For quite some time, I have made reference to certain nutritional substances having anti-inflammatory properties, and others being pro-inflammatory. Why do I keep doing this? Well the obvious, short term gains come from repetitive-motion and overuse injuries. But on the long term outlook, certain diseases including arthritis and (believe it or not) heart disease and Alzheimers disease have inflammation as a major factor.
FINALLY the major health organizations are starting to catch up with the literature...
Inflammation testing suggested for millions at risk of heart disease
Don't wait until the diseases of old age are kicking your a*ss; pass the sushi!
- Bill
Anti-inflammatory substances
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Bill Glasheen
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- Location: Richmond, VA --- Louisville, KY
My question is, and then what?
Check a cholesterol, and you use the results to determine whether you advise diet and exercise (everyone), aspirin, (many), blood pressure and diabetes control where indicated--or advise additional medications like "statins" that lower cholesterol.
Check a CRP, and 120$ later you have a piece of information with resulting marginally better prognostic power, but all you can again do is exercise, diet, aspirin, control diabetes and hypertension and consider a statin.
The CRP doesn't yet pass my booger rule:
"Ordering a test is like picking your nose; you had better know what you're going to do with the result before you go digging." Or put another way, "Ask what you will do if the test is positive. Ask what you will do if the test is negative. If the answer is the same, do not do the test."
Check a cholesterol, and you use the results to determine whether you advise diet and exercise (everyone), aspirin, (many), blood pressure and diabetes control where indicated--or advise additional medications like "statins" that lower cholesterol.
Check a CRP, and 120$ later you have a piece of information with resulting marginally better prognostic power, but all you can again do is exercise, diet, aspirin, control diabetes and hypertension and consider a statin.
The CRP doesn't yet pass my booger rule:
"Ordering a test is like picking your nose; you had better know what you're going to do with the result before you go digging." Or put another way, "Ask what you will do if the test is positive. Ask what you will do if the test is negative. If the answer is the same, do not do the test."
--Ian
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Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
Ian
Nine times out of ten, I love having you say things like this. Hey...this affects OUR bottom line. However...let's take a look at a study done by folks in your neck of the woods. Note my emphasis at the bottom.
MORE IMPORTANTLY...
Folks should understand that inflammation is a cause of many diseases - AND - you can do something about it way before you get to the point where you need to be taking aspirin and antihypertensives and statins. Other than managing weight, not smoking, and exercising, one can modify one's diet to include substances (such as omega 3, 6 and 9 fatty acids) that have natural antiinflammatory properties and exclude substances (such as fatty acids in animal fat) that have proinflammatory properties. You don't need a medical test to treat yourself right at dinnertime.
And eating a diet like this will also be very kind to your joints. There's a ton of literature out there supporting that notion.
- Bill
P.S. My people tell me the test costs $18.50. It's not the test that worries me, it's the lifetime of aggressive therapy following a positive result that saves lives but adds to the bottom line.
Nine times out of ten, I love having you say things like this. Hey...this affects OUR bottom line. However...let's take a look at a study done by folks in your neck of the woods. Note my emphasis at the bottom.
Cholesterol tests are one of the gold standards for assessing risk of cardiovascular disease. Think about how often these tests are done. If something else is going to show risk with a greater sensitivity/specificity AND be reflective of a different causal link, you can be darned sure that a) they will be doing it as often, and b) they won't make the old test go away. This is a fact of the health care system we know today.Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events.
Ridker PM, Rifai N, Rose L, Buring JE, Cook NR.
