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DEALING WITH OSTEOARTHRITIS, RHEUMATOID ARTHRITIS AND GOUT.

 
OSTEOARTHRITIS:

            Multiple Millions of Americans suffer from osteoarthritis.   Where bones meet other bones in the body, there is a cushion of tissue between these bones called cartilage. This cartilage tissue between bones allows for freedom of movement without irritation.  When this cushion of cartilage tissue becomes worn thin to the point that bone rubs on bone, we experience the inflammation called osteoarthritis.  Osteo means of the bone, arthro means of the joint and itis means inflammation.  Cartilage tissue can be damaged through injury, carrying too much body weight, lack of proper nutrition to the joints and even defective DNA.  Aging also plays a role as our ability to repair cartilage tissue diminishes as we age. 

        Cartilage tissue that is found in the joints is called articular cartilage and is basically made up of water, collagen and proteoglycans.  Collagen is a protein that gives structure to the cartilage while proteoglycans are protein/sugar molecules that are woven around and through the collagen fibers creating dense netting inside the cartilage. The proteoglycans act like a sponge, rapidly absorbing water when the joint is relaxed and squeezing water out again when pressure is applied. 

       In addition to collagen and proteoglycans, there are also specialized cells called chondrocytes that are found through the cartilage matrix and are responsible for the formation of new collagen and proteoglycan molecules.  Chondrocytes also release enzymes that break down aging collagen and proteoglycans that are no longer functional.  A nutritional substance called glucosamine is a major building block of proteoglycans and is needed to make glycosaminoglycans.  Glycosaminoglycans are proteins that bind water in the cartilage matrix and therefore are responsible for the shock absorbing ability of cartilage tissue.

       Another nutrient called chondroitin serves to draw water into the proteoglycans where hyaluronic acid acts as a major water holding molecule within the synovial fluid of joint tissue. This gives joint tissue a sponge like ability to supply nutrients to the cartilage as cartilage has no blood supply of its own to provide nourishment.
 

 STANDARD TREATMENT OF OSTEOARTHRITIS:

       The standard approach to relieving pain associated with osteoarthritis is to use Nonsteroidal anti-inflammatory drugs (NSAIDS) such as aspirin and ibuprofen.  NSAIDS appear to reduce inflammation by suppressing the formation of prostaglandins which are chemical compounds created in our bodies due to the activity of certain fatty acids. For more details on how NSAIDS and drugs such as Celebrex work to reduce inflammation, visit Archives #1 on this website.

        While these drugs will lessen the pain of arthritis and thereby provide symptomatic relief, they have also been shown to speed up the degeneration of joint tissue and thus create more series problems with continued usage.  NSAIDS have been shown to inhibit the repair of cartilage by preventing the synthesis of the collagen matrix essential to cartilage repair.  These drugs actually interfere with the formation of glycosaminoglycans.

         In addition to their negative impact on joint tissue, NSAIDS tend to cause irritation of the mucosal lining of the intestinal tract resulting in ulcer formation.  Other side effects of using NSAIDS include the creation of allergies, tinnitus (ringing in the ears), fluid retention, and easy bruising and potential toxicity to the liver and kidneys.  Many thousands of people are each year admitted to hospitals as a result of complications due to the use of NSAIDS.

        Corticosteroids such as prednisone are sometimes used in addition to NSAIDS.  These types of drugs are great at reducing inflammation but the side effects make them downright dangerous.  These drugs are known to depress immunity, create high blood pressure, thin the bones and damage the liver. Depression and other mental disturbances, diabetes, peptic ulcers, insomnia and general weakness are also associated with corticosteroids. 

 TREATING OSTEOARTHRITIS NATURALLY: 

        If the goal is relief of symptoms only, you can continue using NSAIDS or corticosteroids and obtain temporary relief of pain.  The problem is you will be doing nothing to actually repair joint tissue and you will put yourself at risk for the type of side effects described above.  It is therefore better to treat the cause of the problem and not just the effects. The cause of osteoarthritis is lack of sufficient cartilage tissue to cushion the joints.  By working to restore the integrity of joint tissue, we will be treating causes and not just effects.

        Diet is critical to the treatment of any health problem as all body tissue demands a wide range of nutrients provided on a daily basis.  Some studies indicate that 50 to 75 percent of those that suffer from arthritis are malnourished.  Like other tissues of the body, cartilage is constantly going through a cycle of breakdown and repair.  For repair to take place, a wide variety of nutrients are needed.  Eating a diet high in organically grown vegetables and fruit, whole grains and legumes, nuts and seeds and high quality animal products should be the first step in establishing a sound nutritional foundation for dealing with osteoarthritis.  Avoiding processed and refined foods, fast foods, packaged, boxed and canned foods are important considerations in developing a nutrient dense versus a calorie dense diet.

