Healthy Life Newsletter, May 2019
Chiropractic for Low Back Pain: Your Best, First Recommendation
Numerous studies have shown chiropractic spinal manipulation is effective for low back pain, which is good news considering you only have a small chance of avoiding LBP during the course of your lifetime. In fact, it’s estimated that at least eight in 10 people will suffer low back pain at some point, many of whom will experience it on multiple occasions or even chronically.
Now here’s even better news: Evidence suggests chiropractic spinal manipulation is as effective as commonly recommended treatment options such as pain medication for LBP, which should make it your best, first recommendation, particularly in light of the prescription opioid crisis killing more than 100 Americans a day.
In a new review study, published in the British Medical Journal, researchers evaluated findings from 47 previous investigations involving more than 9,000 men and women (average age: 35-60 years). All studies compared the value of spinal manipulative therapy with recommended therapies including nonsteroidial anti-inflammatory drugs (NSAIDs; Aleve, Motrin, etc.), prescription painkillers and exercise. Spinal manipulation relieved LBP as effectively as the recommended therapies and was actually more effective in improving short-term function.
Spinal manipulation still isn’t routinely recommended as a primary treatment for low back pain, despite evolving guidelines in the U.S. and worldwide. The opioid epidemic has opened eyes to the need for safer pain-relief options, but so far, the recommendations don’t go far enough. Why take pain medication and risk the side effects, some of which can be life-threatening, when you can enjoy the benefits of chiropractic spinal manipulation and achieve the same pain relief and functional improvements? Talk to your doctor to learn more.
A Poor Choice for Relieving Your Low Back Pain
Acetaminophen (found in Tylenol and other drugs) is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it’s also the most likely to be taken inappropriately.
In fact, improper use, coupled with the drug’s narrow safety margin, means “a large fraction of users [are] close to a toxic dose in the ordinary course of use,” according to the Food and Drug Administration.
But for the sake of discussion, let’s ignore the safety issues for a moment. Is acetaminophen an effective pain reliever in the first place? Not for low back pain and pain attributable to knee / hip osteoarthritis, conclude the authors of a recent meta-analysis. The just-published review of 13 randomized trials has yielded “high-quality evidence” that paracetamol (acetaminophen) does not reduce pain intensity or disability, and does not improve quality of life, in the short term for people experiencing LBP; and provides only “minimal, short-term benefit” for people suffering from hip or knee pain caused by OA, stating that “the small effects … are not likely to be meaningful for clinicians or patients.”
Back to the safety issues surrounding acetaminophen, which the meta-analysis did little to dilute. According to the review researchers, “high-quality” evidence suggests paracetamol use results in a fourfold risk of an abnormal liver function test. Not surprising, since acetaminophen misuse (overdose) is now the most common cause of acute liver failure (exceeding all other medications combined) and the second most common cause of liver failure requiring transplantation.
In fact, the FDA has mandated that all acetaminophen-containing prescription products feature a “black box” warning (the administration’s strongest safety statement) noting an overdose can cause liver failure and even death; and have been urged to place similar language on OTC acetaminophen products.
How often do you use acetaminophen-containing over-the-counter and/or prescription medications for you LBP and OA pain, even as you pursue relief through chiropractic care? How often do you take these drugs for your spinal / OA pain instead of visiting a chiropractor? As this meta-analysis suggests, acetaminophen is ineffective for these types of pain. So give chiropractic a try – a proven natural pain reliever.
Resources
Machado GC, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised, placebo-controlled trials. Brit Med J, 2015;350. Full text available online.
Dal Pan GJ. “Acetaminophen: Background and Overview.” FDA Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, June 29, 2009.
Greenlaw E. “Your Guide to Over-the Counter Pain Relief. OTC Pain Relief: Understanding Acetaminophen.” WebMD.com.
Healy M. “Acetaminophen in Rx Drugs: For Liver’s Sake, Lower the Dose.” Los Angeles Times, April 28, 2014.
Gerth J, Miller TC. “Use Only as Directed.” ProPublica, Sept. 20, 2013.
Make Your Body Stronger as You Age
Aging can bring on a variety of health issues, but one of the key problems that affect many is overall weakness. The body’s structural system tends to decline with age and muscle areas have been known to also cause a range of debilitating problems.
Most people tend to see these changes as early as their 40s. So, what can you do to make sure your body stays strong as you age?
The key is in exercise by building up muscle strength, you can keep your body strong as you age.
When working out, focus on your upper body - strong trapezius, biceps and triceps muscles could someday make a difference doing basic tasks such as carrying groceries or your grandkids. And the weaker they are, the more prone you are to neck strain.
It is also good to focus on your core. By working out and focusing on your core, you could begin to build up strength can avoid placing extra strain on your lower back. A little prevention goes a long way for back pain, which makes even the most basic tasks, like sitting or bending over, excruciating. To target all the core muscles, activate them during a workout.