Center for Cardiovascular Disease Prevention and the Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston 02215, USA. pridker@partners.org
BACKGROUND: Both C-reactive protein and low-density lipoprotein (LDL) cholesterol levels are elevated in persons at risk for cardiovascular events. However, population-based data directly comparing these two biologic markers are not available. METHODS: C-reactive protein and LDL cholesterol were measured at base line in 27,939 apparently healthy American women, who were then followed for a mean of eight years for the occurrence of myocardial infarction, ischemic stroke, coronary revascularization, or death from cardiovascular causes. We assessed the value of these two measurements in predicting the risk of cardiovascular events in the study population. RESULTS: Although C-reactive protein and LDL cholesterol were minimally correlated (r=0.08), base-line levels of each had a strong linear relation with the incidence of cardiovascular events. After adjustment for age, smoking status, the presence or absence of diabetes mellitus, categorical levels of blood pressure, and use or nonuse of hormone-replacement therapy, the relative risks of first cardiovascular events according to increasing quintiles of C-reactive protein, as compared with the women in the lowest quintile, were 1.4, 1.6, 2.0, and 2.3 (P<0.001), whereas the corresponding relative risks in increasing quintiles of LDL cholesterol, as compared with the lowest, were 0.9, 1.1, 1.3, and 1.5 (P<0.001). Similar effects were observed in separate analyses of each component of the composite end point and among users and nonusers of hormone-replacement therapy. Overall, 77 percent of all events occurred among women with LDL cholesterol levels below 160 mg per deciliter (4.14 mmol per liter), and 46 percent occurred among those with LDL cholesterol levels below 130 mg per deciliter (3.36 mmol per liter). By contrast, because C-reactive protein and LDL cholesterol measurements tended to identify different high-risk groups, screening for both biologic markers provided better prognostic information than screening for either alone. Independent effects were also observed for C-reactive protein in analyses adjusted for all components of the Framingham risk score. CONCLUSIONS: These data suggest that the C-reactive protein level is a stronger predictor of cardiovascular events than the LDL cholesterol level and that it adds prognostic information to that conveyed by the Framingham risk score. Copyright 2002 Massachusetts Medical Society
MORE IMPORTANTLY...
Folks should understand that inflammation is a cause of many diseases - AND - you can do something about it way before you get to the point where you need to be taking aspirin and antihypertensives and statins. Other than managing weight, not smoking, and exercising, one can modify one's diet to include substances (such as omega 3, 6 and 9 fatty acids) that have natural antiinflammatory properties and exclude substances (such as fatty acids in animal fat) that have proinflammatory properties. You don't need a medical test to treat yourself right at dinnertime.
And eating a diet like this will also be very kind to your joints. There's a ton of literature out there supporting that notion.
- Bill
P.S. My people tell me the test costs $18.50. It's not the test that worries me, it's the lifetime of aggressive therapy following a positive result that saves lives but adds to the bottom line.
"you can do something about it way before you get to the point where you need to be taking aspirin and antihypertensives and statins. Other than managing weight, not smoking, and exercising, one can modify one's diet to include substances (such as omega 3, 6 and 9 fatty acids) that have natural antiinflammatory properties and exclude substances (such as fatty acids in animal fat) that have proinflammatory properties. You don't need a medical test to treat yourself right at dinnertime."
Exactly--why not do these things without getting the test? We ought to really know whether making these interventions helps reduce risk in a meaningful or cost effective way. Then we should implement them in the populations that they've been shown to be helpful in. If they're useful for everyone, the test is useless. If they're useful only in the populations with higher CRP, then we could target therapy to the high CRP group and the test would likely save us $ by avoiding therapy in everyone else. But then we're talking totally different data--not whether a test has prognostic value (and this value for CRP is very slight) but whether 1) the therapy works 2) does the test identify those who benefit? Those are the articles I'd like to read--one that reports on clinically important endpoints affected by therapy.
Think arrhythmia. We have anti-arrhythmic drugs. We have tests for arrhythmia. One would assume we should do the tst and then hand out the drug where needed. However, the CAST trial showed that the bulk of the antiarrhythmic drugs used for people with arrhythmias resulted in a HIGHER deathrate than placebo. $ spent on badness! Without CAST, people'd still be getting nasty drugs. We need a "CAST" for the CRP interventions.
Exactly--why not do these things without getting the test? We ought to really know whether making these interventions helps reduce risk in a meaningful or cost effective way. Then we should implement them in the populations that they've been shown to be helpful in. If they're useful for everyone, the test is useless. If they're useful only in the populations with higher CRP, then we could target therapy to the high CRP group and the test would likely save us $ by avoiding therapy in everyone else. But then we're talking totally different data--not whether a test has prognostic value (and this value for CRP is very slight) but whether 1) the therapy works 2) does the test identify those who benefit? Those are the articles I'd like to read--one that reports on clinically important endpoints affected by therapy.
Think arrhythmia. We have anti-arrhythmic drugs. We have tests for arrhythmia. One would assume we should do the tst and then hand out the drug where needed. However, the CAST trial showed that the bulk of the antiarrhythmic drugs used for people with arrhythmias resulted in a HIGHER deathrate than placebo. $ spent on badness! Without CAST, people'd still be getting nasty drugs. We need a "CAST" for the CRP interventions.