        Vitamin C is an essential nutrient in the formation of collagen.  The B vitamin pantothenic acid (vitamin B-5) has been shown to reduce stiffness in the joints and is found to be deficient in those with arthritis.  Studies have shown that vitamin E has an ability to inhibit the breakdown of cartilage as well as stimulate the production of glycosaminoglycans.  A deficiency of the trace mineral boron has been shown to increase the risk for osteoarthritis.  The foregoing is just a small sample of the many nutrients that play a role in the health of joint tissue.  To insure that you are getting these nutrients on a daily basis, we recommend taking a high quality multiple vitamin/mineral supplement and a quality green food concentrate.  Such supplementation, along with a whole food diet, will provide a sound nutritional foundation for dealing with any health problem, including osteoarthritis.

       One supplement that is directly related to the treatment of osteoarthritis is glucosamine. Our bodies produce glucosamine which plays an important role in cartilage development as explained above.  As we age, we lose the ability to manufacture sufficient amounts of glucosamine.  The result is that cartilage tissue begins to lose some of its ability to hold water and act as a shock absorber.  This lack of water holding ability results in less cushion effect and greater wear and tear on cartilage tissue resulting in symptoms associated with osteoarthritis.  The good news is that you can take glucosamine as a supplement and thereby help your body to produce the cartilage components responsible for water retention and thus help protect your cartilage tissue from degeneration. Chondroitin can also be taken as a supplement and will improve the water retention of proteoglycans.

       The supplement MSM, (methy-sulfonyl-methane), as a form of organic sulfur, has been found to be helpful in relieving pain associated with osteoarthritis. The mineral sulfur plays an important role in the repair and maintenance of muscle and joint tissue and in reducing inflammation.  Sulfur deficiencies have been noted in those that suffer from arthritis.  Foods such as garlic, onions, brussels sprouts and cabbage are all good sources of sulfur.  MSM is available as a supplement and is often found in combination with glucosamine and chondrotin preparations.

       Hyaluronic acid can also be taken as a supplement to help maintain fluid retention in joint tissue. As we age, our body’s production of hyaluronic acid decreases considerably.  This results in decreased water retention in all body tissue including our joint tissue.  Adding hyaluronic acid to your supplement program will help maintain lubrication of joint tissue, as well as, improve the texture of skin and all connective tissue.

      The herb Boswellia has been shown to inhibit mediators of inflammation, prevent decreased glycosaminoglycan synthesis and improve blood flow to the joint tissue.  Curcumin, the yellow pigment of the common cooking herb turmeric, is a rather potent natural anti-inflammatory on par with cortisone but without the side effects of cortisone based drugs.  The recommended dosage of curcumin as an anti-inflammatory is 400 to 600 milligrams, three times a day.  Bromelain, a group of enzymes found in pineapple, works to reduce inflammation by blocking the production of kinins which are compounds produced during inflammation.  The herb Feverfew has shown strong anti-inflammatory activity which appears to relate to a chemical compound found in feverfew called parthenolide.

        A liquid collagen protein product called Amino Sculpt has been shown to be effective with some cases of osteoarthritis because it adds collagen protein to the body and thus facilitates repair of joint tissue.  Cod liver oil has been shown to be effective in helping to lubricate the joint tissue and supply the body with important fatty acids that lead to the production of anti-inflammatory prostaglandins in the body. 

       A supplement called SAM-e has been shown in studies to reduce inflammation and the indication is that this substance actually helps to restore damaged cartilage tissue.   SAM-e (S-adenosyl-methionine) is made in the body from the amino acid methionine. In the presence of vitamin B12 and folic acid, SAM-e gives up what is called a methyl group to neighboring tissues and organs.  This action supports a variety of processes such as the maintenance of cell membranes, the removal of toxic substances from body tissue and the production of neurotransmitters such as dopamine and serotonin.  When SAM-e finishes its work as a methyl donor, it breaks down into sulfur groups which help support the maintenance of cartilage tissue.  It is in this capacity that it contributes to the reduction in inflammation of joint tissue.

 RHEUMATOID ARTHRITIS:

         Rheumatoid arthritis (RA) is an inflammatory condition that specifically affects the synovial membranes of joint tissue.  With RA, the body’s immune system attacks the body’s own tissue. Symptoms are painful swelling of the joints.  There does appear to be a strong genetic factor in RA insomuch that 70% of those with RA have a specific genetic marker called histocompatiblity antigen HLA-DRw4.  This marker is found in only 28% of the general population.   RA occurs at four times the average rate in children whose parents have RA. 

