ARTHRITIS, MIGRAINES, and JOINT INJURIES
Naturopathic Doctors are trained to treat and cure all causes of pain, including the most common forms, osteoarthritis, rheumatoid arthritis, migraines, tension headaches, fibromyalgia, and common musculoskeletal pain whether from injuries from sports, motor collisions, or normal wear and tear. Naturopathic Doctors have been trained in many alternative therapies that have withstood the test of time and have proven to be more efficient and affordable in the treatment of acute and chronic pain.
Therapies such as Acupuncture can restore function and reduce pain within hours of a sports injury or motor vehicular accident. Prolotherapy and PRP can rebuild ligaments and tendons to original functional status prior to injury and chronic disability without the use of long term pain medications or needless surgeries.
Naturopathic Doctors also understand the underlying causes of Fibromyalgia, arthritis, and autoimmune disease such as Rheumatoid Arthritis, and can guide you to complete recovery so that you can live everyday without focusing on pain management. We are the specialists when it comes to immediate and chronic pain. We offer immediate solutions for sudden onset of pain syndromes and we can determine the underlying causes of chronic pain and help you eliminate them from your lifestyle. We seek to have all of our patients lead an active, productive, and pain free lifestyle.
PRP and Prolotherapy
What are Platelet Rich Plasma (PRP) and Prolotherapy Injections?
Platelet Rich Plasma (PRP) is concentrated platelets and leukocytes (white blood cells) derived from a patients own blood. The platelets and leukoctyes act as growth factors that stimulate local tissue to repair when injected at sites of acute or chronic injury. Local connective tissue damage is the most significant factor contributing to chronic pain including pain in the feet, knees, hips, low back, neck, shoulders, elbows, and even the hands.
Prolotherapy is a mixture of glucose and an anesthetic, such as procaine or lidocaine, also injected at sites of connective tissue damage to stimulate growth factors. Both types of injections induce healing and repair of injured tissue, returning the tissue to its original tensile strength or better.
What is the root cause of pain?
To understand how PRP and Prolotherapy work, we have to go back to the root cause of most pain in patients. To understand the root cause of pain, we need to know a little about the anatomy of the body. The frame or structure of the body is built on and around the skeleton. The skeleton is made up of many bones that approximate one another but do not touch. One bone adheres to the next by a ligament, and this juncture is called a joint. The body is made for movement and activity. Layered over the bones and crossing the joints are hundreds of muscles that act as pullies. The muscles attach to the bones by tendons. Ligaments and tendons, are the same tissue, with slightly different functions, the ligaments providing support to the scaffolding. Overlying the muscles of course is connective tissue, fat, and the skin. Some joints are contained within a fluid filled capsule. The fluid filled capsules, as we see in the knees, hips, and shoulders, provide cushion for weight bearing joints. These fluid filled joints allow for extreme force to be applied without having the bones contacting or rubbing on one another.
Ligaments and tendons(aka connective tissue) are often described as the glue that holds all things together. Though this glue is living and has a blood supply, two obvious risks exist. One is, connective tissue is very dense, which is why it is also very strong. Due to its density the blood supply is weakest in connective tissue compared to fat, bone, and skin. This equates to slow healing if connective tissue is damaged. It appears, for reasons we do not completely understand, that once a ligamnet or tendon is damaged, its recovery is limited to less than 100 percent.
Secondly, connective tissue as glue is under constant stress wether we are active or not. The constant stress, or constant wear and tear, requires time to heal and repair. If the repair process is unable to recover from an activity or an injury, the tissue becomes weak and frayed. A rubber band can illustrate this concept well. Brand new it has elastic capabilities that restore it to its original shape when it is stretched or pulled. But stretch and pull it 1,000 times and see if it is any weaker than when we started. The joint at that moment becomes unstable. The muscles recieving proprioception from the local damaged tissue, tighten in order to stabilize the local joint, so as not to let any further damage occur. Thus the second layer presents, sooner or later, with referred pain patterns from distal trigger points in associated muscles.
We fail to recognize in addition the normal process of aging in which everything begins to dry out. Ligaments and tendons and particularly capsule joints often just need a little rejuvination to rebuild he normal fluids present in our youth.
The knee is an excellent example of how different forces act upon it to cause pain. The bones of the knee include the femur and the tibia. The approximate one another and are attached on the inside by ligaments called the anterior and inferior cruciate ligaments. They stabilize the knee from moving too far forward or backward. Along the medial and lateral aspects of the knee and crossing the joint from top to bottom are the collateral ligaments. These help the femur and tibia from moving too much to inside or outside. Over the ligaments a connective tissue capsule surrounds the knee joint. Another layer called the menisci, lying inside the knee, serve as a non-liquid cushion keeping the bones from rubbing on one another. In addition, our body creates and maintains fluid as found inside the joint.
Pain then arises when one of the following occur. First a tear in one or both of the cruciate ligaments, or menisci, strain or sprain of the lateral or medial collaterals, loss of fluid within the capsule joint, and development of trigger points as a result of unstable joints. Even when pain is difficult to isolate, joint and muscular pain are intimately connected by the joints they serve and thus are nearly always associated with one another.
Ligament and tendon damage, along with the second root cause of pain, known as trigger points, are found in under trained and even in overtrained or tight muscles. These two conditions most often coincide simultaneously to produce the localized and referred pain patterns which contribute to 80% of all chronic pain. This pain is 100% curable. The cure comes from knowing the exact injury location and the subsequent referred pain patterns that have developed because of localized tissue injury and treating accordingly.
PRP and Prolotherapy are localized injections at the site of ligament, tendon, or capsule joints in order to restore the tissue to its original tensile length and strength, or restore the fluid within capsulated joints. As connective tissue and fluids are restored to their youthful states, pain reduces at the local site. Trigger points, which developed to stabilize the nearby joint, are allowed to release through stretching, trigger point injections, massage, and acupuncture. Pain reduces and function increases.
What is the difference between Prolotherapy and PRP?
