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Can Your Pain and Aches be Partly Due to Oxidative Stress?

by Pain Doc | Jul 29, 2015 | Nutrition

If you have pain or aches in your joints, tendons or muscles that varies in intensity but never seems to go away, you might be experiencing oxidative stress to these areas. Oxidative stress is the cumulative effects of oxidation, a chemical reaction where electrons are stripped off tissues by reactive oxygen species (ROS). ROS or free radicals are atoms or group of atoms that have one or more unpaired electrons. When an atom or molecule has an unpaired electron, it is unstable, and since nature likes stability the radical will seek out electrons elsewhere to “balance” itself. Free radicals are highly reactive to molecules they come in contact with and are therefore dangerous to them. They can destroy them or change their shape and therefore function by altering their molecular structure.

Radicals can have positive, negative or neutral charge. They are formed as intermediates in normal biochemical reactions in cells (cell metabolism), but when generated in excess or not appropriately controlled/ neutralized, radicals can damage adjacent cell structures and tissues. ROS types includes superoxide anion (O2-), hydrogen peroxide (H2O2) and the hydroxide ion (OH-). Think of these things as the cell’s equivalent of noxious exhaust gases generated by an internal combustion engine.

Now, imagine a bunch of these free radicals roaming inside your knees. It’s akin to termites eating away at the frame of your home. At some point, a structural failure will occur; and in the case of the knees, damage to cartilage or synovium (joint inner lining) followed by knee pain and stiffness.

Your body also makes and uses reactive oxygen species for good things. White blood cells generate them to kill bacteria and other pathogens. ROS also influence cell signaling (such as signals to divide, increase membrane permeability and repair membranes) and activate (up-regulate) genes to produce needed substances during certain times. Only when they get to unacceptably high levels, and/or when they aren’t adequately neutralized do ROS become harmful.

Some of the scenarios that can cause excessive ROS formation include:

Hypoxia (low oxygen levels), hyperoxia (high oxygen levels) and excess heat exposure
Ionizing radiation — UV rays, gamma rays trigger massive ROS formation
Prolonged, physical exertion— marathon running, extreme races, hard labor under grueling conditions generates massive amounts of ROS. Oxygen consumption increases by multiples, generating large amounts of free radicals and making it difficult for cellular anti-oxidant defenses to keep up.
Pollution ingestion. This includes smoking, chemical fumes, carbon monoxide, organophosphate pesticides and other substances toxic to humans.
Electromagnetic field exposure. Some studies suggest EMF can cause biological changes that result in excessive free radical formation.

Anti-Oxidants to the Rescue

Anti-oxidants are substances that act as reducing agents, where they donate an electron to a reactive oxygen species; thereby neutralizing it.

There are two main categories- enzymatic anti-oxidants and non-enzymatic anti-oxidants.

Enzymatic anti-oxidants include glutathione peroxidase, superoxide dismutase and catalase. Basically, these components are inside or adjacent to cells (water soluble) and degrade superoxide and hydrogen peroxide by-products of cell metabolism.

Non-enzymatic anti-oxidants include Vitamins A, E, and C, and glutathione. Vitamin E is the major fat soluble anti-oxidant that is responsible for degrading hydrogen peroxide radicals that form along lipid based cell membranes. Glutathione is an important anti-oxidant present in the cell cytoplasm that attracts free radicals, becomes radical itself but then recycles into an anti-oxidant via a special pathway and scavenges again for more free radicals.

Polyphenols, of which there are thousands, are substances (phytochemicals) found in plants that have anti-oxidant properties. This includes blueberries, pomegranate, citrus, green vegetables, apples, cantaloupe, cherries, grapes, plums and other dark and colorful plants. Tannins, quercetin and flavonoids are types of polyphenols.