--Ian
Carisoprodol isn't antiinflammatory, it's a skeletal muscle relaxant. Usually used for a brief course in the management of back sprains and strains, but like bed rest, thought to be harmful after that short course.
--Unusual reactions: weakness, quadriplegia, dizziness, ataxia, vision loss, diplopia, mydriasis, dysarthria, agitation, euphoria, or disorientation usually subside over several hours
--more common reactions: sleepiness, faitgue, headache, tremor, dizzyness, insomnia, depression, agitation.
--sleepiness impairs thinking and coordination.
--supposedly not physically addicting, but there is abuse potential -- and suddenly stopping a high dosage can lead to mild withdrawal symptoms. Abuse is rare but caution is advised in addiction prone people, some of whom used it as a substitute for opiates.
It's one of the substances that a drug seeking patient of mine was found to be obtaining from up to 9 different doctors who were all unaware of the others.
Your antiinflammatories come in a few categories--steroids, nonsteroidal, and other, including nutrients and vitamins like the ones Bill mentioned.
--Unusual reactions: weakness, quadriplegia, dizziness, ataxia, vision loss, diplopia, mydriasis, dysarthria, agitation, euphoria, or disorientation usually subside over several hours
--more common reactions: sleepiness, faitgue, headache, tremor, dizzyness, insomnia, depression, agitation.
--sleepiness impairs thinking and coordination.
--supposedly not physically addicting, but there is abuse potential -- and suddenly stopping a high dosage can lead to mild withdrawal symptoms. Abuse is rare but caution is advised in addiction prone people, some of whom used it as a substitute for opiates.
It's one of the substances that a drug seeking patient of mine was found to be obtaining from up to 9 different doctors who were all unaware of the others.
Your antiinflammatories come in a few categories--steroids, nonsteroidal, and other, including nutrients and vitamins like the ones Bill mentioned.
--Ian
Thanks for your reply, Ian.
That's what I'm waiting for to kick in right now, the sleepiness. Rather the the med to convince the discomfort to subside enough so the sleepiness can take over.more common reactions: sleepiness,
Interesting. I don't get high nor do I feel euphoric. When the weather gets better I leave them alone with no residual attraction.a substitute for opiates.
When the weather gets real cold like this I suffer unusually extra. Usually it's a 1, 2, or 3AM-ish med, but I took one during the morning shortly before I left for work one day last week and my legs, as weak as they are, turned into rubber bands and I noticed I was "real loose" for most of the morning. However, I was as mentally straight and sharp as I usually am, therefore I don't think it affects those faculties in this person.Unusual reactions: weakness,
Always with an even keel.
-- Allen
-- Allen
The drug (aka Soma) doesn't cause those symptoms or other problems in most people that use it... I ust haven't found it particularly useful for low back pain, and there are other meds in the muscle relaxant category that don't have abuse potential warnings, so I tend to stay away. Some people do just fine with it, though.
--Ian
It works for me, but I don't take it every day, and the timing is off sometimes. Like right now. Good thing I have 24/7 access at work because this morning, rather than taking the med only to wake up like a limp piece of elbow macaroni in only an hour or so, I've already showered and am warming the seat on the truck up -- I simply love my remote starter and the heating pad that I wired into my truck on mornings like this.
I'm going to take some Ibuprofin on my way out the door and if that doesn't work, I've got a few Celebrex left at work to take about 6 hours from now.
Thanks for the Info, again, Ian. What other meds could you reccommend? I'll pass them across my doctor on my next visit with him.
I'm going to take some Ibuprofin on my way out the door and if that doesn't work, I've got a few Celebrex left at work to take about 6 hours from now.
Thanks for the Info, again, Ian. What other meds could you reccommend? I'll pass them across my doctor on my next visit with him.
Always with an even keel.
-- Allen
-- Allen
For garden variety low back pain (since I didn't see what condition we're referring to exactly), people do well with full strength ibuprofen (800mg three times a day, some people sneak in four, have to use less or none if kidney disease) or equivalent naproxen dose (more convenient because less often) and when that's not enough, tylenol up to 4g a day (less for people who drink a lot or have liver disease) helps. When I could barely get out of a chair last year, I took them together and staggered them so something was always peaking.