Prolotherapy has offered non-surgical relief for chronic joint pain for over 5 decades. Long before our ability and understanding of PRP, doctors Hemwell and Hackett discovered that glucose or sugar had the ability when injected into ligaments and tendons, to cause new growth or proliferation of new tissue. The end result after a stimulated healing was greater tensile strength in the ligaments or tendons, and a reduction in localized and even referred pain patterns.
In addition to the glucose which is used, they would add a local anesthetic such as procaine or lidocaine. These three ingredients are three of the safest ingredients to inject, with their risk profile in normal doses nearly non-existent. Over the years other ingredients have been added to enhance proliferation of new tissue, but the core formula has not changed.
Platelet Rich Plasma (PRP) is concentrated platelets and leukocytes (white blood cells) derived from a patients own blood. The platelets and leukocytes act as growth factors that stimulate local tissue just the same as glucose would, but with what appears to a much more enhanced response.
Many people wonder why Prolotherapy has not gained more popularity over the last 5 decades when it has become an amazing tool of regeneration. A few possible reasons exist and are worth stating in case one questions the value of Prolotherapy and its lack of becoming mainstream . The first reason is, it has never been taught in medical schools. All doctors trained have been trained in programs outside of medical school. They have carried the burden of expense and risk in something fairly unknown. Their first exposure probably came from another doctor, who had been trained, or a patient asking about prolotherapy. My first exposure was from a fellow doctor, by whom I was treated, with tremendous success.
Another reason possibly is due to the fact that it is fairly inexpensive as a procedure. The supplies required to do the procedure mainly are lidocaine, glucose, and a syringe. The majority of the cost is in the labor itself. I think most insurance companies probably were unwilling to reimburse adequately for the doctors time and expertise. Most doctors probably felt their patients were unwilling to pay out of pocket for these procedures. If they had only known how effective it had been, patients would have gladly pay out-of-pocket as they do now.
Although not completely understood, the lack of recognition, on the whole, from the medical community, Prolotherapy has withstood the test of time. More doctors are trained more than ever before. The techniques and experience have improved upon the delivery methods and overall success of individual treatments. Even as Prolotherapy appears to take second seat to PRP, it still stands as the first truly anti-aging and regenerative therapy available to the world. A sufficiently treatment ligament or tendon of a 60 year old is difficult to differentiate from that of a 20 year old. Prolotherapy is likely to be viable for years to come. Even with the advent of many newer and more advanced therapies, Prolotherapy still stands as the most efficient and affordable treatment for chronic pain, and what can be said about PRP can be also said about Prolotherapy.
How exactly does PRP and Prolotherapy work?
Platelet Rich Plasma(PRP) and Prolotherapy stimulate the bodies own bioactive proteins, also know as growth factors, to replace, repair and regenerate connective tissue. PRP differs slightly from Prolotherapy in that it delivers a concentrated dose of growth factors directly to the pain initiating site in addition. PRP is produced from a small volume of the patients own blood plasma, by drawing a sample of blood from the patient and removing the red blood cells and plasma. The process of extracting the PRP yields a high concentration of platelets and white blood cells that is 5-7 times normal. Tissue injury normally results in platelets collecting at the site and beginning the clotting cycle. These activated platelets release numerous growth factors that are directly responsible for tissue regeneration or healing. By increasing the concentration of these platelets, we deliver a concentrated and effective mixture of growth factors directly to the injured tissue which dramatically enhances the body’s natural healing process. Treatment with PRP or Prolotherapy leads to a more rapid, more efficient, and more thorough restoration of the tissue toward its original healthy state. In addition the action of small needle injections create an orderly trauma resulting in additional local growth factors being excreted. The end result is complete recovery from injury leading to elimination of pain.
What to expect from PRP and Prolotherapy?
Platelet Rich Plasma (PRP) and Prolotherapy have been used for many decades to improve healing, reduce infection, and eliminate pain. Patients have received injections for tennis elbow, plantar fasciitis, achilles tendonitis, rotator cuff tears, meniscal tears, osteoarthritis, knee pain, hip pain, and chronic low back and neck pain. Injections are given with a local anesthetic, using the smallest gauge needle possible, to minimize pain at the injection site. On occasion, an “achy” soreness is felt at the site of injury, just a few hours following the injection. This “soreness” is a positive sign that the healing response has been set in motion. This effect can last for several days and gradually decreases as healing and tissue repair occurs. Often acupuncture is also performed in the local region of the injections, which improves healing response and begins to reduce pain in local tissues.
It is important that anti-inflammatory medications such as Ibuprofen, Naproxen and Aspirin be avoided following PRP or Prolotherapy treatments. These medicines may block the effects of the intended healing response, facilitated by the injection itself. It is acceptable to use Tylenol and apply ice and elevation as needed. You will be permitted to resume normal day to day activities and light exercise following injection. We suggest that you avoid strenuous lifting or high level exercise for at least several days after the injection.
This treatment is not a “quick fix” and is designed to promote long-term healing of the injured tissue. The regeneration of connective tissue can continue for months and may require multiple injections. For most cases 1-5 injections are required at 2-4 week intervals. Research and clinical data show that PRP injections are extremely safe, with minimal risk for any adverse reaction or complication. Because PRP is produced from your own blood, there is no concern for rejection or disease transmission. There is a small risk of infection from any injection into the body, but this is rare. Research suggests that PRP also has an antibacterial property which protects against possible infection. Treatments are completed usually within a hour with the patient able to return to work or home without any consequences.
When should I have surgery over PRP and Prolotherapy?
