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If You Try a “Gluten-Free” Diet…

26 Feb

Gluten is found in wheat, oats, barley, and rye, and for those with Celiac Disease and non-celiac gluten sensitivity (NCGS), gluten can be very dangerous, even lethal. But many people opt to avoid foods containing gluten as part of an anti-inflammatory diet and there seems to be little-to-no argument that anti-inflammatory diets are indeed a very healthy choice.

One study reported that a Mediterranean-style diet can reduce cardiovascular risk factors and can help resolve both metabolic syndrome and non-alcoholic fatty liver disease. Additionally, there are several published studies describing how an anti-inflammatory diet can reduce pain associated with conditions such as rheumatoid arthritis. One such study reported a striking reduction in pain, joint inflammation, and morning stiffness duration reduction utilizing this type of diet—and these improvements persisted when researchers followed-up with participants a year later!

Because low-grade inflammation has now been identified as the driver of most chronic degenerative diseases, it is important to understand that low-grade chronic inflammation manifests itself both locally and systemically through a variety of inflammatory mediators. Many of these can be measured in a blood test and are commonly found in patients with chronic diseases such as atherosclerosis (hardening of the arteries) and osteoarthritis.

Individuals who do their best to cut gluten from their diet often seek out gluten-free versions of their favorite foods. Is there anything these people should know?

Well, an article in the November 2017 issue of Consumer Reports notes that gluten-free foods made with rice flour may contain high levels of arsenic and other heavy metals. The article also points out that those who restrict foods containing gluten tend to eat fewer whole grains, which may result in increased heart disease risk due to lower fiber intake.

What the authors of the article don’t point out is that consuming more fruits and vegetables can make up for this deficit, as these foods can also be high in fiber. The good news is that gluten-free whole grains such as amaranth, freekeh, quinoa, buckwheat, millet, teff, and sorghum are great, healthy substitutes.

Whiplash – Who Will Get Better?

19 Feb

Though most patients with a whiplash injury improve within a few months, about 25% have long-term pain and disability that may persist for many months or years.

 

Now, a team of scientists from Northwestern Medicine Feinberg school of Medicine reports that it may be possible to determine which whiplash patients will develop chronic pain, disability, and/or post-traumatic stress disorder (PTSD) within one to two weeks of their injury—leading to specialized treatment that may reduce their risk for developing a chronic condition.

 

Using a specialized form of MRI that measures the fat and water ratio in the neck muscles, the researchers found that greater fat infiltration into these muscles indicated rapid muscle atrophy. The presence of fat in the muscle is not related to the person’s weight, size, or shape and is believed to represent an injury that is more severe or serious than what might be expected from a typical low-speed car crash.

 

However, though the lead investigator notes that the fat infiltration into the muscle appears to be a response to an injury, what has actually been injured—muscle, nerves/spinal cord, and/or more—remains a mystery.

Another study by the same research team found that chronic pain whiplash victims also exhibited a high level of muscle fat in their legs—indicating atrophy. The researchers hypothesize that these patients may have partially damaged their spinal cord, as this group of patients also reported feeling weak and clumsy when walking.

Current research indicates that when managing whiplash cases, early return to activity, movement restoration, and exercises that specifically target the deep neck flexors lead to better outcomes than a “wait and watch” approach.

Doctors of chiropractic also utilize manipulation, mobilization, exercise training, diet, and nutrition, and encourage a return to a normal lifestyle as quickly as possible when treating patients with a whiplash injury.

Sick & Tired of Neck Pain?

15 Feb

For most of us, neck pain has reared its ugly head more than once. In fact, there are estimates that anywhere from one-in-ten to one-in-five people will experience an episode of neck pain in a given year. Though some studies report that between 33% and 65% of these people will recover within twelve months, many individuals will experience either a relapse of their neck pain or their neck pain will become a chronic health issue.

So what can a doctor of chiropractic do about it? The answer is simple: spinal manipulation (SM) and exercise. Spinal manipulation is the most common form of treatment delivered in a chiropractic setting, and many studies note that neck pain is the second most common reason patients seek chiropractic care (back pain is number one). Regarding exercise, patients may be advised to engage in stretching exercise, strengthening exercises, or both.

