people with MS are so dysbiotic that, "Correcting the dysbiosis and altered gut microbiota might deserve consideration as a potential strategy for the prevention and treatment of MS." Read this sentence again, and let the magnitude of what it is saying sink in.
There is a massive amount of research directly tying DEPRESSION to Dysbiosis (HERE is one of those studies). The latest issue of Cellular Physiology and Biochemistry (Nutritional Aspects of Depression) was frankly shocking in the stupidity of its conclusions. The abstract started by actually discussing "nutrition" ---- certain foods that are probably beneficial for those struggling with Depression, "olive oil, fish, fruits, vegetables, nuts, legumes, poultry, dairy and unprocessed meat." I can buy most of these (legumes and dairy are up for debate). However, the way the medical community thinks can be downright scary. A few sentences later, they tell us about some of the drugs that are showing, "a certain potential to treat depression." These include things like, "pioglitazone, metformin, exenatide, atorvastatin, gram-negative antibiotics."
In other words, even though the medical community wants to pay lip-service to nutrition, what they are really promoting in this study is not nutrition, but drugs. According to them, what you should do to treat Depression is use ANTI-DIABETIC DRUGS, STATINS, and worst of all, Antibiotics. Can we just forget about the symptoms for just a moment? How about we deal with the underlying Dysbiosis / Inflammation? All drugs --- but especially antibiotics --- foul the microbiome (see my earlier links). Sure, these drugs might make some short-term differences, but over the long haul they must, by their very nature, make the underlying cause of the Depression worse. In fact, the August issue of the medical journal Nutritional Review (Microbiota and the Gut-Brain Axis) confirms this by saying that, "alterations to the balance and content of common gut microbes may affect the production of molecules such as neurotransmitters." These would be things like SEROTONIN and DOPAMINE.
OTHER COMMON DISEASE PROCESSES ASSOCIATED WITH POOR GUT HEALTH
This next study shows us THE LINK BETWEEN GLUTEN AND AUTOIMMUNITY --- something that has been known for at least eighty years, but is rarely talked about today by treating physicians. "Rheumatoid arthritis (RA) and celiac disease (CD) belong to the autoimmune disease family. Despite being separate entities they share multiple aspects. At the clinical level, celiac disease exhibits extra-intestinal rheumatic manifestations and RA gastrointestinal ones. Small bowel pathology exists in rheumatic patients. The infectious, dysbiotic and increased intestinal permeability theories, as drivers of the autoimmune cascade, apply to both diseases. A trend towards responsiveness to a gluten free diet has been observed, ameliorating celiac rheumatic manifestations..... Recently, light was shed on the interaction between host genetics and microbiota composition in relation to CD and RA susceptibility, connecting bugs and autoimmunity." Once you understand how intimately Celiac Disease and NON-CELIAC GLUTEN SENSITIVITY are related to each other, you'll start to grasp how important this concept is in your recovery (or health-maintainence) process.
Incidence of ASTHMA has exploded in industrialized areas of the world. Although there are many reasons for this, one of the biggest has to to with --- you guessed it --- poor Gut Health. Just last week, Science Translational Medicine published a study called Early Infancy Microbial and Metabolic Alterations Affect Risk of Childhood Asthma. Although the conclusions certainly aren't new (HERE), we are warned once again that, "Asthma is the most prevalent pediatric chronic disease and affects more than 300 million people worldwide. Infants at risk of asthma exhibited gut microbial dysbiosis during the first 100 days of life." The asthmatic mice in this experiment were given a very specific four-strain injection of bacteria into their Guts, which solved their problem.