The main benefit of PRP and Prolotherapy is that they provide pain relief and healing while eliminating the need for surgery or a prolonged recovery. The benefits of proliferative injection therapy includes lower risks, lower costs than surgery, and can be used on patients, that are not candidates for surgery. PRP and Prolotherapy are a low-risk minimally invasive procedure. The concentrated platelet rich plasma (PRP) or Prolotherapy solutions injected into and around the point of injury, immediately start and magnify the body’s natural healing process. Recovery with PRP and Prolotherapy is much faster than with surgery. PRP and Prolotherapy should be utilized when a patient is not an absolute candidate for surgery, when pain is associated with normal wear and tear of living, and when it affects any joint particularly those joints that are weight bearing such as the feet, knees, hips, and low back, and neck. In essence have surgery when it is absolutely necessary, for everything else try PRP and Prolotherapy first.
How well known is PRP and Prolotherapy?
Prolotherapy has been in use for over 50 years and PRP in use for 20 years. Recent headlines have featured the amazing results of professional athletes experiences with PRP Therapy. Pro football players Hines Ward and Troy Polamalu of the Pittsburgh Steelers received PRP Therapy after injuries that should have sidelined them for months, but they returned to play in a matter of weeks, winning the Super Bowl. Los Angeles Dodgers pitcher Takashi Saito received PRP Therapy for an elbow condition and returned to play in just a few months, versus up to 14 months that recovery from surgery would have taken. Unprecedented results have also been reported for other professional soccer, baseball, and football players. Although PRP Therapy is relatively new to the field of orthopedics, it has been used for more than 20 years in dentistry, and has been used to promote healing, following jaw reconstruction, and for patients with cancer. Many thousands of patients have been treated with Prolotherapy successfully over the last 50 years in countries all around the world. PRP has been utilized for the last 20 years and has been proven to be an effective regenerative force.
LOW BACK PAIN
The most common cause of low back pain is dysfunction in the sacroIliac joint located on both sides of the sacrum where the iliums attach. This location may be the densest connective tissue layer in the body. Consider what it does, as it attaches or connects the upper torso to the lower limbs. This joint is a weight bearing joint that is sensitive to weight bearing activities. This includes walking, running, weights, jumping, and even pregnancy. Pregnancy can aggravate this joint obviously by the addition of 25-60 additional pounds gained during pregnancy, but also by the hormones that are produced to cause ligament laxity widening the birth canal. The lack of activity can also lead to dysfunction of this joint, due to weak muscles that attach near to this joint and function to help stabilize and support this transition point for forces applied above and below the sacrum.
Consider the ligaments of the sacroiliac joint and their potential to become weak, frayed, strained and it is easy to recognize that Platelet Rich Plasma and Prolotherapy can strengthen the sacroiliac joint returning it to full function. Physical manipulation and chiropractic care also can have a positive effect on this joint.
We have found consistently, with those with acute and chronic low back pain, that the muscles that are near or stabilize the sacroiliac joint can develop trigger points that cause referred pain patterns resembling low back pain. For example the glute medius, glute maximus, and piriformis muscles tighten in parts of the specific muscles to shorten and help stabilize the sacroiliac joint. These tight areas or contracted proteins are called trigger points, and will refer pain in a location away from their current location, making it difficult to diagnose pain without a trigger point focused exam.
Trigger points respond very well to acupuncture. In our clinic we apply both PRP and Prolotherapy along with acupuncture to stabilize the joint and reduce the trigger points. Often, the addition of specific stretches done daily or regular massage can also help the muscles remove or reduce trigger point activity. The combination of these therapies leads to a elimination of low back pain. Low back pain is often creating a balance between inactivity and the proper activity which will produce a pain free state.
HIP PAIN
The hip and pain associated with hip is directly related with the sacroiliac joint. This because the glutes and piriformis muscles that attach to the hip originate at portions of and near the sacroiliac junction. Some hip pain can be associated with the iliotibial band and hip flexors on the lateral and anterior of the body. PRP, Prolotherapy and acupuncture perform well in helping reduce pain and return a patient to normal function. Hip pain appears to be more common is those who are very inactive, but also in those who are extreme in activity such as marathoners and triathletes etc;
KNEE PAIN
The knee is an excellent example of how different forces act upon it to cause pain. The bones of the knee include the femur and the tibia. The approximate one another and are attached on the inside by ligaments called the anterior and inferior cruciate ligaments. They stabilize the knee from moving too far forward or backward. Along the medial and lateral aspects of the knee and crossing the joint from top to bottom are the collateral ligaments. These help the femur and tibia from moving too much to inside or outside. Over the ligaments a connective tissue capsule surrounds the knee joint. Another layer called the menisci, lying inside the knee, serve as a non-liquid cushion keeping the bones from rubbing on one another. In addition, our body creates and maintains fluid as found inside the joint.
Pain then arises when one of the following occur. First a tear in one or both of the cruciate ligaments, or menisci, strain or sprain of the lateral or medial collaterals, loss of fluid within the capsule joint, and development of trigger points as a result of unstable joints.
The best treatment for the knee appears to be the injection of PRP into and around the joint capsule. It appears, maybe to the lack of humidity and probably general weight bearing activity, that the fluid within the capsule of the knee can diminish over time. At this point the menisci will begin to make contact, increasing inflammation and irritation, resulting in chronic knee pain and weakness.
The addition of PRP into the capsule regenerates the joint cartilage and fluid, returning the knee to a non-painful state. That means a patient can walk, ruin, and even jump without pain.
Of course the application of acupuncture also helps the knee and is considered the standard of care for our office whenever we do a PRP injection.
ANKLE, FOOT, and PLANTAR FASCIAL PAIN
The major weight bearing joints of the body, in descending order are, the sacroiliac joint, hip joint, knee, and ankle. The ankle carries the brunt or weight of the whole body. With a history of any ankle strains or sprains, regular activity involving running, or lack of adequate arch support, ankle pain, plantar fasciitis, or foot pain can develop. PRP and Prolotherapy injected in and around the supporting ligaments of the ankle strengthen, tighten, and support the ankle reducing pain and improving activity. Acupuncture is also recommended along with an improvement in shoe wear for better arch support.
