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Oh for God sake...
A pro-inflammatory state is one that promotes inflammation and associated sequelae. I was referring in particular to several aspects of diet that puts people into such a state, which is unfortunately very common today. The first thing coming to mind is the typical over-consumption of omega-6 fatty acids, coupled with an under-consumption of omega-3s. The omega-3s, particularly EPA and DHA, promote production of anti-inflammatory eicosanoids, which is good. Since we tend to consume too many omega-6s in our Western diet, the result is the production of pro-inflammatory eicosanoids from arachidonic acid. It's estimated that the typical American has an n6:n3 of 20:1, where the ideal ratio is probably around 4:1. This all drives inflammation. EPA and DHA are also known to directly inhibit NFkB, which is in effect anti-inflammatory.
Another diet-driven promoter of inflammation is the over-consumption of carbs, particularly junk carbs that cause hyperinsulinemia. Insulin drives the omega-6 pathway into a pro-inflammatory direction by favoring the production of arachidonic acid over DGLA (an anti-inflammatory omega-6).
In addition, whatever diet and lifestyle factors lead to increased adipose tissue will also promote inflammation. Adipose tissue synthesizes any number of pro-inflammatory cytokines.
An anti-inflammatory diet, if you will, will include plenty of veggies and fruits, which among other things contain lots of antioxidants, whose actions are anti-inflammatory.
(There's also interesting albeit early research involving probiotics, which appear to not only reduce GI inflammation but systemic inflammation as well. I think we'll see more and more about this avenue of approach in the future.)
For our purposes here, all of this inflammation stuff obviously causes pain. We should keep in mind that chronic, smoldering inflammation is silent (i.e., not painful) but is now thought to contribute to everything from cardiovascular disease to neurodegenerative disease to cancer. Perhaps this has something to do with why Americans are so unhealthy.
<let's all eat some probiotic yogurt per FacetGuy>
yup and there's also this twig that my uncle said that you can eat and apparently it's got analgesic properties. He says Tylenol, vicodin, and motrin are just to man made with too many chemicals. The research is ongoing on this twig he was telling me about. n=1. He was telling me I should put it in a bottle and market it. I wonder if FacetGuy would have any clients that would be interested.
research..as you know unless it's published in a peer reviewed PHYSICIAN journal is similar to reading something in People Mag, Teen, or one of those tabloids.
Hey once it makes it into one of our journals, I'll be cool with it. Until then...
yup and there's also this twig that my uncle said that you can eat and apparently it's got analgesic properties. He says Tylenol, vicodin, and motrin are just to man made with too many chemicals. The research is ongoing on this twig he was telling me about. n=1. He was telling me I should put it in a bottle and market it. I wonder if FacetGuy would have any clients that would be interested.
research..as you know unless it's published in a peer reviewed PHYSICIAN journal is similar to reading something in People Mag, Teen, or one of those tabloids.
Hey once it makes it into one of our journals, I'll be cool with it. Until then...
The typical arguments made by chiropractors and other dietary zealots are made by using multiple orders of extrapolations from the molecular to human organism with large chunks of confirmatory research missing. For example, molecule A is known to produce inflammatory molecule B in rats under certain conditions. Not to mention it may also produce anti-inflammatory molecule C at the same time. Since inflammatory molecule B is known to cause heart disease in dogs when injected with 100 times the normal amounts found in the dog, it must be a bad molecule. Free radical scavengers reduce the amount of molecule B during bench testing therefore free radical scavengers must be good for human hearts because it reduces the concentration of molecule B that is known to cause heart disease....etc...etc....etc.