For example, after an hour of seated computer work, one might experience muscle fatigue from prolonged static postures, especially for those outside of a neutral position. For this scenario, here’s a great STRETCH option to do every 30-60 minutes (yes, SET A TIMER): 1) Tuck the chin (and keep it tucked); 2) reach with the right hand over the top of the head and gently pull the right ear toward the shoulder while the left hand reaches down to the floor (as if to pick up a dollar bill); 3) next, nod the head (as if gesturing “yes”) multiple times; 4) follow this by shaking the head left to right (as if gesturing “no”); 5) repeat steps one through four with the head/neck flexed forward and backwards, “searching” for the tightest spots and “work” them until they loosen up. Repeat on the opposite side.

Here is an exercise to STREGTHEN the neck muscles. 1) Tuck in the chin while looking straight ahead; 2) place the back of your second and third fingers under your chin and nod (up/down) against mild resistance; 3) repeat five to ten times SLOWLY; 4)  repeat steps one through three with head/neck flexed forward and then again backwards (looking towards the ceiling). Repeat multiple times each day.

The KEY is to set the timer to remind you to do these! If you have significant forward head carriage and rounded shoulders, your doctor of chiropractic can show you addition important exercises, but this will be a great start for you to gain control over that chronic, recurring neck pain that you’ve been putting up with for far too long!

Why Is Shoulder Pain So Common?

12 Feb

Shoulder pain is common. If fact, it’s highly likely that many of you reading this currently have or have had a shoulder injury, as studies suggest that about 90% of us will tear our rotator cuff, labrum, and/or capsule at some point in time during our lives. So why is this so common? More importantly, what can be done about this?

The reason for the high prevalence of shoulder pain is due to the anatomy of the shoulder. The shallow “socket” allows for the shoulder’s great range of motion, but with this excellent mobility comes a decrease in stability, as a joint can’t be BOTH stable AND highly mobile. So from a prevention standpoint, consider the following: 1) Don’t reach into the back seat to lift your heavy briefcase or purse to the front seat. 2) Take “mini-breaks” when working overhead. 3) Follow an exercise program that maintains strength in your shoulders. 4) Get help when you know the task you’re about to attempt is going to be a challenge. This list could go on and on but the last point is crucial: don’t feel insecure about asking for help with difficult tasks! As the saying goes, “An ounce of prevention is worth a pound of cure.”

An important goal regarding recovery from a shoulder injury involves restoring the joint space between the ball and socket joint and the “roof” of the shoulder or acromion process (or “acromiohumeral distance”, or AHD). A shoulder impingement injury typically occurs when this space is reduced, resulting in a tighter fit that pinches pain-sensitive structures when one attempts to raise their arm up over their head.

To reduce impingement, try the popular “pendular exercise” by holding a 5-15 lbs (2.26-6.80 kg) weight so that the arm swings loosely like the pendulum of a clock. The weight pulls the shoulder joint open, reducing impingement. Another exercise is gripping the seat of a chair while leaning to the opposite side (focus on relaxing the shoulder while leaning) to open or separate the joint. The joint can also be opened using elastic therapeutic tape. A 2017 study found that taping over the front and back deltoid muscle from insertion to origin worked best to open the AHD to reduce impingement. Doctors of chiropractic can also utilize manipulation and mobilization to open the AHD.

The Most Important Principles for Staying Young: The World Has Death on the Run

8 Feb

Our basic premise is that your body is amazing.  You get a do over. It doesn’t take that long, and it isn’t that hard if you know what to do.  In these notes, we give you a short course in what to do so it becomes easy for you and for you to teach others. We want you to know how much control you have over both the quality and length of your life.

You know from past articles that I believe most of you will be able to live well beyond age 100 with all your faculties intact. We’ve gone from a life expectancy of 47 in 1900 to 77 in 2000 to 83+ today.  You may have heard that life expectancy just declined for the second year since 1970.  Do not be fooled. This decrease was caused by people not taking care of themselves, gaining weight, earning diabetes, and by drug abuse and overdoses. But for those who take care of themselves, life expectancy now exceeds 95. The good news is we’re making progress on not just illness treating, but on life-extension, too, and I expect you to be able to live past 110 by the year 2030.  Let me give you an example of how science is learning to make your repair systems work much better…

Prevention is critical, no doubt. But it’s not the only way to approach aging. Your goal should be to nurture your body so that it can repair itself expeditiously when it breaks. Accidents and illness happen. Stuff breaks. Cars, computers, and relationships all have their own breaking points. And to suggest that stuff will not break either through acute injury or from wear and tear over time would be misleading. While it’s obviously important to keep your biological systems from breaking down, the real secret to longevity isn’t whether or not you break; it’s how well you recover and repair when you do.