       Those with RA have increased intestinal permeability which allows for undigested food, molecules to leak into the general blood circulation.  The immune system responds to the presence of such molecules as though they are the enemy and creates antibodies to bind them.  Such binding of an antibody to what the immune system recognizes as a foreign agent results in the formation of what is called an immune complex.  The presence of an immune complex triggers the immune system to release chemical compounds that destroy the immune complex.  This works fine when the immune complex is formed as a result of the immune systems response to a true foreign agent such as bacteria, viruses, cancer cells, etc.  But when an immune complex is formed in response to food molecules, and that complex is deposited in joint tissue, the immune systems response is to destroy the complex along with surrounding joint tissue. This process creates inflammation in the joint tissue. Continuing inflammation leads to damaged tissue.  Physicians often monitor the progression of RA based on the amount of immune complexes present in the joint tissue.  When these complexes are high the RA symptoms are more severe.  When the immune complex level is low the symptoms are less severe.

        As with osteoarthritis, RA is most often treated with NSAIDS and in many cases with corticosteroid drugs such as prednisone.  As covered above, these drugs provide only temporary relief and their many side effects create additional health problems. 

TREATING RHEUMATOID ARTHRITIS NATURALLY:  

       As mentioned above, intestinal permeability appears to be a leading factor in the development of RA. Such permeability can develop as a result of candida yeast overgrowth which is a problem for many.  Yeast can mature into a fungal organism which then eats its way through the intestinal wall creating microscopic holes through which can pass molecules of undigested foods. Candida is a normal resident of our intestinal tract and is usually held in check by friendly bacteria such as acidophilus and bifidus.  Unfortunately, our friendly bacteria can be easily destroyed through the use of drugs such as antibiotics, birth control pills and a diet, high in refined sugar. Candida lives on sugar. When our friendly bacteria get destroyed, the yeast organisms proliferate and can quickly become the dominant organisms in the intestinal tract.  Yeast can also get into the general blood circulation and travel to various tissues of the body. The task of eliminating yeast overgrowth involves elimination of virtually all simple carbohydrates from the diet, taking products, such as grapefruit seed extract, to kill off the yeast overgrowth and reculturing the intestinal tract with friendly bacteria.  Parasitic infestation can also be a culprit and lead to the same kind of intestinal permeability as can occur with a yeast problem.

        Incomplete digestion in the presence of intestinal permeability often leads to the type of immune response discussed above. It is critical for those with RA to insure that proper digestion of foods is taking place.  Many individuals with RA tend to be deficient in their production of hydrochloric acid (HCL) in the stomach and lack sufficient pancreatic enzymes in the small intestine where the major part of digestion takes place.  If there is bloating, belching, flatulence or just generalized digestive discomfort after eating a meal, it may result from deficient secretion of HCL and/or pancreatic enzymes. Both HCL and pancreatic enzymes can be taken as a supplement. These products can be of great benefit in facilitating better digestion and so prevent undigested food molecules from entering the blood stream creating an immune response.

        Proteolytic (protein digesting) enzymes are especially important as they not only break down protein but also help to keep the small intestine free of parasites, yeasts and intestinal worms.  Research has demonstrated that proteases are effective in treating food allergies and in preventing tissue damage during inflammation.  An important benefit of proteases to those with RA is that they help prevent the disposition of immune complexes in joint tissue which, as explained above, is a major factor in RA.

        The role of what are called essential fatty acids (EFA’s) is very important to those who suffer with RA. Of all the fats you consume, it is the two essential fatty acids, linoleic and linolenic, that are most important to your health.  These fats must be obtained from the diet as your body does not make them.  When ingested, the EFA’s go through a number of conversions in the body which lead to the production of what are called prostaglandins.  These prostaglandins are hormone like substances that play an important role in the mediation of inflammatory processes.  It is recommended you supplement your diet with flax oil and/or fish oil to insure you are getting the fatty acids necessary to produce the necessary prostaglandins. The EFA’s are also very important in the treatment of osteoarthritis.

          Plant sterols and sterolins are chemical compounds found in a variety of foods and have been shown to activate macrophages, enhance the proliferation of T-cells and enhance natural killer cell activity while at the same time lowering pro-inflammatory agents in the body.  Because of their anti-inflammatory effect these compounds have been shown to be very effect in reducing the symptoms of inflammatory diseases such as rheumatoid arthritis.  A combination of sterols and sterolins can be obtained in supplemental form in a product called Moducare Sterinol. 