There are so many studies on ALLERGIES AND MICROBIOME, I could write a book. However, I will leave you with only one (Microbiome Influences on Allergy in Mice and Humans), which was published in a recent issue of Current Opinions in Immunology. In it the authors stated, "The microbiota plays a pivotal role in the development and calibration of host immunity. Over many millennia, finely balanced interactions between the microbiota and host have evolved, imparting metabolic advantages and protection against pathogens, while restricting deleterious immune responses against innocuous antigens. Perturbations in host-microbiota crosstalk at critical developmental windows in early life may underlie allergy and chronic inflammation. In this article, we provide a summary of the development of the microbiota in early life, and describe the evidence from studies of how microbial dysbiosis in early life can alter the trajectory of immune development and provide the setting for allergic disorders in later life." Other than the fact that it touts EVOLUTION, it's a great summary of why you and your family have allergies.
Just last month, a Polish journal which I am not going to try and type, let alone pronounce, published a study called The Microbiome and Dermatological Diseases. In this study, they concluded that, "The human skin harbors hundreds of species of commensal organisms, collectively known as the skin microbiota. The composition of the microbiota can be modified by various factors, such as host genotype, diet, antibiotics, hygiene, and pathogen infections, among others. Changes in these factors can cause microbiome disruption known as dysbiosis, leading to the outgrowth of potential pathogenic bacteria or a decrease in the number of beneficial bacteria. Dysbiosis has been implicated in some dermatological diseases." This is another reason that holding your baby before you shower is a big deal. If you want more information about THE RELATIONSHIP BETWEEN GUT HEALTH AND HEALTHY SKIN, just click the link.
There were so many studies on Atopic Dermatitis (Eczema) and Gut Health that I am not going to mention any specifically. I bring it up because nearly one third of American children deal with varying degrees of this problem (I regularly dealt with this as a kid). Click the link above if you are interested, or go to PubMed and do your own research.
I actually found two different studies showing that HIGH BLOOD PRESSURE (Hypertension) is intimately linked to Dysbiosis and poor Gut Health. In the first, published in Physilogical Genomics (Historical Perspective: Gut Dysbiosis and Hypertension), we learn that, "Mechanisms for hypertension other than steroid metabolism may be influenced by gut dysbiosis. A number of studies over the past 30 years (the original work in 1981) have suggested a role for the gut microbiome in the development of hypertension in rats and man." Did you catch that? Scientists have known about the High Blood Pressure / Dysbiosis link since I was in junior high. But have you heard about it before this?
The second study, published in the June issue of the American Heart Association's Journal of Hypertension (Hypertensive Patients Exhibit Gut Dysbiosis and an Increase in TH-17 Cells) is frankly shocking. Not only do we learn what we did in the previous paragraph ("these observations suggest that gut microbial dysbiosis plays a key role in Hypertension and the establishment of a systemic proinflammatory status... Thus, restoring the gut microbial balance could be a novel therapeutic strategy for the treatment of Hyopertension."), but it delves into the TH-17 system as well. I am not going to get into this now, but if you have any of THESE Autoimmune Disease (or any others for that matter), just remember that having a cursory understanding of the TH-17 system is critical because it regulates your body's "Self Destruct" center (CELLULAR APOPTOSIS).
DIAGNOSIS AND TREATMENT OF DYSBIOSIS
HEALING A SICK GUT
Of course, PROBIOTICS are being used to treat any number of these (inflammatory) problems. Some of the specific problems mentioned in the latest peer-review includes......
- OSTEOPOROSIS: Because it is one of the myriad of problems based on Inflammation (aren't they all?), OSTEOPOROSIS is being tackled with Probiotics, as seen in the issue of Current Osteoporosis Reports that came out just last week (Prebiotic and Probiotic Regulation of Bone Health: Role of the Intestine and its Microbiome). "Bone is an organ that the gut has long been known to regulate through absorption of calcium, the key bone mineral. However, it is clear that modulation of the gut and its microbiome can affect bone density and strength in a variety of animal models and humans." Remember that Osteoporosis is an Inflammatory problem (HERE).