As with a car, you’ll get a lot more mileage out of your body if you perform routine maintenance. Aging is essentially a process in which your cells lose their resilience; they lose their ability to repair damage because the things you might never have heard of (until now), like mitochondria and telomeres, aren’t working the way they should. But it’s within your power to boost that resilience and keep your vehicle going an extra couple hundred thousand miles. And here is one indication research is progressing fast enough that you may have adjuncts to help you repair your mitochondria (your energy factories in each cell) even before 2030.  Yes, you may get the energy you had when you were 20 or 30 back again—that level. Imagine having that amount of energy daily. Scientists tended to view mitochondria as low-IQ biological drones that take glucose and turn it into ATP—the tiny molecular batteries that fuel your body. This is clearly an important role. Complex life forms like you couldn’t exist without mitochondria.

And recently, the view of mitochondria’s role in biology increased in importance.  When we are old, we lack at least one thing that mitochondria need to perform and communicate optimally: nicotinamide adenine dinucleotide (NAD).  NAD is a coenzyme found in all living cells. It is critical for enzymes that fuel reduction-oxidation reactions, carrying electrons from one reaction to another in the production of energy in your mitochondria.  Cellular NAD+ concentrations decrease during aging.  Without sufficient NAD, mitochondria can’t make the ATP energy our cells need. Researchers focused on the aging process are talking seriously about boosting this NAD with it’s precursor, NR (nicotinamide riboside); at an conference on aging that I attended last year, two-thirds of the researchers said they were taking NR already although human trials have only just begun.

Here are some data on that one supplement… NR may help you repair your mitochondria and you gain more energy. In a recent Nature article, Dr. Auwerx and colleagues showed that animals with Alzheimer’s lack sufficient NAD. Mitochondrial energy output is reduced, and damaged mitochondrial proteins are not recycled. Knowing that NR increases NAD levels, they gave the vitamin (NR is a form or niacin) to animals. The result was reduced amyloid deposits, higher energy levels, and improved memory. NR didn’t cause these improvements by directly attacking the pathology of Alzheimer’s disease. Rather, it improved mitochondrial function. That resulted in more efficient and healthier systems overall. This reduced Alzheimer’s disease, at least in animals. A recent article in the journal Circulation titled, “Nicotinamide Riboside Preserves Cardiac Function in a Mouse Model of Dilated Cardiomyopathy,” indicates this benefit of NR on mitochondrial energy function may also affect the heart muscle. This study showed that mice with heart problems have lower NAD levels. This includes dilated cardiomyopathy (enlarged heart) and cardiac hypertrophy caused by constriction of the transverse aorta. They also confirmed that low NAD levels are typical of humans with heart diseases.

So we now know that NR can improve the health of mice with at least two age-related conditions—memory impairment and inability of the heart to pump adequately—presumably by restoring NAD levels to improve mitochondrial function.

And we know that NR increases NAD levels in people. As stated above, cellular NAD+ concentrations decrease during aging. But what is new in addition to Dr. Auwerx work on Alzheimer’s and the Circulation study on cardiac function is that modulation of NAD+ usage or production can make the animal’s RealAge younger and prolong (in animal studies so far) life span substantially (by 20 to 80 percent). We don’t yet have evidence that it increases human health and lifespan, or if it fights or prevents specific human diseases.  But, we should know soon. Several human trials are underway—you can find those trials at clinicaltrials.gov.  Search for nicotinamide riboside for more information. In the meantime, you’ll understand that restoration of mitochondrial function is just one of 14 areas where aging research is progressing quickly. We’ll talk about some in this column in the next several years. And that research and that progress is why I am so optimistic about your (and my) chances of living a lot longer with great health.

All these developments are wonderful news from a human standpoint, but also economically. Think of all the potential genius and innovation the world never sees because disease robs it from us. By preserving these lives, this research can enhance everyone’s life.

