Help for your arthritic patients

Help for your arthritic patients
July 2006
By Shari Lieberman, PhD
Chiropractic Economics

When your patients complain about their osteoarthritic aches and pains, what do you recommend to them? Are there natural alternatives to make them feel better?

Since prescription drugs such as Vioxx and Bextra have been removed from the market, there is clearly a need for safer pain relievers, especially ones that can be used long-term.

The problem is that many non-steroidal anti-inflammatory drugs (NSAIDs) significantly increase the risk of heart attacks. Vioxx alone reported it was responsible for the deaths of at least 27,000 people. Recent analyses and actions by the Food and Drug Administration (FDA) have now broadened the concern to this entire class of drugs, which includes ibuprofen, naproxen, diclofenac, etodolac, and Mobic, as well as nonprescription versions of some NSAIDs, most notably ibuprofen (Advil) and naproxen (Aleve).

In addition to the increased risk of heart attack, the long-term use of these drugs may possibly cause ulcers and potentially fatal gastric bleeding.

While aspirin is also an NSAID and is often prescribed to reduce the risk of heart attacks in addition to its use for inflammation and pain, it also has been linked to adverse events, including gastric bleeding. Even low-dose aspirin is associated with gastrointestinal bleeding. In fact, approximately 107,000 people have been hospitalized for gastrointestinal bleeding due to NSAID use and at least 16,500 people have died as a consequence of NSAID use.

Even the best selling over-the-counter pain reliever, acetaminophen (Tylenol) presents a problem. It has become the second leading cause of toxic drug ingestion in the United States, including one of the leading causes of liver toxicity and is increasingly a common cause of liver failure.

Recent studies have shown that even the recommended use of drugs such as Tylenol and ibuprofen can greatly increase the risk of hypertension when used long term. (See sidebar, ÏAcetaminophen raises blood pressure.Ó)

Our ancestors did not suffer from the same types of aches and pains that we do. One reason is because of their diet.

They consumed a diet rich in natural anti-inflammatories. Their diet consisted of foods having a ratio of 1:1 or 2:1 of omega-6 to omega-3 fatty acids. (Omega-3 fatty acids are natural anti-inflammatories.)

Our diet? We now eat a diet that has an omega-6 to omega-3 ratio of approximately 30:1! As a consequence of our diet, most of us are walking around in a state of chronic inflammation.

It isnÌt that all inflammation is bad. Inflammation signals our immune system to do its job and heal. However, chronic inflammation causes the opposite to occur. Instead of creating healing, chronic inflammation impedes it.

Instead of helping the immune system to work, chronic inflammation either over-stimulates it or exhausts it so it can no longer be effective. With chronic inflammation our immune system thinks it is under constant attack.

When your patients present with chronic inflammation, what can you advise?

1. Change their diet. The change should reduce omega-6 and increase omega-3 intake. Eat more fatty fish, such as Alaskan salmon, which is high in omega-3 fatty acids, eicosapen-taenoic acid, and docosahexaenoic acid; include flax seed in their diet; and snack on walnuts.

2. Take a fatty-acid supplement daily. A good recom-mendation is 2 or 3 grams of fish oil.

3. Increase mineral intake. Consuming mineral-rich foods is extremely important. Minerals such as calcium, magnesium, zinc, selenium, boron, and manganese play a crucial role in regulating tissue repair and inflammation.

Unfortunately, the diet people eat today is based on processed grains, especially wheat. When whole grains are processed into white flour, 70 percent to 90 percent of essential minerals are removed. (Processing of grains also removes other nutrients, such as vitamins and antioxidants.) Although food manufacturers enrich the flour, only a handful of B-vitamins and iron are replaced.

Advise your patients to take a multi-mineral supplement. And if they have persistent arthritic pain, take a mineral supplement specific for this type of pain, such as a mineral complex from the Sierra Mountains.

This mineral complex has a naturally low pH of about 3.5, which facilitates fast ionization and absorption. And it reduces matrix metalloproteinases (MMP) enzymes.

The job of the MMPs is to ÏeatÓ or ÏcleanupÓ joint debris. While this is necessary when inflammation first occurs, if MMPs continue and are not down regulated, they will not stop their job even when they are done; they will continue to ÏeatÓ even the healthy joint tissue. When MMPs are down-regulated, joint repair can proceed.

The mineral complex has been tested in a double-blind placebo controlled study that shows it significantly reduced pain in patients with osteoarthritis.

4. Take vitamin D. Vitamin D is essential for the absorption and utilization of calcium. It is also essential for immune function, bone health, and joint health. Lower intakes of vitamin D predispose us to both rheumatoid and osteoarthritis.

But people are not getting enough of this essential vitamin. Newer research has shown that vitamin D deficiency is a worldwide epidemic. Warnings against overexposure to the sun and the widespread use of sunscreens may be contributing to this deficiency.

Some of your patients may need to take anywhere from 1,000-4,000 IU to achieve normal blood levels of vitamin D. Unless they are in the sun for 15 minutes daily, with exposed skin and no sunscreen, consider advising them to take at least 1,000-2,000 IU of vitamin D each day.

5. Exercise. No recommendation is complete without exercise. Exercise is crucial or joint pain will get worse. Water aerobics is a great place to start for those patients who have not been exercising. This type of exercise will enable them to start exercising without the risk of incurring pain.

References:

Ô Miller, Mark JS, et al, ÏEarly relief of osteoarthritis symptoms with a natural mineral supplement and a herbomineral combination: A randomized controlled trial,ÓJournal of Inflammation, 2005: 2:11

Ô ÏThe NSAID Drugs: Prescriptions and Prices 2004 through 1st Quarter 2005. An AnalysisÓ by Consumers Union and Consumer Reports Best Buy Drugs. June 2005.

Ô Lieberman S. ÏShould ephedrine be banned in weight loss products?Ó Alternative & Complementary Therapies, 2006, April:59-66.

Ô Lieberman S, Bruning N., The Real Vitamin & Mineral Book, 3rd Edition. Avery/Penguin Putnam, NY, NY, 2003.
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