Turmeric, the rhizome of the flower Curcura Longa contains a well-known powerful anti-oxidant called curcumin. Since it is fat soluble (doesn’t stick to water molecules for transport), it has a hard time getting into your cells. Scientists found that if you consume it with piperine, a natural compound found in black pepper, it increases absorption into your cells by 2,000% which is why most curcumin supplements contain black pepper. A fat soluble anti-oxidant, curcumin is believed to protect the lipid-containing cell membrane from free radical damage.

The Bad News

So, at this point you might be thinking that fixing the oxidative stress problem is simple– just take a bunch of anti-oxidant supplements every day, and good bye free radicals, right?

Unfortunately, most of the research done to test this is inconclusive. This means that, at the present, we cannot say that taking anti-oxidant supplements reduces the risk for any type of disease.

While it’s true that people who eat lots of vegetables and fruits in their diet tend to be healthier than those that do not, the causative factor may be something other than anti-oxidant content in the fruits and vegetables. It could be that people who eat more vegetables and fruit are more health conscious overall and take better care of themselves in other ways (avoid smoking, drinking in moderation, avoiding junk food, etc.) that might explain their longevity.

And for some people, anti-oxidants can act as anti-nutrients by binding with essential minerals in the digestive tract such as iron and zinc, preventing them from being absorbed. They may also interfere with post-exercise trauma repair to muscles, as white blood cells use ROS during repair of muscle tissue; anti-oxidants may inhibit this.

So what is the solution if you’re being constantly attacked by reactive oxygen species?

The Solution

The solution is to do what you need to do anyways in order to be healthy in the long-term:

eat in moderation (less food to metabolize means less free radical generation)
make at least 80% of your diet naturally occurring foods emphasizing green vegetables and to a lesser extent colorful fruits
avoid sugary drinks
exercise in moderation regularly
avoid “chronic cardio” exercises such as long-distance running and ultra-workouts as they are counter-productive.
get adequate rest
remove stress in your life (or find a counter to your stress)

Secondly, be aware of the exogenous sources of ROS generation and avoid them as best you can. This means:

avoiding environmental pollution in the air, water and food
staying away from second-hand smoke
minimize your exposure to commercial electromagnetic fields especially when you sleep (see how to counter this here).
minimizing exposure to strong, mid-day sun rays
If you work near an X-ray machine or other radiation source, make sure to wear adequate protection

Lastly, avoid binge eating and gorging on food, especially on an empty stomach! This stresses your digestive system and generates a barrage of free radicals over several hours as your digestive cells stay fired up to metabolize all that food. Those free radicals that weren’t zapped by glutathione and other anti-oxidant defenses roam throughout your body, snatching electrons from cell membranes, DNA, proteins and other important structures. Keep those buggers down; don’t stir up the ant nest.

When you turn off oxidative stress in your body, your body will be able to heal itself faster and those achy muscles and joints will actually start to feel better and stay that way.

Can Red Light Heal Injuries and Lessen Pain?

by Pain Doc | Jul 21, 2015 | Red light therapy

The color of red has a psychological connection to stopping– stop signs, stop lights, red warning signs and so on. And, it turns out that visible light in the red bandwidth may stop pain to some degree.

The use of red light to reduce pain, inflammation and swelling and to promote wound healing has been known for almost forty years now when a scientist doing a laser experiment on mice discovered that the ones that were irradiated with a red laser grew their hair back faster. But how exactly does red light accomplish this? What are the mechanisms of action? And, can it be dangerous?

I’ll attempt to answer these questions in a way that hopefully makes sense.

When white light travels through a prism, it is dispersed into the colors of the visible electromagnetic spectrum; that is, the component colors that collectively comprise what the human eye perceives as white light. The component colors have wavelengths between about 380 nanometers (1 billionth of a meter long) to about 750 nanometers (nm) and are, from left to right: violet, blue, green, yellow, orange then red.

Just to the left of the visible spectrum is ultraviolet (UV) light and to the right is infrared light (IR); both of which are not visible to the human eye (although some animals can see IR).

spectrum

While the the therapeutic effects of red light are still being researched, there is evidence that light in this wavelength range (620-750+ nm) can in fact trigger physiological changes in cells, called photobiomodulation that have beneficial effects for injury healing and pain suppression.