NECK PAIN
Chronic neck pain has a great history with improvement from four therapies, PRP/Prolotherapy, acupuncture, massage, and stretching. A significant number of patients with chronic neck pain have in their history an injury such as whiplash from sports, auto accidents, falls, etc;. Often the few tendons of the multitude of the tendons and muscles in the neck become damaged due to those injuries. Symptoms may not show up until years later. Small injections at the sights of injury provide considerable relief over a few weeks. The addition of acupuncture, massage, and stretching also help to improve the function and activity of the muscles leading to reduced pain.
SHOULDER PAIN
The shoulder joint is the most mobile and thus most at risk joint for injury. It is attached or held on the body mostly by muscles including the pectoralis, deltoid, rhomboids, latissmus dorsi, infraspinatus, supraspintus, subscapularis, and a few others. Often shoulder pain develops immediately following reaching out or up after a fall or to grab something above the head. Treatment involves examining every attachment of the shoulder for strains that then easily treated with PRP and Prolotherapy injections. Often trigger points have developed that cause sever referred pain patterns. These have to be identified and treated also using trigger point injection, acupuncture and stretching.
ELBOW and WRIST PAIN.
Elbow and wrist pain develop as a result of overuse injuries mostly. Cutting hair, painting, lifting weights, playing tennis etc; They are treated successfully using PRP and Prolotherapy to regenerate and rebuild the tendon attachments.
MIGRAINES and HEADACHES
Many patients suffer from ongoing headaches or migraines. The most common type of headache is a tension headache. Tension headaches arise from the muscles in the upper back and neck. Trigger points or knots develop or persist causing a shortening of muscles which attach at the base of the skull. These tight muscles radiate pain either over the top of the head across the forehead or around the temples toward and across the forehead. This type of headache is relieved with trigger point injections to the posterior attachments of the neck muscles at the base of the skull. Acupuncture also helps to relax the muscles and reduce trigger point influence.
Migraines on the other hand or more complex. In having helped many patients eliminate migraines we have discovered that most migraines have multiple triggers. One trigger is tension headaches. Any hx of head or neck trauma can damage tendons and predispose toward more compex migraines. We have also found many different aggravators for migraines over the years. For example IgG food allergies, dehydration, exposure to solvents, cleaners, and perfumes, and candida overgrowth. Clues are gathered during an intake to the other potential triggers. Once these are discovered, eliminated, or treated, migraines become nonexistent.
HERNIATED DISC TREATMENTS
Herniated discs can cause sudden, severe and unrelenting pain syndromes. Patients often present to Emergency Rooms, Primary Care Offices, and even Orthopedic Offices seeking relief from constant burning radiating pain. Treatment is often delayed as patients go through the process of gathering information about their condition including MRI’s, and X-rays. Even then a conservative approach is undertaken through physical therapy to treat and reverse the herniation(s). If this proves unsuccessful, then a variety of injections may be recommended and even surgery considered.
A herniated disc can be the result or cause of instability in joints due to injured tendons. These injured or unstable ligaments and tendons lead to referred pain patterns. Pain begins to reduce with the injection of Prolotherapy and PRP to rebuild weak ligaments and tendons. Prolotherapy and PRP consists of injections that cause proliferation of connective tissue. The proliferation leads to increased density and strength and improvement in joint stability.
Relief can come sooner with the frequent and immediate application of acupuncture. Acupuncture has proven to be a very effective treatment for reduction of the radiating, and stabbing pain that often accompanies herniated discs. Acupuncture works by clearing meridians or channels to allow improved circulation and support to the body’s innate ability to heal. Although acupuncture is new to western medicine, it has been a mainstay in eastern medicine for over 3,000 years. Acupuncture treatment is non-invasive and can begin immediately without interference with physical therapy or other medically prescribed prescriptions. In addition, Acupuncture can help you return to normal and pain free functioning faster than doing just physical therapy alone.
In addition, very specific physical therapy protocols for disc treatment are implemented.The simultaneous treatment with PRP, Acupuncture, and physical therapy produces the quickest and surest way for permanent relief.
FIBROMYALGIA
There exists a cure for Fibromyalgia. It is accessible to each and every patient. It is not a fictitious or stealthy disease, but a disease resulting from a negative synergism of multiple, but treatable causes. In our mesa practice, we see daily, patients who have been to doctor after doctor searching for answers to their fatigue and pain. At the root, we find the most insidious underlying cause, we call yeast.
Yeast and Candida
Yeast is an organism part of an even larger family called Fungi. Fungi have been around for thousands of years and are probably some of the most, if not the most, resilient organisms to exist on this planet. They have adapted to many types of harsh and barren landscapes. They have even developed the ability to live without oxygen or very little oxygen for a time. All of this means they are hard to destroy or eradicate.
The fungus form known as yeast resides in many places, but it enjoys dark, moist, and carbohydrate rich environments, which also includes the gastrointestinal(GI) tract. The question is how does yeast affect the GI tract? Candida is a form of yeast that appears to be the predominant form with activity arising in the GI tract. Although it is not completely clear, it seems these issues with yeast arose with the advent and excessive use of antibiotics. Antibiotics can be miraculous due to their ability to destroy disease causing bacteria in the body, but when taken orally, they disrupt the flora balance of the entire GI tract. Flora is the combination of many types of friendly and even unfriendly bacteria that produce enzymes that digest food, that act as a protective barrier to the intestinal walls, and they enliven or strengthen the immune system. Antibiotics change this fragile balance and create a situation where normal yeast forms, perhaps residing in low dose within the GI tract, begin to flourish and grow or replicate in abundance without any friendly bacteria to control yeast growth. In essence, antibiotic use changes the microflora environment from a protective role, to a war zone taken over by another host in the form of candida or yeast.
These yeast are toxic and begin to cause significant inflammation in the GI tract with a subsequent increase in histamine, eosinophils, mucous, and result in a significant distraction or irritant to the immune system. In addition these yeast can begin to break down the gut barrier leading to and causing “leaky gut syndrome.” This immune distraction is the cause associated with the pain of Fibromyalgia.
