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Oh for God sake...
North American Spine
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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>
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<let's all eat some probiotic yogurt per FacetGuy>
hahahahahaaaahaha
except facetguy is right. one thing i've learned is that not everything known is taught in medical school. my spouse is a dietician and some of the research she has been showing me about this stuff is pretty amazing. omega-6 acids lead to inflammatory mediators, which promote an underlying inflammatory process. this is probably one of the times when you want to keep a lower profile.
this thread needs to die.
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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...
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...
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Cramp Bark?, Seinfeld (again).
Honestly, a pro-inflammatory diet is one that includes a regular supply of thumb tacks. Based on this unusual postulate that inflammation is causing chronic pain- I'll start adding Kineret to my epidurals and facet blocks. We know TNF was already tried and failed.
Making people believe something that is not true is based on the following:
Assertion:
Assertion is commonly used in advertising and modern propaganda. An assertion is an enthusiastic or energetic statement presented as a fact, although it is not necessarily true. They often imply that the statement requires no explanation or back up, but that it should merely be accepted without question. Examples of assertion, although somewhat scarce in wartime propaganda, can be found often in modern advertising propaganda. Any time an advertiser states that their product is the best without providing evidence for this, they are using an assertion. The subject, ideally, should simply agree to the statement without searching for additional information or reasoning. Assertions, although usually simple to spot, are often dangerous forms of propaganda because they often include falsehoods or lies.
Bandwagon:
Bandwagon is one of the most common techniques in both wartime and peacetime and plays an important part in modern advertising. Bandwagon is also one of the seven main propaganda techniques identified by the Institute for Propaganda Analysis in 1938. Bandwagon is an appeal to the subject to follow the crowd, to join in because others are doing so as well. Bandwagon propaganda is, essentially, trying to convince the subject that one side is the winning side, because more people have joined it. The subject is meant to believe that since so many people have joined, that victory is inevitable and defeat impossible. Since the average person always wants to be on the winning side, he or she is compelled to join in. However, in modern propaganda, bandwagon has taken a new twist. The subject is to be convinced by the propaganda that since everyone else is doing it, they will be left out if they do not. This is, effectively, the opposite of the other type of bandwagon, but usually provokes the same results. Subjects of bandwagon are compelled to join in because everyone else is doing so as well. When confronted with bandwagon propaganda, we should weigh the pros and cons of joining in independently from the amount of people who have already joined, and, as with most types of propaganda, we should seek more information.
Card stacking:
Card stacking, or selective omission, is one of the seven techniques identified by the IPA, or Institute for Propaganda Analysis. It involves only presenting information that is positive to an idea or proposal and omitting information contrary to it. Card stacking is used in almost all forms of propaganda, and is extremely effective in convincing the public. Although the majority of information presented by the card stacking approach is true, it is dangerous because it omits important information. The best way to deal with card stacking is to get more information.
Glittering Generalities:
Glittering generalities was one of the seven main propaganda techniques identified by the Institute for Propaganda Analysis in 1938. It also occurs very often in politics and political propaganda. Glittering generalities are words that have different positive meaning for individual subjects, but are linked to highly valued concepts. When these words are used, they demand approval without thinking, simply because such an important concept is involved. For example, when a person is asked to do something in "defense of democracy" they are more likely to agree. The concept of democracy has a positive connotation to them because it is linked to a concept that they value. Words often used as glittering generalities are honor, glory, love of country, and especially in the United States, freedom. When coming across with glittering generalities, we should especially consider the merits of the idea itself when separated from specific words.
Lesser of Two Evils:
The "lesser of two evils" technique tries to convince us of an idea or proposal by presenting it as the least offensive option. This technique is often implemented during wartime to convince people of the need for sacrifices or to justify difficult decisions. This technique is often accompanied by adding blame on an enemy country or political group. One idea or proposal is often depicted as one of the only options or paths. When confronted with this technique, the subject should consider the value of any proposal independently of those it is being compared with.
Name Calling:
Name calling occurs often in politics and wartime scenarios, but very seldom in advertising. It is another of the seven main techniques designated by the Institute for Propaganda Analysis. It is the use of derogatory language or words that carry a negative connotation when describing an enemy. The propaganda attempts to arouse prejudice among the public by labeling the target something that the public dislikes. Often, name calling is employed using sarcasm and ridicule, and shows up often in political cartoons or writings. When examining name calling propaganda, we should attempt to separate our feelings about the name and our feelings about the actual idea or proposal.