Most of us would scoff at this type of pseudoscience, but it has been embraced by the dietary supplement (really is another drug) industry and made popular by pseudoscience babble spewed forth by those that have never taken the time to look for human studies (placebo controlled) under rigid experimental conditions....frequently these studies do not exist. Therefore the nonsense about inflammation and free radical scavengers and how pill D (also sold in the offices of the chiropractor or by the chiropractor). This pseudoscience industry of unregulated drugs is a $2 billion dollar industry fleecing the naive who are promised results that have not been validated. Of course there may be some grains of truth in some of the dietary supplement industry claims, but many studies have recently demonstrated no effect of these supplements compared with placebo, so the house of cards is finally beginning to fall.
are you reading The Journal of Lipid Research and other such esoteric stuff? do you get the e-bulletin from the American Society for Biochemistry and Molecular Biology? i don't know if any physicians are doing molecular research, so it might be up to the lab rats. then the physicians have to do something with that data for you to consider it worthy. it could be a long time in getting something into a journal that you read.
anyway the lab rats have known omega-3 oils suppress cox-2 for years now. there was an article in 1995 arthritis and rheumatism that showed benefit in RA sufferers. this was supported in several studies more recently. granted this was to look at RA, but the point remains that omega-3s have an anti-inflammatory property. fyi: you won't get them in yogurt.
i don't tell anyone with an acute radic to go get that stuff, but it is going to be a safer alternative to telling someone to take an NSAID every day for their chronic condition, be it RA or whatever.
are you reading The Journal of Lipid Research and other such esoteric stuff? do you get the e-bulletin from the American Society for Biochemistry and Molecular Biology? i don't know if any physicians are doing molecular research, so it might be up to the lab rats. then the physicians have to do something with that data for you to consider it worthy. it could be a long time in getting something into a journal that you read.
anyway the lab rats have known omega-3 oils suppress cox-2 for years now. there was an article in 1995 arthritis and rheumatism that showed benefit in RA sufferers. this was supported in several studies more recently. granted this was to look at RA, but the point remains that omega-3s have an anti-inflammatory property.
fyi: you won't get them in yogurt.
i don't tell anyone with an acute radic to go get that stuff, but it is going to be a safer alternative to telling someone to take an NSAID every day for their chronic condition, be it RA or whatever.
please read algos' above post. extrapolating molecular data and applying it directly to humans w/o solid research is dangerous..
please read algos' above post. extrapolating molecular data and applying it directly to humans w/o solid research is dangerous..
So among "joint pain associated with rheumatoid arthritis, inflammatory bowel disease, and dysmenorrhea", which of those disease entities is it appropriate for a chiroprctor to be treating?Do you read the journal Pain?
http://www.ncbi.nlm.nih.gov/pubmed/17335973
None of these studies address your concept of "pro-inflammatory" states. They address anti-inflammatory compounds.The info I posted yesterday on diet-induced pro-inflammatory state is basic biochemistry. And, I think you are exactly wrong when you say "the house of cards is finally beginning to fall". In fact, we are learning more than ever about various nutritional supplements, dietary components, nutrigenomics, and the like on their relationship to pain, inflammation and health and disease in general. You may not be plugged into those avenues of research, but I assure you there is a lot of active investigation happening. And it's not being done by chiropractors, so you can feel better about that. Just take the omega-3 fatty acids research alone; there is tons of new info out there, and some of it relates to your pain patients.
Neuropathic pain: http://www.ncbi.nlm.nih.gov/pubmed/20090445
Inflammatory joint pain: http://www.ncbi.nlm.nih.gov/pubmed/17335973
Neck and back pain: http://www.ncbi.nlm.nih.gov/pubmed/16531187
Inverse relationship to CRP: http://www.ncbi.nlm.nih.gov/pubmed/19352379
http://www.ncbi.nlm.nih.gov/pubmed/19593941
Muscle pain after eccentric exercise: http://www.ncbi.nlm.nih.gov/pubmed/19451765 (randomized double blinded trial)
This took me about 3 minutes to find. A more exhaustive search would fill pages. It's not pseudoscience; it's science you don't know about.
I have a 16 page handout on why to avoid Vax-D (besides the $4k in cash).
So among "joint pain associated with rheumatoid arthritis, inflammatory bowel disease, and dysmenorrhea", which of those disease entities is it appropriate for a chiroprctor to be treating?
By any chance would you happen to have a link to it or know how I can get a copy? I'd like to learn more about this.
,that we take in via diet or supplements and are incorporated into our bodies and influence inflammatory physiology.None of these studies address your concept of "pro-inflammatory" states. They address anti-inflammatory compounds.
So at a more basic level, is your concept that those in a "pro-inflammatory" state are more prone to injury?
Over-respond to injuries of similar magnitude?