        Exercise is a key component in the treatment of both osteo and rheumatoid arthritis.  Exercise will increase muscle tone by increasing oxygen and nutrient flow into the muscle tissue. Exercise improves the flexibility and endurance of muscles, tendons and ligaments.  Aerobic exercise, in particular, will increase serotonin levels, enhance the production of human growth hormone and stimulate the production of endorphins.  Endorphins, which are released by the hypothalamus gland in the head, act as the body’s own morphine-like pain killers.   Greater release of human growth hormone leads to more rapid healing of damaged joint tissue and increased levels of the neurotransmitter serotonin.  Serotonin helps you better tolerate pain associated with  inflammation.                       
      
       While exercise may not appear to be very appealing to someone suffering from pain associated with arthritis, it is a critical requirement in order to facilitate relief from pain and slow down the further degeneration of muscle and connective tissue.  Walking, running, swimming and rebounding are the best forms of exercise for strengthening and toning the body as a whole.  Resistance exercise such as weight lifting, use of Xertubes, etc. are also helpful in maintaining overall conditioning.  With both osteo and rheumatoid arthritis, simple stretching exercises can be very helpful in facilitating greater circulation to the joints and therefore more oxygen and nutrient fed to help restore worn tissue.  Massage and acupressure can also be helpful in facilitating repair of damaged tissue.

 GOUT:

        Gout is an inflammatory problem that is caused by a higher than normal level of uric acid in various of the body fluids.  Uric acid is a breakdown product of a chemical substance called purine which is found primarily in organ meats.  Alcohol increases uric acid production and reduces uric acid excretion by the kidneys. Gout is characterized by intense pain in a joint, usually the first joint of the big toe.  If the attack of gout progresses, fever and chills will appear.  Some degree of kidney dysfunction occurs in nearly 90% of those that experience gout and there is a higher risk of kidney stones.

        A low purine diet and the elimination of alcohol are necessary in order to control excessive build up of uric acid.  Consuming cherry juice and other berries, dark red in color, is an effective way to help reduce uric acid levels.  Their content of the flavonoids anthrocyanidins and proanthocyandins appear to be the chemical compounds that are responsible for their uric acid lowering ability.

UNDERSTANDING VITAMIN D

NEWSLETTER: SEPTEMBER 2006

 What is vitamin D?

     
       Vitamin D is a fat soluble vitamin made in your body as a result of your skin being exposured to ultraviolet (UV) rays from the sun. Vitamin D is also available in some foods.  This vitamin exists in several forms with vitamin D₃, also known as cholecalciferol, being the form that is made in the skin when 7-dehydrocholesterol, a cholesterol compound, reacts with ultraviolet light from the sun. Once made in the skin, cholecalciferol is transported to the liver where it is made into calcidiol (25-hydroxy-vitamin D).  It is this form of the vitamin that the body stores for use. Measuring the blood level of calcidiol is the only way to determine vitamin D levels.

 
Why do you need vitamin D?

 
       The most active form of the vitamin is calcitriol (1, 25 dihydroxy vitamin D₃), which is synthesized from calcidiol in the kidneys where it functions as a hormone by sending messages to the intestines to increase the absorption of calcium and phosphorus. A major biologic function of vitamin D is to maintain normal blood levels of these two minerals.  By promoting calcium absorption, vitamin D helps to form and maintain strong bones and teeth. Insufficient vitamin D can lead to thin, brittle bone tissue and dental problems.

       Research shows vitamin D is also involved in helping to maintain a healthy immune system, regulate cell growth and cell differentiation, and facilitate normal cardiovascular function.  Studies suggest that higher levels of vitamin D correlates with lower incidence of certain cancers.  Researchers have observed that greater exposure to sun is associated with lower death rates from colon and colorectal cancers.  

       Vitamin D emerged as a protective factor in a study of over 3,000 adults (96% of whom were men) who underwent a colonoscopy between 1994 and 1997 to look for polyps or lesions in the colon. About 10% of the group was found to have at least one advanced cancerous lesion in the colon. There was a significantly lower risk of advanced cancerous lesions among those with the highest vitamin D levels. Others studies have shown vitamin D to be a protective factor against breast cancer. Clinical studies show vitamin D deficiency to be associated with four of the most common cancers: breast prostate colon  and skin 

       Vitamin D deficiency has been shown to possibly be linked to diseases such as various cancers, chronic pain, weakness, chronic fatigue, autoimmune diseases like multiple sclerosis  and Type 1 diabetes, high blood pressure, mental illnesses (depression, seasonal affective disorder and possibly schizophrenia), heart disease, rheumatoid arthritis, psoriasis, tuberculosis, periodontal disease and inflammatory bowel disease.  On the other hand, some research indicates that in some chronic diseases where vitamin D levels (25-hydroxy-vitamin D) appear to be low, they are low because the disease causes too much production of the vitamin D’s active hormonal form 1, 25 dihydroxy vitamin D. which can be harmful in amounts beyond normal range.  