Pinpointing the Enemy:
Pinpointing the enemy is used extremely often during wartime, and also in political campaigns and debates. This is an attempt to simplify a complex situation by presenting one specific group or person as the enemy. Although there may be other factors involved the subject is urged to simply view the situation in terms of clear-cut right and wrong. When coming in contact with this technique, the subject should attempt to consider all other factors tied into the situation. As with almost all propaganda techniques, the subject should attempt to find more information on the topic. An informed person is much less susceptible to this sort of propaganda.
Plain Folks:
The plain folks propaganda technique was another of the seven main techniques identified by the IPA, or Institute for Propaganda Analysis. The plain folks device is an attempt by the propagandist to convince the public that his views reflect those of the common person and that they are also working for the benefit of the common person. The propagandist will often attempt to use the accent of a specific audience as well as using specific idioms or jokes. Also, the propagandist, especially during speeches, may attempt to increase the illusion through imperfect pronunciation, stuttering, and a more limited vocabulary. Errors such as these help add to the impression of sincerity and spontaneity. This technique is usually most effective when used with glittering generalities, in an attempt to convince the public that the propagandist views about highly valued ideas are similar to their own and therefore more valid. When confronted by this type of propaganda, the subject should consider the proposals and ideas separately from the personality of the presenter.
Simplification (Stereotyping):
Simplification is extremely similar to pinpointing the enemy, in that it often reduces a complex situation to a clear-cut choice involving good and evil. This technique is often useful in swaying uneducated audiences. When faced with simplification, it is often useful to examine other factors and pieces of the proposal or idea, and, as with all other forms of propaganda, it is essential to get more information.
Testimonials:
Testimonials are another of the seven main forms of propaganda identified by the Institute for Propaganda Analysis. Testimonials are quotations or endorsements, in or out of context, which attempt to connect a famous or respectable person with a product or item. Testimonials are very closely connected to the transfer technique, in that an attempt is made to connect an agreeable person to another item. Testimonials are often used in advertising and political campaigns. When coming across testimonials, the subject should consider the merits of the item or proposal independently of the person of organization giving the testimonial.
Transfer:
Transfer is another of the seven main propaganda terms first used by the Institute for Propaganda Analysis in 1938. Transfer is often used in politics and during wartime. It is an attempt to make the subject view a certain item in the same way as they view another item, to link the two in the subjects mind. Although this technique is often used to transfer negative feelings for one object to another, it can also be used in positive ways. By linking an item to something the subject respects or enjoys, positive feelings can be generated for it. However, in politics, transfer is most often used to transfer blame or bad feelings from one politician to another of his friends or party members, or even to the party itself. When confronted with propaganda using the transfer technique, we should question the merits or problems of the proposal or idea independently of convictions about other objects or proposals.
Honestly, a pro-inflammatory diet is one that includes a regular supply of thumb tacks. Based on this unusual postulate that inflammation is causing chronic pain- I'll start adding Kineret to my epidurals and facet blocks. We know TNF was already tried and failed.
Making people believe something that is not true is based on the following:
Assertion:
Assertion is commonly used in advertising and modern propaganda. An assertion is an enthusiastic or energetic statement presented as a fact, although it is not necessarily true. They often imply that the statement requires no explanation or back up, but that it should merely be accepted without question. Examples of assertion, although somewhat scarce in wartime propaganda, can be found often in modern advertising propaganda. Any time an advertiser states that their product is the best without providing evidence for this, they are using an assertion. The subject, ideally, should simply agree to the statement without searching for additional information or reasoning. Assertions, although usually simple to spot, are often dangerous forms of propaganda because they often include falsehoods or lies.
Bandwagon:
Bandwagon is one of the most common techniques in both wartime and peacetime and plays an important part in modern advertising. Bandwagon is also one of the seven main propaganda techniques identified by the Institute for Propaganda Analysis in 1938. Bandwagon is an appeal to the subject to follow the crowd, to join in because others are doing so as well. Bandwagon propaganda is, essentially, trying to convince the subject that one side is the winning side, because more people have joined it. The subject is meant to believe that since so many people have joined, that victory is inevitable and defeat impossible. Since the average person always wants to be on the winning side, he or she is compelled to join in. However, in modern propaganda, bandwagon has taken a new twist. The subject is to be convinced by the propaganda that since everyone else is doing it, they will be left out if they do not. This is, effectively, the opposite of the other type of bandwagon, but usually provokes the same results. Subjects of bandwagon are compelled to join in because everyone else is doing so as well. When confronted with bandwagon propaganda, we should weigh the pros and cons of joining in independently from the amount of people who have already joined, and, as with most types of propaganda, we should seek more information.