- H. PYLORI AND ULCERS: Another one of those 'dirty-little-secrets' that alternative practitioners have known for the better part of a century, but that mainstream is just figuring out, has to do with H. Pylori infections, which are the known cause of gastritis, stomach ulcers, and a common brand of Dysbiosis. The current issue of Heliobacter (The Effect of Probiotics on Gut Microbiota during the Helicobacter Pylori Eradication: Randomized Controlled Trial) has this to say. "Helicobacter pylori causes chronic gastritis, gastroduodenal ulcers, and gastric cancer, and has been treated with two antibiotics (amoxicillin and clarithromycin) and proton-pump inhibitors (PPIs). However, antibiotic treatment alters the indigenous gut microbiota to cause side effects [so do the PPI's]. Probiotic supplementation can reduce the antibiotic-induced alteration and imbalance of the gut microbiota composition. This effect may restrict the growth of antibiotic-resistant bacteria in the gut and improve the H. pylori eradication success rate."
- IRRITABLE BOWEL SYNDROME: IBS is one of the more common of the Autoimmune Diseases. A study in last month's issue of the Journal of Biochemistry and Nutrition (Effect of Administering a Multi-Species Probiotic Mixture on the Changes in Fecal Microbiota and Symptoms of Irritable Bowel Syndrome) said this; "A 4-week administration of multi-species probiotic mixture significantly increased the fecal concentration of most probiotic strains and improved diarrhea-symptom scores in IBS patients."
- OBESITY: Although I have talked about this one any number of times (HERE is one), there are dozens --- maybe hundreds --- of studies linking OBESITY to fouled up Gut Flora (Dysbiosis). One of the most interesting has to do with why people actually gain more weight drinking diet soda than regular soda (HERE). The July issue of EBioMedicine (Dietary Modulation of Gut Microbiota Contributes to Alleviation of Both Genetic and Simple Obesity in Children) said that, "We found that children genetically obese with Prader-Willi syndrome shared a similar dysbiosis in their gut microbiota with those having diet-related obesity. A diet rich in non-digestible but fermentable carbohydrates significantly promoted beneficial groups of bacteria and reduced toxin-producers, which contributes to the alleviation of metabolic deteriorations in obesity regardless of the primary driving forces."
This is all well and good, but the question that I realize is on everyone's mind has to do with treatment beyond Probiotics. What are people doing to dramatically improve their health other than simply taking Probiotics? I ask this because if curing chronic conditions were as easy to fix as just taking a pill (whether prescription or Probiotic) solutions would be easy. It's not, and HERE'S WHY. As you can see from the previous paragraph, there needs to be some serious change of lifestyle take place.
Numerous studies talk about how to get started with dietary changes such as the July and August issues of EBioMedicine, which published research with clever / catchy names like Getting Healthier Through Microbiome Makeover and You Lose Some, You Win Some: Weight Loss Induces Microbiota and Metabolite Shifts. The bottom line is that you had better change your diet if you want to conquer your demons.
The September issue of Current Opinions in Gastroenterology (Reciprocal Interaction of Diet and Microbiome in Inflammatory Bowel Diseases) bears this out when it says that, "long-term dietary habits have profound effects on composition and function [of the Microbiome] eventually leading to dysbiosis. The available cohort-studies establish associative relationships between microbiota changes and disease." You either eat a healthy diet, or expect to die young, while living an 'inflamed' life; suffering through your life and dying early (take the INFLAMMATION QUIZ to find out if you are inflamed).
Changing your diet is great, but it is important to make sure that you are properly feeding your good bacteria. What do they eat? The bad guys eat sugar, and the good guys live on FIBER. Research that was published just two short weeks ago in Current Opinion in Clinical Nutrition and Metabolic Care (Resistant Starches for the Management of Metabolic Diseases) went even farther. "Data clearly supports a role for resistant starches in improving a variety of metabolic features. The studies presented in this review offer new insights into the potential pathways by which resistant starches enhance metabolic health, including modulation of the gut microbiota, gut peptides, circulating inflammatory mediators, innate immune cells, and the bile acid cycle."
The other potential solution that I would like to suggest you do some research on is FMT (Fecal Microbiota Transplant). No; I am not advocating you DO THIS AT HOME, as that would go against my license to practice here in Missouri. Just realize that with everything you have learned about the importance of Gut Health and a sturdy and diverse Microbiome as it relates to sickness and disease should at least intrigue you just a little --- especially if you are struggling in the 'health' department.