But you got to make it to 2030 or so to benefit from these aging research advances, so we’ll continue to present in this column the medical news and our action tips based on that research for doing just that.  I’m not talking immortality—a five-alarm fire can happen or you can step in front of an RTA (Cleveland Metro) bus. Stuff happens. And, yes, I have thought a lot about how people will react when they realize they can actually be 150 years old in a youthful body that will have an extremely young RealAge. And, yes, I really have no clue how individuals and society will handle these transformations. But that is one of the things I’m looking forward to finding out. We’ll just have to live through the changes to figure them out.

Thanks for reading. Feel free to send questions to: AgeProoflife@gmail.com

Dr. Mike Roizen

PS: Please continue to order the new book by Jean Chatzky and myself, AgeProof: Living Longer Without Running Out of Money or Breaking a Hip. 

 

NOTE: You should NOT take this as medical advice.

This article is of the opinion of its author.

Before you do anything, please consult with your doctor.

 

You can follow Dr Roizen on twitter @YoungDrMike (and get updates on the latest and most important medical stories of the week).  The YOU docs have two newly revised books: The patron saint “book” of this column YOU Staying Young—revised and YOU: The Owner’s Manual…revised —yes a revision of the book that started Dr Oz to being Dr Oz.  These makes great gifts—so do YOU: ON a Diet and YOU: The Owner’s Manual for teens.  

Michael F. Roizen, M.D., is chief wellness officer and chair of the Wellness Institute at the Cleveland Clinic. His radio show streams live on http://www.radioMD.com Saturdays from 5-7 p.m. He is the co-author of 4 #1 NY Times Best Sellers including: YOU Staying Young.

Carpal Tunnel Syndrome – OVERVIEW (Part 1)

5 Feb

Carpal tunnel syndrome (CTS) represents a collection of signs and symptoms resulting from the compression or pinching of the median nerve as it passes through the carpal tunnel at the wrist. In this overview, you will see why CTS can be a challenging ailment to diagnose and treat.

SYMPTOMS: Numbness, tingling, and pain. Less commonly, burning and/or sharp pain in the index to the thumb-side half of the fourth finger, palm-side only. Loss of grip strength (such as unscrewing a jar) may occur but usually later in the course of the condition.

PATHOPHYSIOLOGY: Compression of the median nerve inside the bony carpal tunnel occurs when the pressure inside the tunnel increases, often due to overuse with subsequent swelling. There are multiple epidemiologic factors including genetic, medical, social, vocational, avocational, and demographic with a complex interplay between some or all these factors. However, definitive causative factors remain obscure and unclear in many cases.

EPIDEMIOLOGY: About one to three people per every 1,000 will develop CTS in a given year, and estimates show about 50 people per 1,000 currently live with CTS in the general population. However, the incidence may rise as high as 150 cases per 1,000 subjects per year, with prevalence rates greater than 500 cases per 1,000 subjects in certain high-risk groups. The incidence and prevalence is similar in developed countries like the United States, the United Kingdom, and the Netherlands, but CTS is almost unheard of in some developing countries. The female-to-male ratio for CTS is three-to-ten females to one male. Carpal tunnel syndrome seems to peak at age 45-60 years old with only 10% of CTS patients under the age of 31. The condition is not fatal, but if left untreated, severe cases can lead to complete, irreversible median nerve damage and a loss of much hand function.

CLINICAL PRESENTATION: A patient’s history is often more valuable than the physical examination when it comes to CTS. Patients may report the above-listed symptoms, which may worsen at night and interrupt sleep. Symptoms may also increase in intensity during activities like driving, crocheting, and painting. Frequently, CTS affects both hands, but it’s usually worse in the dominant hand. Patients may have difficulty “mapping” their symptoms well and may feel numbness, tingling, pain, and/or weakness in the whole arm and/or forearm. It’s often prudent to look for additional compression elsewhere in the course of the median nerve in the neck, shoulder, and/or elbow. Less commonly, the patient may experience whole hand hot/cold sensitivity with color changes and/or sweating, which may indicate autonomic nervous system involvement. The use of CTS questionnaires can help diagnose and track progress during care. This discussion will continue next month – stay tuned!

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