The first law of photobiology says that for a low power visible light to have any effect on a living, biological organism the photons (light particles or energy units) must be absorbed by the organism via some type of molecular photo-acceptors, which scientists have given the name chromophores. (Photochem Photobiol. 2002 Aug;76(2):164-70). While the mechanism of action are still being researched, experiments show that human tissue absorbs visible light and undergoes biological changes as a result.

The Plant and Animal Connection

You probably forgot that you were introduced to the phenomenon of photobiomodulation way back in the 3rd grade. Remember in science class when you studied photosynthesis? The name says it all: photo (light) + synthesis (to make something out of other things). Sunlight strikes a plant leaf, gets absorbed by tiny structures in the leaf called chloroplasts which contain chlorophyll (the substance that makes plants green), which creates the energy the plant needs to convert carbon dioxide in the air and water into sugars for its food. Without sunlight, plants would starve to death, and so would every life form that depends on them.

Can it be that mammals have their own version of photosynthesis, or something similar to it? It sure looks that way, considering the tissue healing effects of red light.

How Red Light Influences Cellular Activity

The leading hypothesis of how red light creates photobiomodulation is by increasing cellular energy. Red light gets absorbed by a cell membrane enzyme (a protein) called cytochrome c oxidase, or cox for short. This enzyme influences the electron transport chain, the biological process that occurs in cell mitochondria and determines the rate of ATP (adenosine triphosphate) production and thus available energy in the cell.

Adenosine triphospate is every cell’s “fuel” molecule. Basically, cells trap free energy released from the breakdown (metabolism) of glucose– the basic unit of carbohydrates. The trapped energy is stored in the ATP molecule’s chemical bonds. Mitochondria are the structures in all animal cells where energy is created and can be thought of as the animal version of chloroplasts in plants. The energy released in the bonds of ATP molecules enables the cell to do the things it needs to do, such as repair membranes, remove waste and even multiply.

Another theory on how red light produces beneficial benefits is enhancing gene expression. More ATP production results in more reactive oxygen species production (ROS). In high concentrations this is bad, as excessive ROS can damage tissue and DNA (free radical damage). But with red light therapy ROS production is low level, local to the injury and has beneficial effects. ROS alters the cell’s state of oxidation, or redox state (basically, its electrical charge). Changes in a cell’s redox state induce intracellular signaling pathways such as nucleic acid synthesis, protein synthesis and enzyme activation. This activity then activates changes in transcription factors, which are the substances that up-regulate or down-regulate gene expression. Genes in DNA determine an organism’s physical features and influences its biological processes.

For example, red light activates factors involved in gene expression related to cell proliferation, remodeling, DNA synthesis and repair; ion channel and membrane potential, and cell metabolism. All these processes can benefit wound healing.

Proof of Red Light’s Healing Power

A 2014 Chinese study that involved compressing/ injuring spinal nerves in rats found that LLLT (Low Level Laser Therapy, which uses red and infrared light) “was able to enhance neural regeneration in rats following [the injury] and improve rat ambulatory behavior (ability to crawl and move).” The study’s authors concluded that the therapeutic effects of LLLT in this experiment may be exerted through suppression of the inflammatory response and induction of neuronal repair genes (increased expression of the genes involved in nerve repair). This suggests potential clinical applications for LLLT in the treatment of compression-induced neuronal disorders such as nerve root compression from disc bulges, stenosis and frank injury.

Another study concluded that low-level exposure to 980 nm laser light (near infrared) can accelerate wound healing. Exposure to low- and medium-intensity laser light accelerated cell growth in damaged fibroblast cells, whereas high-intensity light negated the beneficial effects of laser exposure.