Another of those impossible-to-spell Polish medical journals published a study a few weeks ago called Fecal Microbiota Transplantation in Gastrointestinal Diseases: What Practicing Physicians Should Know. This study revealed that, "The use of FMT for non-CDI [C. Diff] indications such as inflammatory bowel disease and irritable bowel syndrome, is likely to increase." That's because not only does it work, but if you look at my links above, you'll see just how safe and effective this treatment really is for a wide variety of health-related issues.
Just one short week ago, the journal Expert Review of Gastroenterology and Hepatology (Fecal Microbiota Transplantation in Gastrointestinal Disease: 2015 Update and the Road Ahead) chimed in with their two cents. "At its height, the Clostridium difficile infection epidemic caused approximately 7000 infections and 300 deaths per day in the USA. Fecal microbiota transplantation (FMT) has demonstrated extraordinary clinical resolution, C. difficile infection cure rates of over 90%, and low recurrence. In tandem with the rise of FMT, the gastrointestinal microbiome has emerged as a 'vital' organ armed with a wealth of microbe 'soldiers' more powerful than known antibiotics. FMTs' reputation has diffused into many new 'indications' yet these appear to be merely the tip of the iceberg when considering its potential applications." Forget C. Diff people. The new frontier in treatment of chronic conditions is FMT ---- something being touted by a growing segment of the scientific community in the Western world.
One more thing I want to mention further before I close --- the relationship between SCAR TISSUE (the medical community refers to this as "Fibrosis") and Inflammation (HERE is a great article for you). Although we talked today about the relationship between Gut Flora, Inflammation, and chronic organic (organ-based) health issues, we could just as easily be talking about MUSCULOSKELETAL PROBLEMS. I would bet my bottom dollar that if you did the research, you would find that dysbiotic Gut Flora is intimately related to Scar Tissue.
Again; why aren't more doctors talking about this information. After all, even though 90% of the research I wrote this post from was published in the last 6 to 8 weeks, most of it has been around long enough that doctors can no longer plead ignorance, or the fact that they don't believe in "alternative" healthcare. The excuse that, "there's not enough research," no longer rings true --- and hasn't for years; maybe decades. It's time for the medical community to remove their collective heads from the sand, wipe the grit from their eyes, and start telling their patients the truth ---- about everything --- all of it. This final study reveals why you won't see it happening any time soon.
The two week old edition of Current Opinions in Pharmacology (Neuroimmune Pharmacological Approaches) helps pull back the curtain and reveal the cold hard facts --- that the great and powerful Oz is really just a tired old man frantically working the controls of a machine that's being used for one purpose and one purpose only --- to fool people into doing his bidding. Listen to the study's fantastic abstract --- but pay special attention to the last sentence.
"Intestinal inflammation is a major health problem which impairs the quality of life, impacts mental health and is exacerbated by stress and psychiatric disturbances which, in turn, can affect disease prognosis and response to treatment. Accumulating evidence indicates that the immune system is an important interface between intestinal inflammation and the enteric, sensory, central and autonomic nervous systems. In addition, the neuroimmune interactions originating from the gastrointestinal tract are orchestrated by the gut microbiota. This article reviews some major insights into this complex homeostatic network that have been achieved during the past two years and attempts to put these advances into perspective with novel opportunities of pharmacological intervention."
Did you catch it? It's not about helping you get better. It's about the PHARMACEUTICAL INDUSTRY and FDA creating new "interventions" --- this is secret code for 'drugs'. There's no money in educating people how to change their diet --- or having them improve to the point they are able to get off 10 of the 12 prescription meds they are on. However, there is big money in creating, marketing, and selling drugs --- especially drugs with the potential to change so many areas of one's physiology and life. As always, your health is largely up to you. TAKE THE BULL BY THE HORNS AND CHANGE YOUR LIFE --- today.
