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An Evidence Informed Analysis of Acupuncture for Essential Hypertension
Essential Hypertension is an endemic affecting over 1 billion people globally of unknown cause and remains a public health challenge.
Always Tell the Doctor If...
I keep a laminated copy of the information in each of my examination / treatment rooms. It is placed where it is obvious to patients and their guests.
Using Traditional Chinese Medicine for Irritable Bowel Syndrome
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) defines irritable bowel syndrome (IBS) as a digestive disorder that affects the large intestine causing symptoms such as abdominal cramping, abdominal bloating, and a change in bowel habits.
Chiropractic in the VA: More Progress and Our Opportunity
The Portland, Ore., VA Medical Center has hired its first full-time chiropractic physician, Dr. Samantha Stolzel, who will help reduce use of harmful pain medications by our honored veterans.
$300 Million Payout to DCs
In 2005, I recognized the opportunity performing commercial driver's license (CDL) exams represented to the chiropractic profession.
Do Free Electrons Flow Through Specific Acupuncture Meridians?
The AMI (Apparatus for Meridian Identification) was used by G. Chavalier and K. Mori to study the meridians entered by free electrons during Earthing.
The Power of Email Marketing
For many of us, our first introduction to email was AOL and the infamous phrase, "You've Got Mail" when you logged on to the site.
Are Your Practice Behaviors Within Practice Guidelines?
I used to wear a tie while treating patients. I don't wear one anymore. I used to wear clinic jackets. I really don't know what happened to them.
Is Your EHR HIPAA Compliant?
Since 2009, the American Recovery and Reinvestment Act has funded a movement toward the implementation and adoption of electronic health records (EHR).
A Major Breakthrough in U.S. Pain Policy
In 2016, the Comprehensive Add-iction and Recovery Act (CARA) was passed by the U.S. Congress.
E-Scooter Injuries: Who Will Pay?
Chiropractors are getting busier with e-scooter accidents. Many victims are badly injured. In 2018, with the rise of companies like Bird and Lime, the U.S. saw more than 1,500 injuries or deaths related to electric scooters according to a study by Consumer Reports,1 and that's just the ones we know about.
We Get Letters and Email
Dr Kyl Bills' article ("Neuroscience 101: Understanding Opioid Addiction," February 2019 issue) was absolutely fascinating from beginning to end.
Streptococcus: A Bacteria That Can Cause Multiple Infections
Streptococcus bacteria (strep) will always live in the human body on some level. How it affects your health depends on your immune system.
Americans Say Acupuncture is on Their To-Do List
Prepare yourself for more patients—according to a recent study, the MINDBODY Wellness Index, Americans are curious about acupuncture.
Invest in Yourself at The National
Each year in Orlando, Fla., thousands of chiropractors, CCPAs, CAs, LMTs and other industry professionals unite at the premier meeting place for chiropractic: The National by Florida Chiropractic Association.
Patients Are Searching for You and Chiropractic Nationwide
There has never been a more exciting time for you to be a doctor of chiropractic than right now.
Acupuncture in Active Sport Recovery—A Review
There is a small body of research that specifically demonstrates the therapeutic viability that acupuncture has to offer in the field of sport and exercise recovery.
A Different Kind of Chiropractic Passion
I learned to be passionate about chiropractic early in life. My DC dad taught me – just as his DC dad had taught him. As a family, we learned about the importance of regular chiropractic adjustments to maintain our health and wellness.
In-Office Screening for VAD
In any given year, nearly one in 100,000 adults will develop a vertebral artery dissection (VAD).
ICA Takes on WFC Research Council
The International Chiropractors Association has a filed a formal complaint with the World Federation of Chiropractic regarding the WFC Research Council, stating that while the association "supports the World Federation endorsement of an evidence-based, patient-centered, interprofessional and collaborative approach in chiropractic ... the suggestion, however, that the practice of vitalistic, subluxation-oriented chiropractic is unscientific and not evidenced-based is a false premise that must be immediately renounced by the WFC on behalf of many of its member national associations."