So, it appears that the evidence on the therapeutic effects of red light therapy is convincing and the models appear plausible. More research is needed to get a better handle on how to best use light for therapeutic purposes. What we know is that light in the red visible spectrum (620-750 nm wavelength) and infrared (700 – 1000 nm) are preferred because they are better absorbed in human tissue. Shorter wavelengths (blue) scatter and are less absorbed. Red light is believed to be more appropriate for superficial areas (skin surface to a few millimeters below) because the light is quickly absorbed by the red hemoglobin of the blood and carried away; whereas the longer wavelength infrared (IR) and near infrared (NIR) light is appropriate for thick muscles and deeper joints since they are able to penetrate deeper into the body.

Factors that can influence therapeutic effect of red light besides wavelength include power output (watts), frequency, pulse rate, dosage and treatment area. Typical dosages used are 0.5 – 60 Joules/cm2, but there is no consensus among researchers on what constitutes the best dosage for any particular conditions.

Using Red Light Therapy

Red light can be delivered by “cold” lasers (lasers with minimal heat production) or diode (phototherapy) machines. The difference between the two is that lasers produce light of only one wavelength that is collimated (focused and organized), enabling deeper penetration but at a fixed depth and smaller area; whereas a red light diode generates a range of red light in different wavelengths, covering more area and depth levels due to the varying densities of human tissue (skin, fat, muscle, ligament, water).

Medical grade lasers and phototherapy devices can cost a few hundred up to thousands of dollars. These therapy devices can be found in some physical therapy, chiropractic and sports medicine clinics. There are low power, consumer level portable red light and infrared devices that get good results as well. Currently, I am not aware of any studies that compare the effectiveness of the expensive medical lasers with the cheaper consumer devices, but one must realize, light is light! If you have a soft-tissue injury or joint pain, I suggest you try a consumer level red light device before you try the more expensive options. They are available for sale direct to the consumer; no doctor’s prescription needed. So far, the studies indicate that red light therapy is safe to use although it is best to protect your eyes from scattered light during its application by wearing protective lenses.

The red light therapy device I use at home and on patients is the handheld red light therapy device, shown below:

tendlight

It is simple to use and gets surprisingly good results (and it doesn’t cost an arm and a leg). Use it for TMJ, epicondylitis, trigger points; pain in the hand and wrist joints and anywhere there is musculoskeletal pain and/or inflammation.

The Bottom Line: Yes, red light therapy can help heal injuries and lessen pain and is generally safe to use. This includes sprains, strains, bruises, burns and minor lacerations. You may even try it over your peri-orbital sinuses to help with tension headaces.

The ideal treatment protocols are not defined, but a good starting point is 2-3 minute applications of red light directly for every two square centimeters, twice a day.

Watch below how I use the red light therapy device to treat chronic tendonitis:

Back Pain from Pregnancy – New Study Finds Spinal Manipulation Dramatically Reduces Pain

by Pain Doc | Jul 9, 2015 | Low Back Pain

According to a new study published in the July issue of the Journal of the American Osteopathic Association, German researchers found osteopathic manipulative therapy (OMTh) decreased postpartum low back pain by over 70 percent in women who had given birth at least three months before beginning treatment.

On average, women who received osteopathic spinal manipulation reported a 73 percent decrease in pain, compared to only seven percent in the control group. Pain was evaluated by a 10-point Visual Analogue Scale (VAS) and functional disability as measured by the Oswestry Disability Index. The Oswestry Disability Index is a battery of questions that asks the subject to rate on a scale of 1-5 how difficult it is to do common, daily activities (such as getting dressed). It is a popular tool doctors in physical medicine use to measure a person’s improvement to treatment, since pain is very subjective in nature. After all, what matters most is not the level of pain but rather the level of physical functioning the person is capable of, despite the pain.

But what exactly is osteopathy, and how different is it from chiropractic?