FASCIA RESEARCH: WHAT'S NEW?
After years of practice and a great deal of study with pioneers like Ida Rolf and DR. LEON CHAITOW, Meyer began to notice very specific structural and functional patterns in MUSCLES and FASCIA, leading him to develop what he coined as Anatomy Trains --- meridians of connective tissue that create, "a unique map of the ‘anatomy of connection’ – whole-body fascial and myofascial linkages. The Anatomy Trains concept joins individual muscles into functional complexes within fascial planes – each with a defined anatomy and ‘meaning’ in human movement." It's difficult to argue with the clinical results Meyer has achieved using his technique (the Steccos have taken this concept a step farther, correlating these meridians to acupuncture points and meridians). The only question that remained was whether or not his ideas could be proven.
About six weeks ago, the August issue of Archives of Physical Medicine and Rehabilitation answered this question with a study called What is Evidence-Based About Myofascial Chains? A Systematic Review. The authors ---- a group of four researchers (MD / Ph.D types) from the Department of Sports Medicine at Frankfurt Germany's Goethe University --- came to some interesting conclusions.
"The studies reviewed suggest strong evidence for the existence of three myofascial meridians: the superficial back line (all three transitions verified, based on 14 studies), the back functional line (all three transitions verified, 8 studies) and the front functional line (both transitions verified, 6 studies). Moderate to strong evidence is available for parts of the spiral line (five of nine verified transitions, 21 studies) and the lateral line (two of five verified transitions, 10 studies)....."
Another study, this one from last month's issue of Evidence-Based Complimentary and Alternative Medicine (Understanding Fibroblasts in Order to Comprehend the Osteopathic Treatment of the Fascia), built on something I have spent time writing about as of late --- something that is critically necessary for healing to take place; FIBROBLASTIC ACTIVITY. Although I believe you could benefit from reading this study in its entirety (it contains much of what I HAVE TALKED ABOUT IN THE PAST), their conclusions were as follows;
"The fibroblasts represent the foundation of the fascial system, a structure of connective tissue that covers and affects every body area. These cells have many properties, including the ability to contract themselves and to communicate with one another. They play a key role in the transmission of the tension produced by the muscles and in the management of the interstitial fluids. They are a source of nociceptive and proprioceptive information as well, which is useful for proper functioning of the body system."
We've known for quite some time that in order for soft tissues such as LIGAMENTS, TENDONS, FASCIA, and Muscles to heal after SPORTS INJURIES, MOTOR VEHICLE ACCIDENTS, ABUSE, DENSIFICATION, or various work-related injuries, the tissue must be mobilized (the medical community calls this TISSUE DEFORMATION) and restored to normal function, or as close to normal function as is humanly possible. This can be hindered by any number of complicating factors, including both INFLAMMATION and SCAR TISSUE (two subjects that are much more INTIMATELY RELATED TO EACH OTHER than most people realize).
The August issue of Manual Therapy carried a study on this topic called The Effectiveness of Soft-Tissue Therapy for the Management of Musculoskeletal Disorders and Injuries of the Upper and Lower Extremities: A Systematic Review by the Ontario Protocol for Traffic Injury Management Collaboration. Fourteen researchers poured over the past century's scientific literature, coming to some interesting 'cherry picked' conclusions.
"We screened 9869 articles.... Movement re-education (contraction / passive stretching) provides better long-term benefit than corticosteroid injection for lateral epicondylitis. Myofascial release improves outcomes compared to sham ultrasound for lateral epicondylitis. Trigger point therapy to the gastrocnemius, soleus and plantar fascia is effective for Plantar Fasciitis."
One of the things I have learned is that doctors routinely over-estimate that success rates of their treatment. I well remember once, when trying to find out the actually success rates of various kinds of SPINAL SURGERY; instead of finding research when I Googled "Spinal Surgery Success Rates," I kept running into doctor's claims on their websites. Most of these sites were touting at least 80% success rates, with many touting 90%. The problem is that no one who knows anything at all about back surgery believes it has a success rate approaching 80% --- especially over the long haul. It seems that the same thing is likely true when it comes to PLANTAR FASCIITIS.