Imagine your immune system to be an army of 1 million white blood cells. They have the job to protect the borders and restore every cell back to normal functioning from the days normal “wear and tear.” Consider now that up to 80% of the bodies immune defense surrounds or resides surrounding the GI tract. The presence of yeast in the GI tract in essence, distracts up to 80% of your normal immune defense from its normal task.
It does not take long before the immune system becomes completely distracted and even exhausted, while it wages a war against yeast which have an endless potential to replicate. Why do I say this? Well, all yeast needs to survive and thrive is sugar. This is of course supplied in abundance in the average diet.
The first and most important step in recovering from Fibromyalgia is to reduce yeast expression in the GI tract. We have created protocols for achieving this goal in the most effective and safest possible way, with improvement in symptoms in just a few weeks. If you are curious if it is yeast, we can test and validate this theory very quickly through our mesa/gilbert office through labs often covered by insurance.
Food Allergies IgG
As is the case with many chronic diseases, by the time they present in our mesa/gilbert offices, they have 3-8 underlying causes to each disease. In other words, it is never just one thing. If yeast is the #1 cause of Fibromyalgia, than #2 is most likely food allergies.
This idea throws many people off since most patients have never noticed any allergic reactions to food. This is because food allergies also produce other antibodies such as IgG, IgM, and even IgA that are different in their immune response compared to IgE, which causes obvious and generally immediate allergic reactions when eaten. The antibodies produced, which are linked to Fibromyalgia, are the IgG class which are actually also known as delayed or slow onset allergic reactions. In other words, the reaction occurs hours and even days following the exposure. These become extremely difficult to determine when using symptoms as the only diagnostic test. With an IgG food allergy test a patient is able to view upwards of a hundred foods anging from grains, animal proteins, fruits, vegetable, legumes, and even yeast and candida. These tests can be invaluable to help determine a potent underlying cause to fibromyalgia.
In previous articles we have stated, that yeast has a major side effect leading to localized inflammation and irritation in the gastrointestinal(GI) tract. Many studies in the last few years have also shed light on the additional contribution from proteins that were once deemed healthy. For example, gluten, contained in wheat, barley, and rye, produces a protein called Zonulin that causes severe irritation of GI cells and leads to leaky gut. This leaky gut in turn causes the GI tract and immune system to react to any and all proteins that are introduced in the GI tract from the diet. In time we become reactive to everything that we eat. Just like yeast, normal or even healthy foods, become major immune distractors.
With the immune system being overwhelmed by these food proteins, healing from normal “wear and tear” is reduced. The patient begins to feel pain in the muscles and joint in multiple locations. The cure is in discovering the food allergies through testing and removing those foods to allow the GI tract to heal. In time with proper dietary protocols and with additional support of an anti-yeast diet symptoms improve. Food allergies along with yeast are the most oft over looked causes of Fibromyalgia. Testing is key and success is sure as we begin to heal the gut. (A negative celiac panel is insufficient to rule out gluten IgG reactivity.) Consider that the leading food allergy is also the leading health food, wheat. A blessing to some and a curse for so many others. IgG food sensitivity testing is the only way to know for sure.
Once a patient begins to treat two of the most common causes, which are candida and food sensitivities, the immune system starts to rebound to full activity. There stands in the immediate path of immune improvement all environmental exposures, the first of which is toxic metals.
Toxic metals
Toxic metals are heavy metals, not required for health or metabolic function, but when present within the body, actually suppress normal metabolic or immune pathways. The mass effect results in immune suppression and fatigue. Most people probably think themselves immune to such exposures. The reality, is actually quite disturbing. If you are living you have been exposed and carry or have carried at some point in time a toxic metal burden. This burden leads to immune suppression, with resultant inability at overcoming simple infections such as viral,, bacterial or fungal infections. This leads to fatigue and inability to recover from daily physical stress.
Toxic metal burden has been linked to cancer, autoimmune disease, heart disease, alzheimers and dementia, and many others. So what metals are we exposed to and what are the sources of these toxic metals? Toxic metals include: Aluminum, Arsenic, Barium, Cadmium, Gadolinium, Lead, Mercury, Nickel, Tin, Uranium to name a few. Each of these metals can be found in our food, air, and water supply. They exist abundantly in cosmetics, lotions, soaps, and cleansers. They are produced as by products in mining, manufacturing, energy production, and technology industries. If we are eating, breathing, and applying non-organic products and foods, we are exposed.
Toxic metals are not easily eradicated or removed from the body. They tend to bioaccumulate or concentrate in connective tissue and organs of the body. Because of this fact, an agent described as a chelator, is given orally or intravenously to grab or attach to toxic metals and discard them through the kidneys or intestines. If a urine sample is collected following the delivery of a chelator, a potential estimate of toxic metal burden can be made. Once we know the degree and possibility of a toxic metal burden, a treatment plan can be designed to reduce the toxic metal load over time.
Patient’s who have had chelation performed notice improvements in blood pressure, immune function, circulation, focus and alertness, memory, diabetes and cholesterol control, and reduction in autoimmune disease. These declines in toxic heavy metals also lead to an improvement in chronic pain and chronic fatigue.
MTHFR and Environmental Toxins
Environmental exposures are now often involved in the inability of normal detox pathways to keep pace. Genetic defects such as Methyltetrahydrofolate Reductase Enzyme (MTHFR) defect, and Phase 2 liver defects, lead to increased exposure within the matrix or extracellular space. This space is where all the hormones, immune cells, and neurotransmitters, cytokines, and other various peptides communicate with one another. With the extra debri present communication is interrupted. Communication is hampered and the long term effects can include endocrine dysregulation or deficiency, immune distraction and eventually anergy, and neurotransmitter depletion.
Testing as offered through standard labs such as Labcorp, and Sonora Quest, are able to determine deficiencies and imbalances. The MTHFR polymorphism is number one on our list to test and treat. Many of our patients have commented since being tested and being treated for MTHFR polymorphism, significant improvements in health, mood , and energy have been obvious. we have found in our clinic that homocysteine levels, as diagnosed through lab testing, is insufficient to measure the activity and optimal functioning of the B12 and folic acid pathways.