This requires a bit of a history lesson. Both disciplines had their start in the mid to late 1800s in the U.S., an era characterized by experimentation in various alternative healing methods. Diseases like syphilis, small pox, polio and other maladies plagued the population and there was very little doctors at the time could do. Vaccines and antibiotics were not discovered yet, and people were desperate to find a cure. This period is also when the term “snake-oil salesman” was coined, as some unscrupulous individuals used the crisis as an opportunity to make money.

Osteopathy has its origin in 1874 when Andrew Taylor Still, a medical doctor was dissatisfied with the limitations of conventional medicine. He theorized that disease originated in bone tissue and could therefore be treated by manipulating bones and tissues. Still developed the discipline of osteopathy and created the first school in Kansas that offered the “D.O.” degree – Doctor of Osteopathy.

Chiropractic has its origin in the 1890s when D.D. Palmer, a magnetic healer theorized that mechanical dysfunction of the spinal joints could influence nerve and blood flow throughout the body, making conditions ideal for disease. He and his son B.J. Palmer developed chiropractic in the early 1900s, emphasizing “adjustments” to the spine using the hands.

As both disciplines grew in popularity, the medical profession took notice. As in big industry today, when such competition arises there is either a buy-out, merger, or attempts to dominate the market (and public opinion) and put the competing entity out of business. Osteopathy eventually got absorbed into the medical (allopathic) model, and today D.O.s are physicians on par with M.D.s. Many D.O.s do not do manual therapies in their practice since drug prescription became the primary treatment methodology among allopathic medical practitioners especially toward the latter half of the 1950s, continuing today.

Chiropractic, on the other hand, blazed its own trail and is an independent specialty outside of the medical umbrella. There used to be significant professional conflict between chiropractors and medical doctors, but these days there is more more cooperation. Physicians are more confident in referring back pain cases to chiropractors, as patients attest to its benefits for helping reduce musculoskeletal pain.

Pregnancy and Back Pain

The Germany study is not surprising. Spinal manipulation, whether osteopathic or chiropractic adjustments, is helpful in restoring alignment and movement in the pelvic structure and lumbar spine following birth. During the last trimester of pregnancy when the mother gains the most weight, the center of gravity of the abdomen moves outwards, placing a greater strain on the lower back. The lumbar spine arcs more acutely, increasing pressure within the facet joints during standing. The weight of the baby can also rotate the pelvis anteriorly over the femur heads which can cause sacral and hip pain, due to it being a weaker stability position..

If after three months of giving birth you still have back pain, consider getting spinal manipulation. The goal is to free up any restrictions that may be present anywhere in the spine, pelvis and hip joints and strengthen surrounding muscles. A good practitioner will show you exercises to do at home to rehabilitate the area.

Below is a video that will give you an idea of what to expect:

One note you should be aware of: Spinal manipulation or “adjustments” is a fine dexterity, complex skill that needs a lot of practice in order for one to become proficient in it. Unlike osteopaths, chiropractors cannot prescribe medications so the bulk of their practice involves delivering spinal manipulation. Chiropractors therefore tend to be more skilled in this area.

Read this article by the American Chiropractic Association on 5 Conditions Chiropractic Care Can Improve During Pregnancy.

For more information on the Germany study that shows the efficacy of spinal manipulation for postpartum low back pain in women.

Golf Injuries and Pain – How to Protect Yourself and Have Fun

by Pain Doc | Jun 27, 2015 | Low Back Pain

If golf is one of your favorite recreational activities, you likely are aware of the unique demands the game places on your body. Perhaps you even sustained an injury or developed pain related to your golf game. Let’s take a closer look at the physical demands of playing 18 holes.

First of all, let me start out by saying that besides being a popular sport, golf is a good opportunity to exercise (especially if you carry your own clubs and don’t use a cart).

Number one, it involves a lot of walking. The best part about walking is that it keeps you away from sitting. It may not sound like a big deal, but it is. Excessive sitting, science is finding, is associated with deleterious health outcomes regardless of physical activity. This means too much sitting is so bad for your health that exercising later cannot recoup the damage it does.