Another body part that weakens dramatically with age are the knees. Knees not only provide overall stability, but they enable you to walk with balance and this is important as you age since you will n
When hitting the gym, remember your knees by doing some leg curls, and walking with a steady pace on the treadmill. This will also help your legs and other parts of your lower body.
Doing overall cardiovascular exercises will also help you work out your heart, which is also essential for aging.
Taking Vitamin D? You Need to Add This Vitamin as Well
Prediabetes is arguably more dangerous to your health than is cigarette smoking. For the smoker who is prediabetic, life insurance is a must.
This danger to your health stems from the fact that prediabetes and diabetes attack pretty much every organ in your body. The blood vessels get destroyed (heart attack and stroke), the DNA of your cells gets damaged (cancer), your kidneys and your brain (Alzheimer’s dementia, cognitive loss and Parkinson’s disease). One organ that many doctors are not aware of in the line of diabetic fire is the liver.
Non-alcoholic steatohepatitis (NASH) or non-alcoholic fatty liver disease (NAFLD) are two liver conditions that are very strongly linked to being prediabetic (NASH is the more progressive of the two conditions).
The principal tool for management of prediabetes and diabetes is diet. While exercise is important, it is not as important as diet. Avoiding environmental chemicals like plastics, styrofoam, pesticides, Teflon and flame retardants is another pillar of diabetes prevention.
That being said, there are a handful of nutrients and supplements that have a good track record for singlehandely fighting off diabetes. The short list includes:
Magnesium
Vitamin D
Fish oils and monounsaturated fats (think olive oil)
Alpha lipoic acid
Folic acid
Vitamin D is a supplement that I have written about extensively over the years. What I haven’t been as outspoken about has been it’s related vitamin, vitamin A. Both vitamins function as hormones, not vitamins. They do this by acting on your DNA to change what a cell is doing. Contrast this with a true vitamin, which will act as a cofactor to help an enzyme do its job. The receptor for vitamin D and the receptor for vitamin A work together to change the way a cell behaves.
It is for this reason that some researchers feel that vitamin D toxicity is really a relative deficiency of vitamin A. Kind of like how taking too much calcium without magnesium can cause heart rhythym problems. This doesn’t happen because of too much calcium, but rather because there is not enough magnesium to counterbalance the higher levels of calcium.
There has been some controversy in the past about mixing vitamin D and vitamin A, with some experts recommending the use of beta carotene (the precursor to vitamin A) rather than preformed vitamin A. But I have looked into this concern and just really haven’t found any solid research suggesting that we need to be that concerned (although I do reserve the right to change my opinion based on future research).
With all of this out of the way, we can talk about the results of this particular study. In it, researchers looked at the relationship between blood levels of vitamin A and the likelihood of developing diabetes-related liver problems (NASH or NAFLD). Here’s what they found:
Blood levels of vitamin A were 47% lower in patients with NAFLD (1.42 ng/mL) and 58% lower in NASH (1.14 ng/mL) versus those without these conditions (2.70 ng/mL)
In those without liver disease, when compared with non-prediabetic patients, vitamin A levels were 19% lower in those with “controlled” type 2 diabetes (2.87 vs. 2.32 ng/mL).
In those with NAFLD who were prediabetic, vitamin A levels were 20% lower when compared to those with NAFLD who were not prediabetic (1.61 vs. 1.28 ng/mL).
In those with NASH who were prediabetic, vitamin A levels were 21% lower when compared to those with NASH who were not prediabetic (1.35 vs. 1.07 ng/mL).
Under special testing done on the liver tissue, flare ups were lower in those who had higher activation of the vitamin A : vitamin D receptor complex (RXRα mRNA expression).
Both blood vitamin A levels and greater activation of the combined vitamin A : vitamin D receptor complex (RXRα mRNA levels) were linked to lower levels of triglyceride accumulation in the liver.
Based on this study, it is clear that vitamin A plays some type of role in protecting against both prediabetes as well as liver damage associated with prediabetes. Given how inexpensive vitamin A is as well as how easy it is to take (much like vitamin D, vitamin A can be taken weekly). Biotics vitamin A-Emulsion forte is the product that we use in the office. I generally try to dose in a 1:1 ration, keeping in mind that this vitamin A has 12,500 per drop, so you’ll have to do the math depending upon how much vitamin D you are taking.
How to Prevent Heart Disease
by Michael Greger M.D.
Heart disease may be a choice.
Like cavities.
Many of today’s lifestyle medicine doctors, myself included, were greatly influenced by Nathan Pritikin, the nutrition pioneer who started reversing heart disease with a plant-based diet and exercise back in the 70s. (More on Nathan Pritikin in Engineering a Cure, Our Number One Killer Can Be Stopped, and The Answer to the Pritikin Puzzle.) But how did he come up with the idea of opening up arteries without drugs or surgery? We tend to think of rural China as a place with a fraction of our disease rates, but we may forget about Africa.