Documenting Pain ... Can Be a Pain
If you have ever worked with a patient who has a pain complaint, you know how frustrating defining pain can be.
Build Your Online Store
I just finished a call with a client who fits a common profile I see across the business and health care industries. He is a fellow chiropractor who has been in practice for a little over 20 years.
Springtime Health: Allergies, Herbs & Relief
As we move out of the winter season and into the warmer days of spring it is important to keep in mind how the seasons can affect our physiology.
Is the NBCE Trying to Evolve?
One of the hallmarks of a maturing organization is its willingness to let go of control by a few in favor of the benefits of diverse perspectives and expertise.
Extending Healing Energy to Others: Understanding Quantum Fields for Healing
Extending the Quantum Field (QF) is the practice of using your own alignment with the universal field of consciousness energy to support or help heal someone else.
Best Practices in SOAP Notation
Taking proper and comprehensive SOAP notes is as important a clinical skill as where to place acupuncture pins and what herbs to prescribe.
December, 2001, Vol. 01, Issue 12
Natural Anti-Inflammatory Supplements: Research Status and Clinical Applications
By James P. Meschino, DC, MS
Editor's note: Dr. James Meschino holds a masters degree in science with specialties in nutrition and biology. He is on the board of advisors of the Academy of Anti-Aging Research, and is the Clinical and Research Director for the RenaiSanté Institute of Integrative Medicine in Toronto.He is also an assistant professor in the division of Graduate Studies and Research at the Canadian Memorial Chiropractic College (CMCC,) and a postgraduate faculty member of the American Council on Exercise (ACE). In recent years, scientific studies have demonstrated that many forms of arthritis and joint inflammatory conditions can be managed effectively through specific dietary and supplementation practices, in addition to joint mobilization; manipulation; muscle therapy; acupuncture; and exercise.1
Beyond the use of glucosamine sulfate as an effective intervention to halt joint cartilage destruction and help regenerate new cartilage in osteoarthritis cases, substantial clinical and experimental evidence supports the use of other natural health products, which demonstrate proven abilities to block inflammation, and reduce the signs and symptoms of arthritis and other joint inflammatory conditions. Studies indicate that many of these natural agents provide similar efficacy as conventional anti-inflammatory drugs, and are safer to use with respect to reported adverse side-effects.
Most medical practitioners have failed to embrace these alternative anti-inflammatory agents, and tend to rely primarily on synthetic anti-inflammatory drugs as their principal approach to managing these problems.2 It is well documented that these nonsteroidal anti-inflammatory drugs (NSAIDs) produce intestinal tract ulcers (with potential internal bleeding) in 10-30 percent of long-term users, and erosions of the stomach lining and intestinal tract in 30-50 percent of cases.3 As a result of these side effects, NSAID use is associated with 10,000 - 20,000 deaths per year in the U.S.4 Even the new COX-2 inhibitor drugs have only been reported to reduce intestinal tract damage by 50 percent, and their toxicity to the liver and kidneys is still under review.5
Anti-inflammatory drugs have been shown to accelerate damage and erosion of joint cartilage, advancing the osteoarthritic process. Conventional NSAIDs are also known to cause liver and kidney damage with long-term use.6 These and other statistics have lead certain esteemed investigators to conclude: "The epidemiological data highlight the importance of implementing acetylsalicylic acid (ASA)/NSAID therapy only when strictly necessary."7
Reducing Inflammation Naturally
The discovery that certain natural agents produce marked anti-inflammatory effects presents an opportunity for chiropractors and other natural health practitioners to add an important and effective adjunct to the management of these cases.