Secondly, you are outdoors exposed to sunshine. Getting adequate sunshine is essential to maintaining normal Vitamin D levels, which promotes strong bones, teeth and supports the body’s immune system. Being outdoors among trees and grass on the weekend is especially beneficial to your health if you have a high-stress office job during the week.

So if you abhor exercising in a gym, perhaps you should investigate the game of golf, if you haven’t already.

Now, back to the topic. Here are the potential problems that can come with playing golf:

Driving. Each hole starts out with a driver, the longer clubs with bigger, heavier heads. These clubs are designed for distance and therefore require a big swing radius (a big wind-up).

Well, that wind-up involves over-rotation of your lumbar spine. That feeling of discomfort when you swing a driver is occurring at the lumbar facet joints, the small joint surfaces behind the vertebral bodies that interlock with adjacent vertebrae above and below.

Most rotation movement of the torso is produced by the thoracic vertebral joints, from the base of the neck down to the beginning of the lumbar (low back) spine. This is because facet joints of thoracic vertebrae are relatively flat and in the same rotational plane, as illustrated below:

Lumbar vertebrae, on the other hand, have deeper, concave facet joint surfaces that act as limiters to rotation. Basically, lumbar vertebrae do not like to twist.

You can feel the pressure in your low back when you have the driver at the top of back swing position and again towards the end of the swing. The rotational (twisting) force is reduced when you lift and turn in your rear foot as you follow through the swing, but if that foot motion is delayed the lumbar spine absorbs more of the rotational force.

Over time, repeated over-twisting of the lumbar spine can cause the lumbar facet joints to degenerate and even develop fractures. This can lead to other problems, like pinched nerve roots from foraminal stenosis (narrowing of nerve passageway due to bone and/or ligament occlusion). Tiger Woods used extreme lumbar rotation in his swing and it caught up to him; he had four low lumbar surgeries over his careerr and now suffers from chronic low back pain.

The lesson here is to make sure you lift your trailing foot at the appropriate time of the swing to avoid excess rotational pressure to your lower back (and be mindful not to over rotate, otherwise risk having back problems in the future).

Another joint that bears a lot of stress during driving is the lead knee. As you follow through with the swing, your pelvis rotates with your spine. Tightly connected to each side of your pelvis are the femoral heads– one half of the hip joint. When you lift your trailing foot, it reduces rotation to your lumbar spine by removing a stabilizer, but at the price of putting a greater rotational burden on the lead knee and ankle. As the pelvis rotates and reaches end-range, it pulls the femur with it. But the femur and tibia remain stationary (golf shoe spikes dug into the turf ensure this; plus more of your weight shifts to the lead leg towards the end of the stroke). This results in a torsional force generated through the lead leg, internally rotating the hip, knee and ankle. This can cause strain to the hip joint, meniscal tears in the knee and sprain to the ankle ligaments.

So the lumbar spine and leading hip, knee and ankle are joints that absorb significant rotational stress during a driving swing.

To a lesser extent, the leading shoulder joint and wrist absorb stress due to their awkward positions; the shoulder with acute internal rotation and the wrist acute radial deviation. This can strain the shoulder rotator cuff and ligaments and tendons of the wrist.

Putting (and driving). It may not seem like a lot of movement is going on during putting, but the putting position is indeed strenuous to the lower lumbar discs. You are bent at a 30 degree angle or so at the waist for an extended time (most people concentrate and take their time before their putt attempt). This is one of the worst positions for your low back as it places tremendous pressure on your L4 and L5 discs. especially if you have a weak core (abdominal and low back muscles).

The hydrostatic pressure builds up in the disc, enough to cause a disc herniation in some people.

In the picture above, the golfer is preparing to hit the ball with a driver. Notice the angle of the torso relative to the legs. The fulcrum is exactly at the L5-S1 joint and the lever is the torso, with the load being the gravity vector of the torso (weight). The force (F) is partially distributed to the back muscles, but the discs still bear significant pressure in this position.