I found a quality matress, as firm as is comfortable, very helpful. They're a major pain in the ass to shop for and are expensive but you spend 1/3 of your life there and that time affects your back for the other 2/3. Careful attendance to posture. EARLY mobilization with low impact exercise, keep walking frequently, don't spend time in bed unless you have to and then MAX 3 days. An inflatable ball also helped me stretch my back out and since it's been gentler to do situps with. Hydration to keep your discs moist. I've met some people who've done very well with self hypnosis or accupuncture or whatever else they think might be worthwhile.
There's nothing wrong with celebrex but it's much more expensive and doesn't do anything that ibuprofen doesn't do. The value is it's supposed to have fewer side effects (stomach irritation, some people get ulcers and have stomach bleeds, most will get small erosions, helps to take with food).
If I use muscle relaxants its for a short course early on. People tell me it helps them fall asleep more than anything else.
Benzos like valium and narcotics from codeine to oxycontin are also used, but its best to stay away. Frequently the users still have pain but then they're stuck on oxycontin. Depends on the condition, of course, if people have cancer, it's a different story. There are other drugs like tricyclic antidepressants and antiepileptics like depakote and neurontin that help with other types of pain especially that from irritated nerves and can be additive.
I found a quality matress, as firm as is comfortable, very helpful. They're a major pain in the ass to shop for and are expensive but you spend 1/3 of your life there and that time affects your back for the other 2/3. Careful attendance to posture. EARLY mobilization with low impact exercise, keep walking frequently, don't spend time in bed unless you have to and then MAX 3 days. An inflatable ball also helped me stretch my back out and since it's been gentler to do situps with. Hydration to keep your discs moist. I've met some people who've done very well with self hypnosis or accupuncture or whatever else they think might be worthwhile.
There's nothing wrong with celebrex but it's much more expensive and doesn't do anything that ibuprofen doesn't do. The value is it's supposed to have fewer side effects (stomach irritation, some people get ulcers and have stomach bleeds, most will get small erosions, helps to take with food).
If I use muscle relaxants its for a short course early on. People tell me it helps them fall asleep more than anything else.
Benzos like valium and narcotics from codeine to oxycontin are also used, but its best to stay away. Frequently the users still have pain but then they're stuck on oxycontin. Depends on the condition, of course, if people have cancer, it's a different story. There are other drugs like tricyclic antidepressants and antiepileptics like depakote and neurontin that help with other types of pain especially that from irritated nerves and can be additive.
--Ian
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RACastanet
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- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA
Hi guys. Ian, I always enjoy reading your posts.
I've been taking Celebrex pretty regularly for about 2.5 years and find it to be vastly superior to any over the counter med. Also on Zantac for a hiatal hernia/gerd so the pairing works well for me with little stomach difficulties. The Celebrex is almost addictive as it makes most of the aches and pains go away.
If it were not for Celebrex I'd likely need to give up on my weekly training visits to Quantico. The Marines seem to get by on large doses of Motrin ( I think it is their official pain killer). I tried Vioxx as well but did not get the same benefit. Both are pricey.
I still hit the Chiropractor monthly whether I need to or not. Also pricey but it sure takes care of back and neck pain.
Any other ideas on NSAIDs?
Rich
I've been taking Celebrex pretty regularly for about 2.5 years and find it to be vastly superior to any over the counter med. Also on Zantac for a hiatal hernia/gerd so the pairing works well for me with little stomach difficulties. The Celebrex is almost addictive as it makes most of the aches and pains go away.
If it were not for Celebrex I'd likely need to give up on my weekly training visits to Quantico. The Marines seem to get by on large doses of Motrin ( I think it is their official pain killer). I tried Vioxx as well but did not get the same benefit. Both are pricey.
I still hit the Chiropractor monthly whether I need to or not. Also pricey but it sure takes care of back and neck pain.
Any other ideas on NSAIDs?
Rich
Member of the world's premier gun club, the USMC!
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Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
Hey, Rich!
The pharmacists on my floor keep up with all this stuff, as you know the COX II inhibitors are expen$ive, and the OTC (over the counter) stuff is cheap.
A quick, quick assessment...
1) Acetaminophen (Tylenol) is a great pain reliever but is not an anti inflammatory. It can be rough on the liver over the long run.
2) The classic NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen, naproxen, and aspirin are all good at attacking inflammation. Their drawback is that they also inhibit the cyclooxygenase I enzyme which ultimately helps develop the lining of your stomach and intestines. So they can be associated with stomach bleeding and ulcers if taken for too long. They can be rough on the kidneys if taken for too long.