Card stacking:
Card stacking, or selective omission, is one of the seven techniques identified by the IPA, or Institute for Propaganda Analysis. It involves only presenting information that is positive to an idea or proposal and omitting information contrary to it. Card stacking is used in almost all forms of propaganda, and is extremely effective in convincing the public. Although the majority of information presented by the card stacking approach is true, it is dangerous because it omits important information. The best way to deal with card stacking is to get more information.
Glittering Generalities:
Glittering generalities was one of the seven main propaganda techniques identified by the Institute for Propaganda Analysis in 1938. It also occurs very often in politics and political propaganda. Glittering generalities are words that have different positive meaning for individual subjects, but are linked to highly valued concepts. When these words are used, they demand approval without thinking, simply because such an important concept is involved. For example, when a person is asked to do something in "defense of democracy" they are more likely to agree. The concept of democracy has a positive connotation to them because it is linked to a concept that they value. Words often used as glittering generalities are honor, glory, love of country, and especially in the United States, freedom. When coming across with glittering generalities, we should especially consider the merits of the idea itself when separated from specific words.
Lesser of Two Evils:
The "lesser of two evils" technique tries to convince us of an idea or proposal by presenting it as the least offensive option. This technique is often implemented during wartime to convince people of the need for sacrifices or to justify difficult decisions. This technique is often accompanied by adding blame on an enemy country or political group. One idea or proposal is often depicted as one of the only options or paths. When confronted with this technique, the subject should consider the value of any proposal independently of those it is being compared with.
Name Calling:
Name calling occurs often in politics and wartime scenarios, but very seldom in advertising. It is another of the seven main techniques designated by the Institute for Propaganda Analysis. It is the use of derogatory language or words that carry a negative connotation when describing an enemy. The propaganda attempts to arouse prejudice among the public by labeling the target something that the public dislikes. Often, name calling is employed using sarcasm and ridicule, and shows up often in political cartoons or writings. When examining name calling propaganda, we should attempt to separate our feelings about the name and our feelings about the actual idea or proposal.
Pinpointing the Enemy:
Pinpointing the enemy is used extremely often during wartime, and also in political campaigns and debates. This is an attempt to simplify a complex situation by presenting one specific group or person as the enemy. Although there may be other factors involved the subject is urged to simply view the situation in terms of clear-cut right and wrong. When coming in contact with this technique, the subject should attempt to consider all other factors tied into the situation. As with almost all propaganda techniques, the subject should attempt to find more information on the topic. An informed person is much less susceptible to this sort of propaganda.
Plain Folks:
The plain folks propaganda technique was another of the seven main techniques identified by the IPA, or Institute for Propaganda Analysis. The plain folks device is an attempt by the propagandist to convince the public that his views reflect those of the common person and that they are also working for the benefit of the common person. The propagandist will often attempt to use the accent of a specific audience as well as using specific idioms or jokes. Also, the propagandist, especially during speeches, may attempt to increase the illusion through imperfect pronunciation, stuttering, and a more limited vocabulary. Errors such as these help add to the impression of sincerity and spontaneity. This technique is usually most effective when used with glittering generalities, in an attempt to convince the public that the propagandist views about highly valued ideas are similar to their own and therefore more valid. When confronted by this type of propaganda, the subject should consider the proposals and ideas separately from the personality of the presenter.
Simplification (Stereotyping):
Simplification is extremely similar to pinpointing the enemy, in that it often reduces a complex situation to a clear-cut choice involving good and evil. This technique is often useful in swaying uneducated audiences. When faced with simplification, it is often useful to examine other factors and pieces of the proposal or idea, and, as with all other forms of propaganda, it is essential to get more information.
Testimonials:
Testimonials are another of the seven main forms of propaganda identified by the Institute for Propaganda Analysis. Testimonials are quotations or endorsements, in or out of context, which attempt to connect a famous or respectable person with a product or item. Testimonials are very closely connected to the transfer technique, in that an attempt is made to connect an agreeable person to another item. Testimonials are often used in advertising and political campaigns. When coming across testimonials, the subject should consider the merits of the item or proposal independently of the person of organization giving the testimonial.
Transfer:
Transfer is another of the seven main propaganda terms first used by the Institute for Propaganda Analysis in 1938. Transfer is often used in politics and during wartime. It is an attempt to make the subject view a certain item in the same way as they view another item, to link the two in the subjects mind. Although this technique is often used to transfer negative feelings for one object to another, it can also be used in positive ways. By linking an item to something the subject respects or enjoys, positive feelings can be generated for it. However, in politics, transfer is most often used to transfer blame or bad feelings from one politician to another of his friends or party members, or even to the party itself. When confronted with propaganda using the transfer technique, we should question the merits or problems of the proposal or idea independently of convictions about other objects or proposals.