Treatment initially restores normal function and balance while supporting detox pathways. As toxins are removed we can see normal production and function restored to the immune, endocrine, methylation, and neurotransmitter systems. Detox pathways are enhanced through the liver, kidneys,colon, and skin to help remove toxins at a faster rate reducing the total load.
Adrenal Fatigue
Adrenal fatigue has been proposed for a number of years as part of the cause of Fibromyalgia. It is difficult to say how it rates in order of importance as an underlying cause, because it also develops as a concurrent problem due to any chronic illness. By the time any patience is diagnosed or discovers through their own research that they have Fibromyalgia, they have frequently developed chronic fatigue or lethargy. Not a surprise really.
Many of the underlying causes for chronic fatigue are the same for Fibromyalgia. Adrenal fatigue is often the result of chronic stress or lack of recovery from normal stress. Under normal conditions the body increases excretion of norepinephrine and epinephrine(same as adrenaline), and cortisol when we are under stress. Normal levels of these neurotransmitters and hormones help us feel like we are able to handle the stress. We have both the physical and mental coping ability to deal with and recover from stress.
Chronic or lingering stress strains the adrenal gland and central nervous system(CNS) leading to a slow depletion of cortisol, and the catecholamines, epinephrine and norepinephrine. Low levels result in fatigue and of feeling of being too easily overwhelmed by what used to be normal or average stressors. Other symptoms that may coexist with stress is poor sleep quality or restful sleep.
Lab testing is required here to determine the presence and extent of the adrenal fatigue. Many types of testing exist from straight measurement of cortisol, DHEA, and adrenaline in differing sources including urine, saliva, and blood or serum. Cortisol is frequenty measured in saliva throughout the day in order to assess the baseline and circadian rythmn. Cortisol should be highest in the morning at rising and in the first few hours of the day. It follows a bell shape curve and reduces toward a steady baseline in the late afternoon and through the night. A flat or low bell curve indicates adrenal fatigue. Typically 4 saliva samples at varying times of the day help to extrapolate the curve. Samples are taken at 8am, 12 noon, 4pm, and 10pm for example.
This same curve or rhythm can be assessed using blood or serum samples throughout the day or simply as a single sample in the morning. If the curve or single sample of cortisol is low, adrenal fatigue is present.
Low DHEA-sulfate in saliva, urine and blood tests will also indicate possible adrenal fatigue. Although low DHEA-s can also be an indicator for hormone imbalance or deficiency. The other extremely valuable test is a serum catecholamine test measuring norepinephrine, epinephrine(adrenaline), and dopamine. Low norepinephrine and epinephrine are indicators for adrenal fatigue. These central and peripheral neurotransmitters are also found present in many other health concerns such as sleep disorders, depression, dysthymia, and inability in managing stress. When treated correctly, adrenal function can return to normal very quickly. Best outcomes occur when both the catecholamines and cortisol are assessed. Treatment to restore adrenals includes targeted amino acid therapy and herbs with specific actions which increase output of norepinephrine, epinephrine, and cortisol.
Hormone Deficiencies
It seems these days everything gets blamed on hormone deficiencies or imbalances. Hormone deficiency affects the thyroid, adrenals, and of course the ovaries(in women), and testes(in men). Hormone deficiencies when treated appropriately, add such a significant benefit, it is often astounding the patients’ responses. Often, good intentioned doctors, utilize only hormones to solve some of the most complex disease cases, but without consistent success. It is true that often people experience miraculous recoveries when starting hormone therapy, but that is because, that is the only thing wrong with them.
The proper restoration and balancing of thyroid, estrogen, progesterone, testosterone, cortisol, and even adrenaline, can really boost natural occurring energy and vitality. By itself, it is rare that a patient would fully recover, or even have fibromyalgia, with just testosterone or estrogen being low. Proper hormone balancing and replacement is part of the complete package.
Sometimes men have difficulty with libido or sexual dysfunction. This may persist for years before being given a cream or injection with a significant and obvious improvement in just 1-2 weeks on replacement therapy. Women may find an immediate improvement in mood and sleep. Hormones affect how we handle stress, when they are low so is our resistance to stress conditions. Hormones, although often associated with sexual function and desire, are more likely to improve general well being, motivation, and recovery from physical and mental stress. It has become one of my favorite therapies to prescribe, due to its obvious and delightful effects on patients.
Patients often ask what is the best method for hormone replacement? There are creams, lozenges, capsules, injections, and even pellets. All these delivery methods work well, and it is just a matter of choice of application, and what best serves the needs of the patient. Hormones improve Fibromyalgia buy improving recovery from stress and exercise. They enhance mood, general wellbeing, sleep, and often sex. Hormones are sometimes the finishing touches on a well designed lifestyle and recovery program.
Nutritional Deficiencies
Nutritional deficiency was for so many alternative doctors, in the past, the most reliable method for restoring normal metabolic function to patients. Disease is sadly much more complex in today’s modern environmentally toxic time. The issues leading to Fibromyalgia are much more complex, but restoration of normal nutrient values is essential to recover full function. The conditions described in prior articles such as candida, food allergies, and toxicities, lead to increased oxidation requiring more than the normal amount of free radical fighters. More strain from active disease processes requires more nutrients.
In addition, candida and other food allergies create an environment leading to malabsorption. Nutrient absorption across the intestinal barrier is impeded with inflammation, absence of friendly bacteria, and overgrowth of candida and yeast.
In our office, we have proven this idea very quickly as we administer vitamin and mineral rich IV therapy with benefit in energy just after 2-3 IV sessions. The IV therapies have a chance to be absorbed nearly 100% due to lack of having to be first absorbed through the intestinal wall. The nutrient rich IV solution is immediately found head to toe circulating through the bloodstream.