The Solution

If you’re an avid golfer, a little sore back isn’t going to stop you from playing, right? That is usually the case in those who love their sport or hobby.

So my advice to you is:

Always use proper form and good posture. When driving, emphasize generating power from your core muscles– abdominals, especially obiques–then your latissimus (“lats”) muscles. Lift your trailing foot at the precise moment to lessen lumbar rotation during a wide swing.
If you are prone to low back pain, modify your driving swing to protect your back. You may have to use less lumbar rotation and more power from your arms and shoulders. Practice your custom swing and hone it so it becomes natural during game time. For example, if you are getting low back pain, shorten your lumbar rotational arc by 30 degrees and generate more power from your latissimus muscles to compensate.
Minimize rounding (flexion) of your low back during putting and driving. A straighter or even concave low back is stronger than a flexed low back. This is called “hinging.” You keep your lumbar spine and pelvis locked, and hinge at the hip joints to lower your torso to the ground.
Exercise and stretch the swing muscles. The muscles you should target for stretching are the trapezius, latissimus dorsi, rhomboids and triceps.
Strengthen your shoulder joints by lifting light dumbbells in all directions/angles (from 12 o’clock position to 6 o’clock position) with palm facing down. Starting position of arm is down to your side; ending is as high as you can go.
Stretch your shoulder joints using a 5-10 lb dumbbell or kettle bell, letting it hang straight down as you lean over and stabilize with the other hand on a chair or your opposite, bent knee. Make small circles with the weight, increasing in size; then reverse directions.
Strengthen your core: abdominals and low back, using medicine ball exercises.
Seek out an Active Release Technique (A.R.T.) therapist in your area. This is a special form of massage that involves engaging certain muscles while the therapist works them and is great for improving range of motion.

And last but not least, my standard mantra: your body will work better for you if you feed it well and give it enough rest. Make at least 80% of your diet naturally-occurring foods (as opposed to processed and prepared foods) emphasizing colorful vegetables, animal protein (grass fed/ pastured when you can) and healthy fats (olive oil, nuts, seeds, eggs, coconut, avocado, fish). A well-nourished body can heal injuries quicker and more completely, which is especially important if you play any kind of sport.

Also, don’t expect to be sedentary all week and be able to do activities physically demanding on the weekend. Excessive sitting/ lack of exercise de-conditions muscles. It makes them less coordinated, smaller and weaker. This is a recipe for injury (“weekend warrior” injuries).

A simple hack to passively get more exercise if you are a desk jockey is to get a standing desk. It’s better for your back, and your overall health (see below).

Now, go and have fun on the golf course! (with this information in mind).

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Curcumin – Hype or New, Natural Pain Reliever?

by Pain Doc | Jun 10, 2015 | Uncategorized

Lately, you may have seen or read news articles about the use of curcumin to treat inflammation and pain. Is curcumin the latest fad supplement to hit the scene, or does this herb actually have any therapeutic benefits?

Curcumin comes from the root stalk (rhizome) of the curcuma longa, better known as turmeric, a perennial plant from the ginger family. Turmeric is native to India, and also occurs in Australia. It has been used for centuries as a spice in South Asian cuisine (curry) and as a food dye. The root stalk is heated in an oven, then ground into a fine powder.

In folk medicine, curcumin is believed to have a wide range of biological effects including anti-inflammatory, antioxidant, anti-tumor, antibacterial, and antiviral activities. However, according to the National Center for Complementary and Alternative Medicine, “there is little reliable evidence to support the use of turmeric for any health condition because few clinical trials have been conducted.”

This is a common disclaimer for herbs, vitamins and other natural supplements. In order to say with certainty that a supplement achieves its claimed therapeutic benefit, a “double-blind, controlled” study involving a large number of people with the same health issue that the supplement targets is required. The study group is divided into two groups, the test group and the control group. The test group is given the nutrient being tested, while the control group is given a placebo supplement (fake). In a double-blind study, which carries the most weight as far as credibility of results is concerned, none of the test subjects are aware of what they are getting (the nutrient or the placebo), and neither do the scientists administering them.