Pritikin was 43 when he was told by his cardiologist that he was going to die from a heart attack, so he began to live on a diet patterned after the black population in Uganda, a population living off plants that was essentially free from death from heart attacks. After curing his own heart disease with a plant-based diet, he went on to save the lives of thousands of others. What was the data that so convinced him?
Last year, the International Journal of Epidemiology reprinted a landmark article from the ‘50s that started out with a shocking statement: “In the African population of Uganda, coronary heart disease is almost non-existent.” Our number one cause of death almost nonexistent? What were they eating? Plantains and sweet potatoes, other vegetables, corn, millet, pumpkins, tomatoes, and “green leafy vegetables are taken by all.” Their protein was almost entirely from plant sources, and they had the cholesterol levels to prove it, similar to modern-day plant-eaters. “Apart from the effects of diet and of the blood cholesterol levels,” the researchers couldn’t figure out any other reasons for their freedom from heart disease.
These fifty-year-old findings are still relevant today. They showed “dietary intake to be a key, modifiable, established and well-recognized risk factor for heart attacks. This contrasts with the rather desperate search in recent decades for even newer cardiovascular risk factors.” We have the only risk factor we need—cholesterol. We’ve known it for 50 years, and we can do something about it. See One in a Thousand: Ending the Heart Disease Epidemic.
As you can see in the video Cavities and Coronaries: Our Choice , according to the Editor-in-Chief of the American Journal of Cardiology, the only risk factor required for atherosclerotic plaques to form is elevated LDL, or “bad” cholesterol in our blood. Dr. William Clifford Roberts is the distinguished cardiac pathologist who doubles as the Editor-in-Chief of the American Journal of Cardiology. More from him in Eliminating the #1 Cause of Death and Heart Attacks and Cholesterol: Purely a Question of Diet.
To drop our LDL cholesterol, we need to drop our intake of three things: trans fat (found in junk food and animal foods – See Trans Fat in Meat and Dairy); saturated fat (found in mostly animal foods); and dietary cholesterol (found exclusively in animal foods). More on lowering LDL in Trans Fat, Saturated Fat, and Cholesterol: Tolerable Upper Intake of Zero.
What Dr. Shaper discovered is that heart disease may be a choice.
Like cavities.
People who lived over 10,000 years before the invention of the toothbrush pretty much had no cavities. Didn’t brush a day in their lives, never flossed, no Listerine, no Waterpik—and yet, no cavities. Why? Because candy bars hadn’t been invented yet! So why do people continue to get cavities when we know they’re preventable though diet? Simple: because the pleasure people derive from dessert may outweigh the cost and discomfort of the dentist.
As long as people understand the consequences of their actions, as a physician what more can I do? If you’re an adult and decide that the benefits outweigh the risks for you and your family, then go for it—I certainly enjoy the occasional indulgence (I’ve got a good dental plan!). But what if instead of the plaque on our teeth, we’re talking about the plaque building up in our arteries? Then we’re no longer just talking about scraping tarter. We’re talking life and death.
The most likely reason our loved ones will die is heart disease. It’s still up to each of us to make our own decisions as to what to eat and how to live, but we should make our choices consciously, educating ourselves about the predictable consequences of our actions.
-Michael Greger, M.D.
It’s Never Too Late to Exercise
Think you’re destined to die before your time because you’ve been sedentary (physically inactive) your entire life? Not so fast. While consistent exercise is associated with a host of health and wellness benefits including significant reductions in disease risk, new research suggests even middle-aged and older adults who haven’t been active their entire lives can benefit dramatically from a little more movement.
Researchers evaluated the exercise habits of more than 315,000 adults ages 50-71 by reviewing surveys each study participant had completed from adolescence, then tracked them for almost 15 years to see who passed away over that time period. Compared to participants who stayed essentially inactive throughout their lives (including the study period), participants who were not active previously, but became active from ages 40-61, were 35 percent less likely to die of all causes during the study period.
Interestingly, people who had been active from the start (youth through middle age) were only slightly less likely to die during the study period: 36 percent less likely compared to the permanently inactive group. In other words, the health benefits of physical activity (at least in terms of longevity) were essentially the same regardless of whether one exercised his/her entire life or became active starting in middle age or older.
With respect to two of the major causes of death, cardiovascular disease and cancer, the risk reductions were also remarkably similar: 42 percent lower risk of death from heart disease and 14 percent lower risk of death from cancer for always exercisers (compared to people who stayed sedentary their entire lives), vs. 43 percent and 16 percent lower risks, respectively, for late exercise adopters. Study findings were published in JAMA Network Open.
The moral to this story: You’re never too old to start exercising – and reaping the longevity benefits. Talk to your doctor for more information on why exercise matters, and ask for help designing a consistent physical activity program suitable to your health and fitness needs.