Develop spontaneous inflammations without any injury at all?
And if, assuming arguendo this is, in fact, borne out with basic science literature, does prophetically altering said patients' diets in any way actually protect them from these dreaded inflammatory conditions? I would appreciate data, and not just a retelling of your personal experiences.
Your responses illustrate your lack of understanding. Inflammation is a response. None of the examples you cite demonstrate a "pro-inflammatory" state. They are all inflammatory responses to insult or injury. None of them entail a pro-inflammatory predisposition, as there is no such thing, outside of the pseudoscientific realm of dietary supplement sales jargon.,that we take in via diet or supplements and are incorporated into our bodies and influence inflammatory physiology.
No. Unless you take into account the vitamin D literature which is finding that low serum vitamin D levels are associated with both inflammation (http://www.ncbi.nlm.nih.gov/pubmed/17599737) and falls in the elderly (http://www.ncbi.nlm.nih.gov/pubmed/19797342).
I would say yes, although that would probably be difficult to prove.
Yes. The best example of this would be in the cardiovascular realm, where much attention is being paid these days to silent chronic inflammation as it relates to cardiovascular disease. The same is true for many other disease states.
I think it does. The quickest example I can think of would be the much-studied Mediterranean Diet and its beneficial health effects, at least in part due to modulation of inflammation: http://www.ncbi.nlm.nih.gov/pubmed/20138282
When I have time later, I'll try to cite more examples.
Your responses illustrate your lack of understanding. Inflammation is a response. None of the examples you cite demonstrate a "pro-inflammatory" state. They are all inflammatory responses to insult or injury. None of them entail a pro-inflammatory predisposition, as there is no such thing, outside of the pseudoscientific realm of dietary supplement sales jargon.
Of course inflammation is a response. In your practice and mine, those insults or injuries are usually some type of overt trauma, such as an acutely herniated disc or a torn joint capsule or whatever. But remember, inflammation isn't just in response to these overt injuries. Inflammation is linked to the immune system, so there are any number of inflammatory triggers and the response can occur systemically. (This is where the concept of systemic inflammation beginning in the gut comes in and why probiotics may play a key role in all of this, but that's another story.)
Anyway, for our purposes here, the issue is what happens when that insult or injury occurs. Let's envision 2 cells. Cell 1's membrane is made entirely of arachidonic acid and Cell 2's membrane is made entirely of EPA. Now, regardless of what its in response to, the inflammatory cascade, at least in large part, involves phospholipase A2 grabbing a fatty acid out of the cell membrane, and that fatty acid then is acted upon by either COX or LOX enzymes, and the result is a host of eicosanoids (prostaglandins, leukotrienes, etc.). The eicosanoids made from Cell 1's arachidonic acid will be primarily inflammatory in nature, so if all of our cells were like Cell 1, we would be highly inflamed. In contrast, the eicosanoids from Cell 2's EPA will be primarily anti-inflammatory in nature, so if all of our cells were like Cell 2, we would be much less likely to be excessively inflamed. (Yes, it's a crude example and in reality we need both, but work with me here.) We could (or you guys could) arrest the whole pathway by inhibiting PLA2 with steroids, but that can't go on forever, at least not ideally. Or we could inhibit COX and LOX with various anti-inflammatory meds. But, these strategies come with side-effects, so they aren't good longterm strategies. So, one way to go about things longterm is to make sure that our membrane fatty acids have a favorable ratio of arachidonic acid to EPA/DHA. Thus, as the inflammatory trigger presents itself, we have a better chance at forming anti-inflammatory eicosanoids.
This isn't pseudoscience as you suggest. There is an enormous body of literature describing the role of fatty acids in health and disease.
let me guess you sell the anti-inflammatory pill. Hey let's see your website. You're in practice, what do you have to loose?
Or will it unfold your unscrupulous practices?
http://bit.ly/95NwjzI also tell them to try glucosamine-chondroitin and tell them about the research that shows for moderate to severe OA related pain, it can be effective (GAIT study from NIH). I tell them to try it for 2-3 months, and if no change, stop because it's a waste of $$.