As such, a review of the physiological action and clinical studies, involving the use of proven natural anti-inflammatory herbal agents, enables practitioners to use these substances in a safe and responsible way, and thereby help patients eliminate or minimize their reliance upon more dangerous NSAIDs and other synthetic anti-inflammatory drugs. Experimental research reveals that the efficacy of many natural anti-inflammatory agents stems from their ability to modulate the activity of the enzymes, cyclooxygenase and/or 5-lipoxygenase.8 The pathophysiology of joint inflammatory conditions involves the conversion of arachidonic acid to prostaglandin series -2 (PG-2) by the cyclooxygenase enzyme. PG-2 synthesis is known to produce a pro-inflammatory effect, exacerbating joint inflammatory conditions. Accordingly, the conversion of arachidonic acid to leukotriene B4 (LTB-4), by the 5-lipoxygenase enzyme within white blood cells, is also known to contribute to inflammation. White blood cell count in normal synovial fluid is less than 100ml on average. However, cellular response rises to 800ml or more in osteoarthritis and much higher than this in rheumatoid diseases, implicating white blood cells in the T-cell-mediated inflammatory response in inflammatory joint conditions.9 As is the case with many synthetic anti-inflammatory drugs, the active constituents of anti-inflammatory herbs have been shown to block the activity of the cyclooxygenase and lipoxygenase enzymes, inhibiting the synthesis of pro-inflammatory eicosanaoids of the PG-2 and LTB-4 series. These natural substances have been shown to reduce inflammation and pain associated with various types of arthritis and traumatic joint injuries. Unlike their synthetic counterparts, they have not been shown to cause erosion injury to the intestinal tract, accelerate cartilage destruction or produce liver and kidney toxicity.8 For these reasons, the following herbal agents can be considered viable alternatives to conventional anti-inflammatory drugs in a large percentage of arthritic patients and those suffering from other joint inflammatory conditions.
Effective Anti-Inflammatory Herbs and Supplements
Curcumin is the active anti-inflammatory agent found in the spice turmeric. It has been shown to inhibit the activity of the 5-lipoxygenase and cyclooxygenase enzymes, blocking the synthesis of pro-inflammatory eicosanoids (PG-2, LTB-4). A large double-blind study demonstrated that curcumin was as effective as a powerful anti-inflammatory drug (phenylbutazone) in reducing pain, swelling and stiffness in rheumatoid arthritis patients. It has also been shown to be effective in the treatment of postsurgical inflammation. Other studies indicate that curcumin can lower histamine levels and is a potent antioxidant. These factors may also contribute to its anti-inflammatory capabilities.
For best results, practitioners should consider using a 95-percent standardized extract of curcumin derived from turmeric. As a singular agent, the daily dosage to consider is 400-600mg, taken one to three times per day. (Lower doses can be used as part of a combination formula containing other anti-inflammatory agents). Side effects are rare, but primarily include heartburn and esophageal reflux. As curcumin inhibits the cyclooxygenase enzyme system, it may reduce platelet aggregation and thus may potentiate the effects of anti-coagulant drugs. To date, no bleeding disorders have been reported with curcumin supplementation, but its concurrent use with warfarin or coumadin should be considered a contraindication.2,8,10,11,12,13,14
Boswellia -- In clinical studies, the gum resin of the boswellia tree (yielding 70 percent boswellic acids) has been shown to improve symptoms in patients with osteoarthritis, and rheumatoid arthritis.12,13 Research indicates that boswellic acids inhibit the 5-lipoxygenase enzyme in white blood cells. As a singular agent, the usual dosage is 150mg, one to three times per day. (Again, lower doses are effective when combined with other natural anti-inflammatory agents.) Boswellia appears to have no important side-effects or drug-nutrient interactions of concern.15,16
White Willow Bark Extract provides anti-inflammatory phenolic glycosides, such as salicin, which have been shown to be effective in the treatment of arthritis, back pain and other joint inflammatory conditions. These phenolic glycosides are known to inhibit cyclooxygenase, blocking the production of PG-2, and exert a mild analgesic effect.
Unlike ASA, naturally occurring salicin (salicylic acid) does not irreversibly inhibit platelet aggregation, reducing the potential for a bleeding disorder. White willow extract has been shown to be slower acting than ASA, but of longer duration in effectiveness. The usual dosage is 20-40mg of salicin, one to three times per day. (Note that 100mg of white willow extract at a 15 percent standardized extract of salicin content yields 15mg of salicin per dosage. A lower dosage can be used as part of a combination formula containing other anti-inflammatory agents.)