Last month's issue of Foot and Ankle International (Long-Term Outcome of Open Plantar Fascia Release) concluded that even though, "Partial plantar fascial release is reported to have a short-term success rate of up to 80%," the authors published this study because, "anecdotally this was not thought to represent our local experience." Although the procedure was shown to be effective some of the time, the authors concluded that, "A prolonged recovery period and generally poor outcomes leads the authors to suggest that open plantar fascia release is of questionable clinical value and that patients may improve in the natural course of the disease, in spite of surgery." They also had some interesting comments concerning Corticosteroid Injections.
I have been a 'harpie' on CORTICOSTEROID INJECTIONS for the duration of my decades in practice. This is because while nothing is more powerful as far as relieving the "ITIS" (inflammation) of Plantar Fasiciitis, nothing has more or worse side-effects --- side-effects that we know from the peer-reviewed scientific literature are UNDER-REPORTED BY AT LEAST 90%. In fact, if you click on the first link in this paragraph, you will see that this class of drugs is not recommended by the standard-of-care guidelines a fraction as much as it is actually used. Not only did the study mentioned above bear this out ("The authors also found worse outcomes with preoperative steroid injections"), but we see the same thing in another new study as well.
The Singapore Medical Journal published a study in it's August issue called The Effectiveness of Corticosteroid Injection in the Treatment of Plantar Fasciitis. To answer the rhetorical question posed by the study's title; they aren't. In this meta-analysis of many studies, the authors determined that, "it is evident from these studies that the effects of corticosteroid injections are usually short-term.... Many [doctors] are concerned about the potential complications associated with this treatment modality, which may offset its benefits." The problem with Corticosteroid Injections for any sort of musculoskeltal problem is that you are essentially trading tomorrow for today (short-term relief, for long-term tendon and connective tissue destruction). This is because this class of drug is a known degenerator of tendons and other COLLAGEN-BASED CONNECTIVE TISSUES.
Although the worst of the mentioned complications of these injections was total rupture of the tendon (plantar fascia rupture), one of the problems the authors brought up was extremely intriguing --- especially in light of what I have shared with you about the debate over TENDINOSIS -vs- TENDINITIS.
"Plantar fasciitis is used to describe heel pain caused by an inflammation of the plantar fascia. This could result from a... tear in the plantar fascia or damage from repetitive microtraumas. Plantar Fasciosis describes the degenerative, non-inflamed phase of plantar fasciopathy. It arises from degenerative processes affecting the junction between the periosteal (calcaneus) and the ligament attachment (plantar fascia)."
In plain English, the PERIOSTEUM (fascial membrane that surrounds bone) becomes aggravated by chronic mechanical stress, not necessarily causing "itis" (Inflammation) as has always been taught, but instead causing "osis" (Degeneration). Because the underlying cause of the problem is mechanical and not inflammatory, the injections or NSAIDS prescribed will either not work at all, or they won't work for very long --- something we have seen over and over and over again in peer-review; even though doctors continue to insist on said treatment. "The recommendation of corticosteroid injections as a tier 1 treatment option by the American College of Foot and Ankle Surgeons was met with much skepticism and raised certain controversial issues."
If you are interested in regaining your health and getting out of pain, whether caused by Fascia or some other chronic issue, one of the best resources on the web can be found HERE.
TENDINITIS OR TENDINOSIS?