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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.
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.
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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...
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.
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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...
Do you read the journal Pain?
http://www.ncbi.nlm.nih.gov/pubmed/17335973 (just one of many similar studies)
So, now that you're cool with it...
Sometimes, when you don't know anything about something, it's just better to remain silent.
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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.
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please read algos' above post. extrapolating molecular data and applying it directly to humans w/o solid research is dangerous..
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Exactly. As I said above, this research is going on all over the place. Clinically-oriented pain physicians aren't likely plugged into this research, but it doesn't mean it's not being published.
No doubt.
If we start out at a familiar place, the COX and LOX pathways, we'll recall that it is the fatty acids arachidonic acid and EPA/DHA that go through those pathways to produce the various eicosanoids, some pro-inflammatory (those from arachidonic acid) and some anti-inflammatory (from EPA/DHA, and also from the omega-6 DGLA). Moving upstream a step, those fatty acids come from the cell membranes, from where PLA2 pulls them (I'm not telling you anything you don't already know, but steroids inhibit PLA2 and are thus very anti-inflammatory). Continuing upstream a step, where do those membrane fatty acids come from? Outer space? Does the Easter Bunny put them there? NO, they come from your DIET! You have a choice of either loading your cell membranes with arachidonic acid or healthier fatty acids, and that has all sorts of health-related implications.
Ha! No, you won't. But my point with the yogurt thing was to make mention of the research going on that is looking at the systemic anti-inflammatory effects of probiotics. Go ahead and enjoy that yogurt!
The dietary/nutritional approach to inflammation is a longterm one. No one would ever say that eating some salmon immediately after traumatically herniating a disc will do much good. The same is true if I smash SleepIsGood's hand with a hammer. But for chronic pain patients, such as RA to use your example, these strategies can be useful.
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But there is already lots of human data. What, your pharma rep never told you about this stuff?
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you can do a basic pubmed search and find out what you don't know. there has been solid research on this subject. like i wrote before, this is a good time to keep a lower profile my boy.
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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?
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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 prophylacticly 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.
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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.
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Well... http://www.ncbi.nlm.nih.gov/pubmed/18394502.
Ha! Just kidding.
My point was two-fold. First, I was pointing out to Sleep that there is in fact good quality diet/nutrition/inflammation/pain research published in mainstream medical journals, contrary to what he had claimed. And second, although this study had the narrow focus you quoted above, the totality of the research indicates an effect on inflammation, pain and disease states in a broader view.
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http://www.chirobase.org/06DD/vaxd/vaxd.html
The guy whose site it is on is pure antichiro. Worse than sleep.
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,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.
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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.
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.
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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.
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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.
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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?
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I don't sell anything.
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I actually helped work on research on CRPS patients looking at their omega 3 to omega 6 ratio vs normal patients without CRPS or any other painful conditions. We found a trend in our small N (hard to find a large number of CRPS patients) but my friend and colleague is continuing this type of research at the NIH.
I actually do check vitamin D levels in addition to ESR, CRP, and rheumatoid panel routinely in patients who complain of multiple joint pain, and/or family history of rheumatoid issues. I have referred a pretty good number of patients to rheumatology based on abnormal labs.
I also routinely write for vitamin D supplementation for patients with low vitamin D levels - one of the orthopods I work with had a critically low vitamin D level (single digits) 2/2 to statin and had to take off work because of all the issues he was having (mostly pain but also fatigue and other symptoms) - after starting vitamin D supplementation and stopping the statin, he felt much better.
When patients ask about "natural" ways to help with pain, I recommend omega 3 supplementation with the caveat that it can thin the blood, and vitamin D 1000 - 1200 units daily. I 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 $$.
I am in a market where my patients ask for this type of information and if I don't give it to them, they will find someone in the community who will sell them a whole bunch of stuff.
I also had my hand surgeon ask me about vitamin C supplementation and prevention of CRPS and have placed patients on vitamin C (patients with remote history of CRPS who fracture their wrists).
http://www.ejbjs.org/cgi/content/abstract/89/7/1424
I do think there are a lot of quacks out there doing a lot of irresponsible things and I am not justifying that. However, I have educated myself on this topic and have helped with a book on this topic so I feel comfortable giving out conservative advice based on limited evidence that is out there.
I actually do check vitamin D levels in addition to ESR, CRP, and rheumatoid panel routinely in patients who complain of multiple joint pain, and/or family history of rheumatoid issues. I have referred a pretty good number of patients to rheumatology based on abnormal labs.