Also, just to be clear, omega-3 oils are contraindicated in people who suffer from fish allergies, those with blood dyscrasias, and patients on anticoagulants.
Also, those on herbal and other supplemental treatments (ginkgo biloba , garlic) are advised to use omega-3 oils with caution, as their use increases the risk of bleeding.
Chiropractors who are untrained in pharmacology, hematology, and clotting cascades put their patients at risk by venturing into the realm of prescribing either dietary changes or nutritional supplements.
Problems with Vit D is that it is not a vitamin, it is a hormone.
Drisdol weekly x8 weeks, then q2 weeks for 4 more doses, then 1000 units daily.
We are all D deficient. But once we get our ergo up, we probably need to get chole to maintain it.
And a little sunshine over here please...
Problems with Vit D is that it is not a vitamin, it is a hormone.
Drisdol weekly x8 weeks, then q2 weeks for 4 more doses, then 1000 units daily.
We are all D deficient. But once we get our ergo up, we probably need to get chole to maintain it.
And a little sunshine over here please...
I don't sell anything.
Right...that's why you arent posting your website right?
If I had one I'd post it...
darn, you beat me to it..
Facetguy....all you have to tell your patients is go outside and get some SUN. Why do you chiropractors fail to tell your patients that?
Right...that's why you arent posting your website right?
If I had one I'd post it...
darn, you beat me to it..
Facetguy....all you have to tell your patients is go outside and get some SUN. Why do you chiropractors fail to tell your patients that?
????
Why antagonize just to antagonize? What does that contribute?
First, for most of the country, we are unable to make vitamin D over the winter months. So, go ahead and stand outside in your panties on a nice sunny January day...you won't be making any vitamin D, unless you are in the southernmost regions of the US. Secondly, most of us wisely use sunscreen to prevent sunburn and skin cancers. Any sunscreen of SPF 8 blocks 95% of vitamin D production; SPF 15+ blocks 99%. Thirdly, the elderly are probably at greatest risk for D deficiency, yet their skin becomes less and less efficient at producing vitamin D in the presence of UVB. That leaves supplements our best option for many people. Finally, if just getting some sun were so effective, why is most of the country still insufficient/deficient in vitamin D? And, for the record, I do tell my patients to get some sensible sun exposure during the times of the year when it makes sense. By the way, in your comments you imply that chiropractors don't tell their patients about sun exposure so we can sell them more vitamin D. Just so you know, a year's supply of vitamin D costs about $25 or so...there's a lot of profit in that, eh??
I'll give you credit. You take a lickin' and keep on postin'. (You're probably too young to remember those ads.)
Dream on Tyson
"most of the country still is insufficient in Vit D". Where's your data? Please oh wise chiropractor show me this statistic in a peer reviewed journal article. Remember not your contrived chiropractics journal with the Vax D ads. A real journal, not a magazine.
ahhh....
Facetguy,
At this point I don't consider myself for or against chiropractor care. I just don't really know enough about it but am learning a lot from the well thought out responses on this thread. I guess I would say I would consider referring a pt to a chiropractor as I would to a massage therapist. However, it is very early in my career and my views are certainly open to change.
Anyhow, out of curiosity, what's the status of chiropractors in the military? Are they commissioned and if not, why? The military has been very active in trying to recruit me and my colleagues since year one of medical school. From the reading material that they give me, it seems that the military is also very active in recruiting other health care providers such as RNs, NPs, PTs, PAs, etc. I know that VA hospitals do invest in the health of our soldiers. For instance, amputee soldiers are allowed to receive top line prosthetics which can be replaced with far more frequency than civilian worn prosthetics. If chiropractic care is effective and beneficial, why are chiropractors not in the military?
P.S. If they are in the military, then I stand corrected and apologize for my ignorance
Ok, it's time to meet IRL and battle it out in a cage match, tag-team style, chiro vs MD/DO. Better yet, in the Thunderdome!
Who's with me?
I haven't been real plugged into the military news because, honestly, it hasn't affected my practice. But from what I understand, there were some pilot programs some years ago that have now been expanded across the country. So, yes, there is chiropractic involvement in the military, exactly to what extent I'm not sure offhand. I'm pretty sure though that Tricare does not pay for chiro treatment for retired military.