Increased energy leads to the body’s ability to recover from stress and free radical damage, resulting in decreased pain. Of course vitamin and mineral are also required as cofactors in production of energy and building and maintaining activity of white blood cells. We cannot live without these micronutrients, and certainly, we are unable to recover from normal stressors of the day when we are nutrient deplete..
Sleep
Sleep is nearly as glorious as food. I don’t know if I could live without one or the other. In fact, many studies show that recovery from stress or exertion of the day, physical and mental, requires 7-9 hours of sleep daily. It is the design of nature for us to rest our bodies and minds for this period of time. Sleep studies indicate that deficits in the duration or depth of sleep leads to chronic fatigue and fibromyalgia. Considering that so many factors disrupt sleep, which also coincide with fibromyalgia, it is no question that the two symptoms so often go hand in hand.
The body requires anywhere from 1.5 to 3 hours of deep sleep per night. This is the total amount of time gathered in Stage 3 and REM sleep, as the body goes through 3-4 sleep cycles during the night. This deep sleep requires sleeping a sufficient number of hours, being undisturbed by noise, light, or pain, and supporting the proper neuro chemistry to facilitate depth and duration of deep sleep. Many patients with fibromyalgia also deal with emotional fragility, stress disorders, depression, and even anxiety. These symptoms can be present in the absence of fibromyalgia, but they are always present in cases of sleep dysfunction.
Quality and quantity of sleep are easily improved through the application of natural medicine. Meditation and relaxation techniques are proven to be more effective than pharmaceutical drugs such as ambien. Many herbs, amino acids, and natural neurotransmitter precursors enhance levels and functioning of specific sleep neurochemicals. The natural approach combined with treatment of other predisposing factors results in sleep recovery. Sleep recovery results in greater energy, improved stress adaptation, enhanced mood, and a reduction in fibromyalgia pain.
RHEUMATOID ARTHRITIS
Rheumatoid Arthritis is a complex immune condition classified as an autoimmune (AI) disease. Through the years of working with many patients, we have discovered many commonalities between AI patients on the whole. One is that most patients have a Methyltetrahydrofolate Reductase (MTHFR) polymorphism, a gluten sensitivity, yeast overgrowth, and one or more toxic environmental triggers.
MTHFR
MTHFR is associated with many AI diseases, and research has validated improvements in disease remission and progression when treated correctly. The clinical application of enhancement folic acid pathways and metabolism due to the MTHFR defect is still very early. But our experiences our providing sufficient evidence that indicates patients are improving with the proper treatment with folic acid and other cofactors to improve folic acid pathways. MTHR is defect in the pathway that converts folic acid to a bioactive form that feeds the pathways for production of methionine from homocysteine, methylation, phosphatidylcholine, neurotransmitters, and many others.
A MTHFR polymorphism we believe results in a reduction in methyl groups and production of glutathione. Methylation and glutathione serve as two of the major pathways for detoxification from both food and environmental exposures. Environmental specialists believe the lack of these two ingredients or a reduction in their production, will result in an ever increasing environmental burden within the extracellular matrix. This burden will have effects on communication of all peptides including neurotransmitters, hormones, cytokines, resulting in a decline in immune function, endocrine function, and neurotransmitter distribution. The overall effect will be more toxicities and side effects of chronic toxic exposures.
This is key to understanding the onset and propagation of AI disease as our environment continues to be laden with more toxic exposures, food additives and chemical enhancers, pesticides and herbicides, and a multitude of cleaning products and solvents. In the news recently we heard that Accutane has been linked to the onset of the AI disease Crohn’s. Thus, we will likely find in the future, many more drugs acting as environmental inducers of AI disease. We believe the MTHFR polymorphism is one of the reasons.
Gluten sensitivity
The worst expression of gluten sensitivity or intolerance is Celiac Disease. The regular and constant exposure of the gluten protein over a period of years slowly destroys the villi or absorptive fingers of the intestine to the point where the whole thing falls apart. It is a serious disease leading to weight loss, malabsorption, and the potential for a permanent colostomy bag.
For many years primary doctors when asked by their patient, about a possible gluten or wheat allergy, would ignore any possibility in the absence of severe and chronic diarrhea. That approach to gluten sensitivity has been misleading. There exists today over 50 known disease either caused by or aggravated by gluten sensitivity that will never lead to celiac disease. This recent awareness has lead doctors to expand the diagnoses for many conditions.
Just a few years ago a researcher named Fasano defined the conditions and proteins produced with exposure to gluten that cause AI disease. He found a protein Zonulin, that is produced in the presence of gluten, in certain individuals. Zonulin has a similar effect on the GI tract as does yeast. It creates inflammation and causes enlargement of gap junctions allowing undigested proteins, bacteria, yeast, drugs, and other toxins to pass the protective lining of the gut barrier and enter into the bloodstream. At this point the immune system kicks in to defend against foreign invaders producing immunoglobulins.
It is thought the the similarity of these foreign proteins, to which the immune system creates an attack force, appear very similar to normal functioning proteins within our body. Our immune system unable to differentiate 100 percent between the two, also attacks normal and healthy tissue.
Tests done through our office are able to determine both an allergic response to gluten and wheat and also check for the genetic risk of celiac or gluten intolerances. Other food sensitivities may coexist which can be discovered and removed from the diet to slow and eventually stop the progression of the disease.
Yeast overgrowth
Yeast is an organism part of an even larger family called Fungi. Fungi have been around for thousands of years and are probably some of the most, if not the most, resilient organisms to exist on this planet. They have adapted to many types of harsh and barren landscapes. They have even developed the ability to live without oxygen or very little oxygen for a time. All of this means they are hard to destroy or eradicate.