The study goes on for many months; sometimes years, and various metrics are taken of both groups. If there is a statistically significant, positive difference in the test group for a given metric (for example, much lower pain rating), then it’s fair to assume that the nutrient was responsible for it. If there are none, then the supplement is basically bogus.

So, how does curcumin stack up to the challenge?

Here are some research studies on curcumin worth mentioning:

A 64-person study testing curcumin for mastitis, a painful condition involving inflammation of the breast, showed that a topical solution containing curcumin successfully decreased pain, breast tension and erythema (redness due to pain) within 72 hours of administration, without side effects.

A Japanese study of 50 patients with knee osteoarthritis found that at 8 weeks after treatment initiation, knee pain scores were significantly lower in the curcumin group than in the placebo group, except in the patients who had the lowest pain score to start, with no major side effects. The study concluded that curcumin shows modest potential for the treatment of human knee osteoarthritis.

A 17-person study was done to determine the effects of curcumin on muscle damage, inflammation and delayed onset muscle soreness (DOMS) in humans. Participants did “unaccustomed, heavy” leg exercises to point of pain and enough to generate blood markers for muscle damage. The conclusion was that oral curcumin likely reduces pain associated with DOMS with some evidence for enhanced recovery of muscle performance, and that further study is required.

A study involving 30 breast cancer patients receiving radiation therapy found that orally taking 6.0 g of curcumin daily during radiotherapy significantly reduced the severity of radiation dermatitis.

A preliminary intervention trial that compared curcumin with a nonsteroidal anti-inflammatory drug (NSAID) in 18 rheumatoid arthritis patients found that improvements in morning stiffness, walking time, and joint swelling after two weeks of curcumin supplementation (1,200 mg/day) were comparable to those experienced after two weeks of phenylbutazone (NSAID) therapy. Since NSAIDs are associated with stomach, renal and liver damage, this is a very promising finding.

A placebo-controlled trial involving 40 male test subjects who had surgery to repair an inguinal hernia or hydrocele found that oral curcumin supplementation (1,200 mg/day) for five days was more effective than placebo in reducing post-surgical edema, tenderness and pain, and was comparable to phenylbutazone therapy (300 mg/day).

As of this writing, this is the extent of human studies that test curcumin’s effects on inflammatory processes. It isn’t much, but the positive effects and demonstrated potential of curcumin to improve inflammatory conditions is unmistakable.

It should also be noted that there are many rat and mice studies in the medical literature that suggest curcumin can reduce pain and inflammation by suppressing oxidative stress and “down regulating” factors (cytokines) that create the inflammatory response. This means that curcumin may tone down gene expression of genes involved in generating and sustaining the inflammatory process.

A number of other studies on curcumin’s potential therapeutic effects on colorectal cancer, Alzheimer’s disease, cystic fibrosis, asthma and other disorders have been completed with no published results at the moment, or are still in progress.

My Advice on Curcumin:

So, should you try curcumin supplements if you have an inflammatory condition? Based on this small sample of studies, my opinion is that it wouldn’t hurt to include curcumin regularly in your diet if you have arthritis, type 2 diabetes, cardiovascular disease, an inflammatory dermatological disorder, fibromyalgia or other, chronic inflammatory disease. You don’t have to buy supplements, although they are convenient; just get the curcumin powder sold in grocery stores and sprinkle it on your food as you would salt. Studies suggest that this herb is generally safe in large doses (6 mg) with minimal side effects; but just don’t over do it. Be careful of the source, as unscrupulous manufacturers may be mixing curcumin powder with the much cheaper lead oxide, which looks very similar to curcumin powder, although more reddish in color. Lead oxide mixes with hydrochloric acid in the stomach, bioaccumulates and can cause lead toxicity.

By the way, I recommend you do not keep spices for more than a year or two, as they can not only lose their taste but can also form mold.