IT DOESN'T MATTER WHEN IT COMES TO ICD-10
"Tendinosis, is damage to a tendon at a cellular level (the suffix "osis" implies a pathology of chronic degeneration without inflammation). It is thought to be caused by microtears in the connective tissue in and around the tendon, leading to an increase in tendon repair cells. This may lead to reduced tensile strength, thus increasing the chance of tendon rupture. Tendinosis is often misdiagnosed as tendinitis due to the limited understanding of tendinopathies by the medical community. The term tendinitis should be reserved for tendon injuries that involve larger-scale acute injuries accompanied by inflammation." From Wikipedia's listing for Tendinosis
For instance, there is a code (V97.29) for your local airport's luggage cart driver being sucked into a jet engine -- without any damage to the aircraft. And if the driver happens to be a male under 5'5", slightly balding, and wearing a tank top, who got sucked into said engine during a full moon, we can code for that too (V97.29&A#gE). It's not all bad, as there are actually a few good codes to describe FASCIAL ADHESIONS. However, there is a major problem with the codes that describe Tendinosis.
Despite huge amounts of research showing that Tendinitis is either rare or does not exist at all (HERE), it is the only diagnosis I find when searching for the proper ICD-10 codes. I can find hundreds of diagnosis for all kinds of Tendinitis, but none --- not a single solitary one ---- for any form of Tendinosis. Is this a big deal, or am I making a mountain out of a mole hill? Let's answer that by creating a chart concerning three things we know about Tendinitis, Tendinosis, and the treatment thereof.
- A.) If you read the quotes from the top of the page, or take a quick glance at the link above (or THIS ONE), you quickly realize that not only is Tendinitis rare, there is actually some debate about whether or not it even exists at all (in other words, some experts believe that everything we are diagnosing as Tendinitis is actually Tendinosis).
- B.) After looking on any number of websites (my favorite was ICD-10 Data), the ICD-10 Chirocode Book, as well as notes / materials from Drs. Ron Short, Gary Street, and Evan Gwilliam, I can't find any diagnosis information on Tendinopathy, let alone Tendinosis. However, I can find hundreds upon hundreds of listings for Tendinitis and Tenosynovitis (an inflammation of the sheath surrounding the tendon).
- C.) The suffix 'itis' means that the problem is based on INFLAMMATION, while the suffix 'osis' indicates that the tendon has become frayed, weakened, and microscopically deranged. In order to fix a Tendinosis, you had better be about the business of doing something to INCREASE FIBROBLASTIC ACTIVITY. In order to effectively treat true Tendinitis, you need to diminish Inflammation (HERE is how I suggest to do that). How do medical doctors typically accomplish this? Although they commonly go all-in by prescribing the "BIG FIVE" ---- especially for people with SYSTEMIC TENDON ISSUES they don't really understand --- they are almost surely going to prescribe CORTICOSTEROIDS and NSAIDS. If you click the links, you'll see that not only are these drugs well known for their brutal side effects, but the 'Standards of Care' that are supposed to guide their use actually recommend against using them for tendon problems (see link on corticosteroids directly above). This is unfortunate for patients who wind up being treated 180 opposite the most current EVIDENCE-BASED guidelines.
So, while I can put down a code that says you were struck by a turtle (W5922XA), are having problems with your in-laws (Z63.1), fell into a bucket of water and drowned (W16.221), have a bizarre personal appearance (R46.1) and were injured while doing arts and crafts (Y93.D), were seriously burned when your water skis caught fire (V91.07XD), had an injurious collision with a spacecraft (W22.02XD: V95.43XS), or suffered a non-venomous insect bite on your anus (S30.867) while attending the opera (Y92.253), I am forced to use Tendinitis codes that were outdated two decades ago to describe my patient's Tendinosis.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
Brain Based Therapy
Can You Help
Cardio Or Strength
Cold Laser Therapy
Death By Medicine
Degenerative Joint Disease
D's Of Chronic Pain
Evidence Based Medicine
Gluten Cross Reactivity
Ice Or Heat
Jacks Fork River
Leaky Gut Syndrome
Number One Health Problem
Platelet Rich Therapy
Post Surgical Scarring
Re Invent Yourself
Rib And Chest Pain
Scar Tissue Removal
Sleeping Pills Kill
Stay Or Go
Stretching Post Treatment
Tensegrity And Fascia
The Big Four
Thoracic Outlet Syndrome
Whole Body Vibration