The fungus form known as yeast resides in many places, but it enjoys dark, moist, and carbohydrate rich environments, which also includes the gastrointestinal(GI) tract. The question is how does yeast affect the GI tract? Candida is a form of yeast that appears to be the predominant form with activity arising in the GI tract. Although it is not completely clear, it seems these issues with yeast arose with the advent and excessive use of antibiotics. Antibiotics can be miraculous due to their ability to destroy disease causing bacteria in the body, but when taken orally, they disrupt the flora balance of the entire GI tract. Flora is the combination of many types of friendly and even unfriendly bacteria that produce enzymes that digest food, that act as a protective barrier to the intestinal walls, and they enliven or strengthen the immune system. Antibiotics change this fragile balance and create a situation where normal yeast forms, perhaps residing in low dose within the GI tract, begin to flourish and grow or replicate in abundance without any friendly bacteria to control yeast growth. In essence, antibiotic use changes the microflora environment from a protective role, to a war zone taken over by another host in the form of candida or yeast.
These yeast are toxic and begin to cause significant inflammation in the GI tract with a subsequent increase in histamine, eosinophils, mucous, and result in a significant distraction or irritant to the immune system. In addition these yeast can begin to break down the gut barrier leading to and causing “leaky gut syndrome.”
Imagine your immune system to be an army of 1 million white blood cells. They have the job to protect the borders and restore every cell back to normal functioning from the days normal “wear and tear.” Consider now that up to 80% of the bodies immune defense surrounds or resides surrounding the GI tract. The presence of yeast in the GI tract in essence, distracts up to 80% of your normal immune defense from its normal task.
It does not take long before the immune system becomes completely distracted and even exhausted, while it wages a war against yeast which have an endless potential to replicate. Why do I say this? Well, all yeast needs to survive and thrive is sugar. This is of course supplied in abundance in the average diet.
We do not believe yeast by itself would actually lead to or cause AI disease, but in the presence of the other mentioned risk factors for AI disease, yeast appears to have a very negative synergizing affect when combine with MTHFR, gluten sensitivity, and drug or environmental triggers. We have created protocols for eradicating yeast in the most effective and safest possible way, with improvement in symptoms in just a few weeks. If you are curious if yeast is present,, we can test and validate this theory very quickly through our mesa/gilbert office through labs often covered by insurance.
Environmental triggers
We already had mentioned Accutane as an inducer of Crohn’s disease, but what do we know about RA and environmental triggers. Factors such as exposure to smoking in utero or secondhand and birthweight are risks for developing RA. We now know that frequent or extended exposure to pesticides may increase the risk for developing autoimmune diseases such as lupus and rheumatoid arthritis.
Nearly a billion pounds of pesticides, typically used to kill termites, fleas and household bugs, are spread into the environment each year, through both agricultural and nonagricultural use. According to the 2008-2009 Annual Report of the President’s Cancer Panel, nearly 1,400 pesticides have been registered and approved by the Environmental Protection Agency. It is been reported that the strongest association between pesticides and the two autoimmune disorders was seen in women who lived on a farm and reported personally applying insecticides. These individuals displayed nearly three times the risk for disease development, compared to women who used no pesticides whatsoever. Meanwhile, lupus/RA risk was doubled for women who underwent 20 or more years of direct exposure (personally applying pesticides) and for those who reported applying insecticides six or more times annually.
In our experience we have found the majority of our patients with RA to have lived near agriculture hot spots where regular and consistent applications of pesticides and herbicides have been applied for years surrounding their main residence.
Naturopathic medicine is one of the only major healthcare organizations to recognize and acknowledge the seriousness of this issue. To that end many Naturopathic physicians have been trained to help their patients develop protocols and procedures to eliminate past and current toxic environmental exposures.
It is helpful to know that all the treatments done can be applied at the same time as the medications currently employed by the rheumatologists.
ARTHRITIS or OSTEOARTHRITIS
Arthritis is a common debilitating condition affecting the quality of life for many patients. The treatment of acute and chronic arthritis with Naturopathic medicine has proven beneficial when compared to the treatment of pain with standard medications, steroid injections, or surgery. Arthritis is not a condition that needs to be tolerated and great relief can be found through treatments offered by Naturopathic Doctors.
Arthritis is caused largely by uncontrolled inflammation in the body, the largest percentage being derived from the diet. Ga
ining control of inflammation requires reducing inflammatory foods in the diet. The most reliable approach to determining inflammatory dietary foods is through performing IgG Food Intolerance Testing. Research continues to substantiate the fact that particular foods can aggravate every type of arthritis. Your physician will also discuss with specific dietary guidelines that help improve inflammatory control. Candida cleansing or detox has also been shown to be very beneficial, when discovered to be present through lab testing.
Our bodies produce a small amount of its own steroid, called cortisol, to keep inflammation under control. With aging and stress, this normal physiological output of cortisol can decline leading to impaired inflammatory control. Adrenal Function Testingmeasures the strength and output of cortisol, and thus providing information allowing for customized anti-inflammatory therapy.
In addition, a significant amount of pain arises from ligament and tendon weakness with the resultant instability in joints. When joints are unstable they fail to perform optimally and cause premature wear and tear. When the wear and tear becomes significant enough, inflammation becomes apparent and patients notice swelling, limited movement, and localized pain. Prolotherapy and PRP are the best treatments for weak ligaments and tendons. Prolotherapy and PRP consists of injections that cause proliferation of connective tissue. The proliferation leads to increased density and strength and improvement in joint stability.
Another effective therapy for the treatment of chronic pain includes acupuncture. Acupuncture works by clearing meridians or channels to allow improved circulation and support to the body’s innate ability to heal. Although acupuncture is new to western medicine, it has been a mainstay in eastern medicine for over 3,000 years. Acupuncture is extremely effective with helping muscles relax and reducing joint inflammation and pain.
Arthritic pain has been linked to derangements in biomechanics, inflammation, injuries, food intolerances, nutritional deficiencies, and even the normal process of aging. Determination of the underlying causes of pain begins with an appropriate assessment, including labs and physical exams. Once the underlying causes have been determined, a specific and directed approach to pain treatment or management will be prescribed. Much of what is applied in the treatment of Fibromyalgia can be applied also to osteoarthritis.