I also routinely write for vitamin D supplementation for patients with low vitamin D levels - one of the orthopods I work with had a critically low vitamin D level (single digits) 2/2 to statin and had to take off work because of all the issues he was having (mostly pain but also fatigue and other symptoms) - after starting vitamin D supplementation and stopping the statin, he felt much better.
When patients ask about "natural" ways to help with pain, I recommend omega 3 supplementation with the caveat that it can thin the blood, and vitamin D 1000 - 1200 units daily. I also tell them to try glucosamine-chondroitin and tell them about the research that shows for moderate to severe OA related pain, it can be effective (GAIT study from NIH). I tell them to try it for 2-3 months, and if no change, stop because it's a waste of $$.
I am in a market where my patients ask for this type of information and if I don't give it to them, they will find someone in the community who will sell them a whole bunch of stuff.
I also had my hand surgeon ask me about vitamin C supplementation and prevention of CRPS and have placed patients on vitamin C (patients with remote history of CRPS who fracture their wrists).
http://www.ejbjs.org/cgi/content/abstract/89/7/1424
I do think there are a lot of quacks out there doing a lot of irresponsible things and I am not justifying that. However, I have educated myself on this topic and have helped with a book on this topic so I feel comfortable giving out conservative advice based on limited evidence that is out there.
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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...
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...
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A bit overstated.
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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?
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Apparently, Celebrex didn't fare that well in this trial either: http://www.drtheo.com/news/FaultyGAITresultreporting.htm
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Maybe I'm behind the times, but I don't have a website.
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????
Why antagonize just to antagonize? What does that contribute?
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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.)
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Shhhhhh! I'm enjoying having a punching bag in this thread.
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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....
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(I swear I am not paying SleepIsGood to be my straight-man, although it sure seems like it.)
Infants and their mothers: http://www.ncbi.nlm.nih.gov/pubmed/20308219
Wordlwide: http://www.ncbi.nlm.nih.gov/pubmed/20197091
Bingo: http://www.ncbi.nlm.nih.gov/pubmed/20133466 . From the abstract: "The newest statistics demonstrate that more than 90% of the pigmented populace of the United States (Blacks, Hispanics, and Asians) now suffer from vitamin D insufficiency (25-hydroxyvitamin D <30 ng/ml), with nearly three fourths of the white population in this country also being vitamin D insufficient."
There are dozens of these studies published in "real journals".
You may want to just change the subject now.
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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
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
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Vitamin D deficiency is definitely very common in the United States, and most likely the world. Most PCPs are ordering Vit D levels and if not, will very likely be soon, at least in the older population. It appears that Vit D deficiency is linked to many co-morbidities. Correcting Vit D is not as simple as standing out in the sun. In fact, prolonged sun exposure can actually worsen Vit D levels. Additionally, higher pigmented skin is less efficient at using UVB rays as a catalyst in the cutaneous production of vitamin D.
I've been supplementing for years.
I've been supplementing for years.
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By the way, it's the allopathic medical community who encourages people to avoid sunlight, especially the dermatologists. Now it seems, however, as opposed to completely avoiding sunlight, it may be more beneficial to strike a balance (as it is in most things in life) between too much and too little sun exposure.
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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.
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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'll take the Chiro's- think they have a lot more former athletes(the ones that
didn't go into medical device sales)
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The fact that I've never heard of or read about the military recruitment of DCs but have seen it for many of the other health professions does mean something to me.
On another note, I apologize for all of the following questions but I've actually never really had a conversation with a chiropractor and this thread has piqued my curiosity. Please educate me a bit as I would definitely like to learn more.
When would you recommend I refer to a chiropractor? Do chiropractors only manage neck and back pain? Do you guys manage peripheral pain as well? Do you use modalities as PTs do? Do you manipulate peripheral joints/soft tissues and treat problems such as carpal tunnel, epicondylitis, rotator cuff, etc? Do you order imaging other than plain films such as MRIs?
I've noticed that some chiros wear stethoscopes. Why is that? Do you feel chiropractors have the experience and training to be primary care doctors for patients? Are chiros really trained in what to listen to and what to do if something is found? For instance, if you hear an arrhythmia and order an EKG, can you truly read it? Also, how would you treat it, assuming that chiros don't write for meds?
I take it from your posts that you give recommendations on issues such as Vitamin D. Are chiros allowed to order labs? If you recommend Vit D supplementation, do you monitor levels to initially confirm deficiency and avoid toxicity? Can you please send me a link where I can read more?
Thank you in advance for your help and time.
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yes - it says "Exploratory analyses suggest that the combination of glucosamine and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain."