These NSAIDs (particularly aspirin) can be useful for thinning the blood (slowing clotting) and so aspirin is recommended for people who have had a heart attack. But what is good for post MI patients is bad for karateka. Aspirin will make you bruise like sin after kotekitae and ashikitae. Ibuprofen and naproxen don't have quite the same effect there.
3) The special brand of NSAIDs known as COX II inhibitors (celebrex, vioxx) allegedly are better for your stomach because they don't inhibit the COX I enzyme. The jury is still out on them, but they are probably better there. Unfortunately they recently have been associated with a higher risk for a cardiac event, so if you have heart disease, forget about it. We are still accumulating data on the long term effects, which is why it remains as a prescription drug.
What works for Joe may not work for Jim. Ibuprofen really is often the best NSAID for body aches, but other NSAIDs may work better for individuals. Many research studies to date show that - ON AVERAGE - the COX II inhibitors don't work any better than ibuprofen. But INDIVIDUAL RESULTS MAY VARY.
Just remember that they all are drugs and they all have long term side effects. Many folks that have end stage renal disease and require dialysis are people that used/abused painkillers for most of their lives. There's never any free lunch in life.
- Bill
The pharmacists on my floor keep up with all this stuff, as you know the COX II inhibitors are expen$ive, and the OTC (over the counter) stuff is cheap.
A quick, quick assessment...
1) Acetaminophen (Tylenol) is a great pain reliever but is not an anti inflammatory. It can be rough on the liver over the long run.
2) The classic NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen, naproxen, and aspirin are all good at attacking inflammation. Their drawback is that they also inhibit the cyclooxygenase I enzyme which ultimately helps develop the lining of your stomach and intestines. So they can be associated with stomach bleeding and ulcers if taken for too long. They can be rough on the kidneys if taken for too long.
These NSAIDs (particularly aspirin) can be useful for thinning the blood (slowing clotting) and so aspirin is recommended for people who have had a heart attack. But what is good for post MI patients is bad for karateka. Aspirin will make you bruise like sin after kotekitae and ashikitae. Ibuprofen and naproxen don't have quite the same effect there.
3) The special brand of NSAIDs known as COX II inhibitors (celebrex, vioxx) allegedly are better for your stomach because they don't inhibit the COX I enzyme. The jury is still out on them, but they are probably better there. Unfortunately they recently have been associated with a higher risk for a cardiac event, so if you have heart disease, forget about it. We are still accumulating data on the long term effects, which is why it remains as a prescription drug.
What works for Joe may not work for Jim. Ibuprofen really is often the best NSAID for body aches, but other NSAIDs may work better for individuals. Many research studies to date show that - ON AVERAGE - the COX II inhibitors don't work any better than ibuprofen. But INDIVIDUAL RESULTS MAY VARY.
Just remember that they all are drugs and they all have long term side effects. Many folks that have end stage renal disease and require dialysis are people that used/abused painkillers for most of their lives. There's never any free lunch in life.
- Bill
WOW! Thanks for the info guys.
I have bad knees due to motorcycle accident when younger and my doctor has told me it is Bursitis. When I started in the MA the stretching and hydration required made the problems with my knees slightly disappear. However, sometimes still my right knee will seem to lock up at knight and the next day hurt like crazy.
I take ibuprofen for it but was wondering if something else would be more benifical for proactive care rather than reactive.
I have bad knees due to motorcycle accident when younger and my doctor has told me it is Bursitis. When I started in the MA the stretching and hydration required made the problems with my knees slightly disappear. However, sometimes still my right knee will seem to lock up at knight and the next day hurt like crazy.
I take ibuprofen for it but was wondering if something else would be more benifical for proactive care rather than reactive.
"Any day in which you learn something new is a day well spent."
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Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
Brett
Make sure you get a physician (and perhaps an orthopedist) to check your knee out if it continues to give you problems. A knee that "locks up" may be a knee that can benefit from some orthopedic attention.
Also, coming from someone who has been there, it helps to keep weight training your quads and hamstrings to take some of the stress off the knee joint.
- Bill
Make sure you get a physician (and perhaps an orthopedist) to check your knee out if it continues to give you problems. A knee that "locks up" may be a knee that can benefit from some orthopedic attention.
Also, coming from someone who has been there, it helps to keep weight training your quads and hamstrings to take some of the stress off the knee joint.
- Bill