Side-effects are rare, but primarily include nausea, headache and digestive upset. Contraindications may include conditions where ASA is contraindicated, including gout; diabetes; hemophilia; kidney disease; active peptic ulcer; glucose-6-phosphate dehydrogenase deficiency; and possibly asthma. However, the salicin content in a single dosage of white willow extract is very low compared to the content of ASA (e.g., 15mg vs. 320mg ); thus, these conditions may not be absolute contraindications for the use of white willow bark extract. It is important to realize that besides salicin, white willow extract contains other phenolic glycosides, which are also known to possess anti-inflammatory properties.8,17,18,19
Ginger Root Extract contains oleo-resins that have shown clinical benefit in the management of various arthritic and muscle inflammation problems, including rheumatoid arthritis, osteoarthritis, and myalgias. The active constituents in this regard are gingerols (oleo-resins), which inhibit the cyclooxygenase and lipoxygenase enzymes. The usual dosage is 500mg, one to three times daily, standardized to a five-percent gingerol content. (A lower dosage can be used as part of a combination formula containing other anti-inflammatory agents). Side-effects are rare, but include heartburn and digestive upset. It should not be given to patients with gallstones. It may also induce a mild anticoagulant effect (by inhibiting cyclooxygenase enzyme in platelets), therefore it should not be taken concurrently with warfarin of coumadin. However, there are no reports of bleeding disorders with ginger supplementation and no adverse drug - nutrient interactions have been reported in the scientific literature to date.2,8,14,20,21
Bromelain contains anti-inflammatory enzymes that have the proven ability to suppress the inflammation and pain of rheumatoid arthritis and osteoarthritis, sports injuries, and other joint inflammatory conditions. Bromelain has been shown to inhibit the cyclooxygenase enzyme, inhibiting the synthesis of PG-2. Bromelain also helps to break down fibrin (fibrinolytic), thereby minimizing local swelling. The usual dosage is 400mg, one to three times per day (a lower dosage can be used as part of a combination anti-inflammatory formulation). Bromelain may inhibit platelet clotting and is a known for its fibrinolytic properties. Therefore, it may potentiate the effects of anticoagulant drugs such as warfarin and coumadin, and should not be recommended in these cases.2,8,14,22,23,24
Quercetin is a bioflavonoid compound that blocks the release of histamine and other anti-inflammatory enzymes at supplemented doses (minimum 100-1500mg per day). Although human studies with arthritic patients are lacking at this time, anecdotal evidence is strong for this application, as is experimental research investigation. There are no well-known side effects or drug-nutrient interactions for quercetin. 14,25,26,27
Devil's Claw contains the anti-inflammatory agent harpogoside. Devil's claw has demonstrated efficacy in the management of low back pain and is used traditionally as an anti-inflammatory by numerous southern African tribes. The usual dosage is 100-400mg, one to three times per day (a lower dosage can be used if part of a combination anti-inflammatory formula). The only consistently reported side-effect is mild digestive upset on rare occasions. It is contraindicated in patients with active gastric ulcers (may increase gastric acid secretion) and in patients taking warfarin or coumadin (due to its anticoagulant effects).8,14,28,29
The body of evidence supports the use of natural anti-inflammatory agents as viable alternatives to synthetic drugs or as a means to help patients lower their requirements for conventional anti-inflammatory pharmaceutical agents. A number of quality-oriented companies manufacture single and combination natural anti-inflammatory supplement products that meet the above dosage and standardized grade criteria, along with dietary changes to lower arachidonic concentrations, support joint cartilage synthesis and promote the formation of anti-inflammatory eicosanoids (e.g., PG-1 and PG-3). Massage therapists may consider discussing the use of these herbal and accessory nutrients with clients suffering from arthritis and other inflammatory joint conditions.
Click here for previous articles by James P. Meschino, DC, MS.
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