 
Vitamin D and the sun:

        Human skin exposed to sunlight can, under the right conditions, produce quantities as large as 20,000 IU in just a few minutes without any apparent toxicity. This is easily enough to avoid deficiency and the vitamin does build up in the body tissue.  Exposure to sunlight also destroys vitamin D, so long term exposure to sunlight cannot cause toxicity, as levels are self-adjusting.

        On the other hand, merely being exposed to sunlight does not automatically mean that vitamin D is produced as only the UV rays in sunlight trigger vitamin D production.   UV rays mainly reach ground level when the sun is high in the sky. This occurs a few hours around solar midday (1 pm summertime).  At higher latitudes, the sun is only high enough in the sky in summer. For example, in the United States, those living north of a line from San Francisco to Philadelphia (about 40 degrees of latitude) will not be able to produce vitamin D  in significant quantities for 3 to 6 months a year.

        Those living in the higher latitudes from the end of summertime to the following spring must rely on stores of this vitamin which gradually deplete. By some estimates 10 to 20% of the population becomes at least mildly deficient by the end of winter.  Sunscreens over 8 SPF significantly interfere with production of Vitamin D_3.   Melanin, the dark pigment found in skin, screens UV light so dark skin is much less efficient at generating vitamin D.  People with darker skin experience greater vitamin D deficiencies, especially if they live at higher latitudes or have an urban lifestyle, as research shows. Vitamin D deficiency is known to be endemic in dark-skinned populations in the UK.

Vitamin D from food:

        Vitamin D3 (cholecalciferol) is found in egg yoke, animal fat, various fish and cod liver oil. Vitamin D2 (ergocalciferol) is found in plants and is a less biologically active form of this vitamin. The vitamin D that is added to milk and some other foods is D2.   Multi-vitamin/mineral supplements will often use Vitamin D2 in their formula.  When buying a multiple or a vitamin D supplement, look for vitamin D₃   (cholecalciferol) on the label as this is the more biologically active form. 

 Vitamin D from Cod Liver Oil:

        Vitamin D₃   can be obtained from cod liver oil.  Taking one teaspoon for every 50 pounds of body weight will provide the average 150 pound adult, with 2-3,000 units of vitamin D. Vitamin K is also present in cod liver oil and is an essential co-factor in building strong bones. Natural vitamin A (retinol) is also present in cod liver oil.  Vitamin A is essential to immune function, healthy skin and numerous other areas of our physiology.  Additionally, vitamin A provides a protective benefit in limiting to high of a calcium level in the body from the action of vitamin D. Vitamin A antagonizes calcium response to vitamin D in humans. Cod liver oil is also a great source for the very beneficial omega three fatty acids EPA and DHA which most Americans are deficient in.

       We recommend the Carlson brand of cod liver oil.  This brand has an excellent tract record of quality and comes in a lemon flavored taste that virtually removes the taste of the oil. 

 Testing for vitamin D in the body:

        There are two vitamin D tests that can be performed by your doctor.  One is called 1, 25(OH) D and the other is called 25(OH) D, sometimes referred to as 25-hydroxyvitamin D.  The 25(OH) D is the better marker of overall D status. It is this marker that is most strongly associated with overall health.

 How much Vitamin D do we need?

            Current FDA recommendations are between 200 and 400 international units (IU) per day.  Recent and ongoing research is finding that this recommendation is far to low.  Such research has shown that much higher dosages of vitamin D would reduce the risk of not only osteoporosis but such serious health problems as cancer and cardiovascular disease.  In the 2004 October/November issue of “Integrative Medicine,” in an article entitled, “The Clinical Importance of Vitamin D (Cholecalciferol): A Paradigm Shift with Implications for All Healthcare Providers,” the authors provided considerable evidence that there is an epidemic of vitamin D deficiency.  These authors recommended intake of up to 4000 IU of Vitamin D per day for adults and several thousand IU for children.

        At Milk ‘N Honey we recommend getting plenty of sunlight (minus the sunscreen) during the summer months and supplementing with Vitamin D during late fall through early spring.  Cod liver oil and a variety of vitamin D products are available at Milk ‘